1.

BHP Vitrektomy posterior +IOL drop(iol sekunder)

NO BAHAN HABIS PAKAI SATUAN HARGA

1. Eye drap 1 Pcs
2. Tripan blue 1 Vial
3. Cathachol 1 Vial
4. Spuit 1 cc 2 Pcs
5. Spuit 10 cc 2 Pcs
6. Clear cut 2.75 1 Pcs
7. Kalvis 1 Pcs
8. Infus set 1 Pcs
9. Rl 500 ml 1 Botol
10. Miriwash 500 ml 1 Pcs
11. Gentamicin 1 Ampul
12. Dexametason 1 Ampul
13. Vigamox ED 5 ml 1 Fls
14. Optalgon ED 5 ml 1 Fls
15. Iodine 30 ml 1 Botol
16. Kassa steril box 10 lembar Box
17. Kapas 50 gr 1 Pcs
18. cotton bud bungkus isi 50 pcs 1 Pcs
19. Handscoend 3 Pcs
20. Kaset vitrektomy posterior 1 Pcs
21. Crieshaber ILM 1 Pcs
22. 20 gauge MVR 1 Pcs
23. Benang 8.0 vikril 1 Pcs
24. Lensa superflex aspheric 1 Pcs
25. Lensa C flex aspheric 1 Pcs
JUMLAH
 2. BHP Vitrektomy posterior +Phaco+iol

NO BHP SATUAN HARGA

1. Eye drap 1 Pcs
2. Tripan blue 1 Vial
3. Cathachol 1 Vial
4. Spuit 1 cc 4 Pcs
5. Spuit 10 cc 3 Pcs
6. Clear cut 2.75 1 Pcs
7. Aok 15 ° 1 Pcs
8. Hyal 1 Pcs
9. Infus set 1 Pcs
10. Rl 500 ml 1 Botol
11. Miriwash 500 ml 1 Pcs
12. Gentamicin 1 Ampul
13. Dexametason 1 Ampul
14. Vigamox ED 5 ml 1 Fls
15. Optalgon ED 5 ml 1 Fls
16. Iodine 30 ml 1 Botol
17. Kassa steril box 10 lembar 1 box
18. Kapas 50 gr 1 Pcs
19. Cotton bud bungkus isi 50 pcs 1 Pcs
20. Handscoend 3 Pcs
21. Kaset vitrektomy posterior 1 Pcs
combined
22. Lensa superflex aspheric 1 Pcs
23. Lensa C flex aspheric 1 Pcs
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 3. BHP Vitrektomy posterior +perdarahan vitreus

