1. quickie s636 bc/sc/mpc power chair - Quickie-Wheelchairs.com

QUICKIE S636 BC/SC/MPCNo Power, Single Power & Multi Power Seating OptionEIS62 - Effective May 2012Account:Date:PO#:Buyer:Marked For:Ship To:Name:Address:City,State,Zip:Phone:The HCPCS CODES provided are based on code verification through PDAC or our interpretation of the code definitions.The use of HCPCS CODES does not ensure coverage or payment. For coverage information, verify the appropriate payer's coverage policy.Option # HCPCS DefinitionPriceOption #HCPCSDefinitionPriceQuickie S636 BC No Power (Not HCPC coded)105PC93 NA Quickie S636 BC $3,995.001. QUICKIE S636 BC/SC/MPC POWER CHAIRThe Inclusion of the previous power wheelchair HCPCS code, K0011, is specifically for those payers that have not adopted thenew HCPCS codes for power mobility devices released by CMS in 2006.Transit105TO25 4 Point Transit Pkg (NA over 300lbs) $300.00Suspension105SV01Up to 175 lb Weight CapacityN/C105SV02 176 to 250 lb Weight Capacity N/C105SV10 251 to 300 lb Weight Capacity N/C 105SV11 301 to 400 lb Weight Capacity(Not available with solid casters)N/CPerformance Packages 105PF866.5 mph / 300 LB Capacity N/CLED Light Package (Requires Rne t) 105PF845.0 mph High Torque Motors (Required$500.00when using 400 lbs. seating.)LED Light Package 105LI04(NA w/recline or Base only) 105PF93 8.5 mph / 300 LB Capacity $2,000.00$1,000.002. POWERED SEATING105PT1105PT3105PT4Power Seating System OptionsE1002 Power CG Tilt - 53°$4,995.00E1005 Power Recline System / Pwr Shear $5,320.00E100850° Tilt Recline w/Pwr Shear Reduction(MPC Only)$9,620.00MPC base can be ordered with any of the above power seating options at initial issue.Expandable controls are required with all MPC BasesPowered Seat Option Electronics105EO1 - Standard Toggle Switch ActivationN/C(select switch on page 4)105TN1 - Toggle Mount RightN/C105TN2 - Toggle Mount LeftN/C105EO3 E2310105EO5 E2311Thru Drive 1 Actuator $1,375.00Thru Drive 2+ Actuators$2,825.00ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.comPage 1

The HCPCS CODES provided are based on code verification through PDAC or our interpretation of the code definitions.The use of HCPCS CODES does not ensure coverage or payment. For coverage information, verify the appropriate payer's coverage policy.Option # HCPCS DefinitionPriceOption #HCPCSDefinitionPrice105C2105C10 - Black Opal N/C105C36 - Candy BlueN/C105C35 - Candy RedN/C105C4105C11 - Toxic Green N/C105C8 - Yellow105C127 - Fuchsia-Black- Midnight Purple105C6 - Forest Green105C38 - Blue Opal3. FRAME COLOR OPTIONSN/C 105C126 - Glow N/CN/CN/CN/C105C5 - Pearl Pink N/CN/C105C128 - Copper N/CN/C4. SEATING105C103 - Rootbeer N/C105C114- Sparkle Silver N/C105C113 - Titanium Color Paint N/CCustom Colors105C42 - Stars & Stripes105C43 - Mossy Oak Camouflage $295.00105C112 - Desert Camouflage $295.00105C108 - Zebra (Choose above base color)$295.00$295.00Std with White unless above base paint is chosenNA with Black.Seat Width105W514" N/C105W615"N/C105W716" N/C105W817"N/C105W9 18"N/C105W10 19"N/C105W11 20" N/C105W13 22" Wide base (27-3/4") Included. N/C105W14 24" Wide base (27-3/4") Included. N/CSeat Depth105SD714"N/C105SD8 15" N/C105SD916" N/C105SD10 17"N/C105SD11 18"N/C105SD12 19"N/C105SD13 20" N/C105SD14 21" N/C105SD33 22" N/CSeat Rail Type 105FT50 Straight Seat Frame (not avail. Withpower ALR/ELR)105FT47105HT10105HT12Flared Seat Frame (Add 1" ea.side)Seat Height18" (Add .5" for Power CG Tilt or Tiltand Recline.)19" (Not available with power seatingoptions. 105HT14 20" (Add .5" for Power CG Tilt or Tiltand Recline.) 105HT17 21" (Not available with power seatingoptions.Seat Frame AngleN/CN/CN/CN/C 105FA3 3° N/C 105FA4 6°N/CNot avail. w/ 18" seat height.105FA5 9°Not avail. w/ 18" seat height.N/CN/CN/CORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.comPage 2

