Xiii. Pola Tarif Igd 2023 Fix

PERHITUNGAN POLA TARIF
TAHUN 2020
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 Harga SARANA (Rp) TAN (Rp) SARANA
NAMA BAHAN ISI Terpakai AN (Rp) AN (Rp)
Pemakaian Satuan (Rp) (Rp) (Rp) (Rp)
(Rp)
1 Pemeriksaan Dokter Umum / drg Kassa Hidrofil 40 yardx80cm 1000 gram 50 kali 133350 2,667
Povidon iodine 300ml 1000 Cc 50 kali 21780 436
Handscoon steril (MAXTER) 50 psg 5 kali 385000 77,000
Tissue 150 Lbr 20 kali 7000 350
Larutan Saline 100 ml 5 kali 31500 6,300
Disposable syringe 3 cc (ONE 100 pcs 9 kali 99800 11,089
Disposable syringe 10 cc (ON 100 pcs 20 kali 138600 6,930
104771.48889 35,000 139,771 93,181 232,952 233,000 139,771 93,181

2 Pemeriksaan Dokter Spesialis kali #DIV/0!
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#DIV/0! 35,000 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
3 Konsultasi Dokter Umum pada jam kerja ( on call) kali #DIV/0!
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4 Konsultasi Dokter Spesialis pada jam kerja ( on call) kali #DIV/0!
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5 Pendaftaran pasien baru kali #DIV/0!
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6 Pemasangan Infus kali #DIV/0!
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7 Jahit Luka Umum ≤ 5 jahitan kali #DIV/0!
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8 Jahitan Luka Umum 6-15 jahitan kali #DIV/0!
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9 Jahitan Luka Umum ≥ 16 jahitan kali #DIV/0!
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10 Bersih Luka / WT kali #DIV/0!
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11 Perawatan luka bakar 1%- 9% kali #DIV/0!
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12 Perawatan Luka Bakar 9%- 18% kali #DIV/0!
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13 Perawatan luka bakar >18 % kali #DIV/0!
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14 Penghentian perdarahan masif pada trauma kali #DIV/0!
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15 Penanganan shock kali #DIV/0!
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16 Pemasangan endotracheal tube ( intubasi ) kali #DIV/0!
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17 RJP tanpa intubasi kali #DIV/0!
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18 tindakan dengan DC Shock / cardioversi kali #DIV/0!
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19 Pemasangan NGT kali #DIV/0!
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20 Pemasangan kateter kali #DIV/0!
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21 Angkat jahitan kali #DIV/0!
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22 EKG kali #DIV/0!
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23 Tindakan Nebulizar / Kali kali #DIV/0!
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24 Reposisi Mandibula kali #DIV/0!
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25 Pemasangan Spalk jari kali #DIV/0!
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26 Pemasangan Spalk lengan kali #DIV/0!
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27 Pemasangan Spalk tungkai kali #DIV/0!
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28 Observasi kali #DIV/0!
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29 Visum Dokter Umum kali #DIV/0!
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30 Debridemen Orofasial ringan kali #DIV/0!
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#DIV/0! 35,000 30% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 50% #DIV/0! #DIV/0! #DIV/0!
31 Debridement orofacial sedang kali #DIV/0!
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32 Debridement orofacial berat kali #DIV/0!
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33 Jahit Luka Gusi 1-3 jahitan kali #DIV/0!
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34 jahit Luka gusi >3 jahitan kali #DIV/0!
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35 Splinting kali #DIV/0!
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36 Insisi Abses kali #DIV/0!
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37 Ekstraksi kuku kali #DIV/0!
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38 Irigasi mata kali #DIV/0!
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39 Nekrotomi kali #DIV/0!
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40 Pemeriksaan GDS kali #DIV/0!
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41 Suction/ penghisapan lendir kali #DIV/0!
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42 Corpus aleanum kali #DIV/0!
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43 Bilas lambung kali #DIV/0!
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44 Pengobatan stomatitis kali #DIV/0!
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45 Infus Pump/ Hari kali #DIV/0!
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46 Pemakaian O2 1-4 L/ Menit ( per satu jam) kali #DIV/0!
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47 Pemakaian O2 1-4 L/ Menit ( > 4jam / 1 hari) kali #DIV/0!
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48 Pemakaian O2 5- 8 L/ Menit ( per satu jam) kali #DIV/0!
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49 Pemakaian O2 5-8 L/ Menit ( > 4jam / 1 hari) kali #DIV/0!
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50 Injeksi SC/ IM/ IV di IGD kali #DIV/0!
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51 Amputasi / Flep 1 jari kali #DIV/0!
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52 Perawatan Jenazah kali #DIV/0!
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53 Ambulance (0 - 12km) kali #DIV/0!

