Siloam Hospitals

Surabaya

HEART SCREENING
888000
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Basic Screening:

  • Laboratory: LDL-Cholesterol, triglycerides, glucose fasting
  • Treadmill
  • CT Calcium Score
  • Consultation with cardiologist

 

Further Check:

  • Echocardiography                                          Rp 655,000
  • Holter                                                             Rp 750,000
  • CT Cardiac Contrast                                      Rp 2,500,000
  • Diagnostic cardiac catheterization                 Rp 9,000,000
BASIC
1250000
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  • Physical Examination
  • Electrocardiogram
  • Thorax
  • Laboratory :full blood count, urinalysis, complete faeces, lipid profile (HDL, LDL, total cholesterol, triglycerides), liver function test (SGOT, SGPT), kidney function test (BUN, creatinine, uric acid), blood sugar levels (glucose fasting, glucose 2 hours post prandial),serology / Immunology (HBs-Ag, Anti-HBs)
  • Pap Smear (Female)
  • Consultation with Medical Check Up’s doctor
SILVER
2400000
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  • Physical Examination
  • Electrocardiogram & Treadmill
  • Radiology (Thorax & USG Abdomen Upper / Lower)
  • Laboratory:full blood count, urinalysis, stool test, lipid profile (HDL, LDL, total cholesterol, triglycerides), liver function test (SGOT, SGPT), kidney function test (BUN, creatinine, uric acid), blood sugar levels (glucose fasting, glucose 2 hours post prandial),serology / Immunology (HBs-Ag, Anti-HBs)
  • Pap Smear (Female)
  • Consultation with internist
Gold Package Male Female
3000000
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Male: Rp 3,000,000

Female: Rp 3,350,000 (include pap smear)

  • Physical Examination
  • Dental Examination
  • Electrocardiogram & Treadmill
  • Radiology (Thorax & USG Abdomen Upper / Lower)
  • Spirometry (lung function)
  • Laboratory:full blood count, urinalysis, stool test, lipid profile (HDL, LDL, total cholesterol, triglycerides), liver function test (SGOT, SGPT), kidney function test (BUN, creatinine, uric acid), blood sugar levels (glucose fasting, glucose 2 hours post prandial),serology / Immunology (HBs-Ag, Anti-HBs, CEA)
  • Pap Smear (Female)
  • Consultation with internist
Platinum Package Male Female
4600000
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Male (include PSA)

Female (include pap smear)

 

  • Physical Examination
  • Dental Examination
  • Eye Examination
  • ENT Examination
  • Electrocardiogram, Treadmill, Echocardiography (consultation with cardiologist)
  • Radiology (Thorax & USG Abdomen Upper / Lower)
  • Spirometry (lung function)
  • Laboratory:full blood count, urinalysis, stool test, lipid profile (HDL, LDL, total cholesterol, triglycerides), liver function test (SGOT, SGPT), kidney function test (BUN, creatinine, uric acid), blood sugar levels (glucose fasting, glucose 2 hours post prandial),serology / Immunology (HBs-Ag, Anti-HBs, CEA, AFP, TPHA)
  • Consultation with internist
MRI Package
2500000
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  • MRI + MRA Brain Rp 2,500,000
  • MRI Neck Rp 2,000,000
  • MRI Lumbosacral Rp 2,000,000
  • MRI Knee Rp 2,000,000
  • MRI Shoulder Rp 2,000,000
  • MRI Whole Spine Rp 4,000,000


Healthy Package
345000
Healthy Package close
  • Economic Healthy PackageRp 345,000

    Laboratory: Full blood count, HbA1c, SGOT, SGPT, lipid profile (total cholesterol, HDL, LDL, triglycerides), uric acid.

    Consultation with medical check up’s doctor

 

  • Special Healthy PackageRp 495,000

    Laboratory: Full blood count, HbA1c, SGOT, SGPT, lipid profile (total cholesterol, HDL, LDL, triglycerides), Kidney function test (BUN, uric acid, creatinine)

    Consultation with internist

 

  • Complete Healthy PackageRp 625,000

Laboratory: Full blood count, HbA1c, SGOT, SGPT, lipid profile (total cholesterol, HDL, LDL, triglycerides), Kidney function test (BUN, uric acid, creatinine), Hepatitis B
Consultation with internist

 

 

  • Optional:

Pap smear liquid               Rp 450,000

Total PSA                            Rp 375,000

USG Abdomen                   Rp 450,000

Healthy Package
345000
Healthy Package close
  • Economic Healthy PackageRp 345,000

    Laboratory: Full blood count, HbA1c, SGOT, SGPT, lipid profile (total cholesterol, HDL, LDL, triglycerides), uric acid.

