PERHITUNGAN POLA TARIF

TAHUN 2022

PELAYANAN DOKTER GIGI UMUM

POLI UMUM POLI VIP
RINCIAN JASA SARANA
NO JENIS PELAYANAN TOTAL TOTAL
JASA JASA
BMHP SARANA JASA TOTAL PEMBULA JASA
Biaya BMHP DASAR PELAYAN PELAYAN
Jumlah SARANA (Rp) TAN (Rp) SARANA
NAMA BAHAN ISI Harga Satuan (Rp) Terpakai AN (Rp) AN (Rp)
Pemakaian (Rp) (Rp) (Rp)
(Rp)

1 VISITE DOKTER KONSULTAN masker 50 box 50 kali 17325 347

Handscoon 100 box 50 kali 37001 740
Tissue 150 lbr 20 kali 7000 350
maintenace alat 1 set 100 kali 5000000 50,000
kali
kali
kali
kali
kali
kali
kali
kali
51436.52 35,000 86,437 57,624 144,061 150,000 86,437 57,624
2 VISITE DOKTER SPESIALIS masker 50 box 50 kali 17325 347
KELAS VIP Handscoon 100 box 50 kali 37001 740
Tissue 150 lbr 20 kali 7000 350
maintenace alat 1 set 400 kali 5000000 12,500
kali
kali
kali
kali
kali
kali
kali
kali
13936.52 35,000 48,937 32,624 81,561 80,000 48,937 32,624
3 VISITE DOKTER SPESIALIS masker 50 box 10 kali 17325 1,733
KELAS I Handscoon 100 box 6 kali 37001 6,167
Tissue 150 lbr 5 kali 7000 1,400
kali
kali
kali
kali
kali
kali
kali
kali
kali
9299.333333 35,000 44,299 29,533 73,832 75,000 44,299 29,533
4 VISITE DOKTER SPESIALIS masker 50 box 50 kali 17325 347
KELAS II Handscoon 100 box 50 kali 37001 740
Tissue 150 lbr 20 kali 7000 350
kali
kali
kali
kali
kali
kali
kali
kali
 kali
1436.52 35,000 36,437 24,291 60,728 70,000 36,437 24,291
5 VISITE DOKTER SPESIALIS masker 50 box 50 kali 17325 347
KELAS III Handscoon 100 box 50 kali 37001 740
Tissue 150 lbr 20 kali 7000 350
kali
kali
kali
kali
kali
kali
kali
kali
kali
1436.52 35,000 36,437 24,291 60,728 65,000 36,437 24,291
6 VISITE DOKTER SPESIALIS Handscoon steril (MAXTER) 50 psg 3 kali 385000 128,333
ISOLASI Tissue 150 Lbr 15 kali 7000 467
masker N 95 20 psg 100 kali 260000 2,600
kali
kali
kali
kali
kali
kali
kali
kali
kali
131400 35,000 166,400 110,933 277,333 75,000 166,400 110,933
7 VISITE DOKTER UMUM masker 50 box 50 kali 17325 347
KELAS VIP Handscoon 100 box 50 kali 37001 740
Tissue 150 lbr 20 kali 7000 350
kali
kali
kali
kali
kali
kali
kali
kali
kali
1436.52 35,000 36,437 24,291 60,728 45,000 36,437 24,291
8 VISITE DOKTER UMUM masker 50 box 50 kali 17325 347
KELAS I Handscoon 100 box 50 kali 37001 740
Tissue 150 lbr 20 kali 7000 350
kali
kali
kali
kali
kali
kali
kali
kali
kali
1436.52 35,000 36,437 24,291 60,728 35,000 36,437 24,291
9 VISITE DOKTER UMUM masker 50 box 50 kali 17325 346.5
KELAS II Handscoon 100 box 50 kali 37001 740.02
Tissue 150 lbr 20 kali 7000 350
kali
kali
kali
kali
 kali
kali
kali
kali
kali
1436.52 35,000 36,437 24,291 60,728 30,000 36,437 24,291
10 VISITE DOKTER UMUM masker 50 box 50 kali 17325 346.5
KELAS III Handscoon 100 box 50 kali 37001 740.02
Tissue 150 lbr 20 kali 7000 350
kali
kali
kali
kali
kali
kali
kali
kali
kali
1436.52 35,000 36,437 24,291 60,728 30,000 36,437 24,291
11 VISITE DOKTER UMUM Handscoon steril (MAXTER) 50 psg 2 kali 385000 192500
ISOLASI Tissue 150 Lbr 30 kali 7000 233.3333333
masker N 95 20 psg 20 kali 260000 13,000
kali
kali
kali
kali
kali
kali
kali
kali
kali
205733.3333 35,000 240,733 160,489 401,222 35,000 240,733 160,489
12 TARIF KAMAR VIP (per tanggal) makan pagi 1 1 kali 35,000 35000
makan siang 1 1 kali 35,000 35000
maksn sore 1 1 kali 35,000 35000
loundry linen 1 1 kali 70,000 70000
Air + Listrik 1 1 kali 275,000 275,000
maintenance alat 1 set 25 kali 5000000 200,000
kali
kali
kali
kali
kali
kali
650000 35,000 685,000 456,667 1,141,667 1,150,000 685,000 456,667
13 TARIF KAMAR KELAS I (per tanggal) makan pagi 1 1 kali 35,000 35000
makan siang 1 1 kali 35,000 35000
maksn sore 1 1 kali 35,000 35000
loundry linen 1 1 kali 50,000 50000
Air + Listrik 1 1 kali 200,000 200000
maintenance alat 1 set 55 kali 5000000 90,909
kali
kali
kali
kali
kali
kali
445909.0909 35,000 480,909 320,606 801,515 800,000 480,909 320,606
14 TARIF KAMAR KELAS II (per tanggal) makan pagi 1 1 kali 35,000 35000
makan siang 1 1 kali 35,000 35000
maksn sore 1 1 kali 35,000 35000
loundry linen 1 1 kali 32,000 32000
Air + Listrik kali 110,000 110000
maintenance alat 1 set 300 kali 3000000 10,000
 kali
kali
kali
kali
kali
kali
257000 35,000 292,000 194,667 486,667 480,000 292,000 194,667
15 TARIF KAMAR KELAS III (per tanggal) makan pagi 1 1 kali 35,000 35000
makan siang 1 1 kali 35,000 35000
maksn sore 1 1 kali 35,000 35000
loundry linen 1 1 kali 30,000 30000
Air + Listrik kali 65,000 65000
kali
kali
kali
kali
kali
kali
kali
200000 35,000 235,000 156,667 391,667 250,000 235,000 156,667
16 TARIF KAMAR ISOLASI (per tanggal) makan pagi 1 1 kali 35,000 35,000
makan siang 1 1 kali 35,000 35,000
maksn sore 1 1 kali 35,000 35,000
loundry linen 1 1 kali 30,000 30,000
Air + Listrik kali 65,000 65,000
kali
kali
kali
kali
kali
kali
kali

200000 35,000 235,000 156,667 391,667 400,000 235,000 156,667

17 Tindakan keperawatan (Per shift) masker 50 box 50 kali 17325 346.5
Handscoon 100 box 5 kali 37001 7400.2
Tissue 150 lbr 10 kali 20000 2000
kali
kali
kali
kali
kali
kali
kali
kali
kali
9746.7 9,747 6,498 16,245 15,000 9,747 6,498
18 Pemasangan Infus / tindakan masker 50 box 50 kali 17325 347
Handscoon 100 box 50 kali 37001 740
abocath 1 Syringe 1 kali 7,000 7,000
cairan infus 1 kolf 1 kali 11,000 11,000
infus set 1 bks 1 kali 5,100 5,100
Non Woven Fixation 1000 cm box 20 kali 43,850 2,193
alkohol swab 100 box 100 kali 10,500 105
kali
 kali
kali
kali
kali
26484.02 26,484 17,656 44,140 45,000 26,484 17,656
19 Perawatan luka /GV (per tindakan) masker 50 box 50 kali 17325 346.5
Handscoon 100 box 50 kali 37001 740.02
nacl 1 kolf 1 kali 11,000 11000
kassa steril 5 box 1 kali 5,500 5500
betadine 1000 ml 80 kali 100,100 1251.25
kali
kali
kali
kali
kali
kali
kali
18837.77 35,000 53,838 35,892 89,730 95,000 53,838 35,892
20 Vital Sign / shift masker 50 box 50 kali 17325 346.5
Handscoon 100 box 50 kali 37001 740.02
kali
kali
kali
kali
kali
kali
kali
kali
kali
kali
1086.52 35,000 36,087 24,058 60,144 20,000 36,087 24,058
21 Pemasangan endotracheal tube ( intubasi ) masker 50 box 50 kali 17325 347
Handscoon 100 box 50 kali 37001 740
ett no 7 1 pcs 1 kali 35,000 35,000
gel 250 ml 50 kali 144,000 2,880
Non Woven Fixation 1000 cm box 50 kali 43,850 877
Spuit 10 cc 100 box 6 kali 130,200 21,700
kali
kali
kali
kali
kali
kali
61543.52 35,000 96,544 64,362 160,906 160,000 96,544 64,362
22 RJP tanpa intubasi masker 50 box 25 kali 17325 693
Handscoon 100 box 2 kali 37001 18,501
kali
kali
kali
kali
kali
kali
kali
kali
kali
kali
19,194 35,000 54,194 36,129 90,323 100,000 54,194 36,129
23 Tindakan dengan DC Shock / cardioversi masker 50 box 25 kali 17325 693
Handscoon 100 box 10 kali 37001 3,700
gel 250 ml 5 kali 144,000 28,800
 kassa steril 5 box 1 kali 5,500 5,500
kali
kali
kali
kali
kali
kali
kali
kali
38,693 35,000 73,693 49,129 122,822 130,000 73,693 49,129
24 Pemasangan NGT masker 50 box 25 kali 17325 693
Handscoon 100 box 20 kali 37001 1,850
gel 250 ml 50 kali 144,000 2,880
Non Woven Fixation 1000 cm box 4 kali 43,850 10,963
ngt no 16 1 pcs 1 kali 8,131 8,131
kali
kali
kali
kali
kali
kali
kali
24,517 35,000 59,517 39,678 99,194 100,000 59,517 39,678
25 Pemasangan kateter masker 50 box 25 kali 17325 693
Handscoon 100 box 20 kali 37001 1,850
gel 250 ml 10 kali 144,000 14,400
Non Woven Fixation 1000 cm box 10 kali 43,850 4,385
urine bag 1 pcs 1 kali 5,500 5,500
Polycatheter no 16 1 pcs 1 kali 11,000 11,000
kali
kali
kali
kali
kali
kali
37,828 20,000 57,828 38,552 96,380 90,000 57,828 38,552
26 lepas kateter masker 50 box 25 kali 17325 693
Handscoon 100 box 20 kali 37001 1,850
gel 250 ml 10 kali 144,000 14,400
Non Woven Fixation 1000 cm box 10 kali 43,850 4,385
urine bag 1 pcs 1 kali 5,500 5,500
Polycatheter no 16 1 pcs 1 kali 11,000 11,000
kali
kali
kali
kali
kali
kali
37,828 37,828 25,219 63,047 60,000 37,828 25,219
27 EKG masker 50 box 25 kali 17325 693
Handscoon 100 box 2 kali 37001 18,501
gel 250 ml 50 kali 144,000 2,880
kassa steril 5 box 1 kali 5,500 5,500
kali
kali
kali
kali
kali
kali
kali
kali
 27,574 20,000 47,574 31,716 79,289 80,000 47,574 31,716
28 Tindakan Nebulizar / Kali masker 50 box 100 kali 17325 173
Handscoon 100 box 50 kali 37001 740
kassa steril 5 box 200 kali 5,500 28
ventolin inhaler 5 flash 50 kali 112,164 2,243
kali
kali
kali
kali
kali
kali
kali
kali
3,184 35,000 38,184 25,456 63,640 60,000 38,184 25,456
29 Pemasangan saturasi oksigen masker 50 box 25 kali 17325 693
Handscoon 100 box 20 kali 37001 1850.05
maintenace alat 1 set 25 kali 500,000 20000
kali
kali
kali
kali
kali
kali
kali
kali
kali
22543.05 22,543 15,029 37,572 35,000 22,543 15,029
30 Suction/ penghisapan lendir masker 50 box 100 kali 17325 173
Handscoon 100 box 100 kali 37001 370
kassa steril 5 box 300 kali 5,500 18
Suction Catheter no 14 1 pcs 200 kali 2,540 13
kali
kali
kali
kali
kali
kali
kali
kali
574 35,000 30% 10,672 46,247 30,831 77,078 70,000 50% 17,787 53,361 35,574
31 syring pump / hari masker 50 box 50 kali 17325 346.5
Handscoon 100 box 50 kali 37001 740.02
Spuit 50 cc 30 box 30 kali 120,300 4010
kali
kali
kali
kali
kali
kali
kali
kali
kali
5096.52 35,000 30% 12,029 52,125 34,750 86,876 90,000 50% 20,048 60,145 40,097
32 Infus Pump/ Hari masker 50 box 50 kali 17325 347
Handscoon 100 box 50 kali 37001 740
kali
kali
kali
kali
kali
 kali
kali
kali
kali
kali
1,087 35,000 30% 10,826 46,912 31,275 78,187 80,000 50% 18,043 54,130 36,087
33 Pemakaian O2 1-4 L/ Menit ( per satu jam) masker 50 box 50 kali 17325 347
Handscoon 100 box 50 kali 37001 740
Nasal oksigen Dewasa (M) 1 pcs 1 kali 6,930 6,930
o2 tabung kecil 2500 ml 5 kali 55,000 11,000
kali
kali
kali
kali
kali
kali
kali
kali
19,017 30% 5,705 24,721 16,481 41,202 40,000 50% 9,508 28,525 19,017
34 Pemakaian O2 1-4 L/ Menit ( > 4jam / 1 hari) masker 50 box 50 kali 17325 347
Handscoon 100 box 50 kali 37001 740
Nasal oksigen Dewasa (M) 1 pcs 1 kali 6,930 6,930
o2 tabung besar 2500 ml 3 kali 110,000 36,667
kali
kali
kali
kali
kali
kali
kali
kali
44,683 30% 13,405 58,088 38,725 96,814 100,000 50% 22,342 67,025 44,683
35 Pemakaian O2 5- 8 L/ Menit ( per satu jam) masker 50 box 50 kali 17325 347
Handscoon 100 box 50 kali 37001 740
Slang musk oksigen 1 pcs 1 kali 9,500 9,500
o2 tabung besar 2500 ml 10 kali 110,000 11,000
kali
kali
kali
kali
kali
kali
kali
kali
21,587 30% 6,476 28,062 18,708 46,771 50,000 50% 10,793 32,380 21,587
36 Pemakaian O2 5-8 L/ Menit ( > 4jam / 1 hari) masker 50 box 50 kali 17325 347
Handscoon 100 box 50 kali 37001 740
Slang musk oksigen 1 pcs 1 kali 9,500 9,500
o2 tabung besar 2500 ml 2 kali 220,000 110,000
kali
kali
kali
kali
kali
kali
kali
kali
120,587 30% 36,176 156,762 104,508 261,271 200,000 50% 60,293 180,880 120,587
37 Injeksi SC/ IM/ IV / skin test (per obat) masker 50 box 100 kali 17325 173
Handscoon 100 box 200 kali 37001 185
Disposable syringe 10 cc (ONEMED) 100 pcs 100 kali 138600 1,386
 Disposable syringe 3 cc (ONEMED) 100 pcs 200 kali 99800 499
aquadest 25 ml 1 kali 12,000 12,000
kali
kali
kali
kali
kali
kali
kali
10,000 30% 3,000 13,000 8,667 21,667 20,000 50% 5,000 15,000 10,000
38 Pemberian obat melalui supositoria(per obat) masker 50 box 50 kali 17325 346.5
Handscoon 100 box 50 kali 37001 740.02
kali
kali
kali
kali
kali
kali
kali
kali
kali
kali
1086.52 50% 543 1,630 1,087 2,716 20,000 50% 543 1,630 1,087
39 Perawatan Jenazah masker 50 box 50 kali 17325 347
Handscoon 100 box 50 kali 37001 740
kassa steril 5 box 100 kali 5,500 55
Kassa Gulung Morina 40x80 1 roll 10 kali 130,000 13,000
kali
kali
kali
kali
kali
kali
kali
kali
14,142 35,000 210% ### 152,339 101,559 253,898 250,000 50% 24,571 73,712 49,142
40 Pelepasan Infus / tindakan masker 50 pcs 50 kali 17325 346.5
Handscoon 100 pcs 50 kali 37001 740.02
Non Woven Fixation 1000 cm pcs 20 kali 43,850 2192.5
alkohol swab 100 pcs 100 kali 10,500 105
kali
kali
kali
kali
kali
kali
kali
kali
3384.02 15,000 18,384 12,256 30,640 30,000 50% 9,192 27,576 18,384
41 Pelepasan NGT masker 50 pcs 50 kali 17325 346.5
Handscoon 100 pcs 50 kali 37001 740.02
kali
kali
kali
kali
kali
kali
kali
kali
kali
kali
 1086.52 20,000 21,087 14,058 35,144 40,000 50% 10,543 31,630 21,087
42 Pemeriksaan BSS/ tindakan masker 50 pcs 50 kali 17325 346.5
Handscoon 100 pcs 50 kali 37001 740.02
Test Strips 1 Box 50 kali 334,000 6680
alkohol swab 100 pcs 100 kali 10,500 105
kali
kali
kali
kali
kali
kali
kali
kali
7871.52 20% 1,574 9,446 6,297 15,743 20,000 50% 3,936 11,807 7,872
43 Verbeden masker 50 pcs 50 kali 17325 346.5
Handscoon 100 pcs 50 kali 37001 740.02
kali
kali
kali
kali
kali
kali
kali
kali
kali
kali
1086.52 15,000 16,087 10,724 26,811 30,000 50% 8,043 24,130 16,087
44 Pemberian makan melalui NGT/Kali masker 50 pcs 50 kali 17325 346.5
Handscoon 100 pcs 50 kali 37001 740.02
Spuit 50 cc 50 pcs 50 kali 250,000 5000
kali
kali
kali
kali
kali
kali
kali
kali
kali
6086.52 5,500 11,587 7,724 19,311 20,000 50% 5,793 17,380 11,587
45 Pemberian obat melalui NGT/Kali masker 50 pcs 50 kali 17325 346.5
Handscoon 100 pcs 50 kali 37001 740.02
Spuit 50 cc 50 pcs 50 kali 250,000 5000
kali
kali
kali
kali
kali
kali
kali
kali
kali
6086.52 5,500 11,587 7,724 19,311 20,000 50% 5,793 17,380 11,587
46 kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
 kali #DIV/0!
kali #DIV/0!

kali #DIV/0!

kali #DIV/0!
#DIV/0! 35,000 30% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 50% #DIV/0! #DIV/0! #DIV/0!
47 kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
#DIV/0! 35,000 30% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 50% #DIV/0! #DIV/0! #DIV/0!
48 kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
#DIV/0! 35,000 30% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 50% #DIV/0! #DIV/0! #DIV/0!
49 kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
#DIV/0! 35,000 30% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 50% #DIV/0! #DIV/0! #DIV/0!
50 kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
#DIV/0! 35,000 30% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 50% #DIV/0! #DIV/0! #DIV/0!
51 kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
 kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
#DIV/0! 35,000 30% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 50% #DIV/0! #DIV/0! #DIV/0!
52 kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
#DIV/0! 35,000 30% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 50% #DIV/0! #DIV/0! #DIV/0!

