Tabel 1.

Biaya Investasi (AIC Gedung) Masing-Masing Pusat Biaya

No Nama Pusat Biaya Luas (m2) Tahun Beli Harga IIC Masa Pakai (t)
1 Kantor 1244 2009 Rp 598,078,225 10
2 Apotek 200 2009 Rp 96,154,055 10
3 Instalasi gizi 200 2009 Rp 96,154,055 10
4 Laundry 1104 2010 Rp 530,770,386 9
5 Poliklinik bedah 56 2010 Rp 26,923,136 9
6 Poliklinik gigi 56 2010 Rp 26,923,136 9
7 Poliklinik umum 56 2010 Rp 26,923,136 9
8 Instalasi rawat inap 1128 2009 Rp 542,308,872 10
Total 4044 - Rp 1,944,235,000 -
Masing Pusat Biaya
Masa Hidup (L) Inflasi (I) AIC
25 9% Rp 56,634,747
25 9% Rp 9,105,265
25 9% Rp 9,105,265
25 9% Rp 46,111,065
25 9% Rp 2,338,967
25 9% Rp 2,338,967
25 9% Rp 2,338,967
25 9% Rp 51,353,693
- - Rp 179,326,936
 Tabel 2.
Biaya Non Medis (AIC Non Medis) Pusat Biaya
No Nama Alat Non Medis Jumlah Tahun Beli Harga Satuan
1 Meja 1/2 biro 15 2013 Rp 800,000
2 Meja 1 biro 3 2013 Rp 1,000,000
3 Filinmg kabinet 4 2013 Rp 850,000
4 Telepon 3 2015 Rp 100,000
5 Kursi tamu 2 2015 Rp 250,000
6 Kursi putar 2 2015 Rp 150,000
7 Lemari arsip 4 2015 Rp 2,000,000
8 Lemari 2 pintu 1 2015 Rp 4,250,000
9 AC spilit 4 2015 Rp 2,379,500
10 Kipas angin 2 2015 Rp 600,000
11 Kursi kayu 15 2015 Rp 450,000
12 Kursi tanpa lengan 5 2015 Rp 200,000
13 Mesin ketik 3 2015 Rp 475,000
14 Jam dinding 5 2015 Rp 155,000
15 Komputer 2 2015 Rp 5,300,000
Total - - -

Tabel 3.
Biaya Non Medis (AIC Non Medis) Pusat Biaya
No Nama Alat Non Medis Jumlah Tahun Beli Harga Satuan
1 Meja 1/2 biro 2 2013 Rp 800,000
2 Lemari obat Kaca 1 2013 Rp 1,150,000
3 Kursi tanpa lengan 4 2013 Rp 200,000
4 Kipas angin 1 2013 Rp 400,000
5 Waskom 2 2017 Rp 70,000
6 Standar waskom 2 2013 Rp 20,000
7 Kursi kayu 2 2013 Rp 350,000
Total - - -

Tabel 4.
Biaya Non Medis (AIC Non Medis) Pusat Biaya Ins
No Nama Alat Non Medis Jumlah Tahun Beli Harga Satuan
1 Meja 1/2 biro 3 2014 Rp 800,000
2 Kursi tanpa lengan 5 2014 Rp 200,000
3 Rak barang 3 2016 Rp 500,000
4 Lemari makan 2 2016 Rp 1,250,000
5 Rak barang/piring 2 2014 Rp 600,000
6 Tabung gas kecil 4 2016 Rp 270,000
7 Tabung gas besar 3 2016 Rp 450,000
8 Kereta makan 2 2016 Rp 650,000
9 Kulkas 3 2014 Rp 3,000,000
10 Tempat air minum sedang 2 2016 Rp 80,000
11 Tempat air minum besar 2 2016 Rp 150,000
12 Tempat nasi besar 3 2016 Rp 50,000
13 Tempat nasi sedang 2 2016 Rp 45,000
14 Wajan besar 4 2016 Rp 70,000
Total - - -

Tabel 5.
Biaya Non Medis (AIC Non Medis) Pusat Biaya L
No Nama Alat Non Medis Jumlah Tahun Beli Harga Satuan
1 Mesin cuci 2 2016 Rp 4,500,000
2 Seterika 2 2016 Rp 200,000
3 Kereta dorong 1 2016 Rp 600,000
4 Lemari dua pintu 1 2016 Rp 4,250,000
5 Meja 1/2 biro 1 2016 Rp 800,000
6 Kursi plastik 2 2016 Rp 60,000
7 Kursi tanpa lengan 1 2016 Rp 200,000
Total - - -

