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2014

DAFTAR HARGA PERALATAN MEDIS


& NON-MEDIS PER-BAGIAN
RUMAH SAKIT
NO INSTALASI
1 INSTALASI UNIT GAWAT DARURAT Rp 4.121.600.000
2 INSTALASI ICU Rp 1.806.650.000
3 INSTALASI NICU Rp 1.909.190.000
4 INSTALASI KAMAR OPERASI Rp 4.069.270.000
5 INSTALASI RUANG BERSALIN Rp 1.109.430.000
6 RUANG PERAWATAN VIP Rp 639.131.000
7 RUANG PERAWATAN KELAS I Rp 861.513.000
8 RUANG PERAWATAN KELAS II Rp 1.447.694.500
9 RUANG PERAWATAN KELAS III Rp 2.237.054.500
10 RUANG PERAWATAN ANAK Rp 400.517.500
11 RUANG PERAWATAN KEBIDANAN Rp 486.032.500
12 RUANG PERAWATAN BAYI Rp 1.516.155.000
13 POLIKLINIK KEBIDANAN Rp 1.894.350.000
14 POLIKLINIK ANAK Rp 77.970.000
15 POLIKLINIK PENYAKIT DALAM Rp 3.145.628.000
16 POLIKLINIK KULIT KELAMIN Rp 220.320.000
17 POLIKLINIK MATA Rp 769.990.000
18 POLIKLINIK T H T Rp 723.257.500
19 POLIKLINIK GIGI DAN MULUT Rp 474.312.553
20 POLIKLINIK PHYSIOTHERAPY DAN REHABILITASI MEDIS Rp 503.379.756
21 POLIKLINIK BEDAH Rp 399.595.000
22 POLIKLINIK UMUM Rp 52.755.000
23 INSTALASI LABORATORIUM Rp 1.624.058.290
24 INSTALASI RADIOLOGY Rp 2.379.570.000
25 UNIT TRANSFUSI DARAH RUMAH SAKIT Rp 1.491.190.115
26 INSTALASI KITCHEN Rp 2.887.780.000
27 INSTALASI LAUNDRY Rp 1.400.270.000
28 INSTALASI KAMAR MAYAT Rp 973.790.000
29 INSTALASI LIMBAH DAN OKSIGEN
INSTALASI OKSIGEN
a OKSIGEN CENTRAL 25 TITIK Rp 898.500.000
b OKSIGEN GENERATOR Rp 1.293.750.000
c OKSIGEN FILLING SYSTEM Rp 2.156.250.000
INSTALASI LIMBAH
a INSTALASI LIMBAH PADAT 0,5 M3 Rp 862.500.000
b INSTALASI LIMBAH CAIR Rp 1.078.130.000
TOTAL : 45.911.584.214
PPN 10% : 4.591.158.421
Grand Total : 50.502.742.635
RENCANA ANGGARAN BIAYA (RAB)
J UMLAH
TAHUN 2013
PERALATAN MEDIS DAN NON-MEDIS
1. INSTALASI UNIT GAWAT DARURAT

SATUAN J UMLAH
1 Patient Monitor DST - USA DS5000A 2 unit 125.000.000 250.000.000
2 Defibrilator CmosDrake - Brazil Life 400 Plus Futura 1 unit 185.000.000 185.000.000
3 Operating Lamp Mobile Emaled - Germany 300 Mobile 1 unit 175.000.000 175.000.000
4 Operating Table Barrfab - Brazil BF 683 ST 1 unit 550.000.000 550.000.000
5 Anaesthesi machine Adox - Argentina AS 2000 1 unit 937.500.000 937.500.000
6 Infusion Pump Angel Pump - Canada AJ 5808-S 2 unit 30.000.000 60.000.000
7 Syringe Pump Daiken - J apan CSP-100CO 2 unit 35.000.000 70.000.000
8 Sterilizer Liarre - Italy Athena 23 2 unit 142.350.000 284.700.000
9 Video Laryngoscope Daiken - J apan VLP-100 1 unit 195.620.000 195.620.000
10 Oxygen Concentrator Elitfarma - Turkey Oxylive Plus 1 unit 37.750.000 37.750.000
11 ECG 3 Channel w/ Interpretation 3Ray ECG-2203G 1 unit 24.710.000 24.710.000
12 Electrocauter 200W Deltronix-Brazil B-3300 SM 1 unit 177.140.000 177.140.000
13 Resucitation Set (Adult, Childresn, Infant) Meditech-UK --- 3 Set 5.500.000 16.500.000
14 Emergency Bag Meditech-UK --- 1 Set 40.000.000 40.000.000
15 Tranport Ventilator Magnamed - Brazil Oxymag 1 Unit 275.000.000 275.000.000
16 Venae Sectio Instrument Set Henniss - Germany Various 1 set 21.420.000 21.420.000
17 Minor Basic Instrument Set Henniss - Germany Various 1 set 23.060.000 23.060.000
18 Infra Red Thermometer TermoRed-OEM MJ -26 1 unit 1.200.000 1.200.000
19 Dressing Trolley Polyjaya - Indonesia Poly - 049 1 unit 20.230.000 20.230.000
20 Instrument Trolley Polyjaya - Indonesia Poly - 036 2 unit 10.510.000 21.020.000
21 X-Ray Film Viewer 4 Film Karixa - Indonesia KA 27-04A 1 unit 15.810.000 15.810.000
22 Emergency Stretcher Polyjaya - Indonesia Poly - 059 4 unit 18.600.000 74.400.000
23 Wheel Chair Indonesia 2 unit 5.380.000 10.760.000
24 Patient Stretcher Polyjaya - Indonesia Poly - 057 2 unit 11.310.000 22.620.000
25 Emergency Trolley Polyjaya - Indonesia Poly - 056 2 unit 25.040.000 50.080.000
26 Bed Screen 2 Pintu Polyjaya - Indonesia Poly - 042 1 unit 6.450.000 6.450.000
27 Examination Lamp Polyjaya - Indonesia Poly - 041 2 unit 14.160.000 28.320.000
28 Hand Scrub Daiken - J apan - 1 unit 215.630.000 215.630.000
29 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 015 1 unit 3.230.000 3.230.000
30 Incubator Transport Polyjaya - Indonesia Poly - 21 TC 1 unit 145.500.000 145.500.000
31 Infant warmer Polyjaya - Indonesia Poly -023 1 unit 121.250.000 121.250.000
32 Lemari Inst. 2 Pintu Baja Polyjaya - Indonesia Poly - 044 1 unit 16.170.000 16.170.000
33 UV Room Sterilizer Polyjaya - Indonesia Poly - 024 1 unit 42.690.000 42.690.000
34 Infusion Stand Polyjaya - Indonesia Poly - 037 2 unit 1.420.000 2.840.000
T O T A L Rp. 4.121.600.000
MERK - ASL.
NEGARA
MODEL
RENCANA ANGGARAN BIAYA (RAB)
PERALATAN MEDIS DAN NON-MEDIS
T.A 2014
HARGA (Rp)
J UMLAH NO NAMA ALAT
2. I NSTALASI I C U
SATUAN J UMLAH
1 Ventilator ICU (Adult & Infant) Magnamed - Brazil Fleximag 1 unit 550.000.000 550.000.000
2 Patient Monitor DST - USA DS5000A 3 unit 125.000.000 375.000.000
3 Oxygen Concentrator Elitfarma - Turkey Oxylive Plus 2 unit 37.750.000 75.500.000
4 ECG 3 Channel w/ Interpretation 3Ray ECG-2203G 1 unit 24.710.000 24.710.000
5 Ultrasonic Nebulizer Elitfarma - Turkey Dropsonics 1 unit 34.320.000 34.320.000
6 Infusion Pump with IV Set Angel Pump - Canada AJ 5808-S 2 unit 30.000.000 60.000.000
7 Syringe Pump Daiken - J apan CSP-100CO 2 unit 35.000.000 70.000.000
8 Venae Sectio Instrument Set Henniss - Germany Various 1 set 21.420.000 21.420.000
9 Bandage Instrument Set Henniss - Germany Various 1 set 23.060.000 23.060.000
10 Infra Red Thermometer TermoRed-OEM MJ -26 2 unit 1.200.000 2.400.000
11 Electric ICU Bed + Mattras Polyjaya - Indonesia Poly - 007 4 unit 107.770.000 431.080.000
12 Bedside Cabinet Polyjaya - Indonesia Poly - 011 4 unit 8.900.000 35.600.000
13 Wheel Chair Indonesia ----- 2 unit 5.380.000 10.760.000
14 Patient Stretcher Polyjaya - Indonesia Poly - 057 2 unit 11.310.000 22.620.000
15 Instrument Trolley Polyjaya - Indonesia Poly - 036 1 unit 10.510.000 10.510.000
16 Bed Screen Polyjaya - Indonesia Poly - 042 1 unit 6.450.000 6.450.000
17 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 015 1 unit 3.230.000 3.230.000
18 Examination Lamp Polyjaya - Indonesia Poly - 041 1 unit 14.160.000 14.160.000
19 X-Ray Film Viewer 2 Film Polyjaya - Indonesia Poly - 069 1 unit 5.120.000 5.120.000
20 Lemari Inst. 2 Pintu St. Steel Polyjaya - Indonesia Poly - 044 1 unit 30.710.000 30.710.000
T O T A L Rp. 1.806.650.000
MODEL
RENCANA ANGGARAN BI AYA (RAB)
PERALATAN MEDI S DAN NON-MEDI S
TA.2012
HARGA (Rp)
J UMLAH NO NAMA ALAT MERK - ASL. NEGARA
3. I NSTALASI NI CU
SATUAN J UMLAH
1 ICU Ventilator+ Ventilator Magnamed - Brazil Babymag 1 unit 500.000.000 500.000.000
2 Bedside Monitor DST - USA DS5000A 1 Unit 125.000.000 125.000.000
3 Infuse Pump with IV Set Angel Pump - Canada AJ 5808-S 2 unit 30.000.000 60.000.000
4 Syringe Pump Daiken - J apan CSP-100CO 2 unit 35.000.000 70.000.000
5 Defibrilator CmosDrake - Brazil Life 400 Futura 1 Unit 185.000.000 185.000.000
6 Central Monitor DST - USA DS 8000 1 Unit 200.000.000 200.000.000
6 Examination Lamp Mobile Polyjaya - Indonesia Poly - 041 2 unit 14.160.000 28.320.000
7 Oxygen Concentrator Elitfarma - Turkey Oxylive Plus 2 Unit 37.750.000 75.500.000
8 Sphygmomanometer Henniss - Germany ----- 2 Unit 1.500.000 3.000.000
9 Sthetoscope Henniss - Germany ----- 2 Unit 600.000 1.200.000
10 Oxygen Therapy Set 1m3 Sharp - J apan Various 1 Unit 5.030.000 5.030.000
11 Autoclaveable Resuscitation Fazzini - Italy -- 2 Set 2.160.000 4.320.000
12 Venae Sectio Instrument Set Henniss - Germany Various 2 Unit 21.420.000 42.840.000
13 Bandage Instrument Set Henniss - Germany Various 2 Set 12.820.000 25.640.000
14 Laryngoscope for baby Henniss - Germany ----- 2 Unit 3.000.000 6.000.000
15 Baby Incubator PMS - India INC - 100 2 Unit 125.000.000 250.000.000
16 Infant Warmer + Resusitasi PMS - India NWC - 100 1 Unit 105.000.000 105.000.000
17 Phototherapy Lamp PMS - India CFL 101 1 Unit 55.000.000 55.000.000
18 Infra Red Thermometer TermoRed-OEM MJ -26 2 unit 1.200.000 2.400.000
19 Baby Basket Polyjaya - Indonesia Poly - 017 4 Unit 8.900.000 35.600.000
20 Bedside Cabinet Polyjaya - Indonesia Poly - 011 4 unit 8.900.000 35.600.000
21 Infusion stand Polyjaya - Indonesia Poly - 037 4 unit 1.420.000 5.680.000
22 Instrument Trolley Polyjaya - Indonesia Poly - 036 2 unit 10.510.000 21.020.000
23 Emergency Trolley Polyjaya - Indonesia Poly - 056 2 unit 25.040.000 50.080.000
24 Lemari Obat Polyjaya - Indonesia Poly - 046 1 Unit 16.960.000 16.960.000
T O T A L Rp. 1.909.190.000
RENCANA ANGGARAN BI AYA (RAB)
PERALATAN MEDI S DAN NON-MEDI S
TA.2012
HARGA (Rp)
MODEL J UMLAH NO NAMA ALAT MERK - ASL. NEGARA
4. INSTALASI KAMAR OPERASI