The HCPCS CODES provided are based on code verification through PDAC or our interpretation of the code definitions.The use of HCPCS CODES does not ensure coverage or payment. For coverage information, verify the appropriate payer's coverage policy.Option # HCPCS DefinitionPriceOption #HCPCSDefinitionPrice5. BACKS105BU42105KE20Jay Solid Backrest (select back height)105KE19 E0956 Lateral Pad Asymmetric $190.00105KE21 E0956 Lateral Pad Asymmetric Swing Away$340.00E1028105BU14E0956E1028E0956Back Type105BU27 Parapak Upholstery (select back height) N/C105BU26105BU35105KE22K0669E0956Jay Precision Back Tall w/ LateralsJay Precision Back Tall omit LateralsLateral Pad Symmetric Swing Away (Notavail. w/ push handles and backrest orBack pad.)Lateral Pad SymmetricOmit Jay Solid Backrest (This optionshould be selected only when using a Jay3 or other aftermarket backrests incombination with tilt seating.)Jay 3 OptionN/C$345.00$345.00$340.00$190.00(15.00)105JB01 - Jay J3 (select OMIT Backrest above) See J3 OF105B88105B95105B97105B10015" - 16"17" - 18"19" - 20"Back Height(Not avail. on Pwr Recline or Tilt& Recline)21"-29" Only available on Reclining and Tilt and Recline Systems.When selecting 21"-29with the Smart Seat only there will be a 7" gap btwn the seat pan & the bottom of thebackrest pad when the shear adj. is fully extended. This provides room for the shearcompensation to operate.105B99105B112Power Recline Back Preset Home Angle 90° 105QK1 95° 105QK2 100° 105QK3N/CN/CN/C21" - 22"N/C23" - 24" N/C25" - 26"105B113 27" - 28" N/C105B114105PN1105PN229"Seat TypeSeat Pan AluminumOmit Seat Pan (not avail. w/Recline Seat)N/CN/CN/C($45.00)105JC03105JC09105JC10105JC11E2622E2623E2605E2606E2603E2604E2607E2608E2607E2609Jay J2 Deep ContourJay Soft Combi PJay GO105JC02See JAY OF 105JC01Jay ION See JAY OF 105JC08 E2607 Jay ZIPJay UNION6. SEAT CUSHIONS105CU1 2" Cushion. $95.00 105JC05See JAY OFSee JAY OFSee JAY OF7. ARMRESTS105JC04105JC07E2622E2623E2622E2623Jay J2Jay J3See JAY OFSee JAY OFE2607 Jay Easy See JAY OFE2601E2602Jay BasicSee JAY OFSee JAY OF105AA30105AA40105AA8105AA60E0973E0973E0973Armrest (Pair)Dual Post Flip BackDual Post Flip Back Height Adj.Single Post Height AdjustableReclining Height Adjustable ( Onlyavailable on Reclining and Tilt and ReclineSystems. )N/C$250.00$260.00N/CArmpads - Reclining (Pair)Only available on Reclining and Tilt and Recline Systems105AM17 Reclining Arm Pad (16")105AM18 K0106 Otto Bock Med forearm pads (11")105AM19 K0106 Otto Bock Lg forearm pads (13")N/C$240.00$240.00105AA60105AA61105AA14105AM7Std Height (9" - 12")Tall Height (11" - 14")Omit ArmrestsArmpads - Non Reclining (Pair)Desk Length Waterfall (10") (not avail. onReclining Height Adjustable Armrest)N/CN/CN/CN/COtto Bock Hand Pads (Pair)To be used with Otto Bock Forearm Pads. Only available on Reclining and Tilt andRecline Systems.105OB02105OB01E2209E2209Medium Flat Hand Pads (4-1/2"x 7")Large Flat Hand Pads (5-1/2"x 9")$105.00$105.00105AM8Full Length Waterfall (14") (not avail. onReclining Height Adjustable Armrest)N/C105AM1Desk Length Standard (10") (not avail. onReclining Height Adjustable Armrest)N/C 105AM2 Full Length Standard (14") (not avail. onN/CReclining Height Adjustable Armrest)ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.comPage 3

