| No | Bidang | Parameter | Sisa Kuota Siklus 1 | Sisa Kuota Siklus 2 | Tarif 1 Siklus (Rp) |
|---|---|---|---|---|---|
| 1 | Hematologi | Hemoglobin, Lekosit, Eritrosit, Trombosit, Hematokrit, MCV, MCH, MCHC | 497 | 497 | 1,500,000 |
| 2 | Kimia Klinik | Bilirubin total, Kolesterol, Kreatinin, Glukosa, Protein Total, Ureum, Asam Urat, Trigliserida, SGOT, SGPT, Albumin, Fosfatase Alkali, Gama GT, CK Nac, Natrium, Kalium, Chlorida, Kalsium, LDH | 498 | 498 | 1,050,000 |
| 3 | Urinalisa | Berat Jenis, pH, Protein, Glukosa, Bilirubin, Urobilinogen, Darah samar, Keton, Nitrit, Lekosit, Tes Kehamilan | 497 | 497 | 1,250,000 |
| 4 | Mikrobiologi | Mikroskopis BTA | 498 | 498 | 650,000 |
| 5 | Mikrobiologi | Mikroskopis Telur Cacing | 99 | 99 | 450,000 |
| 6 | Imunologi | Anti HIV | 498 | 498 | 750,000 |
| 7 | Imunologi | RPR / TPHA | 498 | 498 | 750,000 |
| 8 | Imunologi | HBsAg | 498 | 498 | 750,000 |
| 9 | Imunologi | Anti HCV | 498 | 498 | 900,000 |
| 10 | Mikrobiologi | Mikroskopis Malaria | 498 | 498 | 825,000 |
| 11 | Kimia Kesehatan | Fe, Mn, Cd, Cu, Zn, Nitri, Klorida (7 Parameter Kimia wajib) | 50 | 50 | 1,300,000 |
| 12 | Kimia Kesehatan | Fe, Cd (2 Parameter Kimia Terbatas) | 800,000 | ||
| 13 | Mikrobiologi | Kulture & Resistensi | 49 | 49 | 1,050,000 |
| 14 | Imunologi | Viral Load (VL) HIV | 100 | 100 | 0 |