SATUAN J UMLAH
1 Operating Table Barrfab - Brazil BF 683 ST 1 unit 550.000.000 550.000.000
2 Operating Lamp (Ceiling Model) Emaled - Germany 500/500 1 unit 565.000.000 565.000.000
3 Anesthesia Machine + Ventilator Adox - Argentina AS 2000 1 unit 937.500.000 937.500.000
4 Electrosurgical 380 Watt Deltronix-Brazil B-6600 SM 1 unit 283.960.000 283.960.000
5 Vital Sign Monitor + Recorder DST - USA DS5000A 1 unit 125.000.000 125.000.000
6 Defibrilator CmosDrake - Brazil Life 400 Plus Futura 1 unit 185.000.000 185.000.000
7 Infusion Pump with IV Set Angel Pump - Canada AJ 5808-S 2 unit 30.000.000 60.000.000
8 Syringe Pump Daiken - J apan CSP-100CO 2 unit 35.000.000 70.000.000
9 Suction Pump Ordisi-Spain Futurevac 1 unit 65.000.000 65.000.000
10 Sterilizer Liarre - Italy Athena 23 1 unit 142.350.000 142.350.000
11 Instrument, terdiri dari : -
01. Apendectomy Instr. Set Henniss - Germany Various 1 set 59.340.000 59.340.000
02. Bandage Instr. Set Henniss - Germany Various 1 set 12.820.000 12.820.000
03. Basic Eye Instr. Set Henniss - Germany Various 1 set 22.540.000 22.540.000
04. Basic Gynaecology Operating Set Henniss - Germany Various 1 set 58.630.000 58.630.000
05. Cataract Inst. Set Henniss - Germany Various 1 set 32.520.000 32.520.000
06. Circumsisi Instr. Set Henniss - Germany Various 1 set 7.110.000 7.110.000
07. Dillat. & Curet Diagnostic Set Henniss - Germany Various 1 set 40.250.000 40.250.000
08. Dillat. & Curret Abortus Set Henniss - Germany Various 1 set 40.250.000 40.250.000
09. Embriotomy Instr. Set Henniss - Germany Various 1 set 39.680.000 39.680.000
10. Mayor Basic Instr. Set Henniss - Germany Various 1 set 64.640.000 64.640.000
11. Minor Basic Instr. Set Henniss - Germany Various 1 set 23.060.000 23.060.000
12. Polypectomy Instr. Set Henniss - Germany Various 1 set 14.470.000 14.470.000
13. Partus Instr. Set Henniss - Germany Various 1 set 13.260.000 13.260.000
14. Tonsilectomy Instr. Set Henniss - Germany Various 1 set 55.520.000 55.520.000
15. Tracheotomy Instr. Set Henniss - Germany Various 1 set 16.090.000 16.090.000
16. Venae Sectio Instr. Set Henniss - Germany Various 1 set 21.420.000 21.420.000
17. Laringoscope for Adult Henniss - Germany ----- 1 set 3.000.000 3.000.000
18. Laringoscope for Pediatric Henniss - Germany ----- 1 set 3.000.000 3.000.000
12 Infra Red Thermometer TermoRed-OEM MJ -26 2 unit 1.200.000 2.400.000
13 Infusion Stand Polyjaya - Indonesia Poly - 037 1 unit 1.420.000 1.420.000
14 Instrument Trolley Polyjaya - Indonesia Poly - 036 1 unit 10.510.000 10.510.000
15 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 015 1 unit 3.230.000 3.230.000
16 X-Ray Film Viewer 2 Film Polyjaya - Indonesia Poly - 069 1 unit 5.230.000 5.230.000
17 Ultra Violet Sterilizer Polyjaya - Indonesia Poly - 024 1 unit 40.420.000 40.420.000
18 Patient Stretcher Polyjaya - Indonesia Poly - 057 1 unit 11.310.000 11.310.000
19 Linen Trolley Polyjaya - Indonesia Poly - 053 1 unit 17.800.000 17.800.000
20 Dressing Trolley Polyjaya - Indonesia Poly - 049 1 unit 20.230.000 20.230.000
21 Scrubs Station for 2 Persons Polyjaya - Indonesia Poly - 076 1 unit 436.430.000 436.430.000
22 Mayo Table Polyjaya - Indonesia Poly - 050 1 unit 8.880.000 8.880.000
T O T A L Rp. 4.069.270.000
NO NAMA ALAT
RENCANA ANGGARAN BIAYA (RAB)
PERALATAN MEDIS DAN NON-MEDIS
TA.2013
MERK - ASL. NEGARA MODEL
HARGA (Rp)
J UMLAH
5 I NSTALASI RUANG BERSALI N