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54 kali #DIV/0!
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VIP
PEMBULAT
TOTAL (Rp)
AN (Rp)
232,952 233,000
#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!
#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!
#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!
#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!
#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!
#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!
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XIII. TARIF PELAYANAN UNIT GAWAT DARURAT (UGD) RSKGM
BESAR TARIF (R
Pelayanan Unit Gaw

NO JENIS PELAYANAN
Jasa Sarana
1 2 3
1 27,000
Pemeriksaan Dokter Umum / drg
2 48,000
Pemeriksaan Dokter Spesialis
3 18,000
Konsultasi Dokter Umum pada jam kerja ( on call)
4 36,000
Konsultasi Dokter Spesialis pada jam kerja ( on call)
5 21,000
Pendaftaran pasien baru
6 27,000
Pemasangan Infus
7 48,000
Jahit Luka Umum ≤ 5 jahitan
8 120,000
6- 15 jahitan
9 168,000
≥ 16 jahitan
10 27,000
Bersih Luka / WT
11 57,000
Perawatan luka bakar 1%- 9%
12 66,000
9%- 18%
13 102,000
> 18%
14 36,000
Penghentian perdarahan masif pada trauma
15 60,000
Penanganan shock
16 60,000
Pemasangan endotracheal tube ( intubasi )
17 60,000
RJP tanpa intubasi
18 75,000
tindakan dengan DC Shock / cardioversi
19 24,000
Pemasangan NGT
20 36,000
Pemasangan kateter
21 3,000
Angkat jahitan (Per- Jahitan)
22 27,000
EKG
23 36,000
Tindakan Nebulizar / Kali
24 96,000
Reposisi Mandibula
25 42,000
Pemasangan Spalk jari
26 66,000
Pemasangan Spalk lengan
27 90,000
Pemasangan Spalk tungkai
28 30,000
Observasi
29 48,000
Visum dokter umum
30 36,000
Debridement orofacial ringan
31 108,000
Debridement orofacial sedang
32 180,000
Debridement orofacial berat
33 30,000
Jahit Luka Gusi 1-3 jahitan
34 60,000
jahit Luka gusi >3 jahitan
35 48,000
Splinting
36 204,000
Insisi Abses
37 66,000
Ekstraksi kuku
38 42,000
Irigasi mata
39 72,000
Nekrotomi
40 9,000
Pemeriksaan GDS
41 36,000
Suction/ penghisapan lendir
42 48,000
Corpus aleanum
43 90,000
Bilas lambung
44 18,000
Pengobatan stomatitis
45 45,000
Infus Pump/ Hari
46 21,000
Pemakaian O2 1-4 L/ Menit ( per satu jam)
47 60,000
Pemakaian O2 1-4 L/ Menit ( > 4jam / 1 hari)
48 27,000
Pemakaian O2 5- 8 L/ Menit ( per satu jam)
49 129,000
Pemakaian O2 5-8 L/ Menit ( > 4jam / 1 hari)
50 6,000
Injeksi SC/ IM/ IV di IGD
51 120,000
Amputasi / Flep 1 jari
52 60,000
Perawatan Jenazah
53 90,000
Ambulance (0 - 12km)
BESAR TARIF (RUPIAH)
Pelayanan Unit Gawat Darurat
Jasa Pelayanan TOTAL
4 5
18,000 45,000
32,000 80000
12,000 30000
24,000 60000
14,000 35000
18,000 45000
32,000 80000
80,000 200000
112,000 280000
18,000 45000
38,000 95000
44,000 110000
68,000 170000
24,000 60000
40,000 100000
40,000 100000
40,000 100000
50,000 125000
16,000 40000
24,000 60000
2,000 5000
18,000 45000
24,000 60000
64,000 160000
28,000 70000
44,000 110000
60,000 150000
20,000 50000
32,000 80000
24,000 60000
72,000 180000
120,000 300000
20,000 50000
40,000 100000
32,000 80000
136,000 340000
44,000 110000
28,000 70000
48,000 120000
6,000 15000
24,000 60000
32,000 80000
60,000 150000
12,000 30000
30,000 75000
14,000 35000
40,000 100000
18,000 45000
86,000 215000
4,000 10000
80,000 200000
40,000 100000
60,000 150000
UNIT COST PER TINDAKAN VIP KONSERVASI
Jumlah Harga Jumlah

