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Jenis Biaya Jasa Bahan Tidak Habis

No Keterangan Bahan Habis Pakai Obat-obatan


Tindakan Tindakan Pakai
1. Diagnosis Visus, Funduskopi, TIO Rp. 100.000,- Snelen chart, trial Alkohol, kapas Pantocaine,
lens, Midriatil
funduskopi/oftalmos
kop, schiotz
2. Terapi Ekstraksi corpal/LA Rp. 200.000,- Slit lamp Spuit 1cc, cotton bud, Pantocaine,
a. Ringan kassa, hipafix salep mata
kloramfenikol
Irigasi/LA (per 5x irigasi) Rp. 150.000,- Perlak, bengkok RL 2L, kassa, hipafix Pantocaine
Epilasi/LA Rp. 75.000,- Epilator Kassa Pantocaine
Rawat luka Rp. 50.000,- Pinset, bengkok Kassa, hipafix, Pantocaine
betadine, NS,
handscoen, cotton
bud steril
b. Sedang Insisi kalazion/hordeolum/LA Rp. 350.000,- Chalazion set, Betadine, Kassa steril, Pantocaine,
bengkok, doek mata hipafix, NS, handscoen Lidocaine, salep
steril steril, cotton bud mata xytrol
steril, spuit 1 cc
Ekstirpasi granuloma/LA Rp. 200.000,- Pterigium set, Betadine, Kassa steril, Pantocaine,
bengkok, doek mata hipafix, NS, handscoen Lidocaine, salep
steril, lup/mikroskop steril, cotton bud mata xytrol
operasi steril, spuit 1 cc
Pterigium/LA Rp. 2.000.000,- Pterigium set, Betadine, Kassa steril, Pantocaine,
bengkok, doek mata hipafix, NS, handscoen Lidocaine, salep
steril, lup/mikroskop steril, cotton bud mata xytrol
operasi steril, spuit 1 cc
Nevus palpebra/LA Rp. 1.000.000,- Hecting set, bengkok, Betadine, Kassa steril, Pantocaine,
doek mata steril, hipafix, NS, handscoen Lidocaine, salep
lup/mikroskop steril, cotton bud mata xytrol
operasi steril, spuit 1 cc
c. Berat Repair palpebra/LA/GA Rp. 7-8.000.000,- Hecting set, bengkok, Betadine, Kassa steril, Pantocaine,
doek mata steril, hipafix, NS, handscoen Lidocaine, salep
lup/mikroskop steril, cotton bud mata xytrol
operasi, cauter steril, spuit 1 cc, 3cc,
10 cc
Ekstraksi katarak tanpa Rp. 4.500.000,- Cataract set, Betadine, Kassa steril, Pantocaine,
lensa/LA bengkok, doek mata hipafix, NS, handscoen midriatil,
steril, mikroskop steril, cotton bud Lidocaine, salep
operasi, cauter steril, spuit 1 cc, 3cc, mata xytrol
10cc, visco, tripan
blue, cressent, slit
knife, keratome
Ekstraksi katarak dengan Rp. 5.500.000,- Cataract set, Betadine, Kassa steril, Pantocaine,
lensa/LA bengkok, doek mata hipafix, NS, handscoen midriatil,
steril, mikroskop steril, cotton bud Lidocaine, salep
operasi, cauter steril, spuit 1 cc,3cc, mata xytrol
10cc, visco, tripan
blue, lensa tanam,
cressent, slit knife,
keratome
Ekstraksi corpal/GA Rp. 3-4.000.000,- Hecting set, bengkok, Betadine, Kassa steril, Pantocaine,
doek mata steril, hipafix, NS, handscoen Lidocaine, salep
mikroskop operasi, steril, cotton bud mata
cauter steril, spuit 1 cc,3cc, kloramfenikol
10cc, visco, cressent,
slit knife, keratome

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