NO BAHAN HABIS PAKAI SATUAN HARGA

1. Eye drap 1 Pcs
2. Cathachol 1 Vial
3. Spuit 1 cc 2 Pcs
4. Spuit 10 cc 2 Pcs
5. Kalvis 1 Pcs
6. Infus set 1 Pcs
7, Rl 500 ml 1 Botol
8. Miriwash 500 ml 1 Pcs
9. Gentamicin 1 Ampul
10. Dexametason 1 Ampul
11. Vigamox ED 5 ml 1 Fls
12. Optalgon ED 5 ml 1 Fls
13. Iodine 30 ml 1 Botol
14. Kassa steril box isi 10 lembar 1 box
15. Kapas 50 gr 1 Pcs
16. cotton bud bungkus isi 50 pcs 1 Pcs
17. Handscoend 3 Pcs
18. Kaset vitrektomy posterior 1 Pcs
19. Laser set endoprobe 23 gauge 1 Pcs
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 4. BHP Phaco +IOL
No Nama Satuan Keterangan
1 Eye Drap 1 Pcs
2 Spuit 1cc 5 Pcs
3 Spuit 10cc 3 Pcs
4 Tripan Blue 1 Vial
5 Cathacol 1 Vial
6 Clear Cut 2,75 1 Pcs
7 AOK 150 1 Pcs
8 Infuset 1 Pcs
9 Miriwash 500ml 1 Pcs
10 RL 500ml 1 Botol
11 Handscoon Steril 2 Pcs
12 Kalvis 2 Pcs
13 Lensa Foldable 1 Pcs
14 Dop Mata 1 Pcs
15 Cotton Bud 1 Pcs
16 Kassa 1 Pcs
17 Kapas 1 Pcs
18 Iodine 30ml 1 Botol
19 Vigamox 1 Fls
20 Kaset Phaco 1 Box
21 Tip I.A 1 Pcs
22 Tip Handpiece 1 Pcs
23 Pantocain 1 Fls
24 Mydriatil 1 Fls
25 Lidocain 1 Amp Bila Perlu
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 5. BHP ECCE+IOL
No Nama Satuan Keterangan
1 Eye Drap 1 Pcs
2 Spuit 1cc 5 Pcs
3 Spuit 10cc 3 Pcs
4 Tripan Blue 1 Vial
5 Cathacol 1 Vial
6 Clear Cut 2,75 1 Pcs
8 Infuset 1 Pcs
10 RL 500ml 1 Botol
11 Handscoon Steril 2 Pcs
12 Kalvis 2 Pcs
13 Lensa 1 Pcs
15 Cotton Bud 1 Pcs
16 Kassa 1 Pcs
17 Kapas 1 Pcs
18 Iodine 30ml 1 Botol
19 Vigamox 1 Fls
23 Pantocain 1 Fls
24 Mydriatil 1 Fls
25 Lidocain 1 Amp
26 Dexamethason 1 Amp
27 Gentamicin 1 Amp
28 Benang 10.0 1 Pcs
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 6. BHP EVISERASI DENGAN DFG
No Nama Satuan Keterangan
1 Eye Drap 1 Pcs
2 Spuit 1cc 1 Pcs
3 Spuit 10cc 1 Pcs
4 Mes 1 Pcs
5 AOK 150 1 Pcs
6 Epinephrin 2 Vial
7 Infuset 1 Pcs
8 RL 500ml 1 Botol
9 Handscoon Steril 4 Pcs
10 Convermer 1 Pcs
11 Apron 1 Pcs
12 Cotton Bud 1 Pcs
13 Kassa 10 Pcs
14 Kapas 10 Pcs
15 Iodine 30ml 1 Botol
16 PP 1 Kapsul
17 PLester 1 pcs
18 Benang 4.0 silk 2 pcs
19 Benang 4.0 vicryl 1 pcs
20 Benang 6.0 vicryl 1 pcs
21 Benang 8.0 vicryl 1 pcs
22 Gentamicin Zalp 1 Tube
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 7. BHP EVISERASI TANPA DFG
No Nama Satuan Keterangan
1 Eye Drap 1 Pcs
2 Spuit 1cc 1 Pcs
3 Spuit 10cc 1 Pcs
4 Mes 1 Pcs
5 AOK 150 1 Pcs
6 Epinephrin 2 Vial
7 Infuset 1 Pcs
8 RL 500ml 1 Botol
9 Handscoon Steril 4 Pcs
10 Apron 1 Pcs
11 Cotton Bud 1 Pcs
12 Kassa 5 Pcs
13 Kapas 5 Pcs
14 Iodine 30ml 1 Botol
15 PP 1 Kapsul
16 PLester 1 pcs
17 Benang 4.0 silk 1 pcs
18 Benang 6.0 vicryl 1 pcs
19 Benang 8.0 vicryl 1 pcs
20 Gentamicin Zalp 1 Tube
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 8. BHP AMNION GRAFT
No Nama Satuan Keterangan
1 Eye Drap 1 Pcs
2 Spuit 1cc 2 Pcs
3 Spuit 10cc 2 Pcs
7 Infuset 1 Pcs
8 RL 500ml 1 Botol
9 Handscoon Steril 2 Pcs
10 Ope chip 2 Pcs
11 Vigamox 1 Pcs
12 Kassa 5 Pcs
13 Kapas 5 Pcs
14 Iodine 30ml 1 Botol
15 Gentamicin 1 Amp
16 Plester 1 pcs
17 Benang 10.0 nylon 1 pcs
18 Dexamethason 1 Amp
19 Amnion graft 1 pcs
20 Soflens 1 pcs
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 9. BHP Phaco +IOL+ Trabekulektomi
No Nama Satuan Keterangan
1 Eye Drap 1 Pcs
2 Spuit 1cc 5 Pcs
3 Spuit 10cc 3 Pcs
4 Tripan Blue 1 Vial
5 Cathacol 1 Vial
6 Clear Cut 2,75 1 Pcs
7 AOK 150 1 Pcs
8 Infuset 1 Pcs
9 Miriwash 500ml 1 Pcs
10 RL 500ml 1 Botol
11 Handscoon Steril 2 Pcs
12 Kalvis 2 Pcs
13 Lensa Foldable 1 Pcs
14 Dop Mata 1 Pcs
15 Cotton Bud 1 Pcs
16 Kassa 1 Pcs
17 Kapas 1 Pcs
18 Iodine 30ml 1 Botol
19 Vigamox 1 Fls
20 Kaset Phaco 1 Box
21 Tip I.A 1 Pcs
22 Tip Handpiece 1 Pcs
23 Pantocain 1 Fls
24 Mydriatil 1 Fls
25 Cresent 1 Pcs
26 Nylon 10.0 1 Pcs
27 Lidocain 1 Amp Bila Perlu
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 10. BHP ECCE+IOL+Trabek
No Nama Satuan Keterangan
1 Eye Drap 1 Pcs
2 Spuit 1cc 5 Pcs
3 Spuit 10cc 3 Pcs
4 Tripan Blue 1 Vial
5 Cathacol 1 Vial
6 Clear Cut 2,75 1 Pcs
8 Infuset 1 Pcs
10 RL 500ml 1 Botol
11 Handscoon Steril 2 Pcs
12 Kalvis 2 Pcs
13 Lensa 1 Pcs
15 Cotton Bud 1 Pcs
16 Kassa 1 Pcs
17 Kapas 1 Pcs
18 Iodine 30ml 1 Botol
19 Vigamox 1 Fls
23 Pantocain 1 Fls
24 Mydriatil 1 Fls
25 Lidocain 1 Amp
26 Dexamethason 1 Amp
27 Gentamicin 1 Amp
28 Benang 10.0 1 Pcs
29 Cresent 1 Pcs
30 AOK 150 1 Pcs
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 11. BHP Trabek
No Nama Satuan Keterangan
1 Eye Drap 1 Pcs
2 Spuit 1cc 2 Pcs
3 Spuit 10cc 2 Pcs
4 Benang 10.0 1 Pcs
5 Cathacol 1 Vial
6 Clear Cut 2,75 1 Pcs
8 Infuset 1 Pcs
10 RL 500ml 1 Botol
11 Handscoon Steril 2 Pcs
12 Cresent 1 Pcs
13 AOK 150 1 Pcs
15 Cotton Bud 1 Pcs
16 Kassa 1 Pcs
17 Kapas 1 Pcs
18 Iodine 30ml 1 Botol
19 Vigamox 1 Fls
23 Pantocain 1 Fls
24 Lidocain 1 Amp
25 Dexamethason 1 Amp
26 Gentamicin 1 Amp
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12.BHP Implant Trabek