Tabel 6.
Biaya Non Medis (AIC Non Medis) Pusat Biaya Ka
No Nama Alat Non Medis Jumlah Tahun Beli Harga Satuan
1 Tempat tidur besi 4 2016 Rp 5,000,000
2 Lemari kaca 2 2016 Rp 1,150,000
3 Lemari kayu 2 pintu 3 2016 Rp 4,250,000
4 Meja 1/2 biro 5 2016 Rp 800,000
5 Meja 1 biro 3 2016 Rp 1,050,000
6 Kursi kayu 8 2016 Rp 300,000
7 Meja kayu panjang 1 2016 Rp 600,000
8 Lemari kaca 2 2016 Rp 2,060,000
Total - - -

Tabel 7.
Biaya Non Medis (AIC Non Medis) Pusat Biaya Instala
No Nama Alat Non Medis Jumlah Tahun Beli Harga Satuan
1 Tempat tidur besi 75 2016 Rp 5,000,000
2 Lemari kecil 73 2016 Rp 750,000
3 Kursi plastik 32 2016 Rp 60,000
4 AC split 5 2016 Rp 3,990,250
5 TV 32 inchi 2 2016 Rp 3,200,000
6 Kulkas kecil 2 2016 Rp 1,250,000
7 Kasur 73 2018 Rp 700,000
Total - - -

Tabel 8.
Biaya Non Medis (AIC Non Medis) Pusat Biaya Pol
No Nama Alat Non Medis Jumlah Tahun Beli Harga Satuan
1 Meja tulis 3 2017 Rp 1,250,000
2 Kursi putar 1 2017 Rp 1,250,000
3 AC 1 2017 Rp 3,500,500
4 Kursi/meja 3 2017 Rp 250,000
5 Lemari 1 2017 Rp 2,000,000
Total - - -

Tabel 9.
Biaya Non Medis (AIC Non Medis) Pusat Biaya Polik
No Nama Alat Non Medis Jumlah Tahun Beli Harga Satuan
1 Kursi putar 1 2015 Rp 1,250,000
2 Lemari kayu 1 2016 Rp 2,000,000
3 Tempat tidur 1 2015 Rp 2,000,000
4 Stan waskom 1 2015 Rp 250,000
5 Waskom 1 2016 Rp 60,000
6 Jam dinding 1 2016 Rp 50,000
7 Kursi kerja 4 2015 Rp 250,000
8 Meja tulis 2 2016 Rp 1,250,000
Total - - -
 Tabel 2.
n Medis (AIC Non Medis) Pusat Biaya Kantor
Harga IIC Masa Pakai (t) Masa Hidup (L) Inflasi (I) AIC
Rp 12,000,000 6 10 8% Rp 1,904,249
Rp 3,000,000 6 10 8% Rp 476,062
Rp 3,400,000 6 10 8% Rp 539,537
Rp 300,000 4 15 8% Rp 27,210
Rp 500,000 4 15 8% Rp 45,350
Rp 300,000 4 15 8% Rp 27,210
Rp 8,000,000 4 10 8% Rp 1,088,391
Rp 4,250,000 4 15 8% Rp 385,472
Rp 9,518,000 4 15 8% Rp 863,276
Rp 1,200,000 4 15 8% Rp 108,839
Rp 6,750,000 4 10 8% Rp 918,330
Rp 1,000,000 4 10 8% Rp 136,049
Rp 1,425,000 4 10 8% Rp 193,870
Rp 775,000 4 10 8% Rp 105,438
Rp 10,600,000 4 15 8% Rp 961,412
Rp 63,018,000 - - - Rp 7,780,694

Tabel 3.
n Medis (AIC Non Medis) Pusat Biaya Apotek
Harga IIC Masa Pakai (t) Masa Hidup (L) Inflasi (I) AIC
Rp 1,600,000 6 10 8% Rp 253,900
Rp 1,150,000 6 10 8% Rp 182,491
Rp 800,000 6 10 8% Rp 126,950
Rp 400,000 6 10 8% Rp 63,475
Rp 140,000 2 10 8% Rp 16,330
Rp 40,000 6 10 8% Rp 6,347
Rp 700,000 6 10 8% Rp 111,081
Rp 4,830,000 - - - Rp 760,574