The HCPCS CODES provided are based on code verification through PDAC or our interpretation of the code definitions.The use of HCPCS CODES does not ensure coverage or payment. For coverage information, verify the appropriate payer's coverage policy.Option # HCPCS DefinitionPriceOption #HCPCSDefinitionPrice8. FOOTRESTSHanger (Pair)105H2 70° Swing Away Hanger N/C105H3790° Swing Away (Only available with kidsN/Cangle adjustable footplates) 105H14 E0990 Manual Elevating Hanger (Req.aluminum footplate or angle adj. andMed. Extension Tubes)$280.00 105H38 E1010 Power Elevating (Pair) Order with $1,440.00Power ELR/ALR extension tubes.Maximum rider weight limit 250 lbs.Only available with seat widths 16"and greater.105H39105H32105E1105E2E1010Power Articulating (Pair) Order withPower ELR/ALR extension tubes.Maximum rider weight limit 250 lbs.Only available with seat widths 16"and greater.Omit Hangers ($15.00)Extension TubeNot available with 90° hangers.Short (13" - 15")Medium (15" - 18") Not available withmulti-position footplate.105E5 Long (18" - 20")105E33Power ELR/ALR Med (15.5" to 18")Use Multi-positional Footplates for shorterleg lengths (13" - 15-1/2").$1,880.00N/CN/CN/CN/C Kids Angle Adj. w/ Leg Strap (Only available with 90°hangers) 105F5 K0042 Aluminum (Only avail. w/manual ELR) $30.00 Two-piece Locking w/Heel Loop (Only avail. w/ 70° SA $210.00Hangers)Foot Plate (Pair)Adult Angle Adjust. w/ heel loop$210.00105F282 K0040 Adult Angle Adjustable Footplate$165.00105HL10 E0951 Heel Loop $45.00$195.00105F283 K0040 Kids Angle Adjustable Footplate $165.00105LS13 K0038 Leg Strap $30.00105F61 K0040 Two-piece Locking Footplate$165.00105HL10 E0951 Heel Loop$45.00Multi-Positional w/Heel LoopNot avail. w/med. Ext. tubes. Avail. for use only on the 70°swing-away hanger and the Power ALR and ELR.$215.00105F47 K0040 Multi-Positional Footplate $170.00105HL10 E0951 Heel Loop $45.00105F6 Omit Foot Plate w/Heel Loop N/C105LS3105A110K0038E0952Footrest AccessoriesExtra Leg Strap, BlackToe Loop (Only available with angleadjustable footplates)$30.00$45.00105E34Power ELR/ALR Long (17.5" to 20")N/CORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.comPage 4

The HCPCS CODES provided are based on code verification through PDAC or our interpretation of the code definitions.The use of HCPCS CODES does not ensure coverage or payment. For coverage information, verify the appropriate payer's coverage policy.Option # HCPCS DefinitionPriceOption #HCPCSDefinitionPrice9. ELECTRONICSDrive ControlR-net OMNI and Output Options 105J57 - 90A VR2 Non-Expandable ControllerSTD 105J91 - Omni* Only 105J89 E2373 Compact Joystick with Omni*Drive Controller Upgrade Options 105J90 Output Module w/ Omni* R-Net Expandable Drive Control Upgrade (90A) $950.00 105A401 E2351 Output Module w/o Omni* (ECM)105EX01 E2377 Expandable Controller - R-net$525.00 105A602 - Rnet Bluetooth Mouse-mover105EX02 E2313 Harnessing for Expandable Controller $425.00* Omni is always mounted