    Consultation with medical check up’s doctor

 

  • Special Healthy PackageRp 495,000

    Laboratory: Full blood count, HbA1c, SGOT, SGPT, lipid profile (total cholesterol, HDL, LDL, triglycerides), Kidney function test (BUN, uric acid, creatinine)

    Consultation with internist

 

  • Complete Healthy PackageRp 625,000

Laboratory: Full blood count, HbA1c, SGOT, SGPT, lipid profile (total cholesterol, HDL, LDL, triglycerides), Kidney function test (BUN, uric acid, creatinine), Hepatitis B
Consultation with internist

 

 

  • Optional:

Pap smear liquid               Rp 450,000

Total PSA                            Rp 375,000

USG Abdomen                   Rp 450,000

Healthy Package
345000
Healthy Package close
  • Economic Healthy PackageRp 345,000

    Laboratory: Full blood count, HbA1c, SGOT, SGPT, lipid profile (total cholesterol, HDL, LDL, triglycerides), uric acid.

    Consultation with medical check up’s doctor

 

  • Special Healthy PackageRp 495,000

    Laboratory: Full blood count, HbA1c, SGOT, SGPT, lipid profile (total cholesterol, HDL, LDL, triglycerides), Kidney function test (BUN, uric acid, creatinine)

    Consultation with internist

 

  • Complete Healthy PackageRp 625,000

Laboratory: Full blood count, HbA1c, SGOT, SGPT, lipid profile (total cholesterol, HDL, LDL, triglycerides), Kidney function test (BUN, uric acid, creatinine), Hepatitis B
Consultation with internist

 

 

  • Optional:

Pap smear liquid               Rp 450,000

Total PSA                            Rp 375,000

USG Abdomen                   Rp 450,000

HPV Vaccination
2250000
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  • 1 Shoot Rp 800,000
  • 3 Shoot Rp 2,250,000
CT Scan Package
2500000
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  • CT Contrast Calcium Score + CA Coronary Rp 2,500,000
  • CT Whole Abdominal Rp 2,500,000
  • CT Stonography Rp 2,800,000
Cancer Screening Package
800000
Cancer Screening Package close
  • Basic Rp 800,000

    Full blood count, AFP, CEA, Consultation with internist

 

  • Brain Rp 3,750,000

    MRI Brain with contrast, Consultation with neurologist or neurosurgeo

 

  • Colon Rp 3,750,000

    M2PK, FOBT, Consultation with gastroenterologist

 

  • Lung Rp 4,400,000

    CT Scan Thorax with contrast, Consultation with pulmonogist

 

  • Prostate Rp 3,750,000

USG Prostate, Total PSA, Consultation with urologist

 

  • Cervix Rp 450,000

Pap smear liquid, Consultation with Obstetricians

Pre Marital Check UP
1600000
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Male: Rp 1,600,000

  • Physical examination
  • X-Ray
  • Laboratory: full blood count, urinalysis, glucose fasting, IgM Anti HSV 1, IgM Anti HSV 2, HBs-Ag, blood type and rhesus, Anti HIV, Hb HPLC analysis
  • Consultation with medical check up’s doctor

 

Female: Rp 3,150,000

  • Physical examination
  • X-Ray
  • Uterine ultrasound
  • Laboratory: full blood count, urinalysis, glucose fasting, IgM Anti HSV 1, IgM Anti HSV 2, HBs-Ag, blood type and rhesus, Anti HIV, Hb HPLC analysis, VDRL, Anti Toxoplasma IgM, Anti Rubella IgM, Anti CMV IgM, TPHA.
  • Consultation with medical check up’s doctor
Pre Marital Check UP
1600000
Pre Marital Check UP close

Male: Rp 1,600,000

  • Physical examination
  • X-Ray
  • Laboratory: full blood count, urinalysis, glucose fasting, IgM Anti HSV 1, IgM Anti HSV 2, HBs-Ag, blood type and rhesus, Anti HIV, Hb HPLC analysis
  • Consultation with medical check up’s doctor

 

Female: Rp 3,150,000

  • Physical examination
  • X-Ray
  • Uterine ultrasound
  • Laboratory: full blood count, urinalysis, glucose fasting, IgM Anti HSV 1, IgM Anti HSV 2, HBs-Ag, blood type and rhesus, Anti HIV, Hb HPLC analysis, VDRL, Anti Toxoplasma IgM, Anti Rubella IgM, Anti CMV IgM, TPHA.
  • Consultation with medical check up’s doctor