53 kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
#DIV/0! 35,000 30% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 50% #DIV/0! #DIV/0! #DIV/0!
54 kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
kali #DIV/0!
#DIV/0! 35,000 30% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 50% #DIV/0! #DIV/0! #DIV/0!
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
LI VIP

PEMBULAT
TOTAL (Rp)
AN (Rp)

144,061 145,000

81,561 82,000

73,832 74,000
 60,728 61,000

60,728 61,000

277,333 278,000

60,728 61,000

60,728 61,000
 60,728 61,000

60,728 61,000

401,222 402,000

1,141,667 1,142,000

801,515 802,000
486,667 487,000

391,667 392,000

391,667 392,000

16,245 17,000
 44,140 45,000

89,730 90,000

60,144 61,000

160,906 161,000

90,323 91,000
122,822 123,000

99,194 100,000

96,380 97,000

63,047 64,000
 79,289 80,000

63,640 64,000

37,572 38,000

88,936 89,000

100,241 101,000
 90,216 91,000

47,541 48,000

111,708 112,000

53,966 54,000

301,466 302,000
 25,000 25,000

2,716 3,000

122,854 123,000

45,960 46,000
52,716 53,000

19,679 20,000

40,216 41,000

28,966 29,000

28,966 29,000
#DIV/0! #DIV/0!

#DIV/0! #DIV/0!

#DIV/0! #DIV/0!

#DIV/0! #DIV/0!

#DIV/0! #DIV/0!
#DIV/0! #DIV/0!

#DIV/0! #DIV/0!

#DIV/0! #DIV/0!

#DIV/0! #DIV/0!
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
IX. TARIF PELAYANAN INSTALASI RAWAT INAP RSKGM

BESAR TARIF

Pelayanan R
NO JENIS PELAYANAN

Jasa Sarana

1 2 3

1 90,000
VISITE DOKTER KONSULTAN

VISITE DOKTER SPESIALIS

2 48,000
Kelas VIP

3 45,000
kelas I

4 42,000
Kelas II

5 39,000
Kelas III

6 45,000
Isolasi

VISITE DOKTER UMUM

7 27,000
Kelas VIP

8 21,000
kelas I

9 18,000
Kelas II

10 18,000
Kelas III

11 21,000
Isolasi

TARIF KAMAR

12 690,000
Kelas VIP

13 480,000
kelas I
14 288,000
Kelas II

15 150,000
Kelas III

16 240,000
Isolasi

TINDAKAN KEPERAWATAN ( Per Tindakan)

17 9,000
Tindakan keperawatan (Per Hari)

18 27,000
Pemasangan Infus

19 57,000
Perawatan luka

22 12,000
Vital Sign

23 96,000
Pemasangan endotracheal tube ( intubasi )

24 60,000
RJP tanpa intubasi

25 78,000
Tindakan dengan DC Shock / cardioversi

26 60,000
Pemasangan NGT

27 54,000
Pemasangan kateter

28 36,000
lepas kateter

29 48,000
EKG

30 36,000
Tindakan Nebulizar / Kali

31 21,000
Pemasangan saturasi oksigen

40 42,000
Suction/ penghisapan lendir

41 54,000
Syring pump / hari

42 48,000
Infus Pump/ Hari

43 24,000
Pemakaian O2 1-4 L/ Menit ( per satu jam)
44 60,000
Pemakaian O2 1-4 L/ Menit ( > 4jam / 1 hari)

45 30,000
Pemakaian O2 5- 8 L/ Menit ( per satu jam)
46 120,000
Pemakaian O2 5-8 L/ Menit ( > 4jam / 1 hari)

47 12,000
Injeksi SC/ IM/ IV / skin test

48 150,000
Perawatan Jenazah

49 12,000
pemberian obat melalui supositoria

50 18,000
Pelepasan Infus / tindakan

51 24,000
Pelepasan NGT

52 12,000
Pemeriksaan BSS/ tindakan

53 18,000
Verbeden

54 12,000
Pemberian makan melalui NGT/Kali

55 12,000
Pemberian obat melalui NGT/Kali
BESAR TARIF (RUPIAH)

Pelayanan Rawat Inap

Jasa Pelayanan TOTAL

4 5

60,000 150,000

32,000 80,000

30,000 75,000

28,000 70,000

26,000 65,000

30,000 75,000

18,000 45,000

14,000 35,000

12,000 30,000

12,000 30,000

14,000 35,000

460,000 1,150,000

320,000 800,000
192,000 480,000

100,000 250,000

160,000 400,000

6,000 15,000

18,000 45,000

38,000 95,000

8,000 20,000

64,000 160,000

40,000 100,000

52,000 130,000

40,000 100,000

36,000 90,000

24,000 60,000

32,000 80,000

24,000 60,000

14,000 35,000

28,000 70,000

36,000 90,000

32,000 80,000

16,000 40,000
40,000 100,000

20,000 50,000

80,000 200,000

8,000 20,000

100,000 250,000

8,000 20,000

12,000
30,000

16,000
40,000

8,000
20,000

12,000
30,000

8,000
20,000

8,000
20,000
 BLUD

NO NAMA PERBEKALAN FARMASI SATUAN HARGA SATUAN

(Rp)
I. OBAT
1 Amiodarone iv Kotak Rp 52,201
2 Aspilet thrombo Kotak Rp 123,200
3 Bahan Anaestesi (Pehacain inj) Kotak Rp 95,000
4 Betadin Kumur Btl/190ml Rp -
5 Cefotaxime sodium 1 g Kotak Rp 9,144
6 Ceftriaxone inj Kotak Rp 10,019
7 Citicoline Sodium 125mg.ml Kotak Rp 59,400
8 Difenhydramine 10mg Kotak Rp 53,396
9 Epineprin ampul Rp 320,000
10 Isosorbid dinitrat 5mg Kotak Rp 16,500
11 Ketorolac 10mg inj Kotak Rp 29,453
12 Minosep Botol Rp -
13 Norepineprine Kotak Rp 69,300
14 Orabloc injeksi Kotak Rp 913,000
15 Vaksin hepatitis B carpul Rp 114,400
16 Ventolin inhaler Kotak Rp 112,164
17 Vit K inj Kotak Rp 69,375
II. BMHP
1 Alat cek gula darah Box Rp -
2 Alkacide 1 L btl Rp 3,217,500
3 Alkazyme sachet poch Rp 946,000
4 Alkohol 1 liter botol/1ltr Rp 30,250
5 Alkohol 70% 100ml Btl Rp 5,445
6 Alkohol SWAB box Rp 10,500
7 Benang jahit Nylon 5/0 Box Rp 895,000
8 Benang Jahit 3/0 ( Black Silk) Pcs Rp 740,000
9 Benang Jahit 4,0 ( Black Silk ) Kotak Rp 740,000
10 Bowie Dick indikator KTK Rp 1,950,000
11 Chlor tab kg Rp 70,000
12 Cotton Roll pac Rp 42,500
13 Cotton roll uk 1 Pack Rp 62,700
14 Cotton roll uk 2 Pack Rp 62,700
15 Dental BIB POLIBIB KARTON Rp 240,488
16 H202 3% Botol Rp 3,696
17 Handscoon (M) Box Rp 37,001
18 Handscoon (S) Box Rp 37,001
19 Handscoon (XS) Box Rp 37,001
20 Handscoon S, XS,M Box Rp 70,000
21 Hemostatic sponge (ceraspon) kotak Rp 310,000
22 Indikator Strip box Rp 470,000
23 Jarum cek gula darah (Blood Lancet 28 G) pcs Rp 12,197
24 Jarum dental needle no. 13 Box Rp 28,233
25 Jarum dental needle no. 16 Box Rp 41,382
26 Jarum irigasi 0,4mm (CK-ENDO) kotak Rp -
27 Jas lab uk. M dan XL pcs Rp 190,000
28 Masker box Rp 17,325
29 Nasal oksigen Anak (S) pcs Rp 6,930
30 Nasal oksigen Dewasa (M) pcs Rp 6,930
31 Ozyme Botol Rp 1,064,448
32 PAC kg Rp 33,000
33 Perban Elastis pcs Rp 90,000
34 Pisau Bedah no 12 Kotak Rp 520,000
35 Pisau Bedah no 15 Kotak Rp 129,800
36 Pisau Bedah no. 15 (yunex) Kotak Rp 515,000
37 Pouches 20x5 (100M) Gussete Roll Rp 1,496,000
38 Pouches stericlin flat uk 5 cmx200 Roll Rp 191,767
39 Pouches stericlin flat uk 7,5 cm Roll Rp 285,260
40 Pouches stericlin gusette uk 10cmx100m Roll Rp 333,564
41 Pouches stericlin gusette uk 15cmx5mx100 Roll Rp 1,243,000
42 Pouches stericlin Gusset 10x5cm Roll Rp 1,067,000
43 Pouches stericlin gusset 15x5,0cm Roll Rp 1,999,400
44 Povidon iodine 300ml Btl Rp 21,780
45 Rivanol 300ml Btl Rp 6,776
46 Saliva Ejector bks Rp 412,500
47 Seftalkan spray btl Rp 370,000
48 Seftalkan Tissue poch Rp 142,000
49 Spiritus Liter Rp 25,000
50 Spongostan (hemospon) ktk Rp 110,000
51 Spuit 10 cc box Rp 138,600
52 Spuit 3 cc Box Rp 89,974
53 Spuit 5 cc Box Rp 101,640
54 Steri-one spray 100ml Botol Rp 15,840
55 Stomach tube uk 14 Pcs Rp 8,131
56 Stomach tube uk 16 Pcs Rp 8,131
57 Stomach tube uk 18 Pcs Rp 8,131
58 Strip Asam Urat isi 25 strip tube Rp 188,500
59 Strip Cholesterol isi 10 strip tube Rp 247,000
60 Strip Gula Darah "Glucodr"/cleverchek tube Rp 195,000
61 Strip Gula Darah cleverchek Rp 220,000
62 Suction Catheter no 10 pcs Rp 2,540
63 Suction Catheter no 14 pcs Rp 2,540
64 Threeway Pcs Rp 2,048
65 Aseptic gel 5 liter botol/5ltr Rp 371,800
66 Nurce cap green box/100 Rp 35,060
III. BAHAN/ ALAT GIGI
1 Absorb paper poin 15 box Rp 45,500
2 Alat Polishing ( Mandrel) Pcs Rp 200,000
3 Alginat aroma bks Rp -
4 Amalgam Powder btl Rp -
5 Amplas no 1500 lembar Rp 7,500
6 Amplas no 400 lembar Rp 7,500
7 Amplas no 600 lembar Rp 7,500
8 Anchor Wax box Rp 57,000
9 Bahan Anestesi ( Scandones 2 % ) Kotak Rp -
10 Bahan Anestesi ( Scandones 3 % ) Kotak Rp -
11 Bahan Bleaching (opalescance bost 40%) Kit Rp 2,450,000
12 Bahan Bleaching (opalescance Endo) syringe Rp 900,000
13 Bahan Bleaching (Ultra blend plus dentin) packs Rp 420,000
14 Bahan pengisian saluran akar ( Endomethason) kotak Rp 705,000
15 Bahan pengisian saluran akar (Eugetin) kotak Rp 510,000
16 Bahan pengisian saluran akar endoseal Box Rp 203,500
17 Bahan pulp capping ( calxyl ) Kotak Rp -
18 Bahan Pulp Capping, saluran akar ( Master Dent) Box Rp 195,000
19 Bahan pulp capping/ base liner hydcal Box Rp 176,000
20 Bahan pulp capping/base liner (calsetin) pcs Rp 205,000
21 Bakteri aerob MSDS (FU 2x10) Starback) Liter Rp -
22 Barbered Broach Box Rp 235,000
23 Benang gigi/dental flos Roll/kcl Rp 65,000
24 Benang Refraksi Gingival 000 ktk Rp 260,000
25 BETAplast (hydrocoloid dressing adhesive) pcs Rp -
26 Bite Block (S,M,L) pcs Rp 26,000
27 Bonding 3M Single bond universal Botol Rp 1,255,000
28 Bonding Composit (Anybond) btl Rp 226,000
29 Bonding Composit (Masterdent/ masterbond) Pcs Rp 310,000
30 Bracket Ortho Clear 0,22 radiance ktk Rp -
31 Bracket Ortho Metal 0,22 Low Profile ktk Rp 780,000
32 Breaket Reffil Bks Rp 395,000
33 Brush grinda hitam pcs Rp 57,000
34 Brush polishing composit Kotak Rp 747,000
35 Bucal Tube 0,22 (6 M1, 4 M2) ktk Rp 50,000
36 Bucal Tube Flat (Forestadent) 0,22 x 0,28 Bks Rp -
37 Bur Box (Dochem) Pcs Rp 110,000
38 Bur box aluminium 27 hole pcs Rp -
39 Bur Bulat kecil Dia-dent) Pcs Rp 30,000
40 Bur Bulat sedang (Dia-dent) Pcs Rp 30,000
41 Bur Endo Acces sedang,besar (Dentsplay) Pcs Rp 130,000
42 Bur Finishing pita kuning KIT (Horico) Box Rp 182,000
43 Bur poles pita kuning fissure pack Rp 45,000
44 Bur Poles pita kuning flame Pcs Rp 45,000
45 Bur preparasi bridge Set Rp 1,280,000
46 Bur Stone Polishing Composite Flame High Sp Pcs Rp 32,000
47 Bur stone polishing composite point pcs Rp 32,000
48 Bur Stone Polishing Composite Round High Sp pcs Rp 32,000
49 Bur Tulang 702 Low Speed Pcs Rp 71,500
50 Bur Tulang 703 Low Speed Pcs Rp 71,500
51 Bur tulang 23 mm zekrya Pcs Rp 195,000
52 Bur tulang 28 mm zekrya Pcs Rp 195,000
53 Bur tulang 702 High Speed Pcs Rp 71,500
54 Bur tulang fissure 701 low speed Pcs Rp 71,500
55 Bur tulang oral surgary pack Rp 33,000
56 C Pilot 06 21 mm Blister Rp 320,000
57 C Pilot 06 25 mm Blister Rp 320,000
58 C pilot 08 21 mm Blister Rp 320,000
59 C pilot 08 25 mm Blister Rp 320,000
60 C pilot 10 21 mm vdw Blister Rp 320,000
61 C pilot 10 25 mm vdw Blister Rp 32,000
62 Calcium Hydroxide bubuk (Biodinamika) Kotak Rp 71,500
63 Calcium Hydroxide pasta (Any-Pasta) Syringe Rp 266,000
64 Celluloid strip Bks Rp 93,500
65 Cement crown temporary non druling Tube Rp 455,000
66 CMS btl Rp 940,000
67 Coe Pack Kotak Rp 57,000
68 Composit Filling (Charmfill) A2 Syringe Rp 205,000
69 Composit Filling (Charmfill) A3 Syringe Rp 205,000
70 Composit Filling (Charmfill) A3,5 Syringe Rp 205,000
71 Composit Filling 3M Z350 XT A3,A4 dentinA2,A3en Set Rp 2,620,000
72 Composit filling 3M Z350XT Flowable Syringe Rp 593,800
73 Composit Filling Body (3MZ350 XT) A3, A3,5 Syringe Rp 640,000
74 Composit Filling OA3 (Estelite) Syringe Rp 390,000
75 Composit Filling P60 A3 syringe Rp 481,000
76 Composit Filling universal set (Any-com) Rp 1,173,000
77 Composit Filling Z250 XT A2 syringe Rp 670,000
78 Composit Filling Z250 XT A3 syringe Rp 377,000
79 Composit Filling Z250 XT A3,5 syringe Rp 377,000
80 Composit Filling Z350 XT A2 syringe Rp 692,000
81 Composit Filling Z350 XT A3 syringe Rp 692,000
 82 Composit Filling Z350 XT A3,5 syringe Rp 692,000
83 Composit Filling Z350 XT Flow A3 syringe Rp 742,000
84 Composit solare A3 pcs Rp 900,000
85 Composit Veneer Amaris (Voco) Box Rp 11,700,000
86 Composite filling beauty flow A3 Syringe Rp 710,000
87 Composite Filling Posterior A3 Syringe Rp 455,000
88 Cresophen/cresotin Botol Rp 450,000
89 Cresophene tehnodent cresotin liquid II Botol Rp 357,500
90 Cresotin liq. 1 (pulperyl) btl Rp 221,000
91 Dentin Conditioner GC btl Rp 157,000
92 Devitec/ devital Box Rp 260,000
93 Disclosing Gel (tri plaque ID gel) Box Rp 336,000
94 Double Impression ( Exaflex Putty ) Kotak Rp 1,350,000
95 Double Impression injeksi (Exaflex) Kotak Rp 585,000
96 Double Impression Light Body( vericom) Box Rp 260,000
97 Double Impression Putty ( Zhermax) Box Rp 754,000
98 Edta 18% Ultradent Kotak Rp 390,000
99 Edta gel (diaprep) Kotak Rp 200,000
100 Elastic 3/4 Os bks Rp 30,000
101 Elite cement Mini pack btl Rp 210,000
102 Endo Block mini /Stand Pcs Rp 340,500
103 Endo Box Pcs Rp 100,071
104 Endo Clear stand VDW pcs Rp 385,000
105 ETSA composit (Any Etch) syringe Rp 226,000
106 ETSA Gel Syringe Rp 320,000
107 Eugenol btl Rp 80,000
108 Eugetin Box Rp 514,000
109 Film Dental Hanshin Kotak Rp 374,000
110 Film Rontgen Panoramic 20x25 (8x10)150NF Rp 2,000,000
111 Finger Protector kecil Rp 185,900
112 Finger protector uk S Pcs Rp 143,000
113 Finger Spreaders 10-40 25 mm Box Rp 238,000
114 Finishing Strip Kotak Rp 525,000
115 Fluocal Solution Botol Rp 530,000
116 Fluor Frutti Btl Rp 60,000
117 Gelas kumur disposible pac Rp 335,000
118 Gibs putih kg Rp 10,000
119 Gigi Anterior Rahang Bawah A2 Kotak Rp 250,000
120 Gigi Anterior Rahang Atas A2 Kotak Rp 250,000
121 Gigi Anterior Rahang Atas A3 Kotak Rp 250,000
122 Gigi Anterior Rahang Atas A3,5 Kotak Rp 250,000
123 Gigi Anterior Rahang Atas A4 Kotak Rp 250,000
124 Gigi Anterior Rahang Bawah A3 Kotak Rp 250,000
125 Gigi Anterior Rahang Bawah A3,5 Kotak Rp 250,000
126 Gigi Anterior Rahang Bawah A4 Kotak
Rp 250,000
127 Gigi Full set A2 Kotak Rp 282,000
128 Gigi Full set A3 Kotak Rp 282,000
129 Gigi Full set A3,5 Kotak Rp 282,000
130 Gigi Full set A4 Kotak Rp 282,000

