PT.

Diagnos Laboratorium Utama

Rekapitulasi RAB pembanguan Laboratorium Diagnos RS Pusura Rev.02

No Keterangan Luas Detail Jumlah

1 Pekerjaan Sipil 30m2 120,000,000.00
Pek. Furniture R Lab Teknis 100,000,000.00
Pek. Mekanikal Elektrikal 20,000,000.00
2 Perlengkapan PPIC dan GA 219,611,499.00
Alat Utama Lab -
Alat Bantu Lab 68,215,000.00
Peralatan Sampling 1,645,000.00
Reagen & BHP 140,842,499.00
Peralatan Rumah tangga 8,324,000.00
Atk 585,000.00
3 Peralatan IT 3,755,000.00
4 Biaya Promosi 4,680,000.00
5 Biaya Mutasi Perlengkapan PPIC dan GA 25,000,000.00 25,000,000.00
373,046,499.00

Diajukan oleh, Diperiksa oleh, Diperiksa oleh, Disetujui oleh,

Site Project Manager Direktur Operasional Direktur Keuangan Managing Director

R.Hilman Ridwan Dilly Dwiasri Fergus Richard dr.Dennis Jacobus

RAB PROMOSI
DIAGNOS PUSURA
No Detail Size Quantity Price Price

1 Flyer PGTA A5 1 Rim Rp 750,000 Rp 750,000

2 Flyer DNAandMe A5 1 Rim Rp 750,000 Rp 750,000
3 Flyer HPV A5 1 Rim Rp 750,000 Rp 750,000
4 Flyer NIPT A5 1 Rim Rp 750,000 Rp 750,000
5 Flyer Thalassemia A5 1 Rim Rp 750,000 Rp 750,000
6 Flyer Allergy A5 1 Rim Rp 750,000 Rp 750,000
7 Roll up Banner NIPT 60x160 1 pcs drop from HO drop from HO
8 Roll up Banner DNAandMe 60x160 1 pcs drop from HO drop from HO
9 Roll up banner PGTA 60x160 1 pcs drop from HO drop from HO
10 Spanduk Opening Promo 3x1 1 pcs Rp 180,000 Rp 180,000
11 Neonbox 2x1 1pcs Rp 6,000,000
Total Rp 10,680,000 Rp 4,680,000
RAB Peralatan IT
Outlet
No Perangkat Jumlah UOM Perkiraan Harga satuan Total Harga Total Harga
1 PC Zyrex Standard 3 PCS 8,800,000 26,400,000 stock IT
2 Monitor LG 3 PCS 2,200,000 6,600,000 stock IT
3 Printer Hasil 2 PCS 2,700,000 5,400,000 stock IT
4 Printer Barcode 2 PCS 3,200,000 6,400,000 stock IT
5 Scanner Barcode 1 PCS 1,700,000 1,700,000 stock IT
6 Modem Prolink 4G 1 PCS 2,000,000 2,000,000 stock IT
7 Mikrotik Routerboard RB2011UIAS-RM 1 PCS 2,400,000 2,400,000 stock IT
8 Rak Server 4U 1 PCS 2,000,000 2,000,000 stock IT
9 Wiring Cable 1 PCS 200,000 200,000 stock IT
10 Telepon internet (dengan RS) 1 PCS 1,000,000 1,000,000 1,000,000
11 RJ45 cat6 20 PCS 10,000 200,000 200,000
12 Kabel Belden cat6 0 roll 2,500,000 - dari kontraktor
13 License Wynacom per bulan 2 unit 1,000,000 2,000,000 2,000,000
14 kabel duct (TC4) 30 meter 8,000 240,000 240,000
15 pipa kabel (untuk di atas plafon) 15 meter 10,000 150,000 150,000
16 Wallplate RJ45 isi 2 3 PCS 40,000 120,000 120,000
17 Mousepad 3 PCS 15,000 45,000 45,000
56,855,000 3,755,000
 JENIS LAB Outlet
NAMA LAB Lab Diagnos Morula IVF Surabaya
ALAMAT Jl. Boulevard Famili Sel, Babatan, Kec. Wiyung, Bota Surabaya, Jawa Timur 60227

HARGA SATUAN
NO ITEM KEBUTUHAN SATUAN JUMLAH HARGA KETERANGAN RAB tahap 1 RAB tahap 2
(November 2022)

