Jakarta, 28 November 2022

No : 541/MUP/SRT/XI/22

Kepada Yth :
RS Kasih Ibu Denpasar
Jl. Teuku Umar No.120, Dauh Puri Kauh,
Kec. Denpasar Bar., Kota Denpasar,
Bali 80114

Perihal : Penawaran Harga Alkes Balt & Arthesys

Dengan hormat,
Bersama ini kami sampaikan Penawarn Harga Alat Kesehatan PT. Medikon Utama
Pharmalab Tahun 2022, untuk pemakaian di RS Kasih Ibu Denpasar.

Keterangan mengenai spesifikasi dan lain-lain, dapat dilihat pada lampiran surat penawaran
ini.

Demikianlah penawaran ini kami sampaikan. Besar harapan kami agar Bapak/Ibu berkenan
mempertimbangkan penawaran ini. Atas perhatiannya kami ucapkan terima kasih.

Hormat kami,

Dody Apri Purwoko

Sales Manager
 PRICE LIST of MEDICAL DEVICES 2022
BALT - Neuroradiology Products
RS Kasih Ibu Denpasar
Produk Spesifikasi HNA HNA+PPN 11%
BALT
ACCESS DEVICE
FARGO6F / Proximal O.D. - Distal O.D. 6,0F-4,9F / I.D.
FARGO6F;FARGOMAX6F 1.46mm (.058") / Length 115cm
11,286,000 12,527,460
(Braided guiding catheter) FARGOMAX6F / Proximal O.D. - Distal O.D. 6,0F-6,0F / I.D.
1.78mm (.070") / Length 115cm
VASCO+10D / I.D. .017" / O.D. Proximal - O.D. Distal 2,2F-
1,9F / Length 155cm; VASCO+10MP / I.D. .017" / O.D.
Proximal - O.D. Distal 2,2F-1,9F / Length 155cm;
VASCO+10;18 ; 21 VASCO+18D / I.D. .017" / O.D. Proximal - O.D. Distal 2,2F-
14,107,500 15,659,325
(Braided microcatheter) 1,9F / Length 155cm; VASCO+21 MP / I.D. .017" / O.D.
Proximal - O.D. Distal 2,2F-1,9F / Length 155cm;
VASCO+21D / I.D. .024" / O.D. Proximal - O.D. Distal
2,4F/2,7F / Length 155cm.
GAMA17_D_S I.D. .017" / O.D. Proximal - O.D. Distal 2,5F-2,5F / Length
18,225,000 20,229,750
(Braided microcatheter) 160cm
HYBRID007D;008D HYBRID007D / Distal O.D. .007" (0.18mm) / Length 220cm
10,246,500 11,373,615
(Hydrophilic guidewire) HYBRID008D / Distal O.D. .008" (0.20mm) / Length 220cm
HYBRID1214D;014D HYBRID1214D / Distal O.D. .012" (0.30mm) / Length 200cm
9,504,000 10,549,440
(Hydrophilic guidewire) HYBRID014D / Distal O.D. .014" (0.35mm) / Length 200cm
BALLAST Working length 80,90,100cm ; prox/dist OD 0.106" ; prox/dist
20,250,000 22,477,500
(Long Sheath) ID 0.088" ; hydrophilic coating
ANEURYSMA TREATMENT
LEO+ incl. VASCO+ Diameter 3,5 Length 12/18/25/30/35/50mm
(Self-expandable intracranial Diameter 4,5 Length 15/20/25/30/40/50/75mm 85,050,000 94,405,500
stent) Diameter 5,5 Length 25/30/35/50/60/75mm
LEO+ BABY Diameter 2,0 Length 12/18/25mm
(Self-expandable intracranial Diameter 2,5 Length 12/18/25/30/35mm 85,050,000 94,405,500
stent) Diameter 3,0 Length 12/18/25/35mm
SILK
(Self-expandable stent) incl. Diameter 2,0-5,5 Length 15/20/25/30/35/40 209,250,000 232,267,500
VASCO+
Type Complex 10 Super Soft, Complex 10 Soft, Complex 10
OPTIMA
Standard, Complex 18, Helical 10 Super Soft, Helical 10 Soft, 19,575,000 21,728,250
(Coil system)
Helical 10 Standard
XCEL
(Detachment Controller for Instantaneous detachment < 1 second 2,835,000 3,146,850
OPTIMA)

AVM TREATMENT
MAGIC 1.2F;1.5F;MP
(Progressive suppleness
microcatheter)
SONIC1.2F15/25/35 ; 1.5F15/25/35
(Progressive suppleness braided
microcatheter)
SQUID12;18
(Liquid embolic device)
STROKE TREATMENT
CATCH+, CATCHV35,
CATCHVMAXI50
(Thromboembolectomy system)
CATCH+ MINI
(Thromboembolectomy system)
MAGIC1,2F / Length 165cm / Distal Tip O.D 1,2F
MAGIC1,5F / Length 160cm / Distal Tip O.D 1,5F 14,850,000 16,483,500
MAGICMP / Length 165cm / Distal Tip O.D 1,8F
SONIC1,2F15;25;35 / Length 167cm / Distal O.D. 1,2F /
Distal Tip I.D. 0,23 mm / Fusecath Length 1,5;2,5;3,5cm
27,000,000 29,970,000
SONIC1,5F15;25;35 / Length 167cm / Distal O.D. 1,5F /
Distal Tip I.D. 0,30 mm / Fusecath Length 1.5;2,5;3,5cm
SQUID18 / Viscosity 18cP
27,000,000 29,970,000
SQUID12 / Viscosity 12cP
CATCHV/Stent diameter 4mmx20cm / for vessels up to
diameter 4mm
CATCHV35/Stent diameter 5mmx35cm / for vessels up to
59,400,000 65,934,000
diameter 5mm
CATCHVMAX50/Stent diameter 6mmx50cm / for vessels up
to diameter 6mm
Stent diameter 3mmx15cm / for vessels up to diameter 3mm 89,100,000 98,901,000

CCF TREATMENT
GOLDBAL2 / Max.Volume 0,60ml / Max. Size 7x20mm / I.D.
minimal guiding catheter 1,75mm
GOLDBAL2;3;4 GOLDBAL3 / Max.Volume 0,50ml / Max. Size 9x11mm / I.D.
7,350,750 8,159,333
(Detachable balloon) minimal guiding catheter 2,2mm
GOLDBAL4 / Max.Volume 0,75ml / Max. Size 9x16mm / I.D.
minimal guiding catheter 2,2mm
MABDTE
I.D. Proximal 2,7F / Distal 1,8F / Length 165cm 16,335,000 18,131,850
(Microcatheter for GOLDBAL)
ALN
DVT (Deep Vein Thrombosis)
The implantation kit includes : the ALN filter in its adaptor, an
ALN vena Cava Filter introduction system (dilator, introduction sheath, pushing 25,000,000 27,750,000
catheter), a puncture needle, a J-guidewire
The removel kit includes : a clamp catheter, an introduction
ALN vena Cava Filter Removal system (dilator and introduction sheath, a pushing catheter), a 20,000,000 22,200,000
puncture needle, a J-guidewire.
ARTHESYS
PTCA BALLOON
MAYA PTCA
I.D. .0058" / O.D. Proximal - O.D. Distal 1,9F / Length 140cm 1,801,802 2,000,000
(Baloon Catheter)
AKSESORIS
ARTHESYS Y Connector LSA Push-Pull Haemostatis Valve with a 50cm connection line,
193,694 215,000
50cm Guidewire introducer, Twisting torque device