131 Gigi Posterior Rahang Atas A2 Kotak

Rp 240,000

132 Gigi Posterior Rahang Atas A3 Kotak

Rp 240,000
133 Gigi Posterior Rahang Atas A3,5 Kotak Rp 240,000

134 Gigi Posterior Rahang Atas A4 Kotak

Rp 240,000

135 Gigi Posterior Rahang Bawah A2 Kotak

Rp 240,000
136 Gigi Posterior Rahang Bawah A3 Kotak Rp 240,000
137 Gigi Posterior Rahang Bawah A3,5 Kotak Rp 240,000
138 Gigi Posterior Rahang Bawah A4 Kotak Rp 240,000
139 Glass ionomer ( Fuji II ) Kotak Rp 1,075,000
140 Glass ionomer ( Fuji IX ) Kotak Rp 1,000,000
141 Glass ionomer ( Fuji VII ) Kotak Rp 892,000
142 Glass Ionomer GC ( Fuji I ) Box Rp 1,193,000
143 Glass ionomer Gi Fill Premium Box Rp 436,000
144 Glass ionomer Gi Fill Reguler Box Rp 219,000
145 Gluko Stick Edenta ktk Rp 190,000
146 Gluko Test set Rp 650,000
147 Gutta percha denplus uk 15 Kotak
Rp 48,400
148 Gutta percha denplus uk 15-40 Kotak Rp 50,500
149 Gutta percha denplus uk 45-80 Box Rp 48,400
150 Gutta Percha Protaper Assort M-Two 28mm(25/.06 ktk Rp 455,000
151 Gutta Percha Protaper F1 Kotak Rp 443,000
152 Gutta Percha Protaper F2 Kotak Rp 443,000
153 Gutta Percha Protaper F3 Kotak Rp 443,000
154 Gutta Percha Protaper F4-F5 Kotak Rp 443,000
155 Gutta Percha Proteper Dia Prot Plus (F1,F2,F3) Ktk Rp 320,000
156 Headstroom 15-40 21 mm Pcs Rp 140,000
157 Headstroom 15-40 25 mm Pcs Rp 140,000
158 Heat Curing Akrilik ( ADM) Box Rp 2,960,000
159 IGG Kotak Rp 1,300,000
160 Inlay Wax sorf violet Pcs Rp 40,000
161 K File 15-40 21 mm (VDW) Pcs Rp 298,000
162 K File 15-40 25 mm (M-access) Pcs Rp 160,000
163 K File 15-40 25 mm (VDW) Pcs Rp 298,000
164 K- File 15-40 31 mm Pcs Rp 162,000
165 K File 45-80 21 mm (KENDO) Pcs Rp 162,000
166 K File 45-80 25 mm (KENDO) Pcs Rp 117,000
167 K- File 45-80 25 mm (VDW) Pcs Rp 250,000
168 K- File 45-80 31 mm Blister Rp 160,000
169 K File no 06 21 mm Pcs Rp 160,000
170 K File no 08 21 mm Pcs Rp 160,000
171 K File no 10 21 mm Pcs Rp 160,000
172 K File no 10 25 mm Pcs Rp 11,000
173 Kaca mulut no.4 Pcs Rp 460,000
174 Kawat Niti 0,12 RA dan RB pac Rp 460,000
175 Kawat Niti 0,14 RA dan RB pac Rp 460,000
176 Kawat Niti 0,16 RA dan RB pac Rp 162,500
177 K-File n0 15-40 21 mm Blister Rp 162,500
178 K-File no 06 25 mm Blister Rp 250,000
179 K-File no 08 31 mm Blister Rp 162,500
180 K-File no 08 25 mm Box Rp 250,000
181 K-File no 10 31 mm Blister Rp 25,000
182 Kuas set Rp 105,000
183 Lecrown (pisau malam) Pcs Rp 1,000,000
184 Ledermix Box Rp 4,550,000
185 Lem Ortho (ORMCO) Set Rp 320,000
186 Lentulo 1-4 25 mm 25-40 box Rp 335,000
187 Lienospan 1,8 ml Kotak Rp 363,000
188 Lienospan 1,8 ml ( Septocain/bahan anastesi) Kotak Rp 27,500
189 Ligature kobayashi hook 014 Pack Rp 192,000
190 Matrix Roll Rp 9,000,000
191 Matrix sectional box Rp -
192 Metal Bracket Mini Edgewise Bks Rp 370,000
193 Micro Brush Kotak Rp -
194 MTA (Cerkamed) pcs Rp 708,000
195 N-Methasone (Master Dent) Box Rp 156,000
196 Open Coil Spring tabung Rp 42,000
197 PAC/Water flok Kg Rp 51,000
198 Paper point 20 box Rp 51,000
199 Paper point 25 box Rp 51,000
200 Paper point 30 box
Rp 48,400
201 Paper point dentplus uk 15-40 Box Rp 48,400
202 Paper point dentplus uk 40 Box Rp 29,040
203 Paper point dentplus uk 45-80 Box Rp 570,000
204 Pasak Fiber pcs Rp 930,000
205 Pasak metal ( pin screw ) Kotak Rp 18,000
206 Polident Pcs Rp 370,000
207 Polishing Composit pink (Meisinger) pcs Rp 475,000
208 Polishing Composit Sof-lex 3M ESPE Rp 370,000
209 Polishing Composit White (Meisinger) Pcs Rp 110,000
210 Power Chaine meter Rp 429,000
211 Power O (american ortho) transparan,hitam,silver pack Rp 195,000
212 Precaine (topikal anastesi spray) straw Box Rp 1,180,000
213 Protaper F4 25 mm box Rp 1,180,000
214 Protaper F5 25 mm box Rp 1,222,000
215 Protaper FHU 21 mm Kotak Rp 1,222,000
216 Protaper FHU 25 mm Kotak Rp 1,222,000
217 Protaper rotary 21 mm Box Rp 1,222,000
218 Protaper rotary 25 mm Box Rp 1,222,000
219 Protaper rotary 31 mm Box Rp -
220 Protaper rotary gold 21 mm Pcs Rp 1,100,000
221 Protaper rotary gold 25 mm Pcs Rp 1,100,000
222 Protaper rotary retreatment 25mm pcs Rp 455,000
223 Proxyt Medium RDA 36, Coarse RDA 83 tube Rp 650,000
224 Rockles btl Rp 1,232,000
225 Rotary file (456) 21 mm Blister Rp 1,232,000
226 Rotary file (456) 25 mm Blister Rp 1,232,000
227 Rotary file (457) 21 mm Blister Rp 1,232,000
228 Rotary file (457) 25 mm Blister Rp 1,232,000
229 Rotary Protaper 25 mm Kotak
Rp 6,207,500
230 Ruber Dam (paket besar) set
Rp 1,450,000
231 SDR Refill Pcs
Rp 1,670,000
232 Semen resin relyx U-200 Pcs
Rp 970,000
233
Soft Liner Box Rp 1,950,000
234 Stainless steel crown Set
Rp 190,000
235 Stone plaster kuning (new plastone) packs
Rp 1,950,000
236 Sureflas Kotak Rp 1,280,000
237 Tip Scaler G4 Pcs Rp 2,580,000
238 Tip Scaler (EMS) Pcs Rp 1,280,000
239 Tip Scaler G8 Pcs Rp 120,000
240 TKF Botol Rp -
241 TLD Kontrol bh Rp -
242 TLD Personal bh Rp 181,000
243 Tooth Mouse GC tube Rp 195,000
244 Topical anasthesi gel Botol Rp 452,000
245 Topical anasthesi spray Botol Rp 552,000
246 Topical Anestesi (Xylonor) Botol Rp 230,000
247 Tray Topical aplikasi set Rp 190,000
248 Tumpatan Sementara ( Caviton ) Kotak Rp -
249 Tumpatan sementara (cevitron) Box Rp 60,000
250 Tumpatan sementara Orafil Plus btl Rp 620,000
251 Urbical Kotak Rp 1,439,000
252 Wax and modeling carver set Rp 120,000
253 Wax merah hifflex ktk Rp 185,000
254 Wax mess (pakistan) Pcs Rp 114,400
255 Wire biostater uk 10 Pcs Rp -
256 Z 250 Syringe Intro Kit (3M Espe) set Rp -
257 Articulating Paper Part Dc Pcs Rp 181,500
258 Soflex Spiral mini kit Pcs Rp 322,500
 APBD
NAMA BAHAN GIGI/BMHP
No.

Alkes Habis Pakai

1 Bakteri Aerob-Starbact
2 Black Silk 3/0
3 Blood Adminitration set
4 Bowie & Dick Inikator
5 Chromic 3/0
6 Cologne Fora
7 Do Care Wash Gloves Disp Anti Bacteria
8 Fixomul stretch Plaster
9 Fixomul stretch Plaster
10 Handscoon (L)
11 Handscoon (M)
12 Handscoon (S)
13 Handscoon (XS)
14 Handscoon Steril
15 Handscoon Steril No. 7
16 Imaging Dry Film 150 NIF 20,3x25,4 cm
17 Imaging Dry Film 150 NIF 25,7x36,4 cm
18 Infus set Anak/Pediatrik set
19 IV Catheter 16 G
20 IV Catheter 18 G
21 IV Catheter 20 G
22 IV Catheter 22 G
23 IV Catheter 24 G
24 IV Catheter 26 G
25 Kapas
26 Kapas 1 Kg
27 Kapas 250 gr
28 Kassa Gulung Morina 40x80
29 Kassa Hidrofil 40 yardx80cm
30 Kassa steril 16x16
31 Lanset 28 G
32 Leukoplast 1624
33 Masker 4M Standar Tie on surgical mask
34 Masker Cup Dust Mask
35 Nald Heating Kulit
36 Nald Heating Otott
37 Non Woven Fixation/ 5 Cm x 10 M
38 Nylon 5/0
39 Plain catgut 2/0
40 Plain catgut 3/0
41 Plester semillas
42 Polycatheter no 16
43 Polycatheter no 18
44 Refill Mask Dust
45 Safety Box Needle
46 Scapel Blade
47 Selftalkan Pack
48 Selftalkan Spray
49 Silk black 4/0
50 Slaber
51 Slang musk oksigen
52 Spiritus
53 Spuit 1 cc
54 Spuit 10 cc
55 Spuit 20 cc
56 Spuit 3 cc
57 Spuit 5 cc
58 Spuit 50 cc
59 Steracath 18
60 Steracath 20
61 Stomach tube
62 Surgical Sutures 3/0 plain catgut
63 Tensoban 7cm x 20m
64 Urine Bag
65 Vaselin
66 Wash Gloves Standar
67 Zinc Oxide Tape Fescoplast 5 Cm x 4,5 M
AntiSeptik/Desinfektan
1 Alkacide 1L
2 Alkazyme sachet 25mg
3 Alkohol 70%
4 Alkohol swab
5 Chlorhesidine 4 % Dutacrub
6 Hand scrub 5 Liter
7 Hand scrub 500ml
8 Handrub 5 liter
9 Handrub 500ml
10 Handsrub Softaman/Fresco
11 Povidon iodine 10 % sol
12 Povidon iodine 10 % sol
13 Protector Sol/ Lysol
14 Rivanol
15 Povidon iodin (stardin) 60ml
Bahan Gigi Habis Pakai
1 A. Plus comice adhesive (Gipsum)
2 Adper Single Bond 2 -bonding
3 Algunat Aroma (Algeniux)
4 Amalgam Kapsul
5 Amalgam Likuid
6 Aux 510 Celluloid
7 Bahan devitalisasi pulp
8 Bahan Poles Kryth
9 Bahan Poles Pumis
10 Bahan semen crown (Relyx)
11 Composit Filtek 3M Z 250 XT A 2
12 Composit Filtek 3M Z 250 XT A 3
13 Composit Filtek 3M Z 250 XT A 3,5
14 Composite Filling 3M (BULK FILL)
15 composite Filling 3M (BULK FLOW)
16 Composite Filling Posterior (Filtek P60)A3
17 Compule Gun Komposit
18 Cresophene/cresotin liq
19 Edta gel
20 Etsa composit 3M (etchan gel vial 9ml)
21 Etsa composit 3M universal
22 Eugenol sol
23 Glas ionomer 3M (KETAC UNIVERSAL )
24 Gutta Percha Point dent plus15-40
25 Gutta Percha Point Dochem 45-80
26 Hi Clean Spray (minyak pelumas handpiece
27 Lilin Inlay Violet
28 NaOCl 12 %
29 Polishing composit 3M (soflex Coarse)
30 Polishing composit 3M (soflex medium)
31 Polishing composit 3M (soflex sfine)
32 Polishing composit 3M (soflex thin fine)
33 Self Curing Acrylic Hillon
34 Spongostan/Hemospon
35 Stiky Wax Coklat
36 Stone Biru (Moldano)
37 Stone pink (Meldastone)
38 Tumpatan sementara (bioinamika)/Filltemp
39 AH 26
40 Alvogyl
41 Amalgam powder
42 Anchos Wax
43 Articulating paper lurus
44 Bahan Pulp Capping/Base liner (Master dent)/hydcal
45 Ca(OH)2Pulp Capping Powder
46 Calxyl pasta
47 Tumpatan sementara (Caviton)/ORAFIL
48 CHKM sol
49 CMS
50 Compomer beauty A 3
51 Compomer beauty A 3,5
52 composite Filling Posterior A2
53 Composit Filling Posterior (Filtex P60 B2
54 composite Filling Universal A3,5 Body
55 Core Bult Up Luxacore z
56 Dental Metronidazole
57 Dental stone (snow rock)
58 Diafil flow A 3
59 Diafil flow A 3.5
60 Dyract Flow A2
61 Dyract Flow A3
62 Dyract XP A 3
63 Dyract XP A 3,5
64 Edta gel
65 Edta gel Diaprep plus
66 Endodontic Sealer Resin 2 seal
67 Endomethasone (Root canal sealer)
68 Estelite Flow A 2
69 Estelite Flow A 3
70 Etching agent(Meta Etchant)
71 Etsa Gel
72 Exaflex Injektion
73 Exaflex Putty
74 Fiber Post Refill Luxapost 1,25
75 Fiber Post Refill Luxapost 1,375
76 Fiber Post Refill Luxapost 1,55
77 Fiber Splint
78 Fletcher powder
79 Fleteher liquid
80 Fluor gel
81 Formokresol
82 Fuji I
 83 Fuji II LC
84 Fuji VII
85 Fuji 9 A2
86 Fuji 9 A3
87 Gutta Percha ukr. 15
88 Gutta Percha point F3
89 Gutta percha point F2
90 Gutta Percha Standar Assorted
91 Gutta Percha protaper F2
92 Gutta Percha protaper F1-F3
93 Gutta Percha protaper F3
94 Heat curing acrilic (ADM)
95 Honigum Light Body
96 Intra Coranal Bleaching-Opalescence
97 Komposit Charisma A 2
98 Komposit Charisma A 3
99 Komposit Charisma A 3,5
100 Leadermix
101 Meliodent
102 MTA fillapex
103 Oco
104 Optra Gate size Reguler
105 Optra Gate Size Small
106 Plaster of Paris (Prestia Stone Putih )
107 Stone kuning (Moldadur)
108 Stone merah (wax merah)
109 Pulperyl
110 Resin composite set: etching sol
111 Ribbon Fibre
112 Sealer Rool Canal 2 seal
113 Self Curing Acrilic No 3 Vertex C Putih
114 Semen zinc pospat L dan P
115 Surgical ginggival pack (Septopack)
116 Teco Refill
117 Tetric N Flow Ref 2 gr A2
118 Tetric N Flow Ref 2 gr A3
119 TKF
120 Tooth Mouse
121 Tri Plaque TD Gel
122 Urbical
Alat Gigi Habis Pakai
1 Alat Poles Amalgam Veneer Halus
2 Alat Poles Amalgam Veneer Kasar
3 Alat Poles Amalgam White Stone Round
Alat Poles Protesa Brush Wheel (Brush
4
mounted sandwich cotton)
5 Alat polish komposit Round Low Speed
6 Barbero Broach/Exterpasi File 15-40
7 Bracket Ortho (Clear)
8 Bucal tube M1 022