SATUAN J UMLAH
1 Gynaecolog Bed Barrfab - Brazil BF 683 ST 1 unit 500.000.000 500.000.000
2 Cardio Tocograph (CTG) Zondan - China DS 120B 1 unit 50.000.000 50.000.000
3 Operating Lamp (Floor Model) Emaled - Germany 300M 1 unit 175.000.000 175.000.000
4 Suction Pump Ordisi-Spain Futurevac 1 unit 65.000.000 65.000.000
5 Fetal Doppler Zondan - China DS 120A 1 unit 4.500.000 4.500.000
6 ECG 3 Channel w/ Interpretation 3Ray ECG-2203G 1 unit 24.710.000 24.710.000
7 Partus Instr. Set Henniss - Germany Various 2 set 13.260.000 26.520.000
8 Dillat. & Curret Diagnostic set Henniss - Germany Various 2 set 40.250.000 80.500.000
9 Dillat. & Curet Abortus set Henniss - Germany Various 1 set 40.250.000 40.250.000
10 Minor Surgery Set Henniss - Germany Various 1 set 23.060.000 23.060.000
11 Timbangan Dewasa Laica - Italy EP-1220 1 unit 720.000 720.000
12 Timbangan Bayi Laica - Italy BF-2051 1 unit 5.030.000 5.030.000
13 Infra Red Thermometer TermoRed-OEM MJ -26 2 unit 1.200.000 2.400.000
14 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 015 1 unit 3.230.000 3.230.000
15 Instrument Trolley Polyjaya - Indonesia Poly - 036 2 unit 10.510.000 21.020.000
16 Infusion Stand Polyjaya - Indonesia Poly - 037 1 unit 1.420.000 1.420.000
17 Bed Screen Polyjaya - Indonesia Poly - 042 1 unit 6.450.000 6.450.000
18 Emergency Trolley Polyjaya - Indonesia Poly - 056 1 unit 25.040.000 25.040.000
19 Examination Lamp Polyjaya - Indonesia Poly - 041 1 unit 14.160.000 14.160.000
20 Ultra Violet Sterilizer Polyjaya - Indonesia Poly - 024 1 unit 40.420.000 40.420.000
T O T A L Rp. 1.109.430.000
NO NAMA ALAT
RENCANA ANGGARAN BI AYA (RAB)
PERALATAN MEDI S DAN NON-MEDI S
TA.2013
MERK - ASL. NEGARA MODEL
HARGA (Rp)
J UMLAH
6. RUANG PERAWATAN VI P KAPASI TAS 6 BED

SATUAN J UMLAH
1 Electric Bed Patient with Matras Polyjaya - Indonesia Poly - 006 DLX 6 unit 45.150.000 270.900.000
2 Bedside Cabinet Polyjaya - Indonesia Poly - 012 DLX 6 unit 10.510.000 63.060.000
3 Over Bed Table Polyjaya - Indonesia Poly - 010 6 unit 8.406.500 50.439.000
4 Bandage Instrument set Henniss - Germany Various 1 set 36.259.500 36.259.500
5 Oxygen Concentrator Elitfarma - Turkey Oxylive Plus 1 unit 41.837.000 41.837.000
6 Suction Unit Ordisi-Spain Aspit 2 unit 28.750.000 57.500.000
7 Nebulizer Elitfarma - Turkey Aeroneb 1 unit 1.575.500 1.575.500
8 Infra Red Thermometer TermoRed-OEM MJ -26 3 unit 1.380.000 4.140.000
9 Instrument Cabinet 2 Pintu Polyjaya - Indonesia Poly - 044 SS 1 unit 30.710.000 30.710.000
10 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 013 1 unit 7.270.000 7.270.000
11 Instrument Trolley Polyjaya - Indonesia Poly - 036 1 unit 10.510.000 10.510.000
12 X-Ray Film Viewer 2 Film Polyjaya - Indonesia Poly - 069 1 unit 5.230.000 5.230.000
13 Wheel Chair Indonesia 2 unit 5.380.000 10.760.000
14 Infusion Stand Polyjaya - Indonesia Poly - 037 6 unit 1.420.000 8.520.000
15 Trolley Obat 24 Laci Polyjaya - Indonesia Poly - 048 SS 1 unit 40.420.000 40.420.000
T O T A L Rp. 639.131.000
7. RUANG PERAWATAN KELAS I KAPASI TAS 12 BED

SATUAN J UMLAH
1 Bed Patient with Matras Polyjaya - Indonesia Poly - 006 12 unit 33.390.000 400.680.000
2 Bedside Cabinet Polyjaya - Indonesia Poly - 011 12 unit 8.900.000 106.800.000
3 Over Bed Table Polyjaya - Indonesia Poly - 009 12 unit 8.080.000 96.960.000
4 Oxygen Concentrator Elitfarma - Turkey Oxylive Plus 1 unit 36.259.500 36.259.500
5 Bandage Instrument set Henniss - Germany Various 1 set 13.685.000 13.685.000
6 Suction Unit Ordisi-Spain Aspit 2 unit 28.750.000 57.500.000
7 Nebulizer Elitfarma - Turkey Aeroneb 1 unit 1.368.500 1.368.500
8 Infra Red Thermometer TermoRed-OEM MJ -26 4 unit 1.380.000 5.520.000
9 Instrument Cabinet 2 Pintu Polyjaya - Indonesia Poly - 044 1 unit 30.710.000 30.710.000
10 Bed Screen Polyjaya - Indonesia Poly - 042 6 unit 6.450.000 38.700.000
11 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 015 1 unit 3.230.000 3.230.000
12 Instrument Trolley Polyjaya - Indonesia Poly - 036 1 unit 10.510.000 10.510.000
13 X-ray Film Viewer 2 Film Polyjaya - Indonesia Poly - 069 1 unit 5.230.000 5.230.000
14 Wheel Chair Indonesia ----- 2 unit 5.380.000 10.760.000
15 Infusion Stand Polyjaya - Indonesia Poly - 037 12 unit 1.410.000 16.920.000
16 Trolley Obat 24 Laci Polyjaya - Indonesia Poly - 048 1 unit 26.680.000 26.680.000
T O T A L Rp. 861.513.000
RENCANA ANGGARAN BI AYA (RAB)
PERALATAN MEDI S DAN NON-MEDI S
T.A 2013
NO NAMA ALAT MERK - ASL. NEGARA MODEL
NO
HARGA (Rp)
HARGA (Rp)
NAMA ALAT
J UMLAH
J UMLAH MERK - ASL. NEGARA MODEL
RENCANA ANGGARAN BI AYA (RAB)
PERALATAN MEDI S DAN NON-MEDI S
T.A 2013
8. RUANG PERAWATAN KELAS I I KAPASI TAS 20 BED

SATUAN J UMLAH
1 Bed Patient with Matras Polyjaya - Indonesia Poly - 004 DLX 20 unit 37.560.000 751.200.000
2 Bedside Cabinet Polyjaya - Indonesia Poly - 011 20 unit 8.900.000 178.000.000
3 Over Bed Table Polyjaya - Indonesia Poly - 009 20 unit 8.080.000 161.600.000
4 Oxygen Concentrator Elitfarma - Turkey Oxylive Plus 2 unit 41.837.000 83.674.000
5 Bandage Instrument set Henniss - Germany Various 1 set 13.685.000 13.685.000
6 Suction Unit Ordisi-Spain Aspit 2 unit 28.750.000 57.500.000
7 Nebulizer Elitfarma - Turkey Aeroneb 1 unit 1.575.500 1.575.500
8 Infra Red Thermometer TermoRed-OEM MJ -26 5 unit 1.380.000 6.900.000
9 Instrument Cabinet 2 Pintu Polyjaya - Indonesia Poly - 044 1 unit 30.710.000 30.710.000
10 Bed Screen Polyjaya - Indonesia Poly - 042 10 unit 6.450.000 64.500.000
11 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 015 1 unit 3.230.000 3.230.000
12 Instrument Trolley Polyjaya - Indonesia Poly - 036 1 unit 10.510.000 10.510.000
13 X-ray Film Viewer 2 Film Polyjaya - Indonesia Poly - 069 1 unit 5.230.000 5.230.000
14 Wheel Chair Indonesia ----- 2 unit 5.380.000 10.760.000
15 Infusion Stand Polyjaya - Indonesia Poly - 037 20 unit 1.410.000 28.200.000
16 Trolley Obat 24 Laci Steel Polyjaya - Indonesia Poly - 048 SS 1 unit 40.420.000 40.420.000
T O T A L Rp. 1.447.694.500
9. RUANG PERAWATAN KELAS I I I KAPASI TAS 40 BED

