Hospital Code Governeur Hospital Description Price 411003324 BBTAK 0.00 415001580 Breo Ellipta 100/25 Inhaler 0.00 434000093 #10 FRENCH ADP 132.00 434000094 #10 PIGTAIL 132.00 411001764 #10 SAFETY BLADE 0.00 411001765 #11 SAFETY SCAPEL/BLADE 0.00 411000510 #14 FR.VAN SONNENBERG DRAIN 0.00 411001766 #15 SAFETY SCAPEL/BLADE 0.00 434000091 #8 FRENCH APD 132.00 434000092 #8 PIGTAIL 132.00 325000015 (+) ADD SEQUENTINFUS UP/1 HR 173.00 453500016 (+) ADD SEQUENTINFUS UP/1 HR 173.00 453500017 (+) CONCURRENT INFUSION 101.00 453500030 (+) EA ADD SEQUE INFUS (DIFF S 305.00 453500020 (+) EA ADD SEQUENTIAL INTRAV P 98.00 325000005 (+) EACH ADDIONTAL HOUR 51.00 453500015 (+) EACH ADDITIONAL HOUR 51.00 325000003 (+) EACH ADDITIONAL HOUR 98.00 453500028 (+) EACH ADDITIONAL HOUR 178.00 453500012 (+);EACH ADDITIONAL HOUR 98.00 453500026 (+)INTRAVENPUSH TECH SING/INI 255.00 427900076 (ARC) EXPEDITE IMMUNO WORK-UP 465.00 427900021 (R/X FEE) AHF 25 ML 350 0.00 427900022 (R/X FEE) AHF 25 ML 400 85240 90.00 427900014 (R/X FEE) AHF 300 UNIT 75.00 427900027 (R/X FEE) CRYOPRECIPITATE 51.00 427900025 (R/X FEE) FRESH FROZEN PLASMA 136.00 427900028 (R/X FEE) FROZEN RED CELLS 304.00 427900010 (R/X FEE) RED CELLS REG. 221.00 427900013 (R/X FEE) WASHED RED CELLS 397.00 427900031 (R/X FEE)BLOOD BANK CONSULT. 197.00 427900030 (R/X FEE)BLOOD BANK EVAL URGEN 465.00 427900036 (R/X FEE)COMPAT. SCREENING ARC 135.00 427900032 (R/X FEE)R.B.C. COMPONE (PROD) 99.00 427900033 (R/X FEE)R.B.C. COMPONE (PROD) 177.00 427900015 (R/X FEE)RED CROSS DEL. CHG 75.00 427900009 (R/X FEE)UNIT WHOLE BLOOD 223.00 411000446 .9 NS ADV 100 0.00 411003341 [AL. I/A (COOPERVISION) 0.00 453600081 >1MeV COMPLEX RADIATION TX 492.00 453600080 >1MeV INTERMED RADIATION TX 419.00 453600079 >1MeV SIMPLE RADIATION TX 364.00 411000665 00 SHILEY TUBE 0.00 411001393 0'ENDO SCRUB SHEATH 0.00 411001620 1 1/2"" COVEX COLOSTMY WAFER 0.00 427000069 1 HR GLUCOSE TOLERANCE 72.00 411000667 1 SHILEY TUBE 0.00 411001063 1"" ORTHOGLASS SPLINT 0.00 411001732 1.1cm CIRCLAMP 0.00 411001733 1.3cm CIRCLAMP W/BELL 0.00 411001734 1.45cm CIRCLAMP 0.00 411001784 1.45cm CIRCLAMP W/BELL 0.00 415001521 1/2 Normal Saline w/ 20mEq KCL 0.00 411000146 1/2"" ADAPTIC DRESSING 0.00 411001723 1/2"" GREY FOAM 0.00 415001687 1/2NSw/20Potassium 0.00 411001434 10-28MM SCREWS 3.5 CORTICAL 0.00 411000824 10CC ARTIFICIAL BONE 0.00 411001742 10cm ROSIDAL FOAM 0.00 411000689 10mEq 1000ml SOLUTION 0.00 411000979 10MM ACL KNIFE 0.00 411001551 10mm EXTENDED NAIL END CAP 0.00 411000947 10MM MENICUS ARROW 0.00 411001443 11 HOLE PLATE 0.00 411002525 11 X 380MM X125 LGN KIT 0.00 451000053 11-12 NERVE CONDUCTION STUDIES 204.00 427216099 11-B-PROSTAGLANDIN F2 ALP 114.00 411001444 12 HOLE PLATE 0.00 451000048 1-2 NERVE CONDUCTION STUDIES 84.00 411001752 1200cc CANNISTER 0.00 411001724 12cm COMPRILAN BANDAGE 0.00 411001520 12mm GIA ENDO 