9 Bur Bongkar Amalgam Bulat Besar (EDENTA)

Bur bongkar amalgam bulat besar Low Speed

10
C15RA023 (JOTA)

11 Bur Bongkar Amalgam Bulat Kecil

Bur Bongkar Amalgam Fissure Besar

12
C21RAO10 Low Speed

Bur bongkar amalgam fissure kecil Tappered

13
C23RRA012

14 Bur Finishing pita kuning KIT

15 Bur Inverted Besar Diamond instrumen
16 Bur Tulang Fissure Besar Low Speed 018
17 Bur Tulang Fissure Kecil Low Speed 012
18 Bur tulang high speed carbide
19 Bur tulang low speed carbide
20 C - File 10 L 21
21 C - File 10 L 25
22 C - File 6 L 21
23 C - File 8 L 21
24 Crown sementara
Diamond Bur High Speed Bulat Kecil
25
801G.FG010
26 Film Panoramic Ukr 20x25 (Fuji)
27 Gigi Hardent
28 Gigi Posterior RA A3(Bio eco)
29 Klamer 0,6 kawat niti
30 Klamer 0,7 (kawat niti)
31 Klamer 0,8 (kawat niti)
32 Lentulo Paste Fillers (Dentsply)
33 Mata Bur Belimbing Fraser Fissure Besar
34 Mata Bur Belimbing Fraser Flame
35 Melafol 1002 100 cm x200m
36 Melafol 7,5 (5cm x200m)
37 Micro Aplicator
38 Molar Band
39 Molar Band (isi 2 set M1)
40 Molar Band (isi 2 set M2)
41 Open Coil Niti
42 Pasak Logam
43 Pouches Stericlin Gussette Ukuran 10x5 cm (
44 Pouches Stericlin Gussette Ukuran 20x5 cm (
45 Pouches Stericlin Gussette Ukuran 5x200cm
46 Power O- AO
47 Saliva Ejector Tip
48 Wire N 0,12 U,L
49 Wire N 0,14 U,L
50 Wire N 0,16 U,L
51 Wire Niti 0,16 X 0,16 U,L
52 Wire SS 0,14 U,L
53 Wire SS 0,16 X 0,22 U,L
54 Wire SS 0,16, U,L
55 Wire SS 0,18 U,L
56 Absorban paper point 15-40
57 Absorban paper point 45-80
58 Alat Poles Amalgam White Stone Flame
59 Alat Poles Amalgam Stone Low Speed
60 Alat poles Amalgam Rubber Low Speed
61 Alat Poles Komposit
62 Alat Poles Protesa Cotton Wheel
63 Alat Poles Prothesa Stone Bur (Pink Arkansas
64 Alat polish komposit Flame Pita Kuning
65 Alat Polish Komposite Fissure pita kuning
66 Alat Polish Komposite High Speed
67 Alat Polish Komposite Low Speed
68 Articulating Paper Full Mouth
69 Articulating Paper Partial Mouth
70 Benang Retraksi Gingiva (surcord)
71 Bur Stone Polishing Composit (Round)
72 Bur Stone Polishing Composit (Flame)
73 Bur Stone Polishing Composit (Point)
74 Bur tulang high speed fissure panjang
75 Bur tulang high speed fissure pendek
76 Bur bongkar amalgam bulat kecil C1F6008
77 Bur Bongkar Amalgam Fissure Besar Edenta
Bur bongkar amalgam fissure kecil
78
C23RRA016
79 Bur Bongkar Amalgam Flame Besar High Spee
80 Bur bongkar amalgam flame kecil
81 Bur Diamond set 6 Edenta
82 Bur Porselain
83 Bur Preparasi
84 Bur Preparasi Crown
85 Bur Tulang Bulat HP 6 R FG 6
86 Bur Tulang Bulat Low Speed
87 Bur Tulang Bulat High Speed
88 Bur Tulang Fissure
89 Bur Tulang Fissure pjg High Speed
90 Bur Tulang Fissure Pendek High Speed
91 Bur Tulang Bulat HP06 Round Carbide
92 Bur Tulang HP701 Carbide SS White
93 Bur Tulang HP 703 Carbide SS White
94 Bur Zekrya 23 mm (jota)
95 Bur Zekrya 28 mm (jota)
96 Bur Tulang Round FG 6
97 C -File 10
98 C - File 8 L 25
99 C -File 8
100 C - File 6 L 25
101 CK Endo Irrigation 0,3x25mm
102 Cotton Roll
103 Celluloid Strip
104 Dental X-Ray Film ukr 30x40 mm
105 Diamond Bur ( high speed)
106 Diamond Bur Anak
Diamond Bur High Speed Bulat Besar
107
801G.FG021
Diamond Bur High Speed Bulat Sedang
108
801G.FG018
Diamond Bur High Speed Fissure besar SS
109
WHITE 018
Diamond Bur High Speed Fissure kecil SS
110
WHITE 014
Diamond Bur High Speed Fissure sedang
111
802KG.FG014
 Diamond Bur High Speed Flame besar
112
833G.FG023
Diamond Bur High Speed Flame kecil
113
833G.FG014
114 Diamond Bur High Speed Flame sedang 80G.F
115 Endo Acces Bur
116 Endo Acces Bur Ukr 1
117 Endo Acces Bur Ukr 2 802LG.FG.016
118 Endo Box 60 hole mini
119 Endo Acces Bur Ukr 3
120 File Hand Use 45-80 25 mm
121 Finger Spreader 25 mm
122 Finishing Strip (Sof Lex)
123 Gigi Surpass Anterior
124 Gigi Surpass Posterior
125 Gigi Kaily A3
126 Gigi Kaily A3,5
127 Headstroom File 15-40
128 Headstroom File 15-40 L 21
129 Headstroomn File 15-40 L 25
130 Headstroomn File 45-80
131 Headstroomn File 45-80 L 21
132 Headstroomn File 45-80 L 25
133 Jarum Citoject 16 dochem
134 Jarum Citoject 12 Septodont
135 Jarum Citoject Transcodent
136 K- File 15-40
137 K- File 15-40 L 21 Dia-Dent
138 K- File 15-40 L25
139 K- File 45-80
140 K - File 45-80 L 21
141 K - File 45-80 L 25
142 K- File Niti 15-40 L 21
143 Ligature Wire
144 Mata Bur Ruber (coklat,kuning,hijau @5)
145 Matrik Band
146 Mata Bur Belimbing Fraser Round
147 Melafol 15 cmx200 m (pouches) Flat
148 Melafol 15cmx5,0cm Gussett (pouches)
149 Melafol 20 cmx200m (pouches)
150 Melafol 752 7,5cm x200m
151 Patch File 25 m, Scout Race
152 PP Protaper Univ Ass F1-F3
153 PP Protaper Univ Ass F4-F5
154 Protaper Universal FHU Assort 21mm
155 Protaper Universal FHU Assort 25mm
156 Protaper Universal Rotary Assort 21mm
157 Protaper Universal Rotary Assort 25mm
158 Protaper Universal Retreatment
159 Rotary Instrumen File 25 mm
160 Pouches Stericlin Gussette Ukuran 15x5 cm (
SATUAN HARGA
OBAT

Ltr -
Box 38,068
Bks 33,500
Box 1,950,000
Bks 1,328,712
Btl 16,200
Pack/18 116,886
bks 37,440
Roll 77,801
Box 100's 77,801
Box 100's 81,691
Box 100's 81,691
Box -
PCS -
Ktk/50psg -
Ktk150 -
Ktk150 4,800
Bks 5,100
Syringe 47,000
Syringe 7,000
Syringe 7,000
Syringe 7,000
Syringe 7,000
Syringe -
Bks 50 gr 3,000
Bks 52,000
Bks 12,500
Roll 130,000
Roll 133,350
box 5,500
Box 12,600
Roll -
Box 50's 16,500
Pcs 7,500
Lsn 20,000
Lsn 20,000
Roll 43,850
 Box 45,766
Bks 58,840
Bks -
Roll -
bks 11,000
bks 11,000
Pcs 7,500
Pcs 24,122
Box -
bks 142,000
btl 750 ml 166,016
ktk/12 38,974
Pak 87,250
Bks 9,500
Bks 18,700
Box 100's 110,500
Box/100"s 130,200
Box50"s 97,700
Box 100's 99,800
Box 100's 112,900
Box30"s 120,300
Pcs 4,826
Pcs 4,826
Bks 7,370
Box24 139,700
Roll 24,500
Bks 5,500
Kg -
Pack/2 12,650
Roll 15,175

2,702,700
pcs 801,000
100ML 2,900
Box 19,680
Gln 5 ltr -
Btl 808,000
Btl 90,000
Btl 555,000
Btl 70,000
Btl/500ml 66,700
Btl 300 ml -
Btl 30 ml 2,900
 Btl 1 ltr 15,125
Btl 100ml 2,000
Btl 60ml 15,500

Pcs 37,254
Pcs 261,592
Pcs 102,800
Pcs 1,239,700
Pcs 210,292
Set 96,384
Set 219,000
Set 8,800
Pcs 40,700
Pcs 552,596
Pcs 188,016
Pcs 188,225
Pcs 188,016
Box/4 277,246
Pcs 602,000
Pcs 216,004
Pcs 288,000
strip 160,500
strip 207,428
Strip 120,893
Strip 386,518
Strip 19,765
strip 438,047
Kotak 45,600
Pcs 103,000
ktk 984,000
Box 650,000
box 12,500
Rol 113,088
Rol 113,084
Rol 113,087
Kotak 113,089
Set 290,500
Set 75,600
Box 550,000
Box 83,400
Box 100's 175,500
pcs 121,000
set 984,150
 Set 731,000
Rol -
ktk 33,797
Rol -
Rol 133,000
Rol -
Ktk -
Pak 100 53,000
Pak 38,804
Pak 175,000
Pak 2,213,700
Pak 2,213,700
Pak -
Pak -
Pak -
Pak -
Box -
Box -
Pcs -
Set -
Pcs -
Box -
Pcs -
Pcs -
Pcs -
Pcs -
Pack10 -
Pack10 -
Pak -
Pak -
Kotak -
pcs -
pcs -
pcs -
Pcs -
Pcs -
Pcs -
Pcs 1,095,000
Pcs -
Pcs -
Pcs -
Box -
Pcs -
 Box 6 -
Set -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Strip -
Pcs -
Strip -
Pcs -
Bks 12's 2,567,500
Strip 100 -
ktk 25 -
Box 6's -
Pcs -
Pcs 91,000
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
pcs -
Box -
ktk -
Kotak -
ktk -

Pcs 35,400
Pcs 35,400
 Pcs 15,800

Pcs 28,400
Pcs 165,200
Set 183,400
Set 3,664,000
Set 399,250

Pcs 185,950

Pcs
271,800
Pcs 185,950

Pcs
398,300

Pcs 398,300
Box/4 799,667
Pcs 27,800
Pcs 56,400
Pcs 56,400
strip 241,875
strip 241,875
Strip 234,000
Strip 234,000
Strip 234,000
strip 234,000
Kotak 2,905,000

Pcs 44,200
ktk 3,266,900
Box 1,092,800
box 240,000
Rol 5,750
Rol 5,750
Rol 5,750
Kotak 246,000
Set 379,400
 Set 379,400
Box 2,780,000
Box 555,500
Box 100's 74,000
pcs 74,000
set 75,700
Set 75,700
Rol 100,000
ktk 943,750
Rol 902,550
Rol 1,271,000
Rol 467,500
Ktk 33,000
Pak 100 88,500
Pak 239,300
Pak 239,300
Pak 239,300
Pak 120,000
Pak 120,000
Pak 120,000
Pak 120,000
Pak 120,000
Box -
Box 77,500
Pcs -
Set -
Pcs -
Box -
Pcs -
Pcs -
Pcs -
Pcs -
Pack10 -
Pack10 -
Pak -
Pak 550,000
Kotak -
pcs -
pcs -
pcs -
Pcs -
Pcs -
Pcs -
 Pcs -
Pcs
-
Pcs -
Pcs -
Box -
Pcs -
Box 6 -
Set -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
Strip -
Pcs -
Strip -
Pcs -
Bks 12's -
Strip 100 -
ktk 25 -
Box 6's -
Pcs -
Pcs
44,200
Pcs
44,200
Pcs
44,200
Pcs
-
Pcs
-
 Pcs
-

Pcs -
Pcs -
Pcs -
Pcs -
Pcs -
pcs -
Box -
ktk -
Kotak -
ktk -
Box -
Box -
set -
set -
Kpg 6 -
Kpg 6 -
Kpg 6 -
Kpg 6 269,400
Kpg 6 -
Kpg 6 200,000
Box -
Box 450,000
Box 100 -
Box 6 -
Strip 202,350
Strip -
Box 6 -
Strip -
Strip -
set 158,120
Rol -
Pcs -
Rol -
Set -
rol -
-
rol -
Box -
Box -
ktk -
 ktk -
Box -
Box -
Box -
Box -
ktk"s -
Box -
Rol 1,056,000
REALISASI BELANJA OBAT DAN BAHAN TAHUN ANGGARAN 2023 (APBD)

NO TGL SP NAMA PENYEDIA PDN

1 26/01/2023 PT. BHINEKA MITRA SEJATI  E-Katalog

2 26/01/2023 PT. Safelock Medica  E-Katalog

3 26/01/2023 PT. Safelock Medica  E-Katalog
4 27/01/2023 PT.Bernofarm  E-Katalog
5 27/01/2023 PT.Bernofarm  E-Katalog
6 27/01/2023 PT.Bernofarm  E-Katalog
7 27/01/2023 PT.Bernofarm  E-Katalog
8 27/01/2023 PT.Bernofarm  E-Katalog
9 27/01/2023 PT.Bernofarm  E-Katalog
10 27/01/2023 PT.Bernofarm  E-Katalog
11 27/01/2023 PT.Bernofarm  E-Katalog
12 27/01/2023 PT.Bernofarm  E-Katalog
13 27/01/2023 PT.Bernofarm  E-Katalog
14 27/01/2023 PT.Bernofarm  E-Katalog
15 27/01/2023 PT.Bernofarm  E-Katalog
16 27/01/2023 PT.Bernofarm  E-Katalog
17 27/01/2023 PT.Bernofarm  E-Katalog
18 27/01/2023 PT.Bernofarm  E-Katalog
19 27/01/2023 PT.Bernofarm  E-Katalog
20 27/01/2023 PT.Bernofarm  E-Katalog
21 27/01/2023 PT.Bernofarm  E-Katalog
22 27/01/2023 PT.Bernofarm  E-Katalog
23 27/01/2023 PT.Bernofarm  E-Katalog
24 27/01/2023 PT.Bernofarm  E-Katalog
25 27/01/2023 PT.Bernofarm  E-Katalog
26 27/01/2023 PT.Bernofarm  E-Katalog
27 27/01/2023 PT Mulawarman Kesada Medicalindo  E-Katalog
28 27/01/2023 PT Mulawarman Kesada Medicalindo  E-Katalog
29 27/01/2023 PT Mulawarman Kesada Medicalindo  E-Katalog
30 19/01/2023 PT. DJEMBATAN DUA  E-Katalog
31 19/01/2023 PT. DJEMBATAN DUA  E-Katalog
32 19/01/2023 PT. DJEMBATAN DUA  E-Katalog
33 19/01/2023 PT. Sigma Andalan Nusa  E-Katalog
34 19/01/2023 PT. Sigma Andalan Nusa  E-Katalog
35 19/01/2023 PT. Sigma Andalan Nusa  E-Katalog
36 19/01/2023 PT. DOS NI ROHA E-Katalog


37 27/01/2023 PT. SINAR RODA UTAMA  E-Katalog

38 27/01/2023 PT. SINAR RODA UTAMA  E-Katalog
39 27/01/2023 PT. SINAR RODA UTAMA  E-Katalog
40 27/01/2023 PT. SINAR RODA UTAMA  E-Katalog
41 30/01/2023 PT KASTARA TEKNOLOGI  E-Katalog
INTERNASIONAL
PT. SATORIA ANEKA INDUSTRI
42 30/01/2023  E-Katalog