SATUAN J UMLAH
1 Bed Patient with Matras Polyjaya - Indonesia Poly - 004 40 unit 26.180.000 1.047.200.000
2 Bedside Cabinet Polyjaya - Indonesia Poly - 011 40 unit 8.900.000 356.000.000
3 Over Bed Table Polyjaya - Indonesia Poly - 009 40 unit 8.080.000 323.200.000
4 Oxygen Concentrator Elitfarma - Turkey Oxylive Plus 2 unit 41.837.000 83.674.000
5 Bandage Instrument set Henniss - Germany Various 1 set 13.685.000 13.685.000
6 Suction Unit Ordisi-Spain Aspit 2 unit 28.750.000 57.500.000
7 Nebulizer Elitfarma - Turkey Aeroneb 1 unit 1.575.500 1.575.500
8 Infra Red Thermometer TermoRed-OEM MJ -26 10 unit 1.380.000 13.800.000
9 Instrument Cabinet 2 Pintu Polyjaya - Indonesia Poly - 044 2 unit 30.710.000 61.420.000
10 Bed Screen Polyjaya - Indonesia Poly - 042 20 unit 6.450.000 129.000.000
11 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 015 1 unit 3.230.000 3.230.000
12 Instrument Trolley Polyjaya - Indonesia Poly - 036 2 unit 10.510.000 21.020.000
13 X-ray Film Viewer 2 Film Polyjaya - Indonesia Poly - 069 1 unit 5.230.000 5.230.000
14 Wheel Chair Indonesia ----- 2 unit 5.380.000 10.760.000
15 Infusion Stand Polyjaya - Indonesia Poly - 037 40 unit 1.410.000 56.400.000
16 Trolley Obat 24 Laci Polyjaya - Indonesia Poly - 048 2 unit 26.680.000 53.360.000

T O T A L Rp. 2.237.054.500
NO NAMA ALAT MERK - ASL. NEGARA MODEL
NO NAMA ALAT MODEL MERK - ASL. NEGARA
HARGA (Rp)
HARGA (Rp)
J UMLAH
J UMLAH
RENCANA ANGGARAN BI AYA (RAB)
PERALATAN MEDI S DAN NON-MEDI S
T.A 2013
10. RUANG PERAWATAN ANAK KAPASI TAS 8 BED

SATUAN J UMLAH
1 Pediatric Bed Patient Polyjaya - Indonesia Poly - 028 8 unit 21.030.000 168.240.000
2 Bedside Cabinet Polyjaya - Indonesia Poly - 011 8 unit 8.900.000 71.200.000
3 Infusion Stand Polyjaya - Indonesia Poly - 037 8 unit 1.410.000 11.280.000
4 Oxygen Concentrator Elitfarma - Turkey Oxylive Plus 1 unit 41.837.000 41.837.000
5 Bandage Instrument set Henniss - Germany Various 1 set 13.685.000 13.685.000
6 Suction Unit Ordisi-Spain Aspit 1 unit 28.750.000 28.750.000
7 Nebulizer Elitfarma - Turkey Aeroneb 1 unit 1.575.500 1.575.500
8 Infra Red Thermometer TermoRed-OEM MJ -26 10 unit 1.380.000 13.800.000
9 Bed Screen Polyjaya - Indonesia Poly - 042 4 unit 6.450.000 25.800.000
10 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 015 1 unit 3.230.000 3.230.000
11 Instrument Trolley Polyjaya - Indonesia Poly - 036 1 unit 10.510.000 10.510.000
12 X-ray Film Viewer 2 Film Polyjaya - Indonesia Poly - 069 1 unit 5.230.000 5.230.000
13 Wheel Chair Indonesia ----- 1 unit 5.380.000 5.380.000
T O T A L Rp. 400.517.500
11. RUANG PERAWATAN KEBI DANAN KAPASI TAS 4 BED

SATUAN J UMLAH
1 Oxygen Concentrator Elitfarma - Turkey Oxylive Plus 1 unit 41.837.000 41.837.000
2 Infusion Pump with IV Set Angel Pump - Canada AJ 5808-S 2 unit 34.500.000 69.000.000
3 Syringe Pump Daiken - J apan CSP-100CO 2 unit 37.950.000 75.900.000
4 Ultrasonic Nebulizer Elitfarma - Turkey Aeroneb 1 unit 1.575.500 1.575.500
5 Infra Red Thermometer TermoRed-OEM MJ -26 2 unit 1.380.000 2.760.000
6 Patient Bed with Matras Polyjaya - Indonesia Poly - 006 4 unit 33.390.000 133.560.000
7 Bedside Cabinet Polyjaya - Indonesia Poly - 011 4 unit 8.900.000 35.600.000
8 Patient Stretcher Polyjaya - Indonesia Poly - 057 2 unit 11.310.000 22.620.000
9 Wheel Chair Indonesia 2 unit 5.380.000 10.760.000
10 Overbed Table Polyjaya - Indonesia Poly - 009 4 unit 8.080.000 32.320.000
11 Instrument Trolley Polyjaya - Indonesia Poly - 036 1 unit 10.510.000 10.510.000
12 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 015 1 unit 3.230.000 3.230.000
13 Urinal for Woman Magnate/Thailand SM 0109 4 unit 1.290.000 5.160.000
14 Infusion Stand Polyjaya - Indonesia Poly - 037 4 unit 1.410.000 5.640.000
15 Examination Lamp Polyjaya - Indonesia Poly - 041 1 unit 14.160.000 14.160.000
16 X-ray Film Viewer 2 Film Polyjaya - Indonesia Poly - 069 1 unit 5.230.000 5.230.000
17 Lemari Inst. 2 Pintu Polyjaya - Indonesia Poly - 044 1 unit 16.170.000 16.170.000
T O T A L Rp. 486.032.500
NO
NO MERK - ASL. NEGARA
MERK - ASL. NEGARA MODEL NAMA ALAT
NAMA ALAT MODEL
HARGA (Rp)
HARGA (Rp)
J UMLAH
J UMLAH
RENCANA ANGGARAN BI AYA (RAB)
PERALATAN MEDI S DAN NON-MEDI S
T.A 2013
12. RUANG PERAWATAN BAYI KAPASI TAS 4 BED

SATUAN J UMLAH
1 Infant Ventilator Magnamed - Brazil Fleximag 1 unit 550.000.000 550.000.000
2 Bedside Monitor DST - USA DS5000A 1 unit 125.000.000 125.000.000
3 Infuse Pump Angel Pump - Canada AJ 5808-S 2 unit 30.000.000 60.000.000
4 Syringe Pump Daiken - J apan CSP-100CO 2 unit 35.000.000 70.000.000
5 Defibrilator for Pediatric CmosDrake - Brazil Life 400 Futura 1 unit 185.000.000 185.000.000
6 Oxygen Concentrator Elitfarma - Turkey Oxylive Plus 1 unit 37.750.000 37.750.000
7 Ultrasonic Nebulizer Elitfarma - Turkey Dropsonic 1 unit 34.320.000 34.320.000
8 Resusitasi Bayi Meditech-UK --- 1 Set 5.500.000 5.500.000
9 Oxygen Therapy Set (1 m3) Sharp - J apan Various 1 unit 4.025.000 4.025.000
10 Infra Red Thermometer TermoRed-OEM MJ -26 2 unit 1.200.000 2.400.000
11 Baby Box with Matras Polyjaya - Indonesia Poly - 017 4 unit 8.900.000 35.600.000
12 Bedside Cabinet Polyjaya - Indonesia Poly - 011 4 unit 8.900.000 35.600.000
13 Baby Incubator PMS/India INC - 100 1 Unit 156.250.000 156.250.000
14 Phototherapy Lamp Polyjaya - Indonesia Poly - 025 1 unit 29.110.000 29.110.000
15 Infant Warmer with Resuscitator PMS/India NWC - 100 1 Unit 131.250.000 131.250.000
16 Emergency Trolley Polyjaya - Indonesia Poly - 056 1 unit 25.040.000 25.040.000
17 Infusion Stand Polyjaya - Indonesia Poly - 037 1 unit 1.410.000 1.410.000
18 Instrument Trolley Polyjaya - Indonesia Poly - 036 1 unit 10.510.000 10.510.000
19 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 015 1 unit 3.230.000 3.230.000
20 Examination Lamp Polyjaya - Indonesia Poly - 041 1 unit 14.160.000 14.160.000
T O T A L Rp. 1.516.155.000
NO NAMA ALAT MERK - ASL. NEGARA MODEL J UMLAH
HARGA (Rp)
13. POLI KLI NI K KEBI DANAN