ALAT UTAMA LAB

1 Hematologi Analyzer Sysmex XN-330 (5 Diff) 1 Unit Rp 210,000,000 Rp 210,000,000 mutasi outlet KP Rp -
2 Clinical Chemistry Analyzer Cobas c111 1 Unit KSO Processed to Vendor
3 Urinalisis Analyzer Cobas U1100 1 Unit KSO Processed to Vendor
4 Immunology Analyzer Cobas E411 1 Unit KSO Processed to Vendor
5 Hemostasis Analyzer START MAX 1 Unit KSO PR tahap II Rp -
6 Electrolyte Blood Gas Analyzer 1 Unit KSO PR tahap II Rp -
Rp 210,000,000
ALAT BANTU
6 Microskop CX23 LED - HEMA 1 Unit Rp 20,000,000 Rp 20,000,000 Mutasi Shalom
7 Centrifuge Hettic Eba 200 2 Unit Rp 25,000,000 Rp 50,000,000 Mutasi Shalom (1 unit)/ mutasi stok purchasing HO
8 Centrifuge Ultra High Speed 1 Unit Rp 54,000,000 Rp 54,000,000 PR tahap II Rp 54,000,000
9 Mikropipet Socorex 5-50 uL 1 Unit Rp 3,500,000 Rp 3,500,000 Mutasi Shalom
10 Mikropipet Socorex 20-200 uL 1 Unit Rp 3,500,000 Rp 3,500,000 Mutasi Shalom
11 Mikropipet Socorex 100-1000 uL 1 Unit Rp 3,500,000 Rp 3,500,000 Mutasi Shalom
12 Mikropipet Socorex 50 uL 1 Unit Rp 3,500,000 Rp 3,500,000 Mutasi BIC
13 Mikropipet Socorex 1000 uL 1 Unit Rp 3,500,000 Rp 3,500,000 Mutasi BIC
14 Rak mikropipet + Tip acrilic 1 Unit Rp 250,000 Rp 250,000 Mutasi HO
15 Roller blood mixer Dlab MX T6X 1 Unit Rp 5,000,000 Rp 5,000,000 Mutasi Shalom
16 Rotator gemmy VRN 210 1 Unit Rp 6,000,000 Rp 6,000,000 Mutasi Shalom
17 Bilik Hitung Newbouer improved 1 Unit Rp 2,000,000 Rp 2,000,000 Mutasi shalom/klinik pintar
18 Diff counter 1 Unit Rp 5,000,000 Rp 5,000,000 Mutasi Shalom
19 Bola karet penghisap / Pipet filler 2 Unit Rp 300,000 Rp 600,000 Mutasi shalom/klinik pintar
20 Vol pipet 1 mL iwaki 1 Unit Rp 150,000 Rp 150,000 Mutasi shalom/klinik pintar
21 Vol pipet 2 mL iwaki 1 Unit Rp 150,000 Rp 150,000 Mutasi shalom/klinik pintar
22 Vol pipet 3 mL iwaki 1 Unit Rp 150,000 Rp 150,000 Mutasi shalom/klinik pintar
23 Vol pipet 5 mL iwaki 1 Unit Rp 150,000 Rp 150,000 Mutasi shalom/klinik pintar
24 Vol pipet 10 mL iwaki 1 Unit Rp 150,000 Rp 150,000 Mutasi shalom/klinik pintar
25 Beckerglass 250ml iwaki 1 Unit Rp 150,000 Rp 150,000 Mutasi shalom/klinik pintar
26 Cawan petri glass 90x15mm duran 1 Unit Rp 150,000 Rp 150,000 Mutasi shalom/klinik pintar
27 Ose kaca bulat 1 Unit Rp 100,000 Rp 100,000 Mutasi shalom/klinik pintar
28 Penjepit Kayu / korentang 2 Unit Rp 50,000 Rp 100,000 Mutasi shalom/klinik pintar
Mutasi Shalom/kulkas RT
29 Showcase GEA EXPO 480PH 1 Unit Rp 18,000,000 Rp 18,000,000 Rp 4,000,000
(kulkas Polytron 2 pintu)
30 Freezer -20 Sample GEA AB226R 1 Unit Rp 6,000,000 Rp 6,000,000 PR tahap II Rp 6,000,000
31 Lampu Spirtus 150ml (bunsen) 1 Unit Rp 250,000 Rp 250,000 Mutasi shalom/klinik pintar
32 Stopwatch Digital 1 Unit Rp 200,000 Rp 200,000 Mutasi shalom/klinik pintar
33 Hand tally Counter 1 Unit Rp 100,000 Rp 100,000 Mutasi shalom/klinik pintar
34 Timer RRT 1 Unit Rp 100,000 Rp 100,000 Mutasi shalom/klinik pintar
35 Plate widal besar 1 Unit Rp 100,000 Rp 100,000 Mutasi shalom/klinik pintar
36 Thermometer lemari pendingin digital-freezer 2 Unit Rp 300,000 Rp 600,000 Mutasi shalom/klinik pintar
37 Thermologger (untuk coolbox) 2 Unit Rp 300,000 Rp 600,000 PR tahap I Rp 600,000
38 Termometer ruangan - HTC-1 1 Unit Rp 300,000 Rp 300,000 PR tahap I Rp 300,000
39 Lampu Meja + Bohlam 1 Unit Rp 300,000 Rp 300,000 Mutasi shalom/klinik pintar
40 Rak tabung 12x75, 4x10 dia 12 2 Unit Rp 100,000 Rp 200,000 Mutasi shalom/klinik pintar

Page 1 of 7
 HARGA SATUAN
NO ITEM KEBUTUHAN SATUAN JUMLAH HARGA KETERANGAN RAB tahap 1 RAB tahap 2
(November 2022)