No Jenis Tindakan Nama Bahan Isi
Pemakaian (Rupiah) (Rupiah)
1 Komposit 1 bidang Kapas 1000 gram 1 gram 65,000 65
hybrid Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
Hand Scoon 50 Pasang 2 Pasang 65,000 2,600
Masker 50 Buah 2 Buah 35,250 1,410
Gelas Kumur 2000 Buah 1 Buah 335,000 168
Set Bur Diamond 1 Set 0.1 Set 150,000 15,000
GIC ( Semen Base ) 15 gr 0.2 gr 1,000,000 13,333
Seluloid Strip 100 Lembar 0.5 Lembar 93,500 468
Etsa 3 ml 0.2 ml 320,000 21,333
Bonding 5 ml 0.1 ml 1,255,000 25,100
Composit 4 gr 0.2 gr 516,000 25,800
Alat Sinar
Tissue 150 Lembar 4 Lembar 7,000 187
Kertas Artikulasi 144 Lembar 0.5 Lembar 193,050 670
Set Alat Poles 1 Set 0.05 Set 750,000 37,500
Saliva Ejector 100 Buah 1 Buah 70,000 700
Slabber 100 Lembar 1 Lembar 117,000 1,170
Micro Brush 100 Buah 1 Buah 370,000 3,700
Cotton Roll 600 Buah 10 Buah 42,500 708
Maintenance
CSSD
Air + Listrik
Penyusutan dental Unit
Total Unit Cost 150,116
Betadine 1000 Cc 1 Cc 100,100 100
Etsa 3 ml 0.2 ml 320,000 21,333
Bonding 5 ml 0.1 ml 1,255,000 25,100
Composit 4 gr 0.3 gr 516,000 38,700
Alat Sinar
Maintenance
CSSD
Air + Listrik
3 Komposit >2 bidang Kapas 1000 gram 1 gram 65,000 65
Betadine 1000 Cc 1 Cc 100,100 100
3 Komposit >2 bidang
hybrid