0.00 411001635 12mm TROCAR 0.00 411001668 12mm VERA STEP PLUS 0.00 411001445 13 HOLE PLATE 0.00 451000054 13 OR MORE NERVE CONDUCTION ST 228.00 411000948 13MM MENICUS ARROW 0.00 411001747 13mm POLYPEC SNARE 0.00 411001446 14 HOLE PLATE 0.00 411001376 15"" TUBING W/ FILTER 0.00 411002285 15CC CANCELLOUS CHIPS 0.00 411000177 16FR GASTRO TUBE 0.00 427200932 17 ALPHA HYDROXYPROGESTERONE 265.00 427200488 17 HYDROXY PROGESTERONE 113.00 427200866 17 HYDROXYPROGNENOLONE 113.00 427200398 17 KETOSTERIODS TOTAL 51.00 427200397 17-KETOGENIC STERIODS 51.00 411001805 18"" PORT/BLADDER CUFF 0.00 411001816 18fr CHEST TUBE TRAY 0.00 411001727 18fr T-TUBE CATHETER 0.00 433000076 1CC PROHANCE GADOLINIUM 8.00 427200046 1ST TRIMSCRN W/NT 393.00 411000101 2 X 2 AG AQUACEL DRESSING 0.00 411000098 2 X 2 AQUACEL DRESSING 0.00 411000029 2" STERILE KLING 0.00 411000250 2"" CAST PADDING 0.00 411001064 2"" ORTHOGLASS SPLINT 0.00 411000261 2"" PLASTER X-FAST 0.00 411000254 2"" SYNTHETIC PADDING 0.00 411000745 2"" WEBRIL BANDAGE 0.00 411001522 2.0 GIA 30 ROTIC 0.00 411003006 2.5 COMPRESSION SCREW 0.00 411001523 2.5 GIA 30 ROTICULATOR 0.00 411001526 2.5 GIA 45 ROTICULATOR 0.00 411002542 20/3 FIRST FIX KIT 0.00 411001737 20D BENDABLE BLADE 0.00 411001817 20fr CHEST TUBE TRAY 0.00 411001098 20FR COUNCIL CATHETER 0.00 411001324 20x1 HUBER NEEDLE 0.00 427200811 24 HR HOME URINE 233.00 427000125 24 HR URINE CALCIUM 85.00 427000123 24 HR URINE CHLORIDE 86.00 427000175 24 HR URINE PHOSPHORUS 85.00 427000122 24 HR URINE POTASSIUM 86.00 411001818 24fr CHEST TUBE TRAY 0.00 411001751 2500cc CANNISTER 0.00 411000987 25GA X 4 11/16"" TW NEEDLE 0.00 411001746 27mm POLYPEC SNARE 0.00 411001898 28 FR. THORASIC CATHETER 0.00 427000070 2HR GLUCOSE TOLERANCE TEST 57.00 411001704 2mm EXPRESS KIT 0.00 411000688 2Oeq 1000ml SOLUTION 0.00 427000071 3 HR OB GLUCOSE TOLERANCE TEST 220.00 411000666 3 SHILEY TUBE 0.00 411000001 3" STERILE KLING 0.00 411000255 3"" SYNTHETIC PADDING 0.00 411000251 3"" CAST PADDING 0.00 411000425 3"" ORTHOGLASS SPLINT 0.00 411000258 3"" PLASTER 0.00 411000262 3"" PLASTER X-FAST 0.00 411001861 3"" SYNTHETIC CAST PADDING 0.00 411000746 3"" WEBRIL BANDAGE 0.00 404000040 3.0 BIO SUTURE ANCHOR 1,098.00 411001431 3.5 10 HOLE PLATE 0.00 411001432 3.5 12-HOLE PLATE 0.00 411001419 3.5 2 HOLE PLATES 0.00 411001426 3.5 5 HOLE PLATE 0.00 411001421 3.5 5-HOLE 100 DEG. TUB. PLATE 0.00 411001427 3.5 6 HOLE COMPRESSION PLATE 0.00 411001529 3.5 60 GIA ROTIC 0.00 411001428 3.5 7 HOLE COMP. PLATE 0.00 411001430 3.5 9 HOLE PLATE 0.00 411001391 3.5 BLADE 0.00 411001429 3.5 COMPRESSIO PLATE 0.00 411001435 3.5 CORT. SCREW 0.00 411001436 3.5 CORTICAL SCREW 0.00 411001396 3.5 CUDA BLADE 0.00 411001424 3.5 TUBLAR PLATE 0.00 411001423 3.5 TUBLAR PLATES 0.00 411001420 3.5mm 3 HOLE PLATE 0.00 411000990 3.5MM ABRADER BLADE 0.00 411001276 3.5MM BONE PLATE 0.00 411000949 