SATUAN J UMLAH
1 Cardio Tocograph (CTG) Zondan - China DS 120B 1 unit 50.000.000 50.000.000
2 Fetal Doppler Zondan - China DS 120A 1 unit 4.500.000 4.500.000
3 USG 4 Dimensi Sonoscanner - France Orcheo XQ 1 unit 1.800.000.000 1.800.000.000
4 Timbangan Dewasa Laica - Italy EP.1220 1 unit 720.000 720.000
5 Infra Red Thermometer TermoRed-OEM MJ -26 2 unit 1.200.000 2.400.000
6 Examination Table Polyjaya - Indonesia Poly - 033 1 unit 8.880.000 8.880.000
7 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 015 1 unit 3.230.000 3.230.000
8 X-Ray Film Viewer 2 Film Polyjaya - Indonesia Poly - 069 1 unit 5.230.000 5.230.000
9 Bed Screen Polyjaya - Indonesia Poly - 042 1 unit 6.450.000 6.450.000
10 Lemari Inst. 1 Pintu Polyjaya - Indonesia Poly - 043 1 unit 12.940.000 12.940.000
T O T A L Rp. 1.894.350.000
14. POLI KLI NI K ANAK

SATUAN J UMLAH
1 ECG Pediatric w/ Interpretation 3Ray ECG-2203G 1 unit 24.710.000 24.710.000
2 Stethoscope Henniss-Germany ----- 1 unit 600.000 600.000
3 Sphygmomanometer Henniss-Germany ----- 1 unit 1.500.000 1.500.000
4 Diagnostic set Henniss-Germany ----- 1 unit 4.500.000 4.500.000
5 Timbangan Anak Laica - Italy ----- 1 unit 1.080.000 1.080.000
6 Infra Red Thermometer TermoRed-OEM MJ -26 2 unit 1.200.000 2.400.000
7 Examination Table Polyjaya - Indonesia Poly - 033 1 unit 8.880.000 8.880.000
8 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 015 1 unit 3.230.000 3.230.000
9 X-Ray Film Viewer 2 Film Polyjaya - Indonesia Poly - 069 1 unit 5.230.000 5.230.000
10 Bed Screen Polyjaya - Indonesia Poly - 042 2 unit 6.450.000 12.900.000
11 Lemari Inst. 1 Pintu Polyjaya - Indonesia Poly - 043 1 unit 12.940.000 12.940.000
T O T A L Rp. 77.970.000
RENCANA ANGGARAN BI AYA (RAB)
PERALATAN MEDI S DAN NON-MEDI S
TA.2013
NO NAMA ALAT MERK - ASL. NEGARA MODEL J UMLAH
HARGA (Rp)
HARGA (Rp)
NO NAMA ALAT MERK - ASL. NEGARA MODEL J UMLAH
15. POLI KLI NI K PENYAKI T DALAM

SATUAN J UMLAH
1 ECG Recorder 12 Channel Interp. 3Ray ECG-2212B 1 unit 48.048.000 48.048.000
2 Spirometry Piston-Hungary PDD-301/spf 1 unit 52.000.000 52.000.000
3 Treadmill Strest Test Piston-Hungary --- 1 unit 1.200.000.000 1.200.000.000
4 USG 3D/4D Sonoscanner - France Orcheo XQ 1 unit 1.800.000.000 1.800.000.000
5 Infra Red Thermometer TermoRed-OEM MJ -26 2 unit 1.200.000 2.400.000
6 Examination Table Polyjaya - Indonesia Poly - 033 1 unit 8.880.000 8.880.000
7 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 015 1 unit 3.230.000 3.230.000
8 X-Ray Film Viewer 2 Film Polyjaya - Indonesia Poly - 069 1 unit 5.230.000 5.230.000
9 Bed Screen Polyjaya - Indonesia Poly - 042 2 unit 6.450.000 12.900.000
10 Lemari Inst. 1 Pintu Polyjaya - Indonesia Poly - 043 1 unit 12.940.000 12.940.000
T O T A L Rp. 3.145.628.000
16. POLI KLI NI K KULI T KELAMI N

SATUAN J UMLAH
1 Electrosurgical 200 watt Deltronix-Brazil B-3300 SM 1 unit 177.140.000 177.140.000
2 Examination Table Polyjaya - Indonesia Poly - 033 1 unit 8.880.000 8.880.000
3 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 015 1 unit 3.230.000 3.230.000
4 X-Ray Film Viewer 2 Film Polyjaya - Indonesia Poly - 069 1 unit 5.230.000 5.230.000
5 Bed Screen Polyjaya - Indonesia Poly - 042 2 unit 6.450.000 12.900.000
6 Lemari Inst. 1 Pintu Polyjaya - Indonesia Poly - 043 1 unit 12.940.000 12.940.000
T O T A L Rp. 220.320.000
RENCANA ANGGARAN BI AYA (RAB)
PERALATAN MEDI S DAN NON-MEDI S
TA.2013
HARGA (Rp)
J UMLAH NO NAMA ALAT MERK - ASL. NEGARA MODEL
HARGA (Rp)
NO NAMA ALAT MERK - ASL. NEGARA MODEL J UMLAH
17. POLI KLI NI K MATA

SATUAN J UMLAH
1 Slit Lamp + Table Electric Inami - J apan L-0185 1 unit 503.130.000 503.130.000
2 Trial Lens Set + Trial Frame Inami - J apan K-350A 1 set 215.630.000 215.630.000
3 Tonometer Henniss-Germany ----- 1 unit 7.190.000 7.190.000
4 Snellen Chart Indonesia ----- 1 unit 70.000 70.000
5 Isihara Test Kanehera - J apan 14 plate 1 unit 720.000 720.000
6 Senter Pupil Lokal ----- 1 unit 70.000 70.000
7 Examination Table Polyjaya - Indonesia Poly - 033 1 unit 8.880.000 8.880.000
8 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 015 1 unit 3.230.000 3.230.000
9 X-Ray Film Viewer 2 Film Polyjaya - Indonesia Poly - 069 1 unit 5.230.000 5.230.000
10 Bed Screen Polyjaya - Indonesia Poly - 042 2 unit 6.450.000 12.900.000
11 Lemari Inst. 1 Pintu Polyjaya - Indonesia Poly - 043 1 unit 12.940.000 12.940.000
T O T A L Rp. 769.990.000
18. POLI KLI NI K T H T