Tabel 4.
Medis (AIC Non Medis) Pusat Biaya Instalasi Gizi
 Harga IIC Masa Pakai (t) Masa Hidup (L) Inflasi (I) AIC
Rp 2,400,000 5 10 8% Rp 352,639
Rp 1,000,000 5 10 8% Rp 146,933
Rp 1,500,000 3 13 8% Rp 145,351
Rp 2,500,000 3 10 8% Rp 314,928
Rp 1,200,000 5 10 8% Rp 176,319
Rp 1,080,000 3 30 8% Rp 45,350
Rp 1,350,000 3 30 8% Rp 56,687
Rp 1,300,000 3 10 8% Rp 163,763
Rp 9,000,000 5 15 8% Rp 881,597
Rp 160,000 3 10 8% Rp 20,155
Rp 300,000 3 10 8% Rp 37,791
Rp 150,000 3 10 8% Rp 18,896
Rp 90,000 3 10 8% Rp 11,337
Rp 280,000 3 10 8% Rp 35,272
Rp 22,310,000 - - - Rp 2,407,018

Tabel 5.
Medis (AIC Non Medis) Pusat Biaya Laundry
Harga IIC Masa Pakai (t) Masa Hidup (L) Inflasi (I) AIC
Rp 9,000,000 3 15 8% Rp 755,827
Rp 400,000 3 10 8% Rp 50,388
Rp 600,000 3 15 8% Rp 50,388
Rp 4,250,000 3 15 8% Rp 356,918
Rp 800,000 3 10 8% Rp 100,777
Rp 120,000 3 10 8% Rp 15,117
Rp 200,000 3 10 8% Rp 25,194
Rp 15,370,000 - - - Rp 1,354,610

Tabel 6.
Medis (AIC Non Medis) Pusat Biaya Kamar Bedah
Harga IIC Masa Pakai (t) Masa Hidup (L) Inflasi (I) AIC
Rp 20,000,000 3 15 8% Rp 1,679,616
Rp 2,300,000 3 15 8% Rp 193,156
 Rp 12,750,000 3 15 8% Rp 1,070,755
Rp 4,000,000 3 10 8% Rp 503,885
Rp 3,150,000 3 10 8% Rp 396,809
Rp 2,400,000 3 10 8% Rp 302,331
Rp 600,000 3 10 8% Rp 75,583
Rp 4,120,000 3 15 8% Rp 346,001
Rp 49,320,000 - - - Rp 4,568,136

Tabel 7.
s (AIC Non Medis) Pusat Biaya Instalasi Rawat Inap
Harga IIC Masa Pakai (t) Masa Hidup (L) Inflasi (I) AIC
Rp 375,000,000 3 15 8% Rp 31,492,800
Rp 54,750,000 3 10 8% Rp 6,896,923
Rp 1,920,000 3 10 8% Rp 241,865
Rp 19,951,250 3 15 8% Rp 1,675,522
Rp 6,400,000 3 15 8% Rp 537,477
Rp 2,500,000 3 15 8% Rp 209,952
Rp 51,100,000 1 7 8% Rp 7,884,000
Rp 511,621,250 - - - Rp 48,938,539

Tabel 8.
edis (AIC Non Medis) Pusat Biaya Poliklinik Gigi
Harga IIC Masa Pakai (t) Masa Hidup (L) Inflasi (I) AIC
Rp 3,750,000 2 10 8% Rp 437,400
Rp 1,250,000 2 10 8% Rp 145,800
Rp 3,500,500 2 15 8% Rp 272,199
Rp 750,000 2 10 8% Rp 87,480
Rp 2,000,000 2 10 8% Rp 233,280
Rp 11,250,500 - - - Rp 1,176,159