3.5MM CURVED INCISOR 0.00 411000728 3.5mm MELKER CRIC. CATH SET 0.00 411001682 3.5mm PERIARTIC. SCREWS 0.00 411000812 3.5MM RAZOR CUT 0.00 411001403 3.5MM TAP 0.00 411000952 3.5X42MM SCREW 0.00 411001422 3.6 HOLE PLATE TUBLAR 0.00 411001387 3.7 BLADE 0.00 411000444 3.7mm DISTAL PILOT TIP DRILL 0.00 411001675 3.7mm TIBIAL/HUMERAL DRILL 0.00 411001404 3.8 DRILL BIT 0.00 411000315 30 cc SYRINGE 0.00 460200013 30 MIN GROUP SESSION 88.00 460200011 30 MIN SESSION 97.00 411000565 300 SERIES SHELL 58MM 0.00 411002996 30CM SPLITTER 0.00 411001738 30D BENDABLE BLADE 0.00 411001392 30'ENDO SCRUB SHEATH 0.00 411001687 30fr ESOPHAGEAL BALLOON DILAT. 0.00 451000049 3-4 NERVE CONDUCTION STUDIES 101.00 411001808 34"" SING BLAD DUAL PORT. CUF 0.00 411001415 35-60mm CANCELLOUS SCREW 0.00 411001340 3CC ORTHOBLAST PAS 0.00 435000091 3D INDEPENDENT WORK STATION 217.00 434000078 3D RECON ON SAME WORK STATION 614.00 433000058 3D RECON ON SAME WORK STATION 830.00 434000079 3D RECOND ON INDEPEND WORK STA 571.00 433000059 3D RECONS ON INDEPEND WORK STA 926.00 453600001 3D RECONSTRUCTION 341.00 411002694 3-HOLE LEFT HUMERAL PLATE 0.00 427000072 3HR GLUCOSE TOLERANCE TEST 57.00 411001534 3MM BIO-SUT ACHOR 0.00 411001779 3oz SOLIDIFIER 0.00 411000167 3-WAY STOPCOCK 0.00 411000660 4 CFS SHILEY TUBE 0.00 427000078 4 HOUR GLUCOSE 57.00 411000480 4 LPC SHILEY TUBE 0.00 411000659 4 SHILEY TUBE 0.00 411000102 4 X 4 AG AQUACEL DRESSING 0.00 411000099 4 X 4 AQUACEL DRESSING 0.00 411002201 4 X 4 RED CASTING 0.00 411001715 4 X 4 TRAY SPONGE 0.00 411000252 4"" CAST PADDING 0.00 411001653 4"" COLOSTOMY SET 0.00 411001651 4"" DRAINABLE POUCH 0.00 411000639 4"" ESMARK BANDAGE 0.00 411000426 4"" ORTHOGLASS SPLINT 0.00 411000259 4"" PLASTER 0.00 411001862 4"" SYNTHETIC CAST PADDING 0.00 411000256 4"" SYNTHETIC PADDING 0.00 411001652 4"" WAFER 0.00 411000096 4"" WEBRIL BANDAGE 0.00 411001414 4.0 CANCEL LAG SCREW 0.00 411001418 4.0 CANCELL LAG SCREW 0.00 411001416 4.0 CANCELL. SCREW 0.00 411001262 4.0 MM CANNULATED SCREW 0.00 411001397 4.0 OVAL BUR 0.00 411000950 4.0X34MM SCREW 0.00 411000951 4.0X36MM SCREW 0.00 411001386 4.2 BLADE 0.00 411001389 4.2 CURVED BLADE 0.00 411001674 4.2mm COR 30mm LENGTH SCREW 0.00 411001671 4.2mm COR 35mm LENGTH SCREW 0.00 411001672 4.2mm COR 45mm LENGTH SCREW 0.00 411001466 4.5 BROAD PLATE 0.00 411001390 4.5 BUR 0.00 411001676 4.5 COR SCREWS 0.00 411001469 4.5 CORT. SCREWS 0.00 411001465 4.5 NARROW PLATES 0.00 411002571 4.5 SCREW 0.00 411000811 4.5MM FULL RADIUS CUTTER 0.00 411000810 4.5MM TRIMMER BLADE 0.00 411001643 4.7mm HEXHEAD 3/4"" LEN SCRW 0.00 411001399 4.8 CUDA BLADE 0.00 411001531 4.8 ENDO GIA II 0.00 411001658 400 MICRON LASER FIBER 0.00 411000687 40mEq 1000ml SOLUTION 0.00 460200009 45 MIN SESSION 145.00 411001665 4fr AIRWAY COMBITUBE 0.00 411001569 4-HOLE COMP TUBE 135 DEG PLATE 0.00 411000620 4mm MELKER CRIC.