SATUAN J UMLAH
1 ENT Treatment and Chair Meditech-Korea INU-5500 1 unit 592.618.000 592.618.000
2 Policlinic ENT Instrument Set Henniss - Germany Various 1 unit 62.400.000 62.400.000
3 Laryngoscope Henniss - Germany ----- 1 unit 300.000 300.000
4 Head Lamp Henniss - Germany ----- 1 unit 862.500 862.500
5 Otoscope Henniss - Germany Mini 1 unit 4.025.000 4.025.000
7 Tongue Depressor Henniss - Germany ----- 10 unit 1.023.500 10.235.000
8 Instrument Case with Lid Henniss - Germany HE 410-070 1 unit 9.637.000 9.637.000
9 Examination Table Polyjaya - Indonesia Poly - 033 1 unit 8.880.000 8.880.000
10 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 015 1 unit 3.230.000 3.230.000
11 X-Ray Film Viewer 2 Film Polyjaya - Indonesia Poly - 069 1 unit 5.230.000 5.230.000
12 Bed Screen Polyjaya - Indonesia Poly - 042 2 unit 6.450.000 12.900.000
13 Lemari Inst. 1 Pintu Polyjaya - Indonesia Poly - 043 1 unit 12.940.000 12.940.000
T O T A L Rp. 723.257.500
HARGA (Rp)
HARGA (Rp)
J UMLAH
RENCANA ANGGARAN BI AYA (RAB)
PERALATAN MEDI S DAN NON-MEDI S
TA.2013
NO NAMA ALAT MERK - ASL. NEGARA
NO NAMA ALAT MERK - ASL. NEGARA MODEL
MODEL
J UMLAH
19. POLIKLINIK GIGI DAN MULUT
SATUAN J UMLAH
A. UNIT DENTAL
1 Dental Chair Mounted unit Electric
Pallas - Brazil ATHENAS LI FE SL 1 unit
165.000.000 165.000.000
with Compressor & Doctor's Stool
kompressor 1 unit
28.750.000 28.750.000
2 Dental X-Ray with Accessories Gnatus-Brazil Timex 70 1 unit 172.500.000 172.500.000
B. ALAT-ALAT PENCABUT GIGI
1 Extracting forceps for upper incissor/cuspid,ss
Henniss-Germany 80.001.00
1 Pc 1.973.400 1.973.400
2 Extracting forceps for root bicuspid/premolar,ss
Henniss-Germany 80.007.00
1 Pc 1.973.400 1.973.400
3 Extracting forceps for root bayonet pattern, ss
Henniss-Germany 80.051.00
1 Pc 1.973.400 1.973.400
4 Extracting forceps for upper molar, right side,ss
Henniss-Germany 80.017.00
1 Pc 1.973.400 1.973.400
5 Extracting forceps for upper molar, left side,ss
Henniss-Germany 80.018.00
1 Pc 1.973.400 1.973.400
6 Extracting forceps for lower bicuspid
Henniss-Germany 80.079.00
1 Pc 1.973.400 1.973.400
and caninus, ss
7 Extracting forceps for lower root, ss
Henniss-Germany 80.033.00
1 Pc 1.973.400 1.973.400
8 Extracting forceps for upper wisdom, ss
Henniss-Germany 80.067.00
1 Pc 1.973.400 1.973.400
9 Extracting forceps for lower molar, ss
Henniss-Germany 80.013.00
1 Pc 1.973.400 1.973.400
10 Disposable syringe 3 c with needle
Terumo-J apan ---
1 Box 345.000 345.000
23Gx1 " Box of 100 pcs
11 Surgical Suture Needle 3/8 Circle No.12
Henniss-Germany ---
2 Doz 115.000 230.000
12 Needle Holder Mayo Hegar, 14 cm, ss
Henniss-Germany
24.180.14 1 Pc 868.296 868.296
13 Bein wide, str, ss
Henniss-Germany 82.511.01
1 Pc 789.360 789.360
14 Bein small, str, ss
Henniss-Germany 82.511.00
1 Pc 789.360 789.360
15 Cryer (mesial), ss
Henniss-Germany 82.027.00
1 Pc 789.360 789.360
16 Cryer (destal), ss
Henniss-Germany 82.028.00
1 Pc 789.360 789.360
17 Chisel white
Henniss-Germany 32.620.05
1 Pc 1.223.508 1.223.508
18 Bone Files
Henniss-Germany 82.896.03
1 Pc 1.973.400 1.973.400
19 Knable Forceps
Henniss-Germany 32.109.16
1 Pc 3.788.928 3.788.928
C. ALAT DIAGNOSTIC DAN PENAMBALAN GIGI
1 Mouth mirror,plane,ss
Henniss-Germany
82.702.24 1 Pc 197.340 197.340
2 Mouth mirror,handle,ss
Henniss-Germany
82.726.01 1 Pc 157.872 157.872
3 Explorer lengkung, ss
Henniss-Germany
83.391.06 1 Pc 197.340 197.340
4 Tweezer dressing,ss
Henniss-Germany
83.033.05 1 Pc 276.276 276.276
5 Excavator doule ended, besar-white,ss
Henniss-Germany
83.462.70 1 Pc 394.680 394.680
6 Excavator doule ended, kecil-white,ss
Henniss-Germany
83.462.71 1 Pc 394.680 394.680
7 Spatula for cement,ss
Henniss-Germany
84.436.02 1 Pc 434.148 434.148
8 Spatula plastic
Henniss-Germany
84.457.01 1 Pc 315.744 315.744
9 Cement plugger, double ended,ss
Henniss-Germany
84.175.01 1 Pc 307.850 307.850
10 Amalgam plugger, double ended (kecil),ss
Henniss-Germany
84.175.03 1 Pc 307.850 307.850
11 Amalgam plugger, double ended (besar),ss
Henniss-Germany
84.175.04 1 Pc 345.000 345.000
12 Bunisher, single ended (besar),ss
Henniss-Germany
84.233.22 1 Pc 236.808 236.808
13 Bunisher, single ended (kecil),ss
Henniss-Germany
84.233.21 1 Pc 230.000 230.000
14 Plastic filling instrument, double ended,ss
Henniss-Germany
84.206.21 1 Pc 1.894.464 1.894.464
15 Amalgam piston 14 cm,ss
Henniss-Germany
84.187.01 1 Pc 1.144.572 1.144.572
MERK - ASL. NEGARA MODEL
RENCANA ANGGARAN BIAYA (RAB)
PERALATAN MEDIS DAN NON-MEDIS
TA.2013
J UMLAH
HARGA (Rp)
NO NAMA ALAT
19. POLIKLINIK GIGI DAN MULUT
SATUAN J UMLAH
MERK - ASL. NEGARA MODEL
RENCANA ANGGARAN BIAYA (RAB)
PERALATAN MEDIS DAN NON-MEDIS
TA.2013
J UMLAH
HARGA (Rp)
NO NAMA ALAT
D. ALAT PEMBERSIH KARANG GIGI
1 Air scaler motor dengan ujung 3 macam : Liarre - Italy Piezotec (101) 1 set 39.870.000 39.870.000
lurus, lengkung, interdental
E. BAHAN-BAHAN DAN OBAT-OBAT
1 Temporary filling material fletcher (powder ) Lokal -------- 1 set 1.725.000 1.725.000
100 gram, Zinc oxide eugenol (liquid) 10 cc
2 Eugenol bottle of 10 cc Lokal -------- 1 Btl 241.500 241.500
3 Amalgam silver alloy, 1 btl of 1oz31 fr grain china -------- 2 Btl 1.104.000 2.208.000
4 Mercury dental bottle of 70 gr Lokal -------- 3 Btl 437.000 1.311.000
5 Cement zine phospat (powder & liquid) 100 gr GC -------- 1 Set 1.552.500 1.552.500
6 Anaesthetic lydocain/xylocain base 2% with Erera -------- 1 Box 1.265.000 1.265.000
epinephrine, box of 100 ampuls
7 Sterilisator electric 42 cm CBM - Italy 311N 1 Unit 17.250.000 17.250.000
8 Diamond burs for contra angle handpiece Edenta-Switzerland -------- 1 Bag 862.500 862.500
for low speed
9 Cooton wool dispenser/cotton
Henniss-Germany
88.570.00 1 Pc 1.184.040 1.184.040
10 Mortar and pastle, glass untuk pengaduk Taiwan -------- 1 Pc 115.000 115.000
amalgam
11 Glass mixing slab no.1 detray/normal & tebal
Henniss-Germany
84.410.06 1 Pc 355.212 355.212
12 Kidney Bowl
Henniss-Germany
88.139.17 2 Pc 315.744 631.488
13 Cotton wool holder with spring, ss
Henniss-Germany
88.560.01 1 Pc 1.262.976 1.262.976
14 Cotton wool dispenser, ss
Henniss-Germany
88.570.00 1 Pc 1.184.040 1.184.040
15 Diamond bor untuk high speed (isi 4 pcs) Edenta-Switzerland -------- 1 Set 862.500 862.500
T O T A L Rp. 474.312.553
20. POLIKLINIK PHYSIOTHERAPY DAN REHABILITASI MEDIS