 No Nama Satuan Keterangan
1 Eye Drap 1 Pcs
2 Spuit 1cc 2 Pcs
3 Spuit 10cc 2 Pcs
4 Benang 10.0 1 Pcs
5 Cathacol 1 Vial
6 Clear Cut 2,75 1 Pcs
8 Infuset 1 Pcs
10 RL 500ml 1 Botol
11 Handscoon Steril 2 Pcs
12 Cresent 1 Pcs
13 AOK 150 1 Pcs
15 Cotton Bud 1 Pcs
16 Kassa 1 Pcs
17 Kapas 1 Pcs
18 Iodine 30ml 1 Botol
19 Vigamox 1 Fls
23 Pantocain 1 Fls
24 Lidocain 1 Amp
25 Dexamethason 1 Amp
26 Gentamicin 1 Amp
27 Implant 1 Pcs
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13. BHP INJEKSI SUBTENON

 No Nama Satuan Keterangan
1 Spuit 1cc 2 Pcs
2 Spuit 10cc 1 Pcs
3 Infuset 1 Pcs
4 RL 500ml 1 Botol
5 Handscoon Steril 2 Pcs
6 Kassa 1 Pcs
7 Kapas 1 Pcs
8 Iodine 30ml 1 Botol
9 Vigamox 1 Fls
10 Pantocain 1 Fls
11 Lidocain 1 Amp
12 Dexamethason 1 Amp
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14. BHP KISTE KONJUNGTIVA