41 Rak tabung besar/tb urine 16x100 40 hole dia 16 1 Unit Rp 100,000 Rp 100,000 Mutasi shalom/klinik pintar/stok purchasing HO
42 Rak urine u/ bocal urine 1 Unit Rp 400,000 Rp 400,000 Mutasi shalom/klinik pintar/stok purchasing HO
43 Rak pengecatan/pewarnaan acrilik 1 Unit Rp 500,000 Rp 500,000 Mutasi shalom/klinik pintar
44 Box Spillkit + Isi 1 Set Rp 700,000 Rp 700,000 PR tahap I (mutasi GA HO)
45 APAR CO2 3kg 1 Unit Rp 775,000 Rp 775,000 PR tahap I Rp 775,000
Alat Glukosa POCT (Achucheck Guide) + Pen
46 1 Unit KSO Mutasi dari CP Morula Sby
(KSO)
47 Accu Chek Guide Strip (50 Pcs) 1 Box Rp 473,000 Rp 473,000 Sudah Tersedia
48 ACCU-CHEK Safe-T- Pro Uno (200pcs/box)-Lancet 1 Box Rp 220,000 Rp 220,000 Sudah Tersedia
49 Pinset anatomi 2 Unit Rp 20,000 Rp 40,000 PR tahap I Rp 40,000
50 HANDPHONE + KARTU TLP 1 Set Rp 2,500,000 Rp 2,500,000 PR tahap I Rp 2,500,000
Rp 194,058,000 Rp 8,215,000 Rp 60,000,000
PERALATAN SAMPLING
51 Label Barcode 5 Roll Rp 60,000 Rp 300,000 Mutasi Gudang Utama Dps/mutasi purchasing HO
52 Bantal sampling 1 Pasang Rp 150,000 Rp 150,000 PR tahap I Rp 150,000
Torniquette Vaccuete (Vocuette Torniquette
53 4 PCS Rp 150,000 Rp 600,000 PR tahap I
Latex) Rp 600,000
Tabung Merah BD (Tube PLN 13x75 4.0 PLBL RD /
54 2 Box Rp 230,000 Rp 460,000 Mutasi Gudang Utama Dps
367812)
Tabung Ungu EDTA 3ml BD (Tube EDTA PLH
55 2 Box Rp 244,000 Rp 488,000 Mutasi Gudang Utama Dps
13x75 3.0 BLBLCE LAV / 368857)
Tabung Citrat (VAC 3ml 9NC Ger. 3,2% PREM SW
56 1 Box Rp 111,800 Rp 111,800 Mutasi Gudang Utama Dps
H-BL, (50 Pcs/Box)-454325)
EDTA Tube Mikrotainer (MiniCollect 0,5 ml K3E
57 1 Box Rp 150,000 Rp 150,000 Mutasi Gudang Utama Dps
K3EDTA LAV 450530 (50 Pcs/Box))
Tube Holder (Holder Standard Yellow Bulk
58 5 PCS Rp 20,000 Rp 100,000 PR tahap I
/364879) Rp 100,000
Needle Flashback BD (Needle Flashback
59 1 Box Rp 121,000 Rp 121,000 Mutasi Gudang Utama Dps
22x1/301747)
60 Wing Needle 25g 1 Box Rp 525,000 Rp 525,000 Mutasi Gudang Utama Dps
Wing Needle 23g (Wingset SLBCS 23x75 7LUER /
61 1 Box Rp 525,000 Rp 525,000 Mutasi Gudang Utama Dps
367292)
62 Alkohol Swab Pastik 5 Box Rp 30,000 Rp 150,000 Mutasi Gudang Utama Dps
63 Plester OK-Plast 5 Box Rp 25,000 Rp 125,000 Mutasi Gudang Utama Dps
64 Microphore 1 Inchi 1 Box Rp 290,000 Rp 290,000 Mutasi Gudang Utama Dps
65 Sharp Container 7 ltr 2 Pcs Rp 82,500 Rp 165,000 Mutasi Gudang Utama Dps
66 Handsoap 1 JERIGEN Rp 45,000 Rp 45,000 PR tahap I Rp 45,000
67 botol Dispenser Hansoap 2 PCS Rp 50,000 Rp 100,000 PR tahap I Rp 100,000
68 Handsanityzer + Botol dispenser 4 Botol Rp 100,000 Rp 400,000 Mutasi purchasing HO
69 Botol Spray Desinfectan 1 lt 1 Pcs Rp 50,000 Rp 50,000 PR tahap I Rp 50,000
Sarung Tangan Non steril S (50 Pasang/Box) -
70 5 Box Rp 80,000 Rp 400,000 Mutasi Gudang Utama Dps
Nitril
Sarung Tangan Non steril M (50 Pasang/Box) -
71 5 Box Rp 80,000 Rp 400,000 Mutasi Gudang Utama Dps
Nitril
72 Coverall microporus 10 Pcs Rp 60,000 Rp 600,000 Mutasi Gudang Utama Dps
73 Kacamata Google 5 Pcs Rp 10,000 Rp 50,000 Mutasi Gudang Utama Dps
74 Masker KN95 1 Box Rp 46,620 Rp 46,620 Mutasi Gudang Utama Dps
75 Masker 3 ply 5 Box Rp 29,038 Rp 145,190 Mutasi Gudang Utama Dps
Plastik Kuning sampah infeksius uk M (Biohazard
76 1 Pack Rp 550,000 Rp 550,000 Mutasi purchasing HO
Bag M (100/Pack))

Page 2 of 7
 HARGA SATUAN
NO ITEM KEBUTUHAN SATUAN JUMLAH HARGA KETERANGAN RAB tahap 1 RAB tahap 2
(November 2022)