SATUAN J UMLAH
1 Shortwave Diathermy Ibramed - Brazil THERMOPULSE COMPACT 1 unit 150.000.000 150.000.000
2 Ultrasound Therapy Ibramed - Brazil SonoPulse Compact 1 unit 31.600.000 31.600.000
3 Electro Stimulator Ibramed - Brazil NEURODYN 1 unit 72.740.000 72.740.000
4 Laser Therapy Ibramed - Brazil Laserpulse 1 unit 78.620.256 78.620.256
5 TENS Portable Ibramed - Brazil N-46 1 unit 12.350.000 12.350.000
6 Infra Red Lamp Philips - Holland ----- 1 unit 1.989.500 1.989.500
7 Exercise Stairs Indonesia ----- 1 unit 88.550.000 88.550.000
8 Hot and Cold Pack Indonesia ----- 1 unit 830.000 830.000
9 Mattrass/Therapy Mats Indonesia ----- 1 unit 2.490.000 2.490.000
10 Wheel Chair Indonesia ----- 1 unit 5.530.000 5.530.000
11 Crutch Indonesia ----- 1 unit 1.670.000 1.670.000
12 Walker Indonesia ----- 1 unit 3.880.000 3.880.000
13 Paralel Bar Indonesia ----- 1 unit 53.130.000 53.130.000
T O T A L Rp. 503.379.756

21. POLIKLINIK BEDAH

SATUAN J UMLAH
1 Electrocouter 300 Watt Deltronix-Brazil B-3600 SM 1 unit 254.330.000 254.330.000
2 Instrument Minor Basic Henniss - Germany Various 1 set 23.060.000 23.060.000
3 Timbangan Dewasa Laica - Italy EP.1220 1 unit 575.000 575.000
4 Examination Table Polyjaya - Indonesia Poly - 033 2 unit 8.880.000 17.760.000
5 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 015 1 unit 3.230.000 3.230.000
6 X-Ray Film Viewer 2 Film Polyjaya - Indonesia Poly - 069 1 unit 5.230.000 5.230.000
7 Bed Screen Polyjaya - Indonesia Poly - 042 2 unit 6.450.000 12.900.000
8 Lemari Inst. 1 Pintu Polyjaya - Indonesia Poly - 043 1 unit 12.940.000 12.940.000
9 Examination Lamp Polyjaya - Indonesia Poly - 041 2 unit 14.160.000 28.320.000
10 Dressing Trolley Polyjaya - Indonesia Poly - 049 1 unit 20.230.000 20.230.000
11 Instrument Trolley Polyjaya - Indonesia Poly - 036 2 unit 10.510.000 21.020.000
T O T A L Rp. 399.595.000
J UMLAH
RENCANA ANGGARAN BIAYA (RAB)
PERALATAN MEDIS DAN NON-MEDIS
TA.2013
HARGA (Rp)
NO NAMA ALAT
HARGA (Rp)
J UMLAH
NO NAMA ALAT MERK - ASL. NEGARA MODEL
MERK - ASL. NEGARA MODEL
22. POLIKLINIK UMUM

SATUAN J UMLAH
1 Stethoscope Henniss - Germany ----- 1 unit 600.000 600.000
2 Sphygmomanometer Henniss - Germany ----- 1 unit 1.500.000 1.500.000
3 Diagnostic Set Henniss - Germany ----- 1 set 4.500.000 4.500.000
4 Timbangan Dewasa Laica - Italy
EP 1220
1 unit 575.000 575.000
5 Infra Red Thermometer TermoRed-OEM MJ -26 2 unit 1.200.000 2.400.000
6 Examination Table Polyjaya - Indonesia Poly - 033 1 unit 8.880.000 8.880.000
7 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 015 1 unit 3.230.000 3.230.000
8 X-Ray Film Viewer 2 Film Polyjaya - Indonesia Poly - 069 1 unit 5.230.000 5.230.000
9 Bed Screen Polyjaya - Indonesia Poly - 042 2 unit 6.450.000 12.900.000
10 Lemari Inst. 1 Pintu Polyjaya - Indonesia Poly - 043 1 unit 12.940.000 12.940.000
T O T A L Rp. 52.755.000
23. INSTALASI LABORATORIUM

SATUAN J UMLAH
1 Centrifuge Hettich/Germany EBA 20 2 unit 63.250.000 126.500.000
2 Spectrophotometer AuditDiagnostics/Ireland Sapphire120 1 unit 120.750.000 120.750.000
3 Urine Analyzer AuditDiagnostics/Ireland Uri-Stat 50 1 unit 54.515.175 54.515.175
4 Electrolyte Analyzer --- --- 1 unit --- ---
5 POCT AuditDiagnostics/Ireland LiquitStat 1 unit 345.000.000 345.000.000
6 Oven Laboratorium Memmert/Germany UNB 400 1 unit 57.500.000 57.500.000
7 Mikroskop Binoculair Konus-Italy Biorex 2 unit 26.680.000 53.360.000
8 Micro Pipette (Adj. 10-100 ml) AuditDiagnostics/Ireland APV100A 1 unit 4.168.808 4.168.808
9 Micro Pipette (Adj. 100-1000 ml) AuditDiagnostics/Ireland APV1000A 1 unit 4.168.808 4.168.808
10 Fixed Pipette (1,2,5,10,20,25,50 ml) AuditDiagnostics/Ireland --- 7 unit 2.564.500 17.951.500
11 Hematology Analyzer Labtest/Brazil SDH20 1 unit 634.938.000 634.938.000
12 Sterilisator 42 Cm CBM/Italy 311N 1 unit 17.250.000 17.250.000
13 Laboratory Refrigerator 300 L Ingclimas-Spain CR 180C 1 unit 187.956.000 187.956.000
T O T A L Rp. 1.624.058.290
RENCANA ANGGARAN BIAYA (RAB)
PERALATAN MEDIS DAN NON-MEDIS
TA.2013
HARGA (Rp)
HARGA (Rp)
NO NAMA ALAT MERK - ASL. NEGARA MODEL J UMLAH
NO J UMLAH NAMA ALAT MERK - ASL. NEGARA MODEL
24. I NSTALASI RADI OLOGY

SATUAN J UMLAH
2 X-Ray Radigraphy 500 mA CX-Med/USA RadioLogix 1 unit 1.843.900.000 1.843.900.000
3 Automatic Processing Film Alphatex-USA AX-700LE 1 unit 287.500.000 287.500.000
4 Accessories Radiologi :
a. X-Ray Film Hanger Konex - Brazil ----- 10 unit 1.850.000 18.500.000
b. Safety Lamp Konex - Brazil ----- 1 unit 27.120.000 27.120.000
c. X-Ray Film Transfer Box Konex - Brazil ----- 1 unit 20.860.000 20.860.000
d. X-Ray Film Storage Box Konex - Brazil ----- 1 unit 20.860.000 20.860.000
e. X-Ray Film Cassette without Window : -
- 35x43 cm Konex - Brazil ----- 1 unit 7.140.000 7.140.000
- 35x35 cm Konex - Brazil ----- 1 unit 7.000.000 7.000.000
- 30x40 cm Konex - Brazil ----- 1 unit 7.000.000 7.000.000
- 24x30 cm Konex - Brazil ----- 1 unit 5.160.000 5.160.000
- 18x24 cm Konex - Brazil ----- 1 unit 4.330.000 4.330.000
f. X-Ray Protective Apron Konex - Brazil ----- 4 unit 5.090.000 20.360.000
g. X-Ray Protective Glove Konex - Brazil ----- 1 unit 8.310.000 8.310.000
h. Lead Marker Set Konex - Brazil ----- 1 unit 3.660.000 3.660.000
i. X-Ray Film Dryer 12 Film Konex - Brazil ----- 1 unit 40.810.000 40.810.000
5 Patient Stretcher Polyjaya - Indonesia Poly - 057 1 unit 11.310.000 11.310.000
6 Wheel Chair Indonesia 1 unit 5.380.000 5.380.000
7 Lemari Inst. 2 Pintu Polyjaya - Indonesia Poly - 044 1 unit 16.170.000 16.170.000
8 Instrument Table Polyjaya - Indonesia Poly - 036 1 unit 10.510.000 10.510.000
9 X-Ray Film Viewer 2 Film Polyjaya - Indonesia Poly - 069 2 unit 5.230.000 10.460.000
10 Double Bowl Stand + Bowl Polyjaya - Indonesia Poly - 015 1 unit 3.230.000 3.230.000
T O T A L Rp. 2.379.570.000
NO NAMA ALAT
RENCANA ANGGARAN BIAYA (RAB)
PERALATAN MEDIS DAN NON-MEDIS
TA.2013
MERK - ASAL
NEGARA
MODEL
HARGA (Rp)
J UMLAH
25. UNI T TRANSFUSI DARAH RUMAH SAKI T