Tabel 9.
dis (AIC Non Medis) Pusat Biaya Poliklinik Umum
Harga IIC Masa Pakai (t) Masa Hidup (L) Inflasi (I) AIC
Rp 1,250,000 4 10 8% Rp 170,061
Rp 2,000,000 3 10 8% Rp 251,942
Rp 2,000,000 4 10 8% Rp 272,098
Rp 250,000 4 8 8% Rp 42,515
Rp 60,000 3 5 8% Rp 15,117
Rp 50,000 3 5 8% Rp 12,597
Rp 1,000,000 4 10 8% Rp 136,049
Rp 2,500,000 3 10 8% Rp 314,928
Rp 9,110,000 - - - Rp 1,215,307
 Tabel 10.
Biaya Medis (AIC Medis) Pusat Biaya UPF B
No Nama Alat Medis Jumlah Tahun Beli Harga Satuan
1 Sterilisator aesculap 1 2011 Rp 6,336,000
2 Sterilisator aesculap 1 2010 Rp 6,150,000
3 Lampu operasi 1 2011 Rp 215,000
4 Brankard 2 2011 Rp 370,000
5 Brankard kosong 4 2010 Rp 1,200,000
6 Autoclave HgS hiramaya 1 2010 Rp 490,000
7 Autoclave HK 350 E hiramaya 1 2011 Rp 11,496,200
8 Bak instrumen 3 2011 Rp 1,000,000
9 UV sterilisator 156x 1 2010 Rp 43,645,000
10 UV water sterilisator UMS 693 2 2011 Rp 64,695,000
11 General purpose aesculap 2 2011 Rp 86,321,600
12 Electrosurgical unit aesculap 1 2010 Rp 93,050,268
Total - - -

Tabel 11.
Biaya Medis (AIC Medis) Pusat Biaya Poliklini
No Nama Alat Medis Jumlah Tahun Beli Harga Satuan
1 Dental unit 1 2014 Rp 58,675,000
2 Dental chair 1 2014 Rp 9,412,000
3 Tromol has 2 2014 Rp 672,000
4 Tang cabut gigi 50 2014 Rp 1,505,000
5 Gunting 10 2014 Rp 250,000
6 Mirror 10 2014 Rp 125,000
7 Pinset 10 2013 Rp 120,000
8 Sonde 10 2014 Rp 50,000
Total - - -

Tabel 12.
Biaya Medis (AIC Medis) Pusat Biaya Poliklinik
No Nama Alat Medis Jumlah Tahun Beli Harga Satuan
1 Stetoskop 1 2015 Rp 150,000
2 Tensi meter 1 2015 Rp 300,000
3 Spatel 2 2016 Rp 45,000
Total - - -

Tabel 13.
Biaya Medis (AIC Medis) Pusat Biaya Instalasi Ra
No Nama Alat Medis Jumlah Tahun Beli Harga Satuan
1 Tensi biasa 1 2014 Rp 150,000
2 Tiang infus 2 2014 Rp 1,400,000
3 Timbangan dewasa 1 2014 Rp 150,000
4 Pot feaces 2 2014 Rp 95,000
5 Pispot 2 2014 Rp 95,000
6 Near bekken 2 2014 Rp 16,000
7 Korentang 1 2014 Rp 32,000
8 Gunting verban 2 2014 Rp 45,000
9 Vinset 2 2014 Rp 35,000
10 Sterilisator 1 2015 Rp 2,500,000
11 Oksigen terapi 1 2015 Rp 2,125,000
12 Stateoscop 1 2016 Rp 200,000
13 Tensi meter berdiri 1 2016 Rp 1,450,000
14 Suction pump 1 2016 Rp 3,450,000
15 Basic diagnostic kit 1 2016 Rp 378,000
16 Regulator 1 2016 Rp 425,000
17 Tensi biasa 2 2016 Rp 215,000
18 Tiang infus 2 2016 Rp 1,550,000
Total - - -
 Tabel 10.
Medis (AIC Medis) Pusat Biaya UPF Bedah
Harga IIC Masa Pakai (t) Masa Hidup (L) Inflasi (I) AIC
Rp 6,336,000 8 20 8% Rp 586,375
Rp 6,150,000 9 20 8% Rp 614,694
Rp 215,000 8 20 8% Rp 19,897
Rp 740,000 8 20 8% Rp 68,484
Rp 4,800,000 9 20 8% Rp 479,761
Rp 490,000 9 20 8% Rp 48,976
Rp 11,496,200 8 20 8% Rp 1,063,933
Rp 3,000,000 8 20 8% Rp 277,640
Rp 43,645,000 9 20 8% Rp 4,362,328
Rp 129,390,000 8 20 8% Rp 11,974,593
Rp 172,643,200 8 20 8% Rp 15,977,526
Rp 93,050,268 9 20 8% Rp 9,300,396
Rp 471,955,668 - - - Rp 44,774,602

