This document lists medical service tariffs for Policlinic and Surgery Room services at Perdami. For Policlinic, consultation fees range from 150,000 to 250,000 IDR depending on the type of consultation. Diagnostic tests part 1 (performed by technicians) range from 25,000 to 25,000 IDR. Diagnostic tests part 2 (performed by doctors) range from 100,000 to 200,000 IDR. Non-surgical and minor surgical procedures range from 100,000 to 500,000 IDR. Laser procedures range from 500,000 to 1,000,000 IDR. Surgery room fees for refractive, glaucoma, vitreo-retinal, st

1. Tarif Jasa Medik Perdami:
A. POLIKLINIK
I. KONSULTASI
Jenis tindakan
Konsultasi 150,000
Visite 150,000
Assesment kampimetri 150,000
Assesment kelainan papil 150,000
Assesment pergerakan bola mata 150,000
Assesment Low Vision 150,000
II. DIAGNOSTIK I (PELAKSANA : TEKNISI)
Jenis tindakan
Biometri 25,000
Foto Fundus 25,000
HRT (Heidelberg Retina Tomography) 25,000
Humphrey 25,000
Keratometri 25,000
OCT (Optical Coherence Tomography) 25,000
Refraksi 25,000
Retinometri 25,000
Specular Microscope 25,000
Tonometri 25,000
Visante Glaucoma / 1 mata 25,000
Visante Refractive/1 Mata 25,000
III. DIAGNOSTIK II (PELAKSANA : DOKTER)
Jenis tindakan
ERG 200,000
Fitting Lensa Kontak 200,000
Foto Fluorescein Angiography (F.F.A.) 200,000
Funduscopy 100,000
Gonioscopy 100,000
Pemeriksaan Follow up Lensa Kontak 150,000
Pemeriksaan Retcam 250,000
Scraping cornea / pengambilan unk sediaan apus 100,000
Tonografi 200,000
U.S.G. 200,000
WFDT 100,000

2. VEP 200,000
Hesscreen 100,000
Synoptophore test 150,000
IV. TINDAKAN
IV.1. NON BEDAH
Jenis tindakan
Anel Test 100,000
Epilasi Bulu Mata 100,000
Extraksi corpus alienum cornea / conjungtiva 100,000
Lithiasis 100,000
Spoeling/ irigasi Bola Mata 100,000
IV.2. BEDAH MINOR
Jenis tindakan
Eksisi Chalazion/Hordeolum 500,000
IV.3. LASER
Jenis tindakan
Goniotomi 500,000
Laser Iridotomy 500,000
Fotokoagulasi Laser 1,000,000
Laser Trabeculoplasty (POLTRAB) (SLT) 750,000
Photo Dynamic Theraphy ( PDT) 1,000,000
YAG Laser 500,000
B. KAMAR BEDAH
Jenis tindakan
Bedah Refraktif
Angkat jahitan Kornea 1,000,000
Aspirasi / irigasi/ Reformasi COA 1,000,000
Flap Conjungtiva/Amnion Graft 1,500,000
DSAEK 5,000,000
ECCE/ICCE/SICS 3,000,000

3. ECCE/SICS + IOL 3,500,000
Eksisi Pterigium 2,000,000
Keratoplasty tembus 3,000,000
Lasik 1 (satu) mata 2,000,000
Limbal Relaxing Incision (LRI) 1,500,000
Phaco 3,500,000
Phaco + IOL 4,000,000
Phaco + IOL multIfokal /torik 4,500,000
Phakik IOL 3,000,000
Repair ruptur korneosklera 3,000,000
Reposisi IOL 1,500,000
Reposisi Iris 1,000,000
Sekunder IOL/Fiksasi Sclera/Fiksasi Iris 2,500,000
Glaukoma
Anterior / Posterior Sklerotomi 1,500,000
Cyclo Cryo 1,500,000
Gonioplasty/Goniotomy 1,500,000
Iridektomi perifer 1,000,000
Paracentesis 1,500,000
Tindakan Cyclodia Termi 1,500,000
Trabekulektomi 2,000,000
Trabekulektomi + Phaco +IOL 5,000,000
Tubes implan 3,000,000
Tubes implan + Phaco + IOL 6,000,000
Vitreo Retina
Evakuasi silicon oil 1,500,000
Evakuasi silicon oil + Phaco/ECCE + IOL 5,000,000
Evakuasi silicon oil + ECCE 4,000,000
Injeksi intravitreal 1,000,000
Pneumatic retinopexy 1,500,000
Posterior vitrectomy +/- Sceral buckling 4,000,000
Posterior vitrectomy+ endo laser dengan atau tanpa Silikon Oil/Gas + injeksi intravitreal 5,000,000
Posterior vitrectomy + Phaco + IOL 7,000,000
Posterior vitektomi + SB + Endo laser + Silikon Oil/Gas + Phaco+ IOL 7,500,000
Scleral buckling 2,500,000
Scheral Buckel + Cryo + C3F8 3,000,000
Scleral buckling + Phaco +IOL 5,000,000
Strabismus
Strabismus 1 otot 2,500,000
Strabismus 2 otot 4,000,000
Strabismus 3 otot 5,000,000
Strabismus 4 otot 6,000,000
Rekonstruksi Bedah Mata
Biopsi tumor orbita 1,500,000
Biopsi tumor kelopak 1,000,000
Blefaroplasty 1 kelopak 2,500,000
Eksternal DCR + silikon tube 5,000,000

4. Endoskopi DCR + silikon tube 6,000,000
Eksenterasi 5,000,000
Eksisi tumor adneksa 2,000,000
Ekstirpasi Tumor Adneksa + rekosntruksi 7,000,000
Ektropion 1 kelopak 3,000,000
Entropion 1 kelopak 2,500,000
Eviserasi /enukleasi+implan 5,000,000
Eviserasi /enukleasi 3,000,000
Fraktur Multiple 9,000,000
Koreksi Ptosis 4,000,000
Koreksi Lagoftalmos dengan beban emas 3,000,000
Graft Bibir pada Ptisis Bulbi 2,000,000
Koreksi simblefaron 3,000,000
Probing 1,000,000
Rekonstruksi fraktur dasar orbita 5,000,000
Rekonstruksi Palpebra dengan Graft. 5,000,000
Rekonstruksi soket kontraktur 7,000,000
Rekonstruksi soket landai 5,000,000
Repair Ruptur palpebra 3,000,000
Tumor
Orbitotomi anterior 3,000,000
Orbitotomi lateral 5,000,000
Orbitotomi lateral + superior/medial 7,000,000
Pediatric oftalmologi
Aspirasi irigasi + IOL (Pediatric) 3,000,000
Aspirasi irigasi+ Primary posterior capsulotomy + anterior vitrectomy+ IOL(Pediatric) 3,500,000
Combined Trabeculotomy dan trabeculectomy (Pediatric) 3,000,000
Pupilloplasty, membranectomy, anterior vitrectomy, secondary IOL(Pediatric) 3,000,000
RetCam+Narkose (Pediatric) 1,250,000
Trabeculotomy, untuk glaucoma congenital (Pediatric) 2,500,000