43 30/01/2023 PT. SATORIA ANEKA INDUSTRI  E-Katalog

44 30/01/2023 PT. SATORIA ANEKA INDUSTRI  E-Katalog
45 06/02/2023 PT. Likuid Pharmalab Indonesia  E-Katalog
46 06/02/2023 PT. Likuid Pharmalab Indonesia  E-Katalog
47 06/02/2023 PT. Likuid Pharmalab Indonesia  E-Katalog
48 06/02/2023 PT. Likuid Pharmalab Indonesia  E-Katalog
49 06/02/2023 PT. Likuid Pharmalab Indonesia  E-Katalog
50 06/02/2023 PT. Likuid Pharmalab Indonesia  E-Katalog
51 06/02/2023 PT. Likuid Pharmalab Indonesia  E-Katalog
52 06/02/2023 PT. MEDIHOOP  E-Katalog
53 06/02/2023 PT. MEDIHOOP  E-Katalog
54 06/02/2023 PT. MEDIHOOP  E-Katalog
55 06/02/2023 PT. MEDIHOOP  E-Katalog
56 20/02/2023 PT. Efada Medical Industries Indonesia  E-Katalog

57 21/02/2023 PT Pratapa Nirmala (1)  E-Katalog

58 21/02/2023 PT Pratapa Nirmala (1)  E-Katalog
59 21/02/2023 PT Pratapa Nirmala (2)  E-Katalog
60 22/02/2023 PT. Dexa Medika  E-Katalog
61 22/02/2023 PT. Dexa Medika  E-Katalog
62 22/02/2023 PT. Dexa Medika  E-Katalog
63 22/02/2023 PT. Dexa Medika  E-Katalog
64 22/02/2023 PT.Bernofarm (1)  E-Katalog
65 22/02/2023 PT.Bernofarm (1)  E-Katalog
66 22/02/2023 PT. Phapros Tbk  E-Katalog
67 22/02/2023 PT. Phapros Tbk  E-Katalog
68 22/02/2023 PT. Phapros Tbk  E-Katalog
69 22/02/2023 PT. Phapros Tbk  E-Katalog
70 22/02/2023 PT. Phapros Tbk  E-Katalog
71 23/02/2023 PT NOVAPHARIN (1)  E-Katalog
72 23/02/2023 PT NOVAPHARIN (2)  E-Katalog
73 23/02/2023 PT NOVAPHARIN (2)  E-Katalog
74 23/02/2023 PT NOVAPHARIN (2)  E-Katalog
75 27/02/2023 PT Jayamas Medica Industri (1)  E-Katalog
76 27/02/2023 PT Jayamas Medica Industri (1)  E-Katalog
77 27/02/2023 PT Jayamas Medica Industri (1)  E-Katalog
78 27/02/2023 PT Jayamas Medica Industri (1)  E-Katalog
79 27/02/2023 PT Jayamas Medica Industri (1)  E-Katalog
80 27/02/2023 PT Jayamas Medica Industri (1)  E-Katalog
81 27/02/2023 PT Jayamas Medica Industri (1)  E-Katalog
82 27/02/2023 PT Jayamas Medica Industri (1)  E-Katalog
83 27/02/2023 PT Jayamas Medica Industri (1)  E-Katalog
84 24/02/2023 PT Jayamas Medica Industri (1)  E-Katalog
 85 24/02/2023 PT Jayamas Medica Industri (1)  E-Katalog
86 01/03/2023 PT. Hexpharm Jaya Laboratories  E-Katalog
87 01/03/2023 PT. Hexpharm Jaya Laboratories  E-Katalog
88 01/03/2023 PT. Hexpharm Jaya Laboratories  E-Katalog
89 07/03/2023 PT.GLOBAL DISPOMEDIKA  E-Katalog
90 07/03/2023 PT.GLOBAL DISPOMEDIKA  E-Katalog
91 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
92 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
93 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
94 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
95 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
96 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
97 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
98 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
99 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
100 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
101 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
102 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
103 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
104 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
105 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
106 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
107 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
108 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
109 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
110 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
111 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
112 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
113 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
114 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
115 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
116 10/04/2023 PT. Dentsply Sirona Indonesia  E-Katalog
117 11/04/2023 PT. TAWADA  E-Katalog
118 12/04/2023 PT. ERELLA  E-Katalog
119 12/04/2023 PT. ERELLA  E-Katalog
120 12/04/2023 PT. COBRA DENTAL  E-Katalog
121 12/04/2023 PT. COBRA DENTAL  E-Katalog
122 12/04/2023 PT. COBRA DENTAL  E-Katalog
123 12/04/2023 PT. COBRA DENTAL  E-Katalog
124 12/04/2023 PT. COBRA DENTAL  E-Katalog
125 12/04/2023 PT. COBRA DENTAL  E-Katalog
126 12/04/2023 PT. COBRA DENTAL  E-Katalog
127 12/04/2023 PT. COBRA DENTAL  E-Katalog
128 13/04/2023 3M INDONESIA IMPORTAMA  E-Katalog
129 13/04/2023 3M INDONESIA IMPORTAMA  E-Katalog
130 13/04/2023 3M INDONESIA IMPORTAMA  E-Katalog
131 13/04/2023 3M INDONESIA IMPORTAMA  E-Katalog
132 13/04/2023 3M INDONESIA IMPORTAMA  E-Katalog
133 13/04/2023 3M INDONESIA IMPORTAMA  E-Katalog
134 13/04/2023 3M INDONESIA IMPORTAMA  E-Katalog
135 13/04/2023 3M INDONESIA IMPORTAMA  E-Katalog
136 13/04/2023 3M INDONESIA IMPORTAMA  E-Katalog
137 13/04/2023 3M INDONESIA IMPORTAMA  E-Katalog
138 13/04/2023 3M INDONESIA IMPORTAMA  E-Katalog
139 13/04/2023 3M INDONESIA IMPORTAMA  E-Katalog
140 14/04/2023 PT Tri Putra Mandiri Distribusi  E-Katalog
141 08/05/2023 PT. Swayasa  E-Katalog
142 08/05/2023 PT Ferron Par Pharmaceuticals  E-Katalog
143 09/05/2023 PT. Thomasong Nirmala  E-Katalog
144 09/05/2023 PT. Thomasong Nirmala  E-Katalog
145 09/05/2023 PT. Thomasong Nirmala  E-Katalog
146 09/05/2023 PT. Thomasong Nirmala  E-Katalog
147 09/05/2023 PT. Thomasong Nirmala  E-Katalog
148 09/05/2023 PT. Thomasong Nirmala  E-Katalog
149 09/05/2023 PT. Thomasong Nirmala  E-Katalog
150 09/05/2023 PT. Thomasong Nirmala  E-Katalog
151 09/05/2023 PT. Thomasong Nirmala  E-Katalog
152 09/05/2023 PT. Thomasong Nirmala  E-Katalog
153 09/05/2023 PT. Thomasong Nirmala  E-Katalog
154 09/05/2023 PT. Thomasong Nirmala  E-Katalog
155 09/05/2023 PT. Thomasong Nirmala  E-Katalog
156 09/05/2023 PT. Thomasong Nirmala  E-Katalog
157 10/05/2023 PT. Thomasong Nirmala (1)  E-Katalog
158 10/05/2023 PT. Thomasong Nirmala (1)  E-Katalog
159 10/05/2023 PT. Thomasong Nirmala (1)  E-Katalog
160 10/05/2023 PT. Thomasong Nirmala (1)  E-Katalog
161 10/05/2023 PT. Thomasong Nirmala (1)  E-Katalog
162 10/05/2023 PT. Thomasong Nirmala (1)  E-Katalog
163 10/05/2023 PT. Thomasong Nirmala (1)  E-Katalog
164 10/05/2023 PT. Thomasong Nirmala (1)  E-Katalog
165 10/05/2023 PT. Thomasong Nirmala (1)  E-Katalog
166 10/05/2023 PT. Thomasong Nirmala (1)  E-Katalog
167 10/05/2023 PT. MURSMEDIC  E-Katalog
168 10/05/2023 PT. MURSMEDIC  E-Katalog
169 16/05/2023 PT. PRESISI MANDIRI  E-Katalog
170 16/05/2023 PT. PRESISI MANDIRI  E-Katalog
171 16/05/2023 PT. PRESISI MANDIRI  E-Katalog
172 23/05/2023 PT. AGTIFA DWI PUTRI  E-Katalog
173 23/05/2023 PT. AGTIFA DWI PUTRI  E-Katalog
174 23/05/2023 PT. AGTIFA DWI PUTRI  E-Katalog
175 23/05/2023 PT. AGTIFA DWI PUTRI  E-Katalog
176 23/05/2023 PT. AGTIFA DWI PUTRI  E-Katalog
177 23/05/2023 PT. AGTIFA DWI PUTRI  E-Katalog
178 23/05/2023 PT. AGTIFA DWI PUTRI  E-Katalog
179 23/05/2023 PT. AGTIFA DWI PUTRI  E-Katalog
180 23/05/2023 PT. Sinar Surya Calisa  E-Katalog
181 23/05/2023 PT. Sinar Surya Calisa  E-Katalog
182 23/05/2023 PT. Enseval Putra Megatrading, Tbk.  E-Katalog
183 23/05/2023 CV. Cemerlang Sukses  E-Katalog
184 23/05/2023 PT. Mustika Sarana Piranti  E-Katalog
185 23/05/2023 PT Prodia Diagnostic Line  E-Katalog
186 24/05/2023 PT. Nugarada Abadi Indo Cemerlang  E-Katalog
187 24/05/2023 PT. Minorock Mandiri  E-Katalog
188 29/05/2023 PT. ENDO Indonesia  E-Katalog
189 29/05/2023 PT. ENDO Indonesia  E-Katalog
190 05/06/2023 PT. Jayamas Medica Industri (2)  E-Katalog
191 05/06/2023 PT. Jayamas Medica Industri (2)  E-Katalog
192 05/06/2023 PT. LAZUARDI BERKAT SEJAHTERA  E-Katalog
193 05/06/2023 PT. LAZUARDI BERKAT SEJAHTERA  E-Katalog
194 05/06/2023 PT. LAZUARDI BERKAT SEJAHTERA  E-Katalog
195 05/06/2023 PT. LAZUARDI BERKAT SEJAHTERA  E-Katalog
196 05/06/2023 PT. Saudara Berkah Cemerlang  E-Katalog
197 05/06/2023 PT. Saudara Berkah Cemerlang  E-Katalog
198 05/06/2023 PT. Saudara Berkah Cemerlang  E-Katalog
199 06/06/2023 PT. Phapros Tbk  E-Katalog
200 08/06/2023 PT.GDC  E-Katalog
201 08/06/2023 PT.GDC  E-Katalog
202 13/06/2023 APOTEK MAGHA MULIA  PL
203 13/06/2023 APOTEK MAGHA MULIA  PL
204 27/06/2023 Sigma Andalan Nusa  E-Katalog

205 27/06/2023 Sigma Andalan Nusa  E-Katalog

206 27/06/2023 Sigma Andalan Nusa  E-Katalog

207 27/06/2023 Sigma Andalan Nusa  E-Katalog

208 27/06/2023 Sigma Andalan Nusa  E-Katalog

209 27/06/2023 Sigma Andalan Nusa  E-Katalog
210 27/06/2023 PT. KASTARA  E-Katalog
211 27/06/2023 PT. KASTARA  E-Katalog
212 27/06/2023 PT. KASTARA  E-Katalog
213 13/07/2023 PT. MPM  PL
214 10/07/2023 PT. COBRA DENTAL  PL
215 10/07/2023 PT. COBRA DENTAL  PL
216 10/07/2023 PT. COBRA DENTAL  PL
217 10/07/2023 PT. COBRA DENTAL  PL
218 10/07/2023 PT. COBRA DENTAL  PL
219 10/07/2023 PT. COBRA DENTAL  PL
220 10/07/2023 PT. COBRA DENTAL  PL
221 10/07/2023 PT. COBRA DENTAL  PL
222 10/07/2023 PT. COBRA DENTAL  PL
223 10/07/2023 PT. COBRA DENTAL  PL
224 10/07/2023 PT. COBRA DENTAL  PL
225 10/07/2023 PT. COBRA DENTAL  PL
226 10/07/2023 PT. COBRA DENTAL  PL
227 10/07/2023 PT. COBRA DENTAL  PL
228 10/07/2023 PT. COBRA DENTAL  PL
229 10/07/2023 PT. COBRA DENTAL  PL
230 10/07/2023 PT. COBRA DENTAL  PL
231 10/07/2023 PT. COBRA DENTAL  PL
232 10/07/2023 PT. COBRA DENTAL  PL
233 10/07/2023 PT. COBRA DENTAL  PL
234 10/07/2023 PT. COBRA DENTAL  PL
235 10/07/2023 PT. COBRA DENTAL  PL
236 10/07/2023 PT. COBRA DENTAL  PL
237 10/07/2023 PT. COBRA DENTAL  PL
238 10/07/2023 PT. COBRA DENTAL  PL
239 10/07/2023 PT. COBRA DENTAL  PL
240 10/07/2023 PT. COBRA DENTAL  PL
241 10/07/2023 PT. COBRA DENTAL  PL
242 10/07/2023 PT. COBRA DENTAL  PL
243 13/07/2023 PT.GDC  E-Katalog
244 13/07/2023 PT.GDC  E-Katalog
245 13/07/2023 PT. DJEMBATAN DUA  E-Katalog
246 13/07/2023 PT. DJEMBATAN DUA  E-Katalog
247 13/07/2023 PT. DJEMBATAN DUA  E-Katalog
248 13/07/2023 PT. PRESISI MANDIRI  E-Katalog
249 21/07/2023 PT. COBRA DENTAL INDONESIA  E-Katalog
250 21/07/2023 PT. COBRA DENTAL INDONESIA  E-Katalog
251 21/07/2023 PT. COBRA DENTAL INDONESIA  E-Katalog
252 21/07/2023 PT. COBRA DENTAL INDONESIA  E-Katalog
253 21/07/2023 3M INDONESIA IMPORTAMA  E-Katalog
254 21/07/2023 PT.GLOBAL DISPOMEDIKA  E-Katalog
255 21/07/2023 PT.GLOBAL DISPOMEDIKA  E-Katalog
256 21/07/2023 PT. BHINEKA MITRA SEJATI  E-Katalog
257 21/07/2023 PT. Minorock Mandiri  E-Katalog

258 21/07/2023 PT. Minorock Mandiri  E-Katalog

259 21/07/2023 PT. Enseval Putra Megatrading, Tbk.  E-Katalog
260 21/07/2023 PT Jayamas Medica Industri  E-Katalog
261 21/07/2023 CV.EMERAL WIJAYA PERKASA  E-Katalog
262 25/07/2023 PT. LAZUARDI BERKAT SEJAHTERA  E-Katalog
263 25/07/2023 PT. LAZUARDI BERKAT SEJAHTERA  E-Katalog
264 25/07/2023 PT. LAZUARDI BERKAT SEJAHTERA  E-Katalog
265 25/07/2023 PT. LAZUARDI BERKAT SEJAHTERA  E-Katalog
266 25/07/2023 PT Tri Putra Mandiri Distribusi  E-Katalog
267 26/07/2023 PT. Medihoop  E-Katalog
268 27/07/2023 PT. Kimia Farma  PL
269 03/08/2023 PT.DENTSPLY SIRONA INDONESIA  E-Katalog
270 03/08/2023 PT.DENTSPLY SIRONA INDONESIA  E-Katalog
271 03/08/2023 PT.DENTSPLY SIRONA INDONESIA  E-Katalog
272 03/08/2023 PT.DENTSPLY SIRONA INDONESIA  E-Katalog
273 03/08/2023 PT.DENTSPLY SIRONA INDONESIA  E-Katalog
274 03/08/2023 PT.DENTSPLY SIRONA INDONESIA  E-Katalog
275 03/08/2023 PT.DENTSPLY SIRONA INDONESIA  E-Katalog
276 03/08/2023 PT.DENTSPLY SIRONA INDONESIA  E-Katalog
277 03/08/2023 PT.DENTSPLY SIRONA INDONESIA  E-Katalog
278 03/08/2023 PT.DENTSPLY SIRONA INDONESIA  E-Katalog
279 03/08/2023 PT.DENTSPLY SIRONA INDONESIA  E-Katalog
280 03/08/2023 PT.DENTSPLY SIRONA INDONESIA  E-Katalog
281 03/08/2023 PT.DENTSPLY SIRONA INDONESIA  E-Katalog
282 03/08/2023 PT.DENTSPLY SIRONA INDONESIA  E-Katalog
283 03/08/2023 PT.DENTSPLY SIRONA INDONESIA  E-Katalog
284 03/08/2023 PT.DENTSPLY SIRONA INDONESIA  E-Katalog
285 03/08/2023 PT.DENTSPLY SIRONA INDONESIA  E-Katalog
286 03/08/2023 PT.DENTSPLY SIRONA INDONESIA  E-Katalog
287 03/08/2023 PT.DENTSPLY SIRONA INDONESIA  E-Katalog
288 04/08/2023 PT. CTBA  E-Katalog
289 04/08/2023 SANSICO NATURA RESOURCES  E-Katalog
290 07/08/2023 PT. Medihop  E-Katalog
291 07/08/2023 PT. Medihop  E-Katalog
292 10/08/2023 PT. TAWADA  PL
293 10/08/2023 PT. Agtifa  PL
294 10/08/2023 PT. Agtifa  PL
295 10/08/2023 PT. Agtifa  PL
296 10/08/2023 PT. Agtifa  PL
297 10/08/2023 PT. Agtifa  PL
298 10/08/2023 PT. Agtifa  PL
299 10/08/2023 PT. Agtifa  PL
300 11/08/2023 PT. Euraniaga  PL