No Nama Satuan Keterangan
1 Eye Drap 1 Pcs
2 Spuit 1cc 1 Pcs
3 Spuit 10cc 1 Pcs
Tergantung diameter
4 Benang Vicryl 8.0 1 Pcs
kiste
5 Infuset 1 Pcs
6 RL 500ml 1 Botol
7 Handscoon Steril 2 Pcs
8 Kassa 1 Pcs
9 Kapas 1 Pcs
10 Iodine 30ml 1 Botol
11 Pantocain 1 Fls
12 Lidocain 1 Amp
13 Erlimicitin Zalf 1 Tube
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15. BHP Dislokasi Lensa/Ekspantasi IOL/IOL Exchange

No Nama Satuan Keterangan
1 Eye Drap 1 Pcs
2 Spuit 1cc 2 Pcs
3 Spuit 10cc 1 Pcs
4 Benang 10.0 1 Pcs
5 Cathacol 1 Vial
6 Clear Cut 2,75 1 Pcs
7 Infuset 1 Pcs
Penggantian lensa (IOL)
tergantung kondisi lensa
yang telah terpasang, jika
8 Lensa (IOL) 1 Pcs
masih bisa dipakai maka
operator akan memasang
kembali lensa yang lama
9 RL 500ml 1 Botol
10 Handscoon Steril 2 Pcs
11 Kassa 1 Pcs
12 Kapas 1 Pcs
13 Iodine 30ml 1 Botol
14 Vigamox 1 Fls
15 Pantocain 1 Fls
16 Lidocain 1 Amp
17 Dexamethason 1 Amp
18 Gentamicin 1 Amp
19 Viscoat 1 Pcs
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16. BHP Forced Duction Test

No Nama Satuan Keterangan
1 Spuit 1cc 1 Pcs
2 Handscoon Steril 2 Pcs
3 Kassa 1 Pcs
4 Kapas 1 Pcs
5 Iodine 30ml 1 Botol
6 Vigamox 1 Fls
7 Pantocain 1 Fls
8 Lidocain 1 Amp
9 Erlicitin zalf 1 Tube
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17. BHP Entropion

No Nama Satuan Keterangan
1 Spuit 3 cc 1 Pcs
2 Spuit 10cc 1 Pcs
3 Benang 6.0 Prolene 1 Pcs
4 Benang 5.0 Vicryl 1 Pcs
5 Nald 26 G 1 Pcs
6 Infuset 1 Pcs
7 RL 500ml 1 Botol
8 Handscoon Steril 2 Pcs
9 Kassa 1 Pcs
10 Kapas 1 Pcs
11 Iodine 30ml 1 Botol
12 Pantocain 1 Fls
13 Lidocain 2 Amp
14 Mess 1 Pcs
15 Marker Pen 1 Pcs
16 Erlimicitin zalf 1 Tube
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18. BHP Cross Linking Riboflavin

No Nama Satuan Keterangan
1 Eye Drap 1 Pcs
2 Handscoon Steril 2 Pcs
3 Kassa 1 Pcs
4 Kapas 1 Pcs
5 Iodine 30ml 1 Botol
6 Pantocain 1 Fls
7 Riboflavin 1 Pcs
8 Soflens 1 Pcs
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19. BHP Anastesi Lokal Retrobulbar

No Nama Satuan Keterangan
1 Spuit 5 cc 1 Pcs
2 Handscoon Non Steril 1 Pcs
3 Nald 23 G 1 Pcs
4 Lidocain 2 Pcs
5 Kassa 1 Pcs
6 Kapas 1 Pcs
7 Iodine 30ml 1 Botol
8 Pantocain 1 Fls
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20. BHP Anastesi Lokal Subkonjungtiva

No Nama Satuan Keterangan
1 Spuit 1 cc 1 Pcs
2 Lidocain 1 Pcs
3 Pantocain 1 Fls
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21. BHP Toxic Effect Alcohol Unspecified

No Nama Satuan Keterangan
1 Spuit 5 cc 12 Pcs
2 Handscoon Non Steril 14
Pasang
3 Methyilprednisolon 250 mg 12 Vial
4 Infus set 1 Pcs
5 Abocat 1 Pcs
6 RL 3 Kolf
7 Tagedram 1 Pcs
8 Alcohol swab 14 Pcs
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