BHP PHACO UMUM dan LANGGANAN

BHP dengan lensa premium KALBE 2,100,000

NO BHP SATUAN PEMAKAIAN HARGA TOTAL
1 Lensa Foldable Premium 1 1 2,667,000 2,667,000
2 Kaset Phaco 1 0.1 1,400,000 140,000
3 Stab Knife 1 0.2 223,037 44,607
4 Rohtovisc 1 1 143,637 143,637
5 Keratome Knife 2,75 1 0.2 297,180 59,436
6 Tryphan Blue 1% 1 ml 1 0.2 83,820 16,764
7 Carbachol 1% 1 ml 1 0.2 83,820 16,764
8 Eye Drape 100x70 cm (D700/D700P) 1 1 83,820 83,820
9 Dop Mata Bening 1 1 13,970 13,970
10 BSS 1 0.3 154,940 46,482
11 Spuit 1 cc 1 5 9,000 45,000
12 Spuit 3 cc 1 1 1,000 1,000
13 Spuit 5 cc 1 1 1,000 1,000
14 Spuit 10 cc 1 3 3,000 9,000
15 Bethadine 30 ml 1 0.5 6,000 3,000
16 Alkoloh 70% 1 ml 1 10 500 5,000
17 LFX MD 1 0.05 93,000 4,650
18 Midriasil ED 1 0.05 36,000 1,800
19 Pantocain 2 % 1 0.1 17,000 1,700
20 Lidocain inj 1 1.5 2,000 3,000
21 Dexamethasone inj 1 0.2 2,197 439
22 Adrenalin inj / Epinefrin ijn 1 0.1 10,968 1,097
23 Gentamycin inj 1 0.2 2,790 558
24 Kasa 10 pcs 1 0.5 4,600 2,300
25 Handshcoen steril 1 3 13,000 39,000
26 Handshcoen latex 1 4 700 2,800
27 Topi operasi 1 5 1,500 7,500
28 Masker 1 4 573 2,292
29 Micropore/hansplast 1 1 250 250
30 Bola Kapas/alkohol swab 1 1 350 350
31 Cutton Bud 1 5 -
JUMLAH 3,304,630

BHP PHACO UMUM DAN LANGGANAN

BHP dengan Lensa Biasa 750,000
NO BHP SATUAN PEMAKAIAN HARGA TOTAL
1 Lensa Foldable Premium 1 1 952,500 952,500
2 Kaset Phaco 1 0.1 1,400,000 140,000
3 Stab Knife 1 0.2 223,037 44,607
4 Rohtovisc 1 1 143,637 143,637
5 Keratome Knife 2,75 1 0.2 297,180 59,436
6 Tryphan Blue 1% 1 ml 1 0.2 83,820 16,764
7 Carbachol 1% 1 ml 1 0.2 83,820 16,764
8 Eye Drape 100x70 cm (D700/D700P) 1 1 83,820 83,820
9 Dop Mata Bening 1 1 13,970 13,970
10 BSS 1 0.3 154,940 46,482
11 Spuit 1 cc 1 5 9,000 45,000
12 Spuit 3 cc 1 1 1,000 1,000
13 Spuit 5 cc 1 1 1,000 1,000
14 Spuit 10 cc 1 3 3,000 9,000
15 Bethadine 30 ml 1 0.5 6,000 3,000
16 Alkoloh 70% 1 ml 1 10 500 5,000
17 LFX MD 1 0.05 93,000 4,650
18 Midriasil ED 1 0.05 36,000 1,800
19 Pantocain 2 % 1 0.1 17,000 1,700
20 Lidocain inj 1 1.5 2,000 3,000
21 Dexamethasone inj 1 0.2 2,197 439
22 Adrenalin inj / Epinefrin ijn 1 0.1 10,968 1,097
23 Gentamycin inj 1 0.2 2,790 558
24 Kasa 10 pcs 1 0.5 4,600 2,300
25 Handshcoen steril 1 3 13,000 39,000
26 Handshcoen latex 1 4 700 2,800
27 Topi operasi 1 5 1,500 7,500
28 Masker 1 4 573 2,292
29 Micropore/hansplast 1 1 250 250
30 Bola Kapas/alkohol swab 1 1 350 350
31 Cutton Bud 1 5 -
1,649,717
 BHP PHACO BPJS
BHP dengan Lensa Biasa 750,000
NO BHP SATUAN PEMAKAIAN HARGA TOTAL
1 Lensa Foldable Premium 1 1 952,500 952,500
2 Kaset Phaco 1 0.1 1,400,000 140,000
3 Stab Knife 1 0.2 223,037 44,607
4 Rohtovisc 1 1 143,637 143,637
5 Keratome Knife 2,75 1 0.2 297,180 59,436
6 Tryphan Blue 1% 1 ml 1 0.2 83,820 16,764
7 Carbachol 1% 1 ml 1 0.2 83,820 16,764
8 Eye Drape 100x70 cm (D700/D700P) 1 1 83,820 83,820
9 Dop Mata Bening 1 1 13,970 13,970
10 BSS 1 0.3 154,940 46,482
11 Spuit 1 cc 1 5 9,000 45,000
12 Spuit 3 cc 1 1 1,000 1,000
13 Spuit 5 cc 1 1 1,000 1,000
14 Spuit 10 cc 1 3 3,000 9,000
15 Bethadine 30 ml 1 0.5 6,000 3,000
16 Alkoloh 70% 1 ml 1 10 500 5,000
17 LFX MD 1 0.05 93,000 4,650
18 Midriasil ED 1 0.05 36,000 1,800
19 Pantocain 2 % 1 0.1 17,000 1,700
20 Lidocain inj 1 1.5 2,000 3,000
21 Dexamethasone inj 1 0.2 2,197 439
22 Adrenalin inj / Epinefrin ijn 1 0.1 10,968 1,097
23 Gentamycin inj 1 0.2 2,790 558
24 Kasa 10 pcs 1 0.5 4,600 2,300
25 Handshcoen steril 1 3 13,000 39,000
26 Handshcoen latex 1 4 700 2,800
27 Topi operasi 1 5 1,500 7,500
28 Masker 1 4 573 2,292
29 Micropore/hansplast 1 1 250 250
30 Bola Kapas/alkohol swab 1 1 350 350
31 Cutton Bud 1 5 -
1,649,717