Tabel 11.
edis (AIC Medis) Pusat Biaya Poliklinik Gigi
Harga IIC Masa Pakai (t) Masa Hidup (L) Inflasi (I) AIC
Rp 58,675,000 5 20 8% Rp 4,310,641
Rp 9,412,000 5 20 8% Rp 691,466
Rp 1,344,000 5 10 8% Rp 197,478
Rp 75,250,000 5 10 8% Rp 11,056,694
Rp 2,500,000 5 10 8% Rp 367,332
Rp 1,250,000 5 10 8% Rp 183,666
Rp 1,200,000 6 10 8% Rp 190,425
Rp 500,000 5 10 8% Rp 73,466
- - - Rp 17,071,168

Tabel 12.
dis (AIC Medis) Pusat Biaya Poliklinik Umum
Harga IIC Masa Pakai (t) Masa Hidup (L) Inflasi (I) AIC
Rp 150,000 4 10 8% Rp 20,407
 Rp 300,000 4 10 8% Rp 40,815
Rp 90,000 3 10 8% Rp 11,337
- - - Rp 72,559

Tabel 13.
s (AIC Medis) Pusat Biaya Instalasi Rawat Inap
Harga IIC Masa Pakai (t) Masa Hidup (L) Inflasi (I) AIC
Rp 150,000 5 10 8% Rp 22,040
Rp 2,800,000 5 20 8% Rp 205,706
Rp 150,000 5 10 8% Rp 22,040
Rp 190,000 5 10 8% Rp 27,917
Rp 190,000 5 10 8% Rp 27,917
Rp 32,000 5 10 8% Rp 4,702
Rp 32,000 5 10 8% Rp 4,702
Rp 90,000 5 10 8% Rp 13,224
Rp 70,000 5 10 8% Rp 10,285
Rp 2,500,000 4 10 8% Rp 340,122
Rp 2,125,000 4 20 8% Rp 144,552
Rp 200,000 3 10 8% Rp 25,194
Rp 1,450,000 3 10 8% Rp 182,658
Rp 3,450,000 3 20 8% Rp 217,300
Rp 378,000 3 10 8% Rp 47,617
Rp 425,000 3 15 8% Rp 35,692
Rp 430,000 3 10 8% Rp 54,168
Rp 3,100,000 3 20 8% Rp 195,255
- - - Rp 1,581,092
 Tabel 14.
Biaya Investasi (AIC Gedung) Masing-Masing Pusat Bi
No Nama Kenderaan Merek Tahun Beli Harga IIC
1 Ambulance Toyota 12 2014 Rp 350,000,000
2 Minibus Mitshubishi Colt L300 2014 Rp 300,000,000
3 Minibus Toyota 2014 Rp 38,000,000
4 Sepeda motor Yamaha 2014 Rp 18,000,000
5 Ambulance Toyota 2016 Rp 395,000,000
6 Ambulance Toyota 2016 Rp 395,000,000
7 Avanza Veloz Toyota 2018 Rp 250,000,000
Total - - Rp 1,746,000,000

Tabel 15.
Distribusi Masing-Masing Kendaraan Pada Masing-Masing Pusat Biaya
AIC Kendaraan yang
No Nama Pusat Biaya Jumlah Pegawai % Pegawai
Ditanggung
1 Kantor 15 21% Rp 33,082,029
2 Apotek 5 7% Rp 11,027,343
3 Instalasi gizi 7 10% Rp 15,438,280
4 Laundry 4 6% Rp 8,821,874
5 UPF bedah 9 13% Rp 19,849,218
6 Poliklinik gigi 4 6% Rp 8,821,874
7 Poliklinik umum 6 9% Rp 13,232,812
8 Instalasi rawat inap 20 29% Rp 44,109,372
Total 70 100% Rp 154,382,804
bel 14.
ng) Masing-Masing Pusat Biaya
Masa Pakai (t) Masa Hidup (L) Inflasi (I) AIC
5 15 8% Rp 34,284,322
5 15 8% Rp 29,386,562
5 15 8% Rp 3,722,298
5 10 8% Rp 2,644,791
3 15 8% Rp 33,172,416
3 15 8% Rp 33,172,416
1 15 8% Rp 18,000,000
- - - Rp 154,382,804