301 11/08/2023 PT. Euraniaga  PL

302 11/08/2023 PT. Euraniaga  PL
303 11/08/2023 PT. Euraniaga  PL
304 11/08/2023 PT. Euraniaga  PL
305 11/08/2023 CV. Galaxy Dental  PL
306 11/08/2023 CV. Galaxy Dental  PL
307 11/08/2023 CV. Galaxy Dental  PL
308 11/08/2023 CV. Galaxy Dental  PL
309 11/08/2023 CV. Galaxy Dental  PL
310 11/08/2023 CV. Galaxy Dental  PL
311 11/08/2023 CV. Galaxy Dental  PL
312 11/08/2023 CV. Galaxy Dental  PL
313 11/08/2023 CV. Galaxy Dental  PL
314 11/08/2023 CV. Galaxy Dental  PL
315 11/08/2023 HADYAN INDO PERSADA r E-Katalog
316 11/08/2023 HADYAN INDO PERSADA r E-Katalog
TOTAL BELANJA
N ANGGARAN 2023 (APBD)
HARGA
SPESIFIKASI SATUAN

Kassa Hidrofil 40 yardx80cm 190,000

NRM anak 16,100

NRM dewasa 16,100
Amlodipin 10 mg 475
Amlodipin 5 mg 275
Amoxycillin 500 mg tab 595
Amoxycillin dry syr 125mg/5cc 5,680
Asam mefenamat 500 mg 285
Asam tranexamat tab 500 mg 1,730
Cefadroxyl 500mg 910
Cefadroxyl syr 125mg/5ml 8,850
Cefadroxyl syr 250mg/5ml 12,800
Ciprofloxacin 500mg tab 530
Clindamycin 300 mg 1,240
Dexamethason 0,5 mg tab 106
Dexamethason injeksi 0,5 mg 1,300
Methyl Prednisolon 4 mg 240
Methyl Prednisolon 8 mg 360
Metronidazole infus 100ml 12,300
Natrium Diklofenak 50 mg 195
Nicardipin injeksi 1mg/ml 18,770
Nystatin drop 16,020
Ondansetron inj 4 mg 1,300
Ranitidin inj 1,395
Simvastatin 10 mg 235
Paracetamol 500 mg tab 190
Jarum cek gula darah (Blood Lancet 28 G) 17,000
Nassal canull anak 6,660
Nassal canull dewasa 6,660
Handscoon M 60,000
Handscoon S 60,000
Handscoon XS 60,000
Indikator Strip 177,000
Pouches Gussete 15cmx2,5cm (100m) 955,700
Pouches Gussete 20cmx2,5cm (100m) 995,000
Strip glukosa 2,785,129

Spuit 1 ml 966
Spuit 10 ml 1,299
Spuit 3 ml 888
spuit 5 ml 977
Kassa Deeper 16x16 193,043

NaCl infus 7,673

Aqua pro inj 2,955

RL infus 8,498
Alkali Enizmatik 1 liter 645,000
Alkohol 70% 1L 21,000
Alkohol swab 10,800
Handrub 5 liter 411,000
Handscrub 5 liter 344,000
Liquid chemical sterilants/high level disinfectants 1,000,000
Safety box 16,000
Benang jahit Nylon 5/0 50,838
Benang jahit Nylon 6/0 67,821
Benang Jahit 3-0 ( Black Silk) cutting 26 mm 43,512
Benang Jahit 4-0 ( Black Silk ) Cutting 19 mm 45,843
Benang Jahit Chromic (3-0) Cutting 66,200

Spironolakton 25mg 833

Spironolakton 100mg 2,220
Etoricoxib 60 mg 3,552
Cetirizine 10 mg 197
Norepinephrine inj 1mg/ml 15,225
Clindamycin 150 mg 743
Methyl Prednisolon 16 mg 588
Asam tranexamat inj 3,000
Ceftriaxone inj 1gr 5,875
Captopril 25 mg 129
Natrium Diklofenak 25 mg 147
Lidocain inj 1,259
Metilprednisolon Inj 125mg 14,208
Lidokain inj 2% + Epinefrin 1:80000 2ml 1,439
Vitamin C 250mg 240
Amoxycillin 250 mg tab 448
Ibuprofen 400 mg tab 195
Metronidazole 500 mg 217
Jarum dental needle no. 16 25,814
Suction Catheter no 10 4,432
Suction Catheter no 12 4,432
Suction Catheter no 14 4,432
Suction Catheter no 8 4,432
Alginat 54,733
Saliva Ejector 49,590
Kassa Steril 16x16 8,039
Tegaderm catheter dressing 7cm x 12xm 46,002
Slaber 61,538
Povidon iodin 60ml 6,760
Lansoprazol capsul 480
Cefixime 100mg 708
Cefixime 200mg 1,449
Spray Cleaner Disinfectant 160,900
Lingettes/wipes Alcohol Free Cleaner Disinfectants 138,500
Protaper FHU 21 mm 420,223
Protaper FHU 25 mm 420,223
Protaper rotary gold 21 mm 568,508
Protaper rotary gold 25 mm 568,508
Gutta Percha Protaper F1 108,775
Gutta Percha Protaper F2 108,775
Gutta Percha Protaper F3 108,775
Gutta Percha Protaper F4 108,775
Micro brush 74,143
Barbed broach 51,217
Bahan pulp capping 85,767
Etsa gel 213,404
K- File 15-40 25 mm 38,291
K- File 45-80 25 mm 38,291
K-File no 06 21 mm 103,778
K-File no 06 25 mm 102,678
K-File no 08 21 mm 102,678
K-File no 08 25 mm 102,678
K-File no 10 21 mm 102,678
K-File no 10 25 mm 102,678
EDTA Gel 301,692
Bur Endo Acces sedang,besar 35,364
Bur tulang 23 mm 361,689
Bur tulang 28 mm 361,689
Double Impression Light Bodies 528,754
Double Impression putty 892,394
Film Rontgen Panoramic care stream 1,650,000
Antasida tab 139
Ranitidin tab 150 mg 222
Kaca Mulut 42,250
Bahan pengisian saluran akar 205,350
Calcium Hydroxide pasta 105,450
Tumpatan sementara 66,600
NaOCl 3% 500ml 100,462
Bonding 311,911
Devitalisasi 255,300
Bur Finishing pita kuning KIT 1,065,000
Composit Z250 body A2 438,500
Composite Filling Universal A2 Body Z350 624,900
Bonding Gen 7 1,135,500
Pasak Relyx Fiber Refil 1,516,300
Composit filling Z350 XT A3 (Filtek) 627,627
Composit filling Z350 XT A3 Flow 671,800
Composit filling Z350 XT A3,5 624,900
Composit Filling universal set 2,352,100
Composit Filling Z250 XT A3 249,352
Composit Filling Z250 XT A3,5 250,278
Composite Filling Posterior A3 438,225
Glass ionomer Universal Restrorative 740,400
Lidocain 20 mg, Adrenalin 0,0125 mg 93,000
Spongostan (1box/10 pcs) 224,018
Articain 4%, Epineprin 750,000
Absorban paper point no 25 72,133
Benang gigi/dental flos 79,529
File C06 21mm 251,250
File C06 25mm 251,250
File C08 21mm 253,333
File C08 25mm 253,333
File C10 21mm 257,500
File C10 21mm 257,500
Gutta Percha Points 15-40 93,700
Jarum Irigasi 0,4x25 mm Transcodent 302,833
Matrix band 47,167
Paper point 15 72,941
Paper point 20 71,923
Semen resin luxacore 1,168,000
Absorban paper point 45-80 72,100
Cotton Roll uk 1 147,000
Pasak Fiber refill 1,25 1,390,000
Pasak Fiber refill 1,35 1,390,000
Pasak Fiber refill 1,5 1,481,000
Cerkamed MTA 742,000
Bur diamond round bulat 432,500
Bur Tulang 702 Low Speed 432,333
Eugenol 164,333
Bur Tulang 703 Low Speed 432,500
Composite Filling (BULK FILL) 519,012
Composite Filling (BULK FLOW) 409,262
Pisau Bedah no 14 458,000
Pisau Bedah no 15 458,000
Pisau Bedah no.12 460,000
Amplas no 1000 20,000
Amplas no 1500 20,000
Amplas no 240 20,000
Amplas no 320 20,000
Amplas no 400 20,000
Amplas no 500 20,000
Amplas no 600 20,000
Amplas no 80 20,000
Aseptic gel 500ml 34,250
Protector Sol/ lysol 34,604
Spray mulut kombinasi asam hialuronat dan Aloe vera 76,000
Blue Methylated 98% 70,000
Perban Elastis 47,000
Rapid test antigen 542,500
Ethil klorida 173,000
Klorheksidin glukonat 0.2% 23,000
Kertas ECG/EKG 5 cm 29,900
Kertas ECK/EKG 21 cm 155,000
Non Woven Fixation/ 5 Cm x 10 M 25,408
Leukoplast Hypafix 10cm x 5m 44,056
Parafilm 4x125 1,000,000
Articulating Paper Full 130,000
Glass ionomer fuji VII 1,700,000
Needle 23 30,000
Glass ionomer fuji IX 1,351,563
Cotton roll uk 2 135,000
Edta Solution 18% 150,417
Thiamine 15 mg, Riboflavin 10 mg, Pyridoxine 5 mg, 1,563
Strip Asam Urat isi 25 strip 145,000
Strip Cholesterol isi 10 strip 188,000
Ketorolac Injeksi 1,833
Ibuprofen Syr 8,000
SAN PACK Pouches Sterilization Gussette 995,000
20CMx2.5CMx100M
SAN PACK Pouches Sterilization Gussette 918,200
15CMx2.5CMx100M
Indikator Strip SAN PACK Sterilization Indicating Card 177,100
SAN PACK Pouches Sterilization Gussette 766,700
10CMx2CMx100M
SAN PACK Pouches Sterilization Flat 7.5CMx200M 460,000
SAN PACK Pouches Sterilization Flat 5CMx200M 357,000
Gludetan High Level Disinfectant 1000 ml 1,665,000
Alkali Enizmatik 1 liter TaraZym Enzymatic Detergent 975,707
Kassa Deeper 16x16 199,293
Film Rontgen Panoramic Fuji Fim 2,020,200
Absorban paper point 15-40 Rp 53.280
Absorban paper point no 30 Rp 53.280
Bur High Speed FG 801-016 Rp 46.000
Heat Curing liquid huge 500ml Rp 340.000
Heat Curing powder 1000 gram shade 2S pink Rp 729.999
Bur High Speed FG 859-012 Rp 60.000
Bur stone polishing composite point Rp 60.000
Bur Poles round White Stone Rp 60.000
Bur Tulang Low speed HP33L 021 Rp 60.000
Calcium Hidroxide Bubuk Rp 55.500
Semen resin rely x U-200 Rp 1.559.550
Double Impression injeksi exaflex Rp 487.000
Glass ionomer fuji I Rp 1.151.000
Glass ionomer Gie Fill Premium Rp 310.800
Gibs putih snow rock Rp 177.600
Self Curing acrylic liquid 500ml Rp 330.000
Self Curing powder shade 2s 1000 gram Rp 899.100
Perry Compound Rp 413.000
Single impression exaflex monophase Rp 553.000
Wire N 0.14 U,L Rp 210.000
Wire Niti 0,12 RA dan RB Rp 210.000
Wire Niti 0,16x0,16 U,L Rp 460.000
Wire SS 0,14 U,L Rp 320.000
Wire SS 0,16 x 0,22 U,L Rp 130.000
Headstroom M-Acces 15-40 L21 MM Rp 155.400
Headstroom M-Acces 15-40 L25 MM Rp 155.400
Gibs Stone snow rock biru 5 Kg Rp 205.350
Composite filling 3M Z350 XT A1 (Filtek) Rp 643.800
Composite filling 3M Z350 XT A3 Body Rp 643.800
Strip Asam Urat isi 25 strip 145,000
Strip Cholesterol isi 10 strip 185,000
Handscoon M 60,000
Handscoon S 60,000
Handscoon XS 60,000
Pisau Bedah no 15 458,333
Barbed broach 104,333
Bonding 319,133
Calcium Hydroxide pasta 110,450
Devitalisasi 259,467
Pasak Relyx Fiber Refil 1,541,300
Spray Cleaner Disinfectant 160,900
Lingettes/wipes Alcohol Free Cleaner Disinfectants 138,500
Kassa Hidrofil 40 yardx80cm 194,000
Chlorheksidin larutan kumur 0,1% 14,700

Klorheksidin glukonat 0.2% 23,000

Spray mulut kombinasi asam hialuronat dan Aloe vera 76,000
Slaber 60,608
Oelium cajuput oil cap ayam 11,500
Benang gigi/dental flos 85,000
Glass ionomer fuji IX 1,700,000
Eugenol 160,000
Plester roll kain 5 cm x 4,5 m 90,000
Ethil klorida 250,000
Spongostan 7,064
Alkohol 70% 1L 27,134
Bahan pulp capping 85,767
Bur tulang 23 mm 361,689
Bur tulang 28 mm 361,689
File C06 21mm 240,650
File C06 25mm 236,250
File C08 21mm 236,250
File C08 25mm 236,250
File C10 25mm 236,250
Etsa gel 213,404
K-File no 06 21 mm 134,250
Glyde File 533,875
Protaper FHU 21 mm 836,917
Protaper FHU 25 mm 833,250
Protaper rotary gold 21 mm 894,000
Protaper rotary gold 25 mm 894,000
Gutta Percha Protaper F1 108,775
Gutta Percha Protaper F2 108,775
EDTA Gel 636,750
K-File no 08 21 mm 171,750
Lem Ortho 9,203,000
Rapid test antigen 678,500
Benang Jahit 3-0 ( Black Silk) cutting 26 mm 43,512
Benang Jahit 4-0 ( Black Silk ) Cutting 19 mm 45,843
CMS 840,000
Sungkup anak 32,479
Sungkup bayi 32,479
Sungkup dewasa 34,743
Surgifit resobable 5-0 3,604,392
Perban Elastis 98,568
Amidis 7,187
Kassa Steril 16x16 21,334
Jarum Irigasi 0,4x25 mm (transcodent atau CK-Endo 832,500
warna abu2)
Bleaching Internal (opalescene endo) 1,387,500
Cerkamed MTA (punya thomasong) 1,165,500
Chlor tablet 138,750
Poly Aluminium Chloride (PAC) 111,000
Bahan medikamen saluran akar (cresodent liquid) 244,200
Bite Block Ukuran S 22,200
Bur Tulang low speed round 016 99,900
Absorban paper point 45-80 55,500
Klamer (wire) 0,6 mm 66,600
Membran pericardium 388,500
Absorban paper point no 25 55,500
Mata Bur Poles Belimbing F06 66,600
Mata Bur Poles Belimbing L06 66,600
Metronidazole Gel 210,900
Wire uk 0.25 (dentaurum) 690,000
Wire uk 0.5 (dentaurum) 1,100,000
REALISASI BELANJA OBAT DAN BAHAN TAHUN ANGGARAN 2023 BLUD
NAMA PENYEDIA PD Cara
N Pengadaa
NO TGL SP
n

1 14/03/2023 PT. COBRA DENTAL  PL

2 22/05/2023 Permata Dental  PL
3 22/05/2023 Permata Dental  PL
4 22/05/2023 Permata Dental  PL
5 22/05/2023 Permata Dental  PL
6 22/05/2023 Permata Dental  PL
7 22/05/2023 Permata Dental  PL
8 25/05/2023 PT. Samator Gas Industri  PL
9 25/05/2023 PT. Samator Gas Industri  PL
10 08/06/2023 Apotek Maggha Mulia  PL
11 13/06/2023 PT. COBRA DENTAL  PL
12 13/06/2023 PT. COBRA DENTAL  PL
13 13/06/2023 PT. COBRA DENTAL  PL
14 13/06/2023 PT Intisumber Hasil Sempurna  PL
15 10/07/2023 PT. Antarmitra Sembada  PL
16 12/07/2023 K24 Burlian  PL
17 13/07/2023 PT. Antarmitra Sembada  PL
18 18/07/2023 PT. Samator Gas Industri  PL
19 18/07/2023 PT. Samator Gas Industri  PL
20 18/07/2023 RS. Muhammadiyah  PL
21 20/07/2023 RS. Siti Khodijah  PL
22 20/07/2023 RS. Siti Khodijah  PL
23 20/07/2023 RS. Siti Khodijah  PL
24 20/07/2023 RS. Siti Khodijah  PL
25 20/07/2023 PT. FINUSOLPRIMA FARMA  E-Katalog
26 30/07/2023 PT. AAM  PL
27 31/07/2023 PT. PARIT PADANG GLOBAL  PL
28 31/07/2023 PT. PARIT PADANG GLOBAL  PL
29 31/07/2023 PT. PARIT PADANG GLOBAL  PL
30 31/07/2023 PT. PARIT PADANG GLOBAL  PL
31 31/07/2023 PT. PARIT PADANG GLOBAL  PL
32 31/07/2023 PT. PARIT PADANG GLOBAL  PL
33 31/07/2023 PT. PARIT PADANG GLOBAL  PL

34 31/07/2023 PT. PARIT PADANG GLOBAL  PL

35 31/07/2023 PT. KIMIA FARMA TRADING &  PL
36 31/07/2023 PT. KIMIA FARMA TRADING &  PL
37 31/07/2023 PT. KIMIA FARMA TRADING &  PL
38 31/07/2023 PT. KIMIA FARMA TRADING &  PL
39 31/07/2023 PT. KIMIA FARMA TRADING &  PL
40 02/08/2023 PT. KIMIA FARMA TRADING &  PL
41 02/08/2023 PT. ANTARMITRA SEMBADA  PL
42 02/08/2023 PT. ANTARMITRA SEMBADA  PL
43 02/08/2023 PT. Dwiasri (GDC)  E-Katalog
44 02/08/2023 PT. Dwiasri (GDC)  E-Katalog
45 02/08/2023 PT. Dwiasri (GDC)  E-Katalog
73 16/08/2023 PT. COBRA DENTAL  PL
74 16/08/2023 PT. COBRA DENTAL  PL
75 16/08/2023 PT. COBRA DENTAL  PL
76 16/08/2023 PT. COBRA DENTAL  PL
77 02/08/2023 PT. Intisumber Hasil Sempurna  PL
78 02/08/2023 PT. Intisumber Hasil Sempurna  PL
79 02/08/2023 PT. Intisumber Hasil Sempurna  PL
80 11/08/2023 PT.EURANIAGA MITRA ABADI  PL