Matrix Sectional 1 Set 0.004 Set 9,000,000 36,000
Etsa 3 ml 0.2 ml 320,000 21,333
Bonding 5 ml 0.1 ml 1,255,000 25,100
Composit 4 gr 0.4 gr 516,000 51,600
Alat Sinar
Maintenance
CSSD
Air + Listrik
Jumlah Harga Jumlah
Nano Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
Etsa 3 ml 0.2 ml 320,000 21,333
Bonding 5 ml 0.1 ml 1,255,000 25,100
Composit 4 gr 0.2 gr 516,000 25,800
Alat Sinar
Maintenance
CSSD
Air + Listrik
Betadine 1000 Cc 1 Cc 100,100 100
Etsa 3 ml 0.2 ml 320,000 21,333
Bonding 5 ml 0.1 ml 1,255,000 25,100
Composit 4 gr 0.3 gr 516,000 38,700
Alat Sinar
Maintenance
CSSD
Air + Listrik
6 Komposit >2 bidang Kapas 1000 gram 1 gram 65,000 65
Betadine 1000 Cc 1 Cc 100,100 100
Matrix Sectional 1 Set 0.004 Set 9,000,000 36,000
Etsa 3 ml 0.2 ml 320,000 21,333
Bonding 5 ml 0.1 ml 1,255,000 25,100
Composit 4 gr 0.4 gr 516,000 51,600
Alat Sinar
Maintenance
CSSD
Air + Listrik
Jumlah Harga Jumlah
7 Tambalan GIC Kecil Kapas 1000 gram 1 gram 65,000 65
Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
Glassionomer 15 gr 0.2 gr 1,000,000 13,333
Dentin Conditioner 5.7 ml 0.02 Botol 157,000 551
Maintenance
CSSD
Air + Listrik
8 Tambalan GIC Besar Kapas 1000 gram 1 gram 65,000 65
Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
Glassionomer 15 gr 0.3 gr 1,000,000 20,000
Dentin Conditioner 5.7 ml 0.02 Botol 157,000 551
Maintenance
CSSD
Air + Listrik
9 Direct Veneer Kapas 1000 gram 1 gram 65,000 65
Composite Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
Composite Veneer Amaris 31.6 gr 0.6 gr 11,700,000 222,152
Etsa 3 ml 0.2 ml 320,000 21,333
Bonding 5 ml 0.1 ml 1,255,000 25,100
Alat sinar
Alat poles ( Soft Lex ) 40 buah 4 buah 520,000 52,000
Mikro Brush 100 Buah 1 Buah 370,000 3,700
Saliva Ejector 100 Buah 1 Buah 700,000 7,000
Finishing Strip 100 Lembar 0.5 Lembar 525,000 2,625
Maintenance
CSSD
Air + Listrik
Jumlah Harga Jumlah
10 Amalgam Kavitas Kapas 1000 gram 1 gram 65,000 65
Kecil Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
Zinc Phospat 30 gram 0.25 gram 386,100 3,218
Eugenol 20 ml 0.05 ml 80,000 200
Alloy Amalgam 50 Kapsul 1 Kapsul 0
Amalgamator
Cotton Roll 600 Buah 10 Buah 42,500 1,083
Maintenance
CSSD
Air + Listrik
11 Amalgam Kavitas Kapas 1000 gram 1 gram 65,000 65
Besar Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
Zinc Phospat 30 gram 0.25 gram 386,100 3,218
Eugenol 20 ml 0.05 ml 80,000 200
Alloy Amalgam 50 Kapsul 2 Kapsul 0
Amalgamator
Maintenance
CSSD
Air + Listrik
12 Pulp Capping Kapas 1000 gram 1 gram 65,000 65
Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
Kalsium Hidroksida 13 gram 0.1 gram 620,000 4,769
GIC 15 gram 0.2 gram 1,000,000 13,333
Tambalan Sementara 30 gram 0.3 gram 190,000 1,900
Maintenance
CSSD
Air + Listrik
13 Trepanasi Kapas 1000 gram 1 gram 65,000 65
Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
Larutan NaOCl 3 % 1000 cc 10 cc 84,500 845
Larutan H2O2 1000 cc 10 cc 42,900 429
Spuit 3 cc 100 Buah 1 Buah 85,000 850
Maintenance
CSSD
Air + Listrik
Jumlah Harga Jumlah
14 PSA 1 Saluran Akar Kapas 1000 gram 1 gram 65,000 65
Manual Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
Set Bur 1 Set 0.1 Set 150,000 15,000
Jarum ekstirpasi 1 Set 0.1 Set 235,000 23,500
K-File 06 1 Buah 0.2 Buah 53,400 10,680
K-File 08 1 Buah 0.1 Buah 53,400 5,340
K File 10 1 Buah 0.1 Buah 53,400 5,340
Protaper Manual 1 set 0.1 set 1,222,000 122,200
Larutan Aquadest 1000 cc 10 cc 5,000 50
Larutan NaOCl 3 % 1000 cc 10 cc 169,000 1,690
Larutan Chlorhexidine 2% 100 ml 5 ml 58,500 2,925
EDTA Liquid 17 % 30 cc 1 cc 71,500 2,383
Edta Gel 12 gram 0.3 gram 200,000 5,000
Paper Point 200 Buah 3 Buah 45,000 675
TKF/ Rockles/ Creso 13 ml 0.05 ml 450,000 1,731
Jarum Irigasi 100 Buah 1 Buah 390,000 3,900
Endo Access 1 Buah 0.1 Buah 130,000 13,000
Apex Locator
Maintenance
CSSD
Air + Listrik
Rotary Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
Set Bur 1 Set 0.1 Set 200,000 20,000
K-File 06 1 Buah 0.2 Buah 53,400 10,680
K-File 08 1 Buah 0.1 Buah 53,400 5,340
K File 10 1 Buah 0.1 Buah 53,400 5,340
Protaper Rotary 1 set 0.1 set 1,222,000 122,200
EDTA Liquid 17 % 30 cc 1 cc 71,500 2,383
Endomotor
Apex Locator
Maintenance
CSSD
Air + Listrik
Jumlah Harga Jumlah
16 PSA 2 Saluran Akar
Manual Kapas 1000 gram 1 gram 65,000 65

