This study aims to analyze the comparison of hemodialysis profitability based on hospital rates, unit costs, and Indonesia Case Base Groups (INA-CBGs) and evaluate the implementation of INA-CBGS tariff for hemodialysis. The object in this study was Hemodialysis Unit at Siloam Hospitals Balikpapan (SHBP). This type of research used the mix-methods method with a cross-sectional approach and case study. Primary data were obtained from in-depth interviews with structural and functional staff related to hemodialysis unit. Secondary data were obtained in the form of financial data for hemodialysis measures in 2018. Quantitative analysis was carried out to obtain unit cost values and comparison of the profitability of each tariff. Realist evaluation analysis was used to evaluate the implementation of INA-CBGs rates for hemodialysis. The results of the study showed that (1) the calculations of unit cost using Relative Value Units (RVU) method of both hemodialysis in SHBP was greater than the hospital unit cost; (2) The tariff calculation using RVU method with a margin of 20% was found that the hospital and INA-CBGs rates for both hemodialysis were smaller; (3) The calculation of both profitability hospital rates and INA-CBGs rates on the unit cost of the RVU method on both hemodialysis indicated that hospitals experienced losses from both hemodialysis; (4) Hemodialysis Standard Operating Procedure (SOP) and Clinical Pathway (CP) were already available and applied in hospitals. (5) Human resources and the amount of hemodialysis machines in the hemodialysis unit in SHBP were still lacking.