SATUAN J UMLAH
1 Blood Bank Refrigerator Labtop - India LBR 400 2 Unit 305.260.000 610.520.000
2 Mikroskop Binoculair Konus-Italy Biorex 2 unit 33.350.000 66.700.000
3 Oven Laboratorium Memmert/Germany UNB 400 1 unit 71.880.000 71.880.000
4 Centrifuge Hettich/Germany EBA 20 2 unit 79.060.000 158.120.000
5 Blood Infusion Warmer Nuova - Brazil Nuova/05 Plus 5 Unit 100.000.000 500.000.000
Perlengkapan Penunjang BDRS
1 Timer Lokal -------- 3 Pcs 960.000 2.880.000
2 Labu semprot Lokal -------- 10 Pcs 70.000 700.000
3 Tabung Reaksi Lokal -------- 50 Pcs 40.000 2.000.000
4 Objek Glas Lokal -------- 10 Box 60.000 600.000
5 Rak Tabung Lokal -------- 5 Pcs 360.000 1.800.000
6 Cool Box Lokal -------- 2 Pcs 10.780.000 21.560.000
7 Blood Grouping Plate Lokal -------- 2 Pcs 7.190.000 14.380.000
8 Sarung Tangan Lokal -------- 20 Box 140.000 2.800.000
9 J as Labororatorium Lokal -------- 3 Pcs 1.440.000 4.320.000
10 Termometer Digital Termored/OEM MJ 26 10 Pcs 1.200.000 12.000.000
11 Korentang 25 Cm Henniss-Germany 16.170.25 5 Pc 1.253.500 6.267.500
12 Gunting Bedah Standard Henniss/Germany 08.110.14 10 Pcs 517.500 5.175.000
13 Klem Plastik Henniss/Germany 12.312.14 2 Pc 575.000 1.150.000
14 Micro Pipette (Adj. 10-100 ml) AuditDiagnostics/I reland APV100A 1 unit 4.168.808 4.168.808
15 Micro Pipette (Adj. 100-1000 ml) AuditDiagnostics/I reland APV1000A 1 unit 4.168.808 4.168.808
T O T A L Rp. 1.491.190.115
NO NAMA ALAT MERK - ASL. NEGARA MODEL J UMLAH
HARGA (Rp)
RENCANA ANGGARAN BIAYA (RAB)
PERALATAN MEDIS DAN NON-MEDIS
TA.2013
26. I NSTALASI KI TCEN

SATUAN J UMLAH
1 Gas Boiling Pan Silko/Italy PG9AD15 2 unit 359.380.000 718.760.000
2 Gas Rice Cooker Sun Wave/J apan LG-606-150 2 unit 287.500.000 575.000.000
3 Gas Kwalie Range 3 Tungku Polyjaya/Indonesia -------- 1 unit 50.310.000 50.310.000
4 Gas Range 4 Tungku with Oven Silko/Italy -------- 1 unit 343.390.000 343.390.000
5 Meja Cuci Double S/S Polyjaya/Indonesia -------- 2 unit 35.940.000 71.880.000
6 Meja Persiapan S/S Polyjaya/Indonesia -------- 2 unit 28.750.000 57.500.000
7 Gas Stock Pot Polyjaya/Indonesia -------- 3 unit 21.560.000 64.680.000
8 Freezer 4 Pintu Polyjaya/Indonesia -------- 2 unit 215.630.000 431.260.000
9 Rak Susun S/S Polyjaya/Indonesia -------- 2 unit 28.750.000 57.500.000
10 Exhaust Hood Wall Type S/S Polyjaya/Indonesia -------- 1 unit 64.690.000 64.690.000
11 Meja Distribusi S/S Polyjaya/Indonesia -------- 2 unit 28.750.000 57.500.000
12 Food Trolley Polyjaya/Indonesia -------- 2 unit 28.750.000 57.500.000
13 Electric Food Trolley Polyjaya/Indonesia -------- 1 unit 50.310.000 50.310.000
14 Pot Sink Table S/S Polyjaya/Indonesia -------- 2 unit 28.750.000 57.500.000
15 Soiled Table W/Scrap Hole S/S Polyjaya/Indonesia -------- 1 unit 28.750.000 28.750.000
16 Service Trolley St. Steel Polyjaya/Indonesia -------- 1 unit 21.560.000 21.560.000
17 Upright Cabinet Polyjaya/Indonesia -------- 1 unit 86.250.000 86.250.000
18 Heated Cabinet Polyjaya/Indonesia -------- 1 unit 93.440.000 93.440.000
T O T A L Rp. 2.887.780.000
27. I NSTALASI LAUNDRY

SATUAN J UMLAH
1 Mesin Cuci 30 Kg Electric Danube/France 3097XE 1 unit 682.400.000 682.400.000
2 Mesin Pengering 34 Kg Electric Danube/France TD38E 1 unit 290.480.000 290.480.000
3 Mesin Sterika Danube/France ECOMINA 1 unit 240.160.000 240.160.000
4 Trolley Pakaian Kering Polyjaya/Indonesia -------- 3 unit 9.870.000 29.610.000
5 Trolley Pakaian Bersih Kotor Polyjaya/Indonesia -------- 1 unit 17.840.000 17.840.000
6 Trolley Pakaian Kotor Polyjaya/Indonesia -------- 3 unit 17.840.000 53.520.000
7 Rak Susun S/S 4 Shelf Polyjaya/Indonesia -------- 2 unit 43.130.000 86.260.000
T O T A L Rp. 1.400.270.000
RENCANA ANGGARAN BIAYA (RAB)
PERALATAN MEDIS DAN NON-MEDIS
T.A 2013
J UMLAH
HARGA (Rp)
NO NAMA ALAT MERK / EX TYPE
HARGA (Rp)
NO NAMA ALAT MERK / EX TYPE J UMLAH
28. KAMAR MAYAT

SATUAN J UMLAH
1 Lemari Pendingin 4 J enazah Polyjaya/Indonesia -------- 1 unit 637.560.000 637.560.000
2 Meja Mandi J enazah Polyjaya/Indonesia -------- 2 unit 28.080.000 56.160.000
3 Trolley Pembawa J enazah Polyjaya/Indonesia -------- 2 unit 36.050.000 72.100.000
4 Brancar Komplit S/S Polyjaya/Indonesia -------- 3 unit 24.290.000 72.870.000
5 Lemari Instrument 2 Pintu S/S Polyjaya/Indonesia -------- 2 unit 30.360.000 60.720.000
6 Stand Waskom S/S Double K.4 + Waskom Polyjaya/Indonesia -------- 2 unit 9.110.000 18.220.000
7 Meja Otopsi Polyjaya/Indonesia -------- 2 unit 28.080.000 56.160.000
T O T A L Rp. 973.790.000
29. I NSTALASI LI MBAH DAN OKSI GEN

SATUAN J UMLAH
LI MBAH PADAT
1 I ncinerator 0,5 M3 ( 2 Burner ) Polyjaya/ I ndonesia -------- 1 unit 862.500.000 862.500.000
LI MBAH CAI R
1 I nstalasi Pengolahan Air Limbah 100 BED Polyjaya/ I ndonesia -------- 1 unit 1.078.130.000 1.078.130.000
I NSTALASI GAS CENTRAL
1 INSTALASI GAS CENTRAL 25 TITIK Polyjaya/Indonesia -------- 25 Titik 35.940.000 898.500.000
2 Oxygen Generator Polyjaya/Indonesia -------- 1 Set 1.293.750.000 1.293.750.000
3 Oxygen Filling System Polyjaya/Indonesia -------- 1 Set 2.156.250.000 2.156.250.000
T O T A L Rp. 4.348.500.000
RENCANA ANGGARAN BIAYA (RAB)
PERALATAN MEDIS DAN NON-MEDIS
TA.2013
J UMLAH
HARGA (Rp)
NO NAMA ALAT MERK / EX TYPE
HARGA (Rp)
NO NAMA ALAT MERK / EX TYPE J UMLAH