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RSU dr H.

KOESNADI BONDOWOSO
BIAYA PELAYANAN HEMODIALISA 5 JAM (DENGAN HEPARIN DAN NaCl tanpa depresiasi alat dan gedung) tanpa profit
NO Keterangan BARU 1R 4R 7R 9R

I Consumable Inti
1. Artificial kidney
2. Blood line
3. AV Fistula (2)
4. Cairan :
- acid
- bicnat Rp 579,500 Rp 359,100 Rp 359,100 Rp 359,100 Rp 359,100

Jumlah Rp 579,500 Rp 359,100 Rp 359,100 Rp 359,100 Rp 359,100

II Consumable Tambahan
1. NaCl 0.9% (3 liter) Rp 22,800 Rp 22,800 Rp 22,800 Rp 22,800 Rp 22,800
2. Heparin (12500 U) Rp 30,900 Rp 30,900 Rp 30,900 Rp 30,900 Rp 30,900
3. Infus set (2) Rp 4,700 Rp 4,700 Rp 4,700 Rp 4,700 Rp 4,700
4. Syringe 1 cc (1) Rp 1,900 Rp 1,900 Rp 1,900 Rp 1,900 Rp 1,900
5. Syringe 3 cc (1) Rp 800 Rp 800 Rp 800 Rp 800 Rp 800
6. Syringe 20 cc (1) Rp 1,900 Rp 1,900 Rp 1,900 Rp 1,900 Rp 1,900
7. Lidocain 2% (2) Rp 2,503 Rp 2,503 Rp 2,503 Rp 2,503 Rp 2,503
8. Masker (1) Rp 600 Rp 600 Rp 600 Rp 600 Rp 600
9. Sarung tangan steril (1) Rp 1,892 Rp 1,892 Rp 1,892 Rp 1,892 Rp 1,892
10. BMHP dasar Rp 24,000 Rp 24,000 Rp 24,000 Rp 24,000 Rp 24,000
11. Keperluan mesin :
- Bayclin Rp 5,850 Rp 5,850 Rp 5,850 Rp 5,850 Rp 5,850
- syringe 50 cc
- Asam asetat 25% Rp 254 Rp 254 Rp 254 Rp 254 Rp 254
- Asam sitrat Rp 4,020 Rp 4,020 Rp 4,020 Rp 4,020 Rp 4,020
- H2O2 5% Rp 480 Rp 480 Rp 480 Rp 480 Rp 480
- Garam Non Yodium Rp 180 Rp 180 Rp 180 Rp 180 Rp 180
- MW Filter Rp 2,383 Rp 2,383 Rp 2,383 Rp 2,383 Rp 2,383

Jumlah Rp 105,162 Rp 105,162 Rp 105,162 Rp 105,162 Rp 105,162

III Cairan Reused Renalin Rp - Rp 1,900 Rp 1,900 Rp 1,900 Rp 1,900

IV Barang Non Medis


1. Listrik Rp 15,000 Rp 15,000 Rp 15,000 Rp 15,000 Rp 15,000
2. Air Rp 1,725 Rp 1,725 Rp 1,725 Rp 1,725 Rp 1,725
3. Binatu Rp 8,912 Rp 8,912 Rp 8,912 Rp 8,912 Rp 8,912
4. Pemeliharaan Rp 4,456 Rp 4,456 Rp 4,456 Rp 4,456 Rp 4,456

Jumlah Rp 30,093 Rp 30,093 Rp 30,093 Rp 30,093 Rp 30,093

V Gaji pokok Tenaga Medis (dr dan perawat) Rp 70,000 Rp 70,000 Rp 70,000 Rp 70,000 Rp 70,000

VI Administrasi Rp 75,000 Rp 75,000 Rp 75,000 Rp 75,000 Rp 75,000

Jasa medis(KGH, SpPD, dr umum, perawat) (sesuai rekomendasi


VII IDI- tipe C) Rp 98,000 Rp 98,000 Rp 98,000 Rp 98,000 Rp 98,000
Jumlah Total Rp 859,807 Rp 641,307 Rp 641,307 Rp 641,307 Rp 641,307
Obat Tambahan
erytropoitin Rp 168,000 Rp 168,000
amino infus Rp 59,100 Rp 59,100
Jumlah Total + obat tambahan Rp 859,807 Rp 809,307 Rp 700,407 Rp 809,307 Rp 700,407