Plastik Kuning sampah infeksius uk L (Biohazard

77 1 Pack Rp 600,000 Rp 600,000 PR tahap I
Bag L (100/Pack)) Rp 600,000
Rp 7,647,610 Rp 1,645,000 Rp -
REAGEN & BHP
ROCHE c111-Alanine Transaminase ALTL (4x100
78 1 Box Rp 672,000 Rp 672,000 PR tahap I
test)/4718569190 Rp 672,000
ROCHE c111-Aspartate Transaminase ASTL
79 1 Box Rp 672,000 Rp 672,000 PR tahap I
(4x100 test)/4657543190 Rp 672,000
ROCHE c111- Billirubin Total Gen 3
80 1 Box Rp 577,000 Rp 577,000 PR tahap I
(4x100test)/5795648190 Rp 577,000
ROCHE c111-Bilirubin Direk BILD Gen.2(2x50test)
81 1 Box Rp 219,000 Rp 219,000 PR tahap I
/5589134190 Rp 219,000
ROCHE c111-Total Protein (TP2) (4x100
82 1 Box Rp 519,000 Rp 519,000 PR tahap I
test)/4657586190 Rp 519,000
83 ROCHE c111-Albumin BCG 400T / 4657357190 1 Box Rp 557,000 Rp 557,000 PR tahap I
Rp 557,000
ROCHE c111-Cholesterol CHOL2L (4x100
84 1 Box Rp 624,000 Rp 624,000 PR tahap I
test)/4718917190 Rp 624,000
ROCHE c111-HDL-Cholesterol Plus Gen.4 HDLC4
85 1 Box Rp 1,383,616 Rp 1,383,616 PR tahap I
(2x100 test)/7528604190 Rp 1,383,616
ROCHE c111-LDL Cholesterol Gen3 LDLC3 (2x50
86 1 Box Rp 1,166,000 Rp 1,166,000 PR tahap I
test)/7005806190 Rp 1,166,000
87 ROCHE c111-Triglyceride (4x50 test)/4657594190 1 Box Rp 421,578 Rp 421,578 PR tahap I
Rp 421,578
ROCHE c111-Glucose HK GLUC2 (4x100
88 1 Box Rp 488,400 Rp 488,400 PR tahap I
test)/4657527190 Rp 488,400
ROCHE c111-Urea UREAL (4x100
89 1 Box Rp 820,290 Rp 820,290 PR tahap I
test)/4657616190 Rp 820,290
ROCHE c111-Creatinin Plus CREP2 (2x100
90 1 Box Rp 651,570 Rp 651,570 PR tahap I
test)/5401470190 Rp 651,570
ROCHE c111-Uric Acid UA2 (4x100
91 1 Box Rp 650,460 Rp 650,460 PR tahap I
test)/4657608190 Rp 650,460
C.F.A.S (Calibrator for Automated Systems) (12x3
92 1 Box Rp 1,228,770 Rp 1,228,770 Mutasi Gudang Utama Dps
mL)/ 10759350190
C.F.A.S Lipids 12172623122 (3x1 mL)
93 1 Box Rp 836,940 Rp 836,940 Mutasi Gudang Utama Dps
/12172623122
C.F.A.S Protein 11355279216 (5x1 mL) /
94 1 Box Rp 2,181,000 Rp 2,181,000 Mutasi Gudang Utama Dps
11355279216
PreciControl ClinChem Multi 2 QCS (20x5 mL) /
95 1 Box Rp 4,195,800 Rp 4,195,800 Mutasi Gudang Utama Dps
5117291922
PreciControl ClinChem Multi 1 QCS (20x5 mL) /
96 1 Box Rp 4,195,800 Rp 4,195,800 Mutasi Gudang Utama Dps
5117208922
ROCHE c111-ISE Deproteinizer (2x11
97 1 Botol Rp 173,160 Rp 173,160 PR tahap I
mLt)/4838181001 Rp 173,160
ROCHE c111- Activator For Cobas 5x12 ml
98 1 Box Rp 2,640,690 Rp 2,640,690 PR tahap I
(4663632190) Rp 2,640,690
ROCHE c111-Cuvette Segment (168 x 10 pcs) /
99 1 Box Rp 2,883,780 Rp 2,883,780 PR tahap I
4357108001 Rp 2,883,780
100 ROCHE c111-Cleaner 1000 ml / 20754765322 1 Botol Rp 1,416,360 Rp 1,416,360 PR tahap I Rp 1,416,360
ROCHE c111-Printer Paper (5 rol/box) /
101 1 Box Rp 142,080 Rp 142,080 PR tahap I
4352483001 Rp 142,080
102 ROCHE c111-Cleaner, basic(4x21 Ml)/4774248190 1 Box Rp 509,490 Rp 509,490 PR tahap I
Rp 509,490

Page 3 of 7
 HARGA SATUAN
NO ITEM KEBUTUHAN SATUAN JUMLAH HARGA KETERANGAN RAB tahap 1 RAB tahap 2
(November 2022)

ROCHE c111-Nacl Diluent 9% Cobas (4x12 ml)