Betadine 1000 Cc 1 Cc 100,100 100
Set Bur 1 Set 0.1 Set 150,000 15,000
K-File 06 1 Buah 0.4 Buah 53,400 21,360
K-File 08 1 Buah 0.2 Buah 53,400 10,680
K File 10 1 Buah 0.2 Buah 53,400 10,680
EDTA Liquid 17 % 30 cc 1 cc 71,500 2,383
Apex Locator
Maintenance
CSSD
Air + Listrik
Betadine 1000 Cc 1 Cc 100,100 100
Set Bur 1 Set 0.1 Set 150,000 15,000
K-File 06 1 Buah 0.4 Buah 53,400 21,360
K-File 08 1 Buah 0.2 Buah 53,400 10,680
K File 10 1 Buah 0.2 Buah 53,400 10,680
EDTA Liquid 17 % 30 cc 1 cc 71,500 2,383
Endomotor
Apex Locator
Maintenance
CSSD
Air + Listrik
Jumlah Harga Jumlah
18 PSA >2 Saluran Akar Kapas 1000 gram 1 gram 65,000 65
Betadine 1000 Cc 1 Cc 100,100 100
Set Bur 1 Set 0.1 Set 150,000 15,000
K-File 06 1 Buah 0.6 Buah 53,400 32,040
K-File 08 1 Buah 0.3 Buah 53,400 16,020
K File 10 1 Buah 0.3 Buah 53,400 16,020
EDTA Liquid 17 % 30 cc 1 cc 71,500 2,383
Apex Locator
Maintenance
CSSD
Air + Listrik
19 PSA >2 Saluran Akar Kapas 1000 gram 1 gram 65,000 65
Betadine 1000 Cc 1 Cc 100,100 100
Set Bur 1 Set 0.1 Set 150,000 15,000
K-File 06 1 Buah 0.6 Buah 53,400 32,040
K-File 08 1 Buah 0.3 Buah 53,400 16,020
K File 10 1 Buah 0.3 Buah 53,400 16,020
EDTA Liquid 17 % 30 cc 1 cc 71,500 2,383
Endomotor
Apex Locator
Maintenance
CSSD
Air + Listrik
Jumlah Harga Jumlah
20 Medikamen 1 Saluran Kapas 1000 gram 1 gram 65,000 65
akar Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
Set Bur 1 Set 0.1 Set 150,000 15,000
Ca(OH)2 10 gram 0.1 gram 71,500 715
K-File Manual 1 Set 0.1 Set 162,000 16,200
Maintenance
CSSD
Air + Listrik
21 Medikamen 2 Saluran Kapas 1000 gram 1 gram 65,000 65
akar Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
Set Bur 1 Set 0.1 Set 150,000 15,000
Ca(OH)2 10 gram 0.1 gram 71,500 715
Maintenance
CSSD
Air + Listrik
22 Medikamen >2 Kapas 1000 gram 1 gram 65,000 65
Saluran akar Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
Set Bur 1 Set 0.1 Set 150,000 15,000
Ca(OH)2 10 gram 0.1 gram 71,500 715
Maintenance
CSSD
Air + Listrik
23 Pengisian 1 Saluran Kapas 1000 gram 1 gram 65,000 65
Akar Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
Jarum Lentulo 1 Set 0.01 Set 200,000 2,000
Finger Spreader 1 Set 0.01 Set 200,000 2,000
Finger Plugger 1 Set 0.01 Set 200,000 2,000
Gutta Percha 200 Buah 1 Buah 576,000 2,880
Endomethasone 14 gram 0.2 gram 708,000 10,114
AH Plus 8 gram 0.2 gram 1,300,000 32,500
MTA 50,000
EDTA Liquid 17 % 30 cc 1 cc 71,500 2,383
GIC 15 gram 0.2 gram 1,000,000 13,333
Maintenance
CSSD
Air + Listrik
Total Unit Cost (Endomethason) 50,093
Total Unit Cost (Resin) 72,478
Total Unit Cost (MTA) 89,978
24 Pengisian 2 Saluran Kapas 1000 gram 1 gram 65,000 65
Betadine 1000 Cc 1 Cc 100,100 100
AH Plus 8 gram 0.3 gram 1,300,000 48,750
MTA 60,000
EDTA Liquid 17 % 30 cc 1 cc 71,500 2,383
GIC 15 gram 0.2 gram 1,000,000 13,333
Maintenance
CSSD
Air + Listrik
25 Pengisian >2 Saluran Kapas 1000 gram 1 gram 65,000 65
Betadine 1000 Cc 1 Cc 100,100 100
AH Plus 8 gram 0.4 gram 1,300,000 65,000
MTA 75,000
EDTA Liquid 17 % 30 cc 1 cc 71,500 2,383
GIC 15 gram 0.2 gram 1,000,000 13,333
Maintenance
CSSD
Air + Listrik
26 BLEACHING Kapas 1000 gram 1 gram 65,000 65
EKSTERNAL Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
GIC 15 gram 0.4 gram 1,000,000 26,667
Bahan Bleaching 1 Set 1 Set 2,450,000 2,450,000
Vitamin E 16 kapsul 1 kapsul 25,000 1,563
Maintenance
CSSD
Air + Listrik
Total Unit Cost 2,499,732
27 BLEACHING Kapas 1000 gram 1 gram 65,000 65
INTERNAL Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
GIC 15 gram 0.5 gram 1,000,000 33,333
Bahan Bleaching 1 Set 0.1 Set 900,000 90,000
Vitamin E 16 kapsul 1 kapsul 25,000 1,563
Maintenance
CSSD
Air + Listrik
28 DOWEL + Cetak Kapas 1000 gram 1 gram 65,000 65
Metal Post Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
Bur Peaso Reamer 1 Set 0.02 Set 500,000 10,000
Spuit 3 cc 100 Buah 2 Buah 85,000 1,700
GIC Fuji I 35 gram 0.5 gram 1,193,000 17,043
Pin / Pasak Logam 100 Buah 1 Buah 1,250,000 12,500
Core Built Up 4 gram 0.4 gram 377,000 37,700
Maintenance
CSSD
Air + Listrik
29 DOWEL + Cetak Kapas 1000 gram 1 gram 65,000 65
Fiber Post Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
Bur Peaso Reamer 1 Set 0.02 Set 500,000 10,000
Pasak Fiber 5 Buah 1 Buah 1,180,000 236,000
Core Built Up 9 gram 0.9 gram 1,534,000 153,400
Etsa 3 ml 0.2 ml 320,000 21,333
Bonding 5 ml 0.2 ml 1,255,000 50,200
Maintenance
CSSD
Air + Listrik
30 Inlay/Onlay/Uplay Kapas 1000 gram 1 gram 65,000 65
LOGAM Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
30 Inlay/Onlay/Uplay
LOGAM