Rp 957,755
RSU dr H. KOESNADI BONDOWOSO
BIAYA PELAYANAN HEMODIALISA 5 JAM (DENGAN HEPARIN DAN NaCl tanpa depresiasi alat dan gedung) dengan profit
NO Keterangan BARU 1R 4R 7R 9R

I Consumable Inti
1. Artificial kidney
2. Blood line
3. AV Fistula (2)
Rp 579,500 Rp 359,100 Rp 359,100 Rp 359,100 Rp 359,100
4. Cairan :
- acid
- bicnat

Jumlah Rp 579,500 Rp 359,100 Rp 359,100 Rp 359,100 Rp 359,100

II Consumable Tambahan
1. NaCl 0.9% (3 liter) Rp 22,800 Rp 22,800 Rp 22,800 Rp 22,800 Rp 22,800
2. Heparin (12500 U) Rp 30,900 Rp 30,900 Rp 30,900 Rp 30,900 Rp 30,900
3. Infus set (2) Rp 4,700 Rp 4,700 Rp 4,700 Rp 4,700 Rp 4,700
4. Syringe 1 cc (1) Rp 1,900 Rp 1,900 Rp 1,900 Rp 1,900 Rp 1,900
5. Syringe 3 cc (1) Rp 800 Rp 800 Rp 800 Rp 800 Rp 800
6. Syringe 20 cc (1) Rp 1,900 Rp 1,900 Rp 1,900 Rp 1,900 Rp 1,900
7. Lidocain 2% (2) Rp 2,503 Rp 2,503 Rp 2,503 Rp 2,503 Rp 2,503
8. Masker (1) Rp 600 Rp 600 Rp 600 Rp 600 Rp 600
9. Sarung tangan steril (1) Rp 1,892 Rp 1,892 Rp 1,892 Rp 1,892 Rp 1,892
10. BMHP dasar Rp 24,000 Rp 24,000 Rp 24,000 Rp 24,000 Rp 24,000
11. Keperluan mesin :
- Bayclin Rp 5,850 Rp 5,850 Rp 5,850 Rp 5,850 Rp 5,850
- syringe 50 cc
- Asam asetat 25% Rp 254 Rp 254 Rp 254 Rp 254 Rp 254
- Asam sitrat Rp 4,020 Rp 4,020 Rp 4,020 Rp 4,020 Rp 4,020
- H2O2 5% Rp 480 Rp 480 Rp 480 Rp 480 Rp 480
- Garam Non Yodium Rp 180 Rp 180 Rp 180 Rp 180 Rp 180
- MW Filter Rp 2,383 Rp 2,383 Rp 2,383 Rp 2,383 Rp 2,383

Jumlah Rp 105,162 Rp 105,162 Rp 105,162 Rp 105,162 Rp 105,162

III Cairan Reused Renalin Rp - Rp 1,900 Rp 1,900 Rp 1,900 Rp 1,900

IV Barang Non Medis


1. Listrik Rp 15,000 Rp 15,000 Rp 15,000 Rp 15,000 Rp 15,000
2. Air Rp 1,725 Rp 1,725 Rp 1,725 Rp 1,725 Rp 1,725
3. Binatu Rp 8,912 Rp 8,912 Rp 8,912 Rp 8,912 Rp 8,912
4. Pemeliharaan Rp 4,456 Rp 4,456 Rp 4,456 Rp 4,456 Rp 4,456

Jumlah Rp 30,093 Rp 30,093 Rp 30,093 Rp 30,093 Rp 30,093

V Gaji pokok Tenaga Medis (dr dan perawat) Rp 70,000 Rp 70,000 Rp 70,000 Rp 70,000 Rp 70,000

VI Administrasi Rp 75,000 Rp 75,000 Rp 75,000 Rp 75,000 Rp 75,000

Jasa medis(KGH, SpPD, dr umum, perawat) (sesuai


VII rekomendasi IDI- tipe C) Rp 98,000 Rp 98,000 Rp 98,000 Rp 98,000 Rp 98,000

Jumlah Total Rp 859,807 Rp 641,307 Rp 641,307 Rp 641,307 Rp 641,307


Profit margin 15 % Rp 988,778 Rp 737,503 Rp 737,503 Rp 737,503 Rp 737,503
Obat Tambahan
erytropoitin Rp 168,000 Rp 168,000
amino infus Rp 59,100 Rp 59,100
Jumlah Total + obat tambahan Rp 988,778 Rp 905,503 Rp 796,603 Rp 905,503 Rp 796,603