103 1 Box Rp 516,150 Rp 516,150 PR tahap I
/4774230190 Rp 516,150
ROCHE-Sample Cup (20 x 250 pcs) /10394246001 1 Box Rp 2,731,710 Rp 2,731,710 Mutasi purchasing HO
104 Elecsys Vitamin D Total III (100 Test) / 9038078190 1 Box Rp 6,658,335 Rp 6,658,335 PR tahap II Rp 6,658,335
105 Elecsys PSA (100 Test) / 08791686190 1 Box Rp 5,257,737 Rp 5,257,737 PR tahap II Rp 5,257,737
106 Elecsys HCG+B II (100 Test) / 3271749190 1 Box Rp 3,866,130 Rp 3,866,130 PR tahap II Rp 3,866,130
107 Elecsys Testosterone Gen 2 (100 Test) / 8946353190 1 Box Rp 3,910,086 Rp 3,910,086 PR tahap II Rp 3,910,086
108 Elecsys FSH (100 Test) / 8932352190 1 Box Rp 4,092,903 Rp 4,092,903 PR tahap II Rp 4,092,903
109 Elecsys LH (100 Test) / 11732234122 1 Box Rp 4,326,669 Rp 4,326,669 PR tahap II Rp 4,326,669
110 Elecsys AMH Plus (100 Test) / 8818061190 1 Box Rp 32,280,687 Rp 32,280,687 PR tahap II Rp 32,280,687
111 Elecsys Progesteron III (100 Test) / 7092539190 1 Box Rp 4,433,562 Rp 4,433,562 PR tahap II Rp 4,433,562
112 Elecsys Prolactin (100 Test) / 3203093190 1 Box Rp 4,433,562 Rp 4,433,562 PR tahap II Rp 4,433,562
113 PreciControl Varia (4x3 mL) / 5618860190 1 Box Rp 1,202,796 Rp 1,202,796 PR tahap II Rp 1,202,796
PreciControl Tumor Marker (2x6 mL) /
114 1 Box Rp 1,966,032 Rp 1,966,032 PR tahap II
11776452122 Rp 1,966,032
PreciControl Universal Gen 2 (4x3 mL) /
115 1 Box Rp 1,494,504 Rp 1,494,504 PR tahap II
11731416190 Rp 1,494,504
116 PreciControl AMH Plus (4x4 mL) / 7957211190 1 Box Rp 7,991,001 Rp 7,991,001 PR tahap II Rp 7,991,001
Elecsys Vitamin D Total Calset (4x1 mL) /
117 1 Box Rp 3,663,333 Rp 3,663,333 PR tahap II
9038116190 Rp 3,663,333
118 Elecsys PSA Calset II (4x1 mL) / 8838534190 1 Box Rp 1,202,796 Rp 1,202,796 PR tahap II Rp 1,202,796
119 Elecsys HCG+B Calset (4x1 mL) / 3302652190 1 Box Rp 1,202,796 Rp 1,202,796 PR tahap II Rp 1,202,796
120 Elecsys FSH Calset (4x1 mL) / 8932417190 1 Box Rp 1,202,796 Rp 1,202,796 PR tahap II Rp 1,202,796
121 Elecsys LH Calset (4 x 1 mL) / 3561097190 1 Box Rp 1,202,796 Rp 1,202,796 PR tahap II Rp 1,202,796
122 Elecsys AMH Plus Calset (4x1 mL) / 7957203190 1 Box Rp 8,070,921 Rp 8,070,921 PR tahap II Rp 8,070,921
Elecsys Progesterone III Calset (4x1 mL) /
123 1 Box Rp 1,538,460 Rp 1,538,460 PR tahap II
7092547190 Rp 1,538,460
124 Elecsys Prolactin II Calset (4x1 mL) / 3277356190 1 Box Rp 1,078,920 Rp 1,078,920 PR tahap II Rp 1,078,920
Elecsys Diluent Universal (2x16 mL) /
125 1 Box Rp 1,202,796 Rp 1,202,796 PR tahap II
11732277122 Rp 1,202,796
Elecsys c411 Sys Wash Solution (500 ml) /
126 1 Box Rp 494,505 Rp 494,505 PR tahap II
11930346122 Rp 494,505
127 Elecsys Pro Cell (6x380 mL) / 11662988122 1 Box Rp 943,056 Rp 943,056 PR tahap II Rp 943,056
128 Elecsys Clean Cell (6x380 mL) / 11662970122 1 Box Rp 943,056 Rp 943,056 PR tahap II Rp 943,056
Elecsys c411 Assay Tip 2010 (30x120 pcs) /
129 1 Box Rp 1,657,341 Rp 1,657,341 PR tahap II
11706799001 Rp 1,657,341
Elecsys c411 Assay Cup 2010 (60x60 pcs)
130 1 Box Rp 1,885,113 Rp 1,885,113 PR tahap II
/11706802001 Rp 1,885,113
Combur 10 UX U1100
131 1 Box Rp 447,330 Rp 447,330 PR tahap I
(100strip/box)/11544373173 Rp 447,330
Control Test M U1100 (50 strip/Box)
132 1 Box Rp 389,610 Rp 389,610 PR tahap I
/11379194263 Rp 389,610
133 Thermall Papper Urisys U1100 / 6431321001 1 Box Rp 26,015 Rp 26,015 PR tahap I Rp 26,015
134 LED Sediplast + Rak 1 Box Rp 3,046,950 Rp 3,046,950 PR tahap I Rp 3,046,950
135 Spirtus 1 lt 1 Botol Rp 34,965 Rp 34,965 PR tahap I Rp 34,965
136 Pot Urine Non Steril 50cc- tutup biru 100pcs/box 1 Box Rp 150,960 Rp 150,960 Mutasi Gudang Utama Dps
Faeces Container 30 mL Transparan (250
137 1 Box Rp 550,000 Rp 550,000 Mutasi Gudang Utama Dps
pcs/box)
138 Pot Urine Steril 50cc Tutup Kuning 100 Pcs Rp 2,220 Rp 222,000 Mutasi Gudang Utama Dps
139 Urine Collector 24 jam 2 Pcs Rp 32,190 Rp 64,380 Mutasi shalom/klinik pintar
140 Kertas Saring 5 Lembar Rp 19,500 Rp 97,500 PR tahap I Rp 97,500
141 Parafilm 4" x 125 FT - 3M 1 ROLL Rp 450,000 Rp 450,000 PR tahap I Rp 450,000

Page 4 of 7
 HARGA SATUAN
NO ITEM KEBUTUHAN SATUAN JUMLAH HARGA KETERANGAN RAB tahap 1 RAB tahap 2
(November 2022)