BHP PHACO UMUM dan LANGGANAN

BHP dengan lensa premium AFINA " Type 2CB00(+5.0 to 34.0) 2,337,500
NO BHP SATUAN PEMAKAIAN HARGA TOTAL
1 Lensa Foldable Premium 1 1 2,968,625 2,968,625
2 Kaset Phaco 1 0.1 1,400,000 140,000
3 Stab Knife 1 0.2 223,037 44,607
4 Rohtovisc 1 1 143,637 143,637
5 Keratome Knife 2,75 1 0.2 297,180 59,436
6 Tryphan Blue 1% 1 ml 1 0.2 83,820 16,764
7 Carbachol 1% 1 ml 1 0.2 83,820 16,764
8 Eye Drape 100x70 cm (D700/D700P) 1 1 83,820 83,820
9 Dop Mata Bening 1 1 13,970 13,970
10 BSS 1 0.3 154,940 46,482
11 Spuit 1 cc 1 5 9,000 45,000
12 Spuit 3 cc 1 1 1,000 1,000
13 Spuit 5 cc 1 1 1,000 1,000
14 Spuit 10 cc 1 3 3,000 9,000
 15 Bethadine 30 ml 1 0.5 6,000 3,000
16 Alkoloh 70% 1 ml 1 10 500 5,000
17 LFX MD 1 0.05 93,000 4,650
18 Midriasil ED 1 0.05 36,000 1,800
19 Pantocain 2 % 1 0.1 17,000 1,700
20 Lidocain inj 1 1.5 2,000 3,000
21 Dexamethasone inj 1 0.2 2,197 439
22 Adrenalin inj / Epinefrin ijn 1 0.1 10,968 1,097
23 Gentamycin inj 1 0.2 2,790 558
24 Kasa 10 pcs 1 0.5 4,600 2,300
25 Handshcoen steril 1 3 13,000 39,000
26 Handshcoen latex 1 4 700 2,800
27 Topi operasi 1 5 1,500 7,500
28 Masker 1 4 573 2,292
29 Micropore/hansplast 1 1 250 250
30 Bola Kapas/alkohol swab 1 1 350 350
31 Cutton Bud 1 5 -
JUMLAH 3,606,255