Bahan Cetak Alginat 500 gram 18 gram 156,000 5,616
Double Impression Putty 1000 gram 37.5 gram 1,350,000 50,625
Double Impression Inj 148 ml 6 ml 585,000 23,716
Moldano 1000 gram 85 gram 84,000 7,140
Lilin Casting 10 Lembar 0.3 Lembar 55,000 1,650
GIC Fuji I 35 gram 0.5 gram 1,193,000 17,043
Spritus 1000 Liter 10 Liter 13,000 130
Lab Teknik - - - - - -
Polishing Brush 2 Buah 0.2 Buah 105,000 10,500
Maintenance
CSSD
Air + Listrik
Emax Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
Semen Resin 4 gram 0.4 gram 1,670,000 167,000
Silane 3 ml 0.05 ml 325,000 5,417
Etsa 3 ml 0.2 ml 320,000 21,333
Bonding 5 ml 0.2 ml 1,255,000 50,200
Lab Dental
Gingival Cord 245 cm 3 cm 280,000 3,429
Maintenance
CSSD
Air + Listrik
PFM Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
GI Fuji I 35 gram 0.5 gram 1,193,000 17,043
Lab Dental
Gingival Cord 245 cm 3 cm 280,000 3,429
Polishing Brush 2 Buah 0.2 Buah 105,000 10,500
Maintenance
CSSD
Air + Listrik
33 Retreatment Kapas 1000 gram 1 gram 65,000 65
Alkohol 1000 Cc 2 Cc 52,000 104
Betadine 1000 Cc 1 Cc 100,100 100
Solvent Guttap 13 ml 0.5 ml 450,000 17,308
Jarum Hedstrom 1 Set 0.1 Set 100,000 10,000
Larutan EDTA 30 cc 0.5 cc 71,500 1,192
Paper Point 200 Buah 6 Buah 45,000 1,350
Cresotin 15 ml 0.05 ml 450,000 1,500
Maintenance
CSSD
Air + Listrik
34 Inlay/Onlay/Uplay
Emax
Total Unit Cost 0