142 Objeck Glass Frostip (72 pcs/Box)- 5 Box Rp 38,850 Rp 194,250 PR tahap I Rp 194,250
143 Spuit Terumo 3 cc (100 Pcs/box) 1 Box Rp 577,200 Rp 577,200 Mutasi Gudang Utama Dps
144 Spuit Terumo 5 cc (100 Pcs/box) 1 Box Rp 699,300 Rp 699,300 Mutasi Gudang Utama Dps
145 Yellow Tip (1000 Pcs) 1 Pack Rp 143,745 Rp 143,745 PR tahap I Rp 143,745
146 Blue Tip (1000 Pcs) 1 Pack Rp 190,365 Rp 190,365 PR tahap I Rp 190,365
147 NaCl 0,9 % 500 mL - Otsuka 1 Botol Rp 18,000 Rp 18,000 PR tahap I Rp 18,000
148 Aquabidest 500 ml (botol kaca) 1 Botol Rp 29,193 Rp 29,193 PR tahap I Rp 29,193
149 Aquadest 20 Liter (Aqua DM) 1 Jerigen Rp 157,287 Rp 157,287 PR tahap I Rp 157,287
150 Sample cup 1,5 mL 100 pcs/box (STARDEC) 1 Box Rp 333,000 Rp 333,000 PR tahap I Rp 333,000
151 coverglass 24x24 mm (10pack/Box) /deck glass 1 Box Rp 943,500 Rp 943,500 PR tahap I Rp 943,500
Tabung reaksi kaca 12 x 75 kaca 500pcs/box
152 50 Pcs Rp 6,500 Rp 325,000 PR tahap I
duran Rp 325,000
Tabung reaksi kaca 16 x 100 kaca 50pcs/box
153 50 Pcs Rp 13,000 Rp 650,000 PR tahap I
duran Rp 650,000
Urine Analysis SY systems standardlisasi 1000
154 1 Box Rp 5,006,000 Rp 5,006,000 Mutasi Gudang Utama Dps
test/box with 10mL tube / SY1000
155 Alkohol 70% 1 lt 1 Botol Rp 41,441 Rp 41,441 PR tahap I Rp 41,441
156 Golongan Darah Eldoncard (Eldone Bag 2521-25) 1 Pack Rp 1,243,200 Rp 1,243,200 PR tahap I Rp 1,243,200
157 Wright eosin (Sigma) 1 Botol Rp 1,221,000 Rp 1,221,000 PR tahap I Rp 1,221,000
158 Methanol 1 lt 1 Botol Rp 388,500 Rp 388,500 PR tahap I Rp 388,500
RIGHTSIGN- COVID19 Antigen Rapid Test Cassete
159 1 Box Rp 380,000 Rp 380,000 Sudah punya 17/01/2023
(Nasopharyngeal Swab)
STANDARD Q - Dengue IgG/IgM (25 tets/box) /
160 1 Box Rp 2,220,000 Rp 2,220,000 Mutasi Gudang Utama Dps
09DEN20D
161 STANDARD Q - Dengue NS1 (25 tets/box) / 1 Box Rp 2,220,000 Rp 2,220,000 Mutasi Gudang Utama Dps
162 Fortress Salmonella Paratyphi Antigen O 1 Box Rp 95,460 Rp 95,460 PR tahap I Rp 95,460
163 Fortress Salmonella Paratyphi Antigen AO 1 Box Rp 95,460 Rp 95,460 PR tahap I Rp 95,460
164 Fortress Salmonella Paratyphi Antigen BO 1 Box Rp 95,460 Rp 95,460 PR tahap I Rp 95,460
165 Fortress Salmonella Paratyphi Antigen CO 1 Box Rp 95,460 Rp 95,460 PR tahap I Rp 95,460
166 Fortress Salmonella Paratyphi Antigen H 1 Box Rp 95,460 Rp 95,460 PR tahap I Rp 95,460
167 Fortress Salmonella Paratyphi Antigen AH 1 Box Rp 95,460 Rp 95,460 PR tahap I Rp 95,460
168 Fortress Salmonella Paratyphi Antigen BH 1 Box Rp 95,460 Rp 95,460 PR tahap I Rp 95,460
169 Fortress Salmonella Paratyphi Antigen CH 1 Box Rp 95,460 Rp 95,460 PR tahap I Rp 95,460
170 RF (Rhematoid Factor)- 100 Test 1 kit Rp 501,165 Rp 501,165 PR tahap II Rp 501,165
171 Fortress - ASO Latex 100 Test 1 kit Rp 620,490 Rp 620,490 PR tahap II Rp 620,490
172 Xylol (100mL) - ST 1 Botol Rp 200,000 Rp 200,000 PR tahap I Rp 200,000
173 Immersion Oil - Indo reagen 0330544A 100 mL 1 Botol Rp 400,000 Rp 400,000 PR tahap I Rp 400,000
174 DALF - Anti-HIV 1,2 wb Drop Test (25 Test/Box) 1 Box Rp 1,580,000 Rp 1,580,000 Mutasi Gudang Utama Dps
DALF - BN HEPATITIS B ANTIGEN DROP TEST /
175 1 Box Rp 800,000 Rp 800,000 Mutasi Gudang Utama Dps
21110404
Pewarna sedimen urine (SY Urine sediment
176 1 Botol Rp 146,520 Rp 146,520 Mutasi Gudang Utama Dps
staining solution 50mL/vial / SY Stain)
177 Benedict 500 ml 1 Botol Rp 60,000 Rp 60,000 PR tahap I Rp 60,000
178 Asam sulfosalisilat 20% 100 ml 1 Botol Rp 580,000 Rp 580,000 PR tahap I Rp 580,000
179 Fouchet 100 ml 1 Botol Rp 300,000 Rp 300,000 PR tahap I Rp 300,000
180 BaCl2 100 ml 1 Botol Rp 300,000 Rp 300,000 PR tahap I Rp 300,000
181 BCB / Brom cresil Blue 100 ml (retikulosit) 1 Botol Rp 815,000 Rp 815,000 PR tahap I Rp 815,000
182 Ammonium Oxalat 100ml (trombosit) 1 Botol Rp 25,000 Rp 25,000 PR tahap I Rp 25,000
183 SD Bioline FOB-Darah samar (50 test/kit) / 25FK12 1 Box Rp 1,687,000 Rp 1,687,000 Mutasi Gudang Utama Dps
184 HCG Urine (Tes Kehamilan) 1 Box Rp 790,875 Rp 790,875 Mutasi Gudang Utama Dps
Rp 173,306,754 Rp 31,518,155 Rp 109,324,344
ALAT RUMAH TANGGA
185 Dispenser air minum 1 Unit Rp 1,500,000 Rp 1,500,000 PR tahap I / mutasi bandung Rp 1,500,000
186 Galon air mineral 2 Unit Rp 200,000 Rp 400,000 PR tahap I / mutasi bandung Rp 400,000