81 14/08/2023 PT. PARIT PADANG GLOBAL  PL

82 14/08/2023 PT. PARIT PADANG GLOBAL  PL
83 11/08/2023 PT. Tri Sapta Jaya  PL
84 11/08/2023 PT. Tri Sapta Jaya  PL
85 11/08/2023 PT. Tri Sapta Jaya  PL
86 11/08/2023 PT. Tri Sapta Jaya  PL
87 11/08/2023 PT. Tri Sapta Jaya  PL
88 11/08/2023 PT. Tri Sapta Jaya  PL
89 11/08/2023 PT. BINA SAN PRIMA  PL
90 11/08/2023 PT. BINA SAN PRIMA  PL
91 16/08/2023 PT. Tri Sapta Jaya  PL
92 16/08/2023 PT. Tri Sapta Jaya  PL
93 16/08/2023 PT. Tri Sapta Jaya  PL
94 18/08/2023 PT. Tri Putra Mandiri  PL
95 18/08/2023 PT. Tri Putra Mandiri  PL
96 18/08/2023 PT. Tri Putra Mandiri  PL
97 18/08/2023 PT. Tri Putra Mandiri  PL
98 18/08/2023 PT. Tri Putra Mandiri  PL
99 28/08/2023 PT. Dexa Medica (AAM)  E-Katalog
100 28/08/2023 PT. Dexa Medica (AAM)  E-Katalog
101 28/08/2023 PT. Dexa Medica (AAM)  E-Katalog
102 28/08/2023 PT. Dexa Medica (AAM)  E-Katalog
103 28/08/2023 PT. Dexa Medica (AAM)  E-Katalog
104 07/08/2023 PT. AGTIFA DWI PUTRI  PL
105 07/08/2023 PT. AGTIFA DWI PUTRI  PL
106 07/08/2023 PT. AGTIFA DWI PUTRI  PL
107 07/08/2023 PT. AGTIFA DWI PUTRI  PL
108 07/08/2023 PT. AGTIFA DWI PUTRI  PL
109 07/08/2023 PT. AGTIFA DWI PUTRI  PL
110 07/08/2023 PT. AGTIFA DWI PUTRI  PL
111 07/08/2023 PT. AGTIFA DWI PUTRI  PL
112 07/08/2023 PT. AGTIFA DWI PUTRI  PL
113 07/08/2023 PT. AGTIFA DWI PUTRI  PL
114 07/08/2023 PT. AGTIFA DWI PUTRI  PL
115 07/08/2023 PT. AGTIFA DWI PUTRI  PL
116 18/09/2023 PT. Enseval  PL
117 18/09/2023 PT. Enseval  PL
118 18/09/2023 PT. KIMIA FARMA TRADING &  PL
119 18/09/2023 PT. KIMIA FARMA TRADING &  PL
120 18/09/2023 PT. KIMIA FARMA TRADING &  PL
121 18/09/2023 PT. KIMIA FARMA TRADING &  PL
122 18/09/2023 PT. KIMIA FARMA TRADING &  PL
123 18/09/2023 PT. KIMIA FARMA TRADING &  PL
124 18/09/2023 PT. KIMIA FARMA TRADING &  PL
125 21/09/2023 PT. PARIT PADANG GLOBAL  PL
126 21/09/2023 PT. PARIT PADANG GLOBAL  PL
127 21/09/2023 PT. PARIT PADANG GLOBAL  PL
TOTAL BELANJA
AN 2023 BLUD
HARGA
SATUAN
SPESIFIKASI

Film Rontgen Dental 264,000

Kawat klamer 0,7 75,000
kawat klamer 0,8 75,000
Base Plate wax 34,000
Kuvet L 163,000
Mata bor KK-0016 60,000
Mata bor KK-0018 60,000
Refill N 20 Cap 20 Kg 3,330,000
Reffill Oksigen (O2) Cap 6 m3 61,150
Candesartan 16 mg 51,333
Minyak Handpiece 764,790
Tutup Oly 173,160
Disclosing gel biru 345,000
Autoclave Label + Ink Roller 3,671,325
Propofol Injeksi 10mg/ml 353,258
KSR 600 mg 61,500
Propofol Injeksi 10mg/ml 353,258
Tabung Besar 6 m2 61,150
Tabung Kecil 1 m2 49,950
Cinam Injeksi 54,000
KCL Infus 4,358
3 Way Stoppock 4,274
Extention Tube 150 58,719
Dispossible 50 ml Terumo 47,230
Propofol Injeksi 10mg/ml 18,000
Lidocain gel 31,000
Paracetamol inf 1000 mg/100 ml 14,740
Ranitidine inj 50 mg/2 ml 1,570
Dexamethason inj 5mg/ml 1,360
Asam tranexamat inj 500mg/ml 3,140
Lidocain 2% Inj 1,250
Tramadol inj 50mg/ml 2,850
Clindamycin 300 mg 1,241

Natrium Diklofenak 50 mg 197

IV Chateter no.18 isi 50 4,862
Nasal canul dewasa 7,100
Fentanyl inj 28,274
Omeprazole inj 6,549
Paracetamol syr 120 mg/5 ml 3,200
Ampicilin sulbactam 1,5gr inj 17,982
Atrakurium inj 50mg/5ml 55,778
Efedrin 50mg/ml 29,748
ETT non kingking no. 6,5 139,500
Oropharingeal airway no.4 Size 10 8,820
ETT kingking no.7 28,497
Fuji II 864,000
Bucal tube M1 38,850
Bucal tube M2 38,850
Headstrom 45-80 L 21 mm 210,900
Suction cateter no.12 4,432
Gudel Airway No.80 mm 13,203
IV Chateter no 20 139,860
Kasa jaring penutup luka vaselline 105,000
swab
Furosemid ampul 37,590
Ketorolac injeksi 1,709
Bisoprolol tablet 2,5mg 40,792
Cefixime 200 mg 85,414
Ciprofloxacin 500 mg 62,160
Glimepirid 1mg 42,412
Glimepirid 3mg 97,006
Glimepirid 4mg 129,396
Amoxsan 500mg 366,300
Mefinal 500mg 155,400
Cataflam 50mg 322,566
Nacl 3 % 7,673
Ventolin / combivent nebu 219,436
Cefixime 100 mg 87,900
Digoxin tablet 0,25mg 46,400
Furosemid tablet 39,000
Spironalakton 25mg 43,200
Kapsul no. 0 61,900
Amlodipin 5 mg 450
Candesartan 16 mg 440
Dobutamin 250 mg/5 mg 12,758
Methyl Prednisolon 8 mg 328
Norepinephrine Inj 12,941
Gelang dewasa laki- laki 156,677
Gelang dewasa perempuan 156,677
Gelang anak laki-laki 156,677
Gelang anak perempuan 156,677
Gelang Fall Risk (Risiko Jatuh) 61,605
Gelang DNR (Do Not Resusitasi) 61,050
Gelang Allergy 61,050
Alergi Tinggi terhadap obat 61,050
Alergi Latex 61,050
Klip Fall Risk (Risiko Jatuh) 168,276
Klip DNR 168,276
Klip Alergi 168,276
Apidra insulin 451,568
Lantus insulin 448,995
Ketoprofen suppos 140,220
Aminophyllin injeksi 24 mg/ml 233,100
Epinephrine Inj 116,550
Paracetamol syr 120mg/5ml 3,200
Difenhydramine 150 mg/ 15 ml 66,600
Ranitidin inj 50 mg/2 ml 49,950
Petidin inj 50mg/ml 139,650
Fargoxin 27,750
Amiodarone 11,799
Celecoxib 2,590
 RENCANA KEBUTUHAN OBAT OBATAN DAN BAHAN MEDIS HABIS PAKAI (BMHP)
RSK. GIGI DAN MULUT PROVINSI SUMATERA SELATAN
TAHUN ANGGARAN 2023 (APBD)

NO Nama Barang Jumlah Satuan Harga

I. Obat-obatan e- katalog
1 Amlodipin 10 mg 1,000 tablet 479
2 Amlodipin 5 mg 100 tablet 279
3 Amoxycillin 250 mg tab 500 tablet 452
4 Amoxycillin 500 mg tab 50,000 tablet 599
5 Amoxycillin dry syr 125mg/5cc 100 botol 5,684
6 Antasida tab 1,000 tablet 143
7 Aqua pro inj 3,000 botol 2,959
8 Articain 4%, Epineprin 100 box 750,004
9 Asam mefenamat 500 mg 50,000 tablet 289
10 Asam tranexamat inj 40 ampul 3,004
11 Asam tranexamat tab 200 tablet 1,734
12 Captopril 25 mg 300 tablet 133
13 Cefadroxyl 500mg 10,000 kapsul 914
14 Cefadroxyl syr 125mg/5ml 120 botol 8,854
15 Cefadroxyl syr 250mg/5ml 80 botol 12,804
16 Cefixime 100mg 1,000 kapsul 712
17 Cefixime 200mg 1,000 tablet 1,453
18 Ceftriaxone inj 1gr 1,500 vial 5,879
19 Cetirizine 10 mg 2,000 tablet 201
20 Ciprofloxacin 500mg tab 800 tablet 534
21 Clindamycin 150 mg 30,000 kapsul 747
22 Clindamycin 300 mg 20,000 kapsul 1,244
23 Dexamethason 0,5mg tab 200 tablet 110
24 Dexamethason injeksi 400 ampul 1,304
25 Etoricoxib 60 mg 720 tablet 3,556
26 Ibuprofen 400 mg tab 6,000 tablet 199
27 Klorheksidin glukonat 0.2% 100 botol 24,004
28 Lansoprazol capsul 800 kapsul 484
29 Lidocain 20 mg, Adrenalin 0,0125 mg 66 box 93,004
30 Lidocain inj 100 ampul 1,263
31 Lidokain inj 2% + Epinefrin 1:80000 2ml 6,000 ampul 1,443
32 Methyl Prednisolon 16 mg 10,000 tablet 592
33 Methyl Prednisolon 4 mg 30,000 tablet 244
34 Methyl Prednisolon 8 mg 1,000 tablet 364
35 Metilprednisolon Inj 125mg 10 vial 14,212
36 Metronidazole 500 mg 20,000 tablet 221
37 Metronidazole infus 100ml 240 botol 12,304
38 NaCl infus 320 botol 7,677
39 Natrium Diklofenak 25 mg 10,000 tablet 151
40 Natrium Diklofenak 50 mg 20,000 tablet 199
41 Nicardipin injeksi 1mg/ml 10 box/5 Ampul 18,774
42 Norepinephrine inj 1mg/ml 10 ampul 15,229
43 Nystatin drop 40 botol 16,024
44 Ondansetron inj 50 ampul 1,304
45 Paracetamol 500 mg tab 50,000 tablet 194
46 Povidon iodin 60ml 132 btl 6,764
47 Ranitidin inj 100 ampul 1,399
48 Ranitidin tab 150 mg 5,000 tablet 226
49 RL infus 320 botol 8,502
50 Simvastatin 10 mg 200 tablet 239
51 Spironolakton 100mg 100 tablet 2,224
52 Spironolakton 25mg 100 tablet 837
Spray mulut kombinasi asam hialuronat dan Aloe
53 89 botol 76,004
vera
Thiamine 15 mg, Riboflavin 10 mg, Pyridoxine 5
mg, Cyanocobalamin 100 mcg, Calcium
54 6,300 box 1,567
Pantothenate 30 mg, Nicotinamide 50 mg, Vitamin
C 500 mg, Tocopherol 30 mg
55 Vitamin C 250mg 10,200 tablet 244
II. Obat-obatan Non e- katalog
56 Ketorolac inj 30mg 120 ampul 1,855
57 Ibuprofen syr 12 botol 8,005
III. BMHP e-Katalog
58 Absorban paper point 45-80 10 Box 73,100
59 Absorban paper point no 25 15 Box 73,133
60 Alginat 50 bungkus 55,733
61 Alkali Enizmatik 1 liter 30 Botol/ 1 liter 646,000
62 Alkohol 70% 1L 100 Botol/ 1 liter 22,000
63 Alkohol swab 200 Kotak 11,800
64 Amplas no 1000 20 lembar 21,000
65 Amplas no 1500 20 lembar 21,000
66 Amplas no 240 20 lembar 21,000
67 Amplas no 320 20 lembar 21,000
68 Amplas no 400 20 lembar 21,000
69 Amplas no 500 20 lembar 21,000
70 Amplas no 600 20 lembar 21,000
71 Amplas no 80 20 lembar 21,000
72 AQUASIL PUTTY SOFT REG STDPACK 2 Kotak 893,394
73 AQUASIL ULTRA XLV, 4X50ML REGULER SET 2 syringe 529,754
74 Articulating Paper Full 6 pcs 131,000
75 Aseptic gel 500ml 20 botol 35,250
76 Bahan pengisian saluran akar 19 Kotak 206,350
77 Bahan pulp capping 5 box 86,767
78 Barbed broach 16 pack 52,217
79 Benang gigi/dental flos 41 pcs 80,529
80 Benang jahit Nylon 5/0 180 pcs 51,838
81 Benang jahit Nylon 6/0 72 pcs 68,821
82 Benang Jahit 3-0 ( Black Silk) cutting 26 mm 264 pcs 44,512
83 Benang Jahit 4-0 ( Black Silk ) Cutting 19 mm 264 pcs 46,843
84 Benang Jahit Chromic (3-0) Cutting 12 Pcs 67,200
derigent/
85 Blue Methylated 98% 125 71,000
25liter
86 Bonding 45 ktk 312,911
87 Bonding Gen 7 3 botol 1,136,500
88 Bur diamond round bulat 8 Kotak 433,500
 89 Bur Endo Acces sedang,besar 10 Pcs 36,364
90 Bur Finishing pita kuning KIT 3 Pcs 1,066,000
91 Bur Tulang 702 Low Speed 3 Pcs 433,333
92 Bur Tulang 703 Low Speed 2 Pcs 433,500
93 Bur tulang 23 mm 26 pcs 362,689
94 Bur tulang 28 mm 22 pcs 362,689
95 Calcium Hydroxide pasta 19 Kotak 106,450
96 Cerkamed MTA 1 set 743,000
97 Composit filling Z350 XT A3 (Filtek) 11 Bks 628,627
98 Composit filling Z350 XT A3 Flow 20 Bks 672,800
99 Composit Filling universal set 9 set 2,353,100
100 Composit Filling Z250 XT A3 27 syringe 250,352
101 Composit Filling Z250 XT A3,5 18 syringe 251,278
102 Composit filling Z350 XT A3,5 5 Bks 625,900
103 Composit Z250 body A2 9 bks 439,500
104 Composite Filling (BULK FILL) 12 Bks 520,012
105 composite Filling (BULK FLOW) 10 Bks 410,262
106 Composite Filling Posterior A3 16 strip 100 439,225
107 Composite Filling Universal A2 Body Z350 3 Pak 625,900
108 Cotton Roll uk 1 20 pack 148,000
109 Cotton roll uk 2 20 pack 136,000
110 Devitalisasi 17 Kotak 256,300
111 EDTA Gel 13 pcs 302,692
112 Edta Solution 18% 12 Botol 151,417
113 Ethil klorida 10 btl 174,000
114 Etsa gel 20 syringe 214,404
115 Eugenol 6 botol 165,333
116 File C06 21mm 8 blister 252,250
117 File C06 25mm 8 blister 252,250
118 File C08 21mm 6 blister 254,333
119 File C08 25mm 6 blister 254,333
120 File C10 21mm 4 blister 258,500
121 File C10 25mm 4 blister 258,500
122 Film Rontgen Panoramic care stream 12 box 1,651,000
123 Glass ionomer fuji IX 16 Kotak 1,352,563
124 Glass ionomer fuji VII 5 Kotak 1,701,000
125 Glass ionomer Universal Restrorative 4 Kotak 741,400
126 Gutta Percha Points 15-40 20 Kotak 94,700
127 Gutta Percha Protaper F1 18 Kotak 109,775
128 Gutta Percha Protaper F2 5 Kotak 109,775
129 Gutta Percha Protaper F3 4 Kotak 109,775
130 Gutta Percha Protaper F4 4 Kotak 109,775
Derigen/5
131 Handrub 5 liter 10 412,000
ltr
132 Handscoon M 200 Box 61,000
133 Handscoon S 1,000 Box 61,000
134 Handscoon XS 200 Box 61,000
135 Handscrub 5 liter 20 derigent 345,000
136 Indikator Strip 5 box 178,000
137 Jarum cek gula darah (Blood Lancet 28 G) 400 box 17,500
138 Jarum dental needle no. 16 122 Box 26,814
139 Jarum Irigasi 0,4x25 mm Transcodent 6 box 303,833
140 K- File 15-40 25 mm 30 Strip 39,291
141 K- File 45-80 25 mm 12 Strip 39,291
142 Kaca Mulut 200 Pcs 43,250
143 Kasa Depper 50 Bks 194,043
144 Kassa Hidrofil 40 yardx80cm 50 roll 191,000
145 Kassa Steril 16x16 42 box 9,039
146 Kertas ECG/EKG 5 cm 6 roll 30,900
147 Kertas ECK/EKG 21 cm 6 roll 156,000
148 K-File no 06 21 mm 20 Strip 104,778
149 K-File no 06 25 mm 5 Strip 103,678
150 K-File no 08 21 mm 10 Strip 103,678
151 K-File no 08 25 mm 5 Strip 103,678
152 K-File no 10 21 mm 10 Strip 103,678
153 K-File no 10 25 mm 12 Strip 103,678
154 Leukoplast Hypafix 10cm x 5m 20 roll 45,056
155 Lingettes/wipes Alcohol Free Cleaner Disinfectants 50 pack 139,500
156 Liquid chemical sterilants/high level disinfectants 15 Botol/ 1 liter 1,001,000
157 Matrix band 12 roll 48,167
158 Micro brush 30 box 75,143
159 NaOCl 3% 500ml 178 botol 101,462
160 Nassal canull anak 5 pcs 7,660
161 Nassal canull dewasa 20 pcs 7,660
162 Needle 23 2 pcs 31,000
163 Non Woven Fixation/ 5 Cm x 10 M 80 pcs 26,408
164 NRM anak 5 pcs 17,100
165 NRM dewasa 10 pcs 17,100
166 Paper point 15 17 Kotak 73,941
167 Paper point 20 26 Kotak 72,923
168 Parafilm 4x125 1 roll 1,001,000
169 Pasak Fiber refill 1,25 10 Pak 1,391,000
170 Pasak Fiber refill 1,375 10 Pak 1,391,000
171 Pasak Fiber refill 1,5 10 Pak 1,482,000
172 Pasak Relyx Fiber Refil 2 Kotak 1,517,300
173 Perban Elastis 30 roll 48,000
174 Pisau Bedah no 14 5 Kotak 459,000
175 Pisau Bedah no 15 5 Kotak 459,000
176 Pisau Bedah no.12 2 box 461,000
177 Pouches Gussete 15cmx5cm (100m) 40 Roll 956,700
178 Pouches Gussete 20cmx5cm (100m) 80 Roll 996,000
179 Protaper FHU 21 mm 20 Kotak 421,223
180 Protaper FHU 25 mm 20 Kotak 421,223
181 Protaper rotary gold 21 mm 10 Kotak 569,508
182 Protaper rotary gold 25 mm 20 Kotak 569,508
183 Protector Sol/ lysol 48 Btl 1 ltr 35,604
184 Rapid test antigen 2 pcs 543,500
185 Safety Box Needle @5 liter 200 Pcs 17,000
186 Saliva Ejector 100 Bks 50,590
187 Semen resin luxacore 10 syringe 1,169,000
188 Slaber 30 pcs 62,538
189 Spongostan (1box/10 pcs) 20 box 225,018
190 Spray Cleaner Disinfectant 10 botol 161,900
191 Spuit 1 cc 700 pcs 1,966
192 Spuit 10 cc 500 pcs 2,299
193 Spuit 3 cc 7,000 pcs 1,888
194 Spuit 5 cc 5,000 pcs 1,977
195 Strip glukosa 1 Box 2,786,129
196 Suction Catheter no 10 100 pcs 5,432
197 Suction Catheter no 12 100 pcs 5,432
198 Suction Catheter no 14 20 pcs 5,432
199 Suction Catheter no 8 100 pcs 5,432
200 Tegaderm catheter dressing 7cm x 12xm 10 Kotak 47,002
201 Tumpatan sementara 30 Kotak 67,600
202 Strip Asam Urat isi 25 strip 6 Kotak 146,000
203 Strip Cholesterol isi 10 strip 6 Kotak 189,000