Pembulatan
(Rupiah)
150116.079
163016.079
0
211448.579
0
Pembulatan
(Rupiah)
0
Pembulatan
(Rupiah)
40933.623
47600.2897
0
0
Pembulatan
(Rupiah)
0
42589.1641
23837.2667
0
Pembulatan
(Rupiah)
222667.369
227667.369
0
Pembulatan
(Rupiah)
0
0
Pembulatan
(Rupiah)
0
0
Pembulatan
(Rupiah)
0
0
0
0
0
0
0
0
0
-
0
0
0
0
0
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
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
27 27/01/2023 PT Mulawarman Kesada Medicalindo  E-Katalog
30 19/01/2023 PT. DJEMBATAN DUA  E-Katalog
33 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

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
52 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

60 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
71 23/02/2023 PT NOVAPHARIN (1)  E-Katalog
75 27/02/2023 PT Jayamas Medica Industri (1)  E-Katalog
86 01/03/2023 PT. Hexpharm Jaya Laboratories  E-Katalog
89 07/03/2023 PT.GLOBAL DISPOMEDIKA  E-Katalog
91 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
128 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
157 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
172 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
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
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


210 27/06/2023 PT. KASTARA  E-Katalog
213 13/07/2023 PT. MPM  PL
214 10/07/2023 PT. COBRA DENTAL  PL
243 13/07/2023 PT.GDC  E-Katalog
244 13/07/2023 PT.GDC  E-Katalog
249 21/07/2023 PT. COBRA DENTAL INDONESIA  E-Katalog
256 21/07/2023 PT. BHINEKA MITRA SEJATI  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
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
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
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
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
Asam tranexamat inj 3,000
Ceftriaxone inj 1gr 5,875
Captopril 25 mg 129
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
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 rotary gold 21 mm 568,508
Gutta Percha Protaper F1 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
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
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.12 460,000
Amplas no 1000 20,000
Amplas no 1500 20,000
Amplas no 240 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
15CMx2.5CMx100M
Indikator Strip SAN PACK Sterilization Indicating Card 177,100
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
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
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
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
8 25/05/2023 PT. Samator Gas Industri  PL
10 08/06/2023 Apotek Maggha Mulia  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
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

35 31/07/2023 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
77 02/08/2023 PT. Intisumber Hasil Sempurna  PL
80 11/08/2023 PT.EURANIAGA MITRA ABADI  PL

83 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
94 18/08/2023 PT. Tri Putra Mandiri  PL
99 28/08/2023 PT. Dexa Medica (AAM)  E-Katalog
104 07/08/2023 PT. AGTIFA DWI PUTRI  PL
116 18/09/2023 PT. Enseval  PL
117 18/09/2023 PT. Enseval  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
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
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

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
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
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
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
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
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
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
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
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

Xiii. Pola Tarif Igd 2023 Fix

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Xiii. Pola Tarif Igd 2023 Fix

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PERHITUNGAN POLA TARIF

PELAYANAN DOKTER GIGI UMUM

104771.48889 35,000 139,771 93,181 232,952 233,000 139,771 93,181

53 Ambulance (0 - 12km) kali #DIV/0!

Pelayanan Unit Gaw

Pelayanan Unit Gawat Darurat

Jasa Pelayanan TOTAL

Jumlah Harga Jumlah

Gelas Kumur 2000 Buah 1 Buah 335,000 168

Manual Alkohol 1000 Cc 2 Cc 52,000 104

Hand Scoon 50 Pasang 2 Pasang 65,000 2,600

Total Unit Cost 0

KONSULTASI MEDIS DAN TINDAKAN KEPERAWATAN

TINDAKAN MEDIK DARURAT

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

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

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

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

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

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

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

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

301 11/08/2023 PT. Euraniaga  PL

Kassa Hidrofil 40 yardx80cm 190,000

NRM anak 16,100

NaCl infus 7,673

Aqua pro inj 2,955

Spironolakton 25mg 833

Klorheksidin glukonat 0.2% 23,000

1 14/03/2023 PT. COBRA DENTAL  PL

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

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

Film Rontgen Dental 264,000

Natrium Diklofenak 50 mg 197

NO Nama Barang Jumlah Satuan Harga

IV. BMHP Non e-katalog

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