Page 5 of 7
 HARGA SATUAN
NO ITEM KEBUTUHAN SATUAN JUMLAH HARGA KETERANGAN RAB tahap 1 RAB tahap 2
(November 2022)

187 Tempat Sampah 30 lt 2 Unit Rp 350,000 Rp 700,000 PR tahap I Rp 700,000

188 Tempat Sampah 15 lt 4 Unit Rp 350,000 Rp 1,400,000 Mutasi Shalom (3 unit)
189 Tempat Sampah stainlees loby 1 Unit Rp 700,000 Rp 700,000 x
190 Tempat sampah toilet 1 Unit Rp 350,000 Rp 350,000 x
191 Tempat sampah kecil di atas meja 3 Unit Rp 100,000 Rp 300,000 PR tahap I Rp 300,000
192 Sapu + serokan 1 Set Rp 150,000 Rp 150,000 x
193 Pel lantai 1 Set Rp 350,000 Rp 350,000 x
194 Pembersih kaca + cairan pembersih kaca 1 Set Rp 200,000 Rp 200,000 x
195 Kanebo 2 Pcs Rp 100,000 Rp 200,000 PR tahap I Rp 200,000
196 Kain lap fiber 2 Pcs Rp 50,000 Rp 100,000 PR tahap I Rp 100,000
197 Rak Sepatu 1 Unit Rp 500,000 Rp 500,000 PR tahap I Rp 500,000
198 Gantungan Baju hanger 5 Unit Rp 50,000 Rp 250,000 PR tahap I Rp 250,000
199 Gantungan baju/tas di dinding/pintu 1 Unit Rp 300,000 Rp 300,000 PR tahap I Rp 300,000
200 Sepatu karet tertutup di lab 6 Pasang Rp 150,000 Rp 900,000 PR tahap I (4 Pasang) Rp 900,000
201 Keset welcome door loby 1 Pcs Rp 500,000 Rp 500,000 PR tahap I Rp 500,000
202 Pembersih Lantai 1 Botol Rp 100,000 Rp 100,000 x
203 Pembersih Kamar mandi/Toilet 1 Botol Rp 100,000 Rp 100,000 x
204 Box Tissue kotak di meja 2 Unit Rp 100,000 Rp 200,000 PR tahap I Rp 200,000
205 Box Tissue (tempel dekat westafel) 1 Unit Rp 400,000 Rp 400,000 PR tahap I Rp 400,000
206 baki plastik uk. 30x25x10 cm 2 Unit Rp 50,000 Rp 100,000 PR tahap I Rp 100,000
207 Nampan 1 Pcs Rp 100,000 Rp 100,000 PR tahap I Rp 100,000
208 Tissue Kasar 10 Pack Rp 15,000 Rp 150,000 Mutasi Gudang Utama Dps
209 Tissue Halus kotak kecil 10 Pack Rp 5,000 Rp 50,000 Mutasi Gudang Utama Dps
210 Sunligt Cuci piring 1 Botol Rp 20,000 Rp 20,000 PR tahap I Rp 20,000
211 Spons Cuci Piring 1 Pcs Rp 10,000 Rp 10,000 PR tahap I Rp 10,000
212 Coolbox Sample Rujukan 2 Pcs Rp 500,000 Rp 1,000,000 PR tahap I (1 unit) Rp 1,000,000
213 Plastik Klip sample 2 Box Rp 50,000 Rp 100,000 Mutasi Gudang Utama Dps
214 Plastik Hitam sampah non Infeksius 1 Box Rp 50,000 Rp 50,000 Mutasi Gudang Utama Dps
215 Rak sampling (box organizer 3 susun) 3 Unit Rp 150,000 Rp 450,000 PR tahap I Rp 450,000
216 Box sampling (toolbox kit yellow) 2 Unit Rp 157,000 Rp 314,000 PR tahap I (1 unit) Rp 314,000
217 Box Sample Sterofoam 3 Liter 2 Unit Rp 40,000 Rp 80,000 PR tahap I Rp 80,000
Rp 12,024,000 Rp 8,324,000 Rp -
ATK
218 Formulir Pemeriksaan Lab 20 Buku Rp 40,000 Rp 800,000 Mutasi Gudang Utama Dps
219 Amplop Hasil Lab 10 Pack Rp 208,585 Rp 2,085,850 Mutasi Gudang Utama Dps
220 Stempel Nilai Kritis 1 Pcs Rp 250,000 Rp 250,000 PR tahap I Rp 250,000
221 Stempel Tanggal 1 Pcs Rp 70,000 Rp 70,000 PR tahap I Rp 70,000
222 Stempel Logo Diagnos 1 Pcs Rp 120,000 Rp 120,000 PR tahap I Rp 120,000
223 Kertas A5 1 Rim Rp 22,500 Rp 22,500 Mutasi Gudang Utama Dps
224 Kertas A4 70gr 5 Rim Rp 45,500 Rp 227,500 Mutasi Gudang Utama Dps
225 Rak Susun dokumen 2 Pcs Rp 72,500 Rp 145,000 PR tahap I (1 unit) Rp 145,000
226 gunting 2 Pcs Rp 30,000 Rp 60,000 Mutasi Gudang Utama Dps
227 Cutter A-300 Joyko 2 Pcs Rp 7,500 Rp 15,000 Mutasi Gudang Utama Dps
228 Pulpen 1 Box Rp 48,000 Rp 48,000 Mutasi Gudang Utama Dps
229 Spidol permanen 1 Box Rp 78,000 Rp 78,000 Mutasi Gudang Utama Dps
230 Pensil 1 Box Rp 54,000 Rp 54,000 Mutasi Gudang Utama Dps
231 Penghapus 2 pcs Rp 4,000 Rp 8,000 Mutasi Gudang Utama Dps
232 Penggaris besi 30cm 2 Pcs Rp 10,000 Rp 20,000 Mutasi Gudang Utama Dps
233 Tempat pensil meja 2 Pcs Rp 16,000 Rp 32,000 Mutasi Gudang Utama Dps
234 Rautan Pensil 1 Pcs Rp 4,000 Rp 4,000 Mutasi Gudang Utama Dps
235 Rak brosur deflecto 4tier leaflet 1 Pcs Rp 120,000 Rp 120,000 Mutasi Gudang Utama Dps

