Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | North Texas Division | ||
| Site/Hospital | NTXD HHCCA | ||
| Billing | Delivery | ||
| Name | marlo.cooper@medicalcityhealth.com | Name | Marlo Cooper |
| George.Greene1@healthtrustpg.com | marlo.cooper@medicalcityhealth.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | HCA Healthcare Center for Clinical Advancement c/o Marlo Cooper |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | 3201 Dallas Parkway |
| Address Line 3 | Suite 1100 | Address Line 3 | Suite 900 |
| City | Nashville | City | Frisco |
| State | TX | State | TX |
| ZIP | 37203 | ZIP | 75201 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| C99002 | Brayden Adult Airway Silicone Flap Valve (Pack of 24) | 24 | $177.12 |
| C99003 | Brayden Adult Airway Filter (Pack of 24) | 24 | $102.00 |
| A99002 | Brayden Adult Compression Spring Addon | 24 | $544.80 |
| S13107 | Brayden Adult Airway Valve Assembly | 48 | $171.36 |
| C99101 | Brayden Adult Face Skin Piece | 18 | $263.70 |
| S13106 | Brayden Adult Face/Mouth Connector | 24 | $60.48 |
| C13101 | Brayden Adv Adult Body Skin Piece | 18 | $718.20 |
| S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 60 | $94.80 |
| C17004 | Brayden Baby/Infant Back Skin | 12 | $504.00 |
| C17003 | Brayden Baby/Infant Body Skin | 18 | $1,039.50 |
| A17001 | Brayden Baby/Infant Cotton Diaper | 12 | $189.00 |
| C17006 | Brayden Baby/Infant Double Filter (Pack of 5) | 18 | $510.30 |
| C17002 | Brayden Baby/Infant Face Skin Piece | 14 | $882.00 |
| S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 48 | $138.72 |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 100 | $945.00 |
| S17008 | Brayden Baby/Infant Spring | 24 | $365.52 |
| C99110 | Brayden Junior Replacement Face Skin Piece (single) | 10 | $146.50 |
| A99003 | Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug | 24 | $351.60 |
| C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 18 | $1,587.60 |
| C16101 | Brayden Pro Adult Body Skin | 18 | $756.00 |
| S16402 | Brayden Pro Adult Body Skin Magnet | 48 | $189.12 |
| $0.00 | |||
| Sub-Total | $9,737.32 | ||