BHP PHACO UMUM dan LANGGANAN

BHP dengan lensa premium AFINA " Type ZA59003(+10.0 to 30.0) 2,123,000
NO BHP SATUAN PEMAKAIAN HARGA TOTAL
1 Lensa Foldable Premium 1 1 2,696,210 2,696,210
2 Kaset Phaco 1 0.1 1,400,000 140,000
3 Stab Knife 1 0.2 223,037 44,607
4 Rohtovisc 1 1 143,637 143,637
5 Keratome Knife 2,75 1 0.2 297,180 59,436
6 Tryphan Blue 1% 1 ml 1 0.2 83,820 16,764
7 Carbachol 1% 1 ml 1 0.2 83,820 16,764
8 Eye Drape 100x70 cm (D700/D700P) 1 1 83,820 83,820
9 Dop Mata Bening 1 1 13,970 13,970
10 BSS 1 0.3 154,940 46,482
11 Spuit 1 cc 1 5 9,000 45,000
12 Spuit 3 cc 1 1 1,000 1,000
13 Spuit 5 cc 1 1 1,000 1,000
14 Spuit 10 cc 1 3 3,000 9,000
15 Bethadine 30 ml 1 0.5 6,000 3,000
16 Alkoloh 70% 1 ml 1 10 500 5,000
17 LFX MD 1 0.05 93,000 4,650
18 Midriasil ED 1 0.05 36,000 1,800
19 Pantocain 2 % 1 0.1 17,000 1,700
20 Lidocain inj 1 1.5 2,000 3,000
21 Dexamethasone inj 1 0.2 2,197 439
22 Adrenalin inj / Epinefrin ijn 1 0.1 10,968 1,097
23 Gentamycin inj 1 0.2 2,790 558
24 Kasa 10 pcs 1 0.5 4,600 2,300
25 Handshcoen steril 1 3 13,000 39,000
26 Handshcoen latex 1 4 700 2,800
27 Topi operasi 1 5 1,500 7,500
28 Masker 1 4 573 2,292
29 Micropore/hansplast 1 1 250 250
30 Bola Kapas/alkohol swab 1 1 350 350
31 Cutton Bud 1 5 -
JUMLAH 3,333,840
 TARIF TINDAKAN MATA
UMUM DAN LANGGANAN

JASA
NO JENIS TINDAKAN KELAS DOKTER PEMERIKSAAN BHP TARIF LAYANAN
RS
1 Paket Operasi PHACO dengan Rayone Asphire III 3,758,160 745,000 3,304,530 7,807,690
KALBE II 4,509,792 745,000 3,304,530 8,559,322
I 5,411,750 745,000 3,304,530 9,461,280
VIP 6,494,100 745,000 3,304,530 10,543,630
SVIP 7,792,919 745,000 3,304,530 11,842,449

2 Paket Operasi PHACO dengan Intraocular Lens Monofocal Aspheric III 3,758,160 745,000 3,333,840 7,837,000
Type ZA59003 (+10.0 to 30.0 ) AFINA II 4,509,792 745,000 3,333,840 8,588,632
I 5,411,750 745,000 3,333,840 9,490,590
VIP 6,494,100 745,000 3,333,840 10,572,940
SVIP 7,792,919 745,000 3,333,840 11,871,759

3 Paket Operasi PHACO dengan Intraocular Lens Monofocal Aspheric III 3,758,160 745,000 3,506,255 8,009,415
Type ZCB00 (+5.0 to 34.0 ) AFINA II 4,509,792 745,000 3,506,255 8,761,047
I 5,411,750 745,000 3,506,255 9,663,005
VIP 6,494,100 745,000 3,506,255 10,745,355
SVIP 7,792,919 745,000 3,506,255 12,044,174

TARIF TINDAKAN MATA

BPJS

JASA TARIF LAYANAN TARIF INCBG'S SELISIH TARIF

NO JENIS TINDAKAN KELAS PEMERIKSAAN BHP
DOKTER RS INACBG'S - RS
1 Paket Operasi PHACO dengan Lensa Foldable III 2,684,400 745,000 1,649,717 5,079,117 8,033,200 2,954,083
 BIAYA PEMERIKSAAN

NO JENIS PEMERIKSAAN HARGA

1 Co dr. Penyaki Dalam 150,000

2 EKG 115,000
3 GDS 25,000
4 HbsAg 125,000
5 Anti HIV 280,000
6 CT 25,000
7 BT 25,000
745,000