Page 6 of 7
 HARGA SATUAN
NO ITEM KEBUTUHAN SATUAN JUMLAH HARGA KETERANGAN RAB tahap 1 RAB tahap 2
(November 2022)

236 Stapler HD-10 2 Pcs Rp 14,500 Rp 29,000 Mutasi Gudang Utama Dps
237 Isi staples no.10 5 Pcs Rp 2,250 Rp 11,250 Mutasi Gudang Utama Dps
238 Acrilic standing A4 1 Pcs Rp 65,000 Rp 65,000 Mutasi Gudang Utama Dps
239 Acrilic standing A5 1 Pcs Rp 45,000 Rp 45,000 Mutasi Gudang Utama Dps
240 Papan Jalan (clipboard folio) 1 Pcs Rp 22,500 Rp 22,500 Mutasi Gudang Utama Dps
Rp 4,332,600 Rp 585,000 Rp -
TOTAL Rp 601,368,964 Rp 50,287,155 Rp 169,324,344

Page 7 of 7
RENCANA ANGGARAN BIAYA ( RAB )
PEK. INTERIOR DIAGNOS RSIA PUSURA MORULA SURABAYA

Penawaran No. 01/pry-diagnos/I/2023

NO URAIAN PEKERJAAN SPESIFIKASI SAT VOL HARGA SAT JML HARGA

I Pek. Furniture R Lab Teknis

1 Meja teknis - A depan ( centrifunge + komputer ) Custum , duco , top SOLID Surface ( 80 x 250 ) unit 1,00 12.500.000,00 12.500.000,00
2 Meja teknis - B - Kiri ( zink + urine analyzer ) Custum , duco , top SOLID Surface ( 80 x 310) unit 1,00 14.650.000,00 14.650.000,00
3 Meja Teknis C - Belakang (kimia analyzer dll ) Custum , duco , top SOLID Surface ( 80 x 500) unit 1,00 24.450.000,00 24.450.000,00
4 Meja Teknis D - kanan (Hernatology analyzer dll ) Custum , duco , top SOLID Surface ( 80 x 310) unit 1,00 14.650.000,00 14.650.000,00
5 Meja tengah ( 120 x 220 ) Custum , duco , top SOLID Surface unit 1,00 12.760.000,00 12.760.000,00
6 lemari gantung ( 310x40x90) finishing Duco unit 1,00 10.500.000,00 10.500.000,00
7 Lemari gantung di atas Zink ( 310x40x90) finishing Duco unit 1,00 10.500.000,00 10.500.000,00
8 Kursi Lab unit 4,00 2.300.000,00 9.200.000,00

Sub tot I 109.210.000,00

II PEK. MEKANIKAL DAN ELEKTRIKAL

1 Inst. Listrik kabel ex. Supreme / setara Kabel 4 besar , ex Supreme titik 6,00 450.000,00 2.700.000,00
2 Stop Kontak 4 lubang Panasonic/clipsal /setara ttk 8,00 550.000,00 4.400.000,00
3 Kabel Data Belden Cat - 6 titik 6,00 580.000,00 3.480.000,00
5 Tambahan AC R Lab Gree 1,5 PK unit 1,00 9.500.000,00 9.500.000,00
6 Plumbimg Pipa PVC titik 2,00 750.000,00 1.500.000,00
7 Bak Zink stainless steel bh 1,00 1.200.000,00 1.200.000,00
8 Pengadaan alat Eyewasher Eyewash portable Haws 7500 non cairan unit 1,00 4.750.000,00 4.750.000,00

Sub Tot - II 27.530.000,00

TOTAL ( I - II ) 136.740.000,00

Disc khusus 10% 13.674.000,00

nett 123.066.000,00

Di Bulatkan 120.000.000,00

Jakarta , 18 Januari 2023

( I Made Dwipayana )