IV. BMHP Non e-katalog

204 Absorban paper point 15-40 20 Box 83,571
205 Absorban paper point no 30 10 Pcs 72,000
206 Bahan medikamen saluran akar 3 botol 152,000
207 Bleaching Internal 1 Set 802,000
208 Bur High Speed FG 801-016 20 Pcs 29,800
209 Bur High Speed FG 859-012 20 Pcs 58,400
210 Bur Poles round White Stone 30 pcs 52,000
211 Bur stone polishing composite point 5 Pcs 202,000
212 Bur Tulang low speed 016 50 Pcs 52,000
213 Bur Tulang Low speed 121 50 Pcs 52,000
214 Calcium Hidroxide Bubuk 20 kotak 57,000
215 Chlor tablet 10 Kg 822,000
216 CMS 4 Btl 162,500
217 Collagent Graft H060803002 (CSD1020) 2 pcs 4,876,000
218 Double Impression injeksi exaflex 40 Kotak 502,000
219 Film Rontgen Panoramic Fuji Fim 12 box 3,402,000
220 Fit Checker 2 box 902,000
221 Gibs putih snow rock 12 Kaleng 22,000
222 Glass ionomer fuji I 8 Kotak 1,202,000
223 Glass ionomer Gie Fill Premium 10 Kotak 302,000
224 Gutta Percha Points 15 30 Kotak 110,098
225 Gutta Percha Points 20 30 Kotak 110,098
226 Gutta Percha Points 45-80 20 Kotak 110,098
227 Heat Curing liquid huge 500ml 8 btl 302,000
228 Heat Curing powder 1000 gram 3 kg 802,000
229 Lem Ortho 2 box 3,302,000
230 Mata bur poles pink 5 pcs 402,000
231 Membran kolagen 25X 2 pcs 2,002,000
232 Membran pericardium 2 pcs 2,002,000
233 Metronidazole Gel 5 syringe 302,000
234 Perry Compound 5 box 402,000
235 Poly Aluminium Chloride (PAC) 6 bks/1kg 122,000
236 Relyx Ultimate 2 Pcs 1,202,000
237 Self Curing acrylic liquid 500ml 3 btl 302,000
238 Self Curing powder shade 2s 1000 gram 2 kg 802,000
239 Semen resin rely x U-200 6 Box 1,342,000
240 Separato Karet 15 Pack 152,000
241 Single impression exaflex monophase 6 Box 552,000
242 Soft liner 1 set 1,702,000
243 Sungkup anak 5 Pcs 15,200
244 Sungkup bayi 2 Pcs 19,642
245 Sungkup dewasa 10 Pcs 15,200
246 Surgifit resobable 5-0 20 Pcs 81,143
247 Wax hiflex 6 Kotak 1,113,681
248 Wire N 0.14 U,L 2 roll 202,000
249 Wire Niti 0,12 RA dan RB 2 Pack 502,000
250 Wire Niti 0,16x0,16 U,L 2 Pack 202,000
251 Wire SS 0,14 U,L 2 Pack 202,000
252 Wire SS 0,16 x 0,22 U,L 2 Pack 202,000
253 Wire uk 0.025 6 roll 302,000
254 Wire uk 0.5 2 roll 802,000
TOTAL BELANJA E KATALOG
TOTAL BELANJA NON E KATALOG
TOTAL BELANJA
HABIS PAKAI (BMHP)
SELATAN

Total
286,740,598
479,000 774,605,615
27,900 1,061,346,213 1,040,786,412 20,559,801
226,000
29,950,000
568,400
143,000
8,877,000
75,000,400
14,450,000
120,160
346,800
39,900
9,140,000
1,062,480
1,024,320
712,000
1,453,000
8,818,500
402,000
427,200
22,410,000
24,880,000
22,000
521,600
2,560,320
1,194,000
2,400,400
387,200
6,138,264
126,300
8,658,000
5,920,000
7,320,000
364,000
142,120
4,420,000
2,952,960
2,456,640
1,510,000
3,980,000
187,740
152,290
640,960
65,200
9,700,000
892,848
139,900
1,130,000
2,720,640
47,800
222,400
83,700
6,764,356

9,872,100

2,488,800

222,600
96,060

731,000
1,097,000
2,786,660
19,380,000
2,200,000
2,360,000
420,000
420,000
420,000
420,000
420,000
420,000
420,000
420,000
1,786,788
1,059,508
786,000
705,000
3,920,650
433,835
835,472
3,301,700
9,330,840
4,955,112
11,751,168
12,366,552
806,400

8,875,000

14,081,000
3,409,500
3,468,000
 363,640
3,198,000
1,300,000
867,000
9,429,914
7,979,158
2,022,550
743,000
6,914,900
13,456,000
21,177,900
6,759,500
4,523,000
3,129,500
3,955,500
6,240,144
4,102,620
7,027,600
1,877,700
2,960,000
2,720,000
4,357,100
3,934,996
1,817,000
1,740,000
4,288,080
992,000
2,018,000
2,018,000
1,526,000
1,526,000
1,034,000
1,034,000
19,812,000
21,641,000
8,505,000
2,965,600
1,894,000
1,975,950
548,875
439,100
439,100

4,120,000

12,200,000
61,000,000
12,200,000
6,900,000
890,000
7,000,000
 3,271,328
1,823,000
1,178,730
471,492
8,650,000
9,702,150
9,550,000
379,622
185,400
936,000
2,095,560
518,390
1,036,780
518,390
1,036,780
1,244,136
901,118
6,975,000
15,015,000
578,000
2,254,290
18,060,200
38,300
153,200
62,000
2,112,632
85,500
171,000
1,257,000
1,896,000
1,001,000
13,910,000
13,910,000
14,820,000
3,034,600
1,440,000
2,295,000
2,295,000
922,000
38,268,000
79,680,000
8,424,460
8,424,460
5,695,080
11,390,160
1,709,000
1,087,000
3,400,000
5,059,036
11,690,000
 1,876,152
4,500,360
1,619,000
1,375,990
1,149,350
13,216,000
9,884,000
2,786,129
543,190
543,190
108,638
543,190
470,020
2,028,000
876,000
1,134,000

1,671,420
720,000
456,000
802,000
596,000
1,168,000
1,560,000
1,010,000
2,600,000
2,600,000
1,140,000
8,220,000
650,000
9,752,000
20,080,000
40,824,000
1,804,000
264,000
9,616,000
3,020,000
3,302,940
3,302,940
2,201,960
2,416,000
2,406,000
6,604,000
2,010,000
4,004,000
4,004,000
1,510,000
 2,010,000
732,000
2,404,000
906,000
1,604,000
8,052,000
2,280,000
3,312,000
1,702,000
76,000
39,284
152,000
1,622,860
6,682,083
404,000
1,004,000
404,000
404,000
404,000
1,812,000
1,604,000
1,063,356,213
178,244,147
1,241,600,360 1,241,600,360 1,600,000,000 358,399,640
 TARIF PELAYANAN RUANG IGD RSK GIGI DAN MULUT PROVINSI SUMATERA SELATAN

KONSULTASI MEDIS DAN TINDAKAN KEPERAWATAN

NO JENIS KEGIATAN TARIF (Rp)
1 Pemeriksaan Dokter Umum / drg 40000
2 Pemeriksaan Dokter Spesialis 80000
3 Konsultasi Dokter Spesialis pada jam kerja ( on call) 30000
4 Konsultasi Dokter Spesialis pada jam kerja ( on call) 60000
5 Pendaftaran pasien baru 35000

TINDAKAN MEDIK DARURAT

NO TINDAKAN SATUAN TARIF (Rp)
1 Pemasangan Infus Per tindakan 45000
2 Jahit Luka Umum ≤ 5 jahitan Per tindakan 80000
3 6- 15 jahitan Per tindakan 200000
4 ≥ 16 jahitan Per tindakan 280000
5 Bersih Luka / WT Per tindakan 45000
6 Perawatan luka bakar 1%- 9% Per tindakan 95000
7 9%- 18% Per tindakan 110000
8 > 18% Per tindakan 170000
10 Penghentian perdarahan masif pada trauma Per tindakan 60000
11 Penanganan shock Per tindakan 100000
12 Pemasangan endotracheal tube ( intubasi ) Per tindakan 100000
13 RJP tanpa intubasi Per tindakan 100000
14 tindakan dengan DC Shock / cardioversi Per tindakan 125000
15 Pemasangan NGT Per tindakan 40000
16 Pemasangan kateter Per tindakan 60000
17 Angkat jahitan Per tindakan 5000 / jahitan
18 EKG Per tindakan 45000
19 Tindakan Nebulizar / Kali Per tindakan 60000
20 Reposisi Mandibula Per tindakan 160000
21 Pemasangan Spalk jari Per tindakan 70000
22 Pemasangan Spalk lengan Per tindakan 110000
23 Pemasangan Spalk tungkai Per tindakan 150000
24 Observasi Per hari 50000
25 Visum dokter umum Per tindakan 80000
26 Debridement orofacial ringan Per tindakan 60000
27 Debridement orofacial sedang Per tindakan 180000
28 Debridement orofacial berat Per tindakan 300000
29 Jahit Luka Gusi 1-3 jahitan Per tindakan 50000
30 jahit Luka gusi >3 jahitan Per tindakan 100000
31 Splinting Per tindakan 80000
32 Insisi Abses Per tindakan 340000
33 Ekstraksi kuku Per tindakan 110000
34 Irigasi mata Per tindakan 70000
35 Nekrotomi Per tindakan 120000
38 Pemeriksaan GDS Per tindakan 15000
39 Suction/ penghisapan lendir Per tindakan 60000
40 Corpus aleanum Per tindakan 80000
41 Bilas lambung Per tindakan 150000
42 Pengobatan stomatitis Per tindakan 30000
43 Infus Pump/ Hari Per hari 75000
44 Pemakaian O2 1-4 L/ Menit ( per satu jam) Per tindakan 35000
45 Pemakaian O2 1-4 L/ Menit ( > 4jam / 1 hari) Per tindakan 100000
46 Pemakaian O2 5- 8 L/ Menit ( per satu jam) Per tindakan 45000
47 Pemakaian O2 5-8 L/ Menit ( > 4jam / 1 hari) Per tindakan 215000
48 Injeksi SC/ IM/ IV di IGD Per tindakan 10000
49 Amputasi / Flep 1 jari Per tindakan 200000
50 Perawatan Jenazah Per tindakan 100000
51 Ambulance (0 - 12km) Per tindakan 150000
 TARIF PELAYANAN RUANG RAWAT INAP RSK GIGI DAN MULUT PROVINSI SUMATERA SELATAN

KONSULTASI MEDIS DAN TINDAKAN KEPERAWATAN

NO TARIF (Rp)
1 visite dokter konsultan 150.000
Visit dokter spesialis
1 KELAS VIP 80.000
2 KELAS I 75.000
3 KELAS II 70.000
4 KELAS III 65.000
5 ISOLASI 75.000
Visit dokter umum
1 KELAS VIP 45.000
2 KELAS I 35.000
3 KELAS II 30.000
4 KELAS III 30.000
5 ISOLASI 35.000

TARIF KAMAR
NO KELAS TARIF (Rp)
1 KELAS VIP 650.000
2 KELAS I 450.000
3 KELAS II 250.000
4 KELAS III 150.000
5 ISOLASI 250.000

TINDAKAN KEPERAWATAN
NO TINDAKAN SATUAN
1 Tindakan keperawatan Per hari
2 Pemasangan Infus Per tindakan
3 Perawatan luka Per tindakan
6 vital Sign Per tindakan
7 Pemasangan endotracheal tube ( intubasi ) Per tindakan
8 RJP tanpa intubasi Per tindakan
9 tindakan dengan DC Shock / cardioversi Per tindakan
10 Pemasangan NGT Per tindakan
11 Pemasangan kateter Per tindakan
12 lepas kateter
13 EKG Per tindakan
14 Tindakan Nebulizar / Kali Per tindakan
15 pemasangan saturasi oksigen Per tindakan
16 Suction/ penghisapan lendir Per tindakan
17 syring pump / hari Per tindakan
18 Infus Pump/ Hari Per hari
19 Pemakaian O2 1-4 L/ Menit ( per satu jam) Per tindakan
20 Pemakaian O2 1-4 L/ Menit ( > 4jam / 1 hari) Per tindakan
21 Pemakaian O2 5- 8 L/ Menit ( per satu jam) Per tindakan
22 Pemakaian O2 5-8 L/ Menit ( > 4jam / 1 hari) Per tindakan
23 Injeksi SC/ IM/ IV / skin test Per tindakan
24 Perawatan Jenazah Per tindakan
25 pemberian obat melalui supositoria Per tindakan
26 Pelepasan Infus / tindakan Per tindakan
27 Pelepasan NGT Per tindakan
28 Pemeriksaan BSS/ tindakan Per tindakan
29 Verbeden Per tindakan
30 Pemberian makan melalui NGT/Kali Per tindakan
31 Pemberian obat melalui NGT/Kali Per tindakan
 VINSI SUMATERA SELATAN

WATAN

TARIF (Rp)
15.000
45000
95000
10.000
100000
100000
125000
40000
60000

45000
60000
35000
60000
75000
75000
 35000
100000
45000
215000
10000
100000
10.000
IX. TARIF PELAYANAN RAWAT INAP

NO JENIS PELAYANAN BESAR TARIF (RUPIAH)

1 2 3
1 RAWAT INAP/HARI
a. Kelas VVIP 800,000
b. Kelas VIP 650,000
c. Kelas I 450,000
d. Kelas II 250,000
2 SEWA KAMAR OPERASI 1,000,000

3 ANASTESI UMUM 1,000,000

4 JASA DOKTER KONSULTAN 150,000

5 JASA DOKTER VISIT 60,000

RIF (RUPIAH) KETERANGAN

3 4
Sewa kamar inap untuk pasien RSGM yang memerlukan Perawatan
0,000 intensif
0,000
0,000
0,000
00,000 Untuk dokter spesialis gigi tamu (bukan dokter gigi dari RSGM yang
ingin menyewa kamar operasi RSGM)
00,000 Jasa tenaga dokter anestesi dari luar RSGM
0,000 Jasa dokter konsultan untuk pasien yang dioperasi dengan anastersi
umum
0,000 Tarif untuk dokter dalam melakukan visite pasien rawat inap (per
visit)