on the opposite side of the joystick$975.00$1,050.00$1,050.00$995.00$850.00R-net Joystick and Expandable Options105J70 - Std LED Joystick for Expandable Ctrls N/C105J93 - Joystick w/mono jacks$200.00and monochrome display105J88 - Joystick W/Toggle, Spd Pot & Color Disp. $395.00105JM1 -105JM2 E1028Joystick Mount (Fixed or Swing Away)Fixed MountSwing Away MountJoystick Mount (Location)$235.00Height Adjustable.105HM1 - Right Side Mount N/C105HM2 - Left Side Mount N/CJoystick Handle105JH1 E2323 Ball Handle $75.00105JH2 E2323 Foam Ball Handle $75.00105JH4 E2323 T-Handle$75.00105JH6 E2323 Goalpost $75.00N/CAddition of Second Joystick to Specialty Input105J88105A404-E2351Joystick w/Toggle/Speed Pot /Color Disp.2nd Output module for additional ports$395.00$1,050.00OMNI Mount (If used with Joystick must be mounted opposite side) 105DK2 - Left Side MountN/C 105DK1 - Right Side MountN/CBattery Charger 105BJ19 8 A Battery Charger CTE N/C 105BJ3Omit Charger-$40.00Batteries 105A47 E2361 Battery 22NF Gel Pair $320.00 105A48 E2363 Battery GP-24 Gel Pair (for best range) $390.00Battery Straps 105BK2Battery Strap and Insert 22NFN/C 105BK1 Battery Strap GP-24N/C10. SPECIALTY INPUT INDIVIDUAL COMPONENTSSpecialty Input Device - Requires USCM105ID6CA-5 Interface Box$150.00105ID9 Mini Proportional Joystick$780.00105ID10 Penta Switch $200.00Specialty Input Device - Single Switch105SW1 Buddy Button Switch $75.00105SW2 Disc Switch$160.00105SW10 Egg Switch-Black $95.00105SW4105SW6105SW9105SW11Specialty Input Device - Single Switch (cont)Micro Light Switch$75.00Ribbon Switch $95.00Wobble SwitchSwitch Mount Bracket (Not availablewith wobble switch)$500.00$195.00ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.comPage 5

The HCPCS CODES provided are based on code verification through PDAC or our interpretation of the code definitions.The use of HCPCS CODES does not ensure coverage or payment. For coverage information, verify the appropriate payer's coverage policy.Option # HCPCS DefinitionPriceOption #HCPCSDefinitionPrice11. POSITIONING OPTIONSSolid backrest must be selectedHeadrest (Included on Specified Specialty Controls)Headrest (Included on Specified Specialty Controls)Headrest 8" x 4.5"$495.00 Headrest 9" x 4.5" $495.00105HE1 E0955 Curved Headrest 8" x 4.5"$270.00105HE2 E0955 Curved Headrest 9" x 4.5" $270.00105MH1 E1028 Removable Mount$225.00105MH1 E1028 Removable Mount $225.0012. LATERAL THORACIC SUPPORTRequires Jay Solid BackrestPad StylePad SizeLateral Pads Curved$450.00 105KD1 Lateral Support 3" x 6" (pr) N/C105KE1 E0956 Lateral Pad Curved Pair$225.00 105KD2Lateral Support 4" x 5" (pr)N/C105LM1 E1028 Swing Away Mount Pair$225.00 105KD3Lateral Support 4" x 6" (pr)N/CLateral Pads Straight$440.00105KE2 E0956 Lateral Pad Straight Pair $215.00105LM1 E1028 Swing Away Mount Pair$225.0013. WHEELSDrive WheelWheel Lock105DW1414" Cast Wheel Pneumatic TireN/C105WL8Push to Lock $85.00105DW15 14" Cast Wheel Pneumatic w/Ins. N/C105WL12Do Not MountN/C105DW2414" Chrome/Black Whl Pneumatic $140.00105DW25 14" Chrome/Black Pneumatic w/Ins. $140.00Drive Wheel Tire105DT1 Knobby STD14. CASTERSRear Caster WheelCaster Fork105RK1 4" Soft Polyurethane N/CSuspension Fork Options are only available with 8" casters.105RK24" Micro Lighted $60.00105CF31 Solid Caster Fork N/C105CF34 E1016 Suspension Fork Light 0-150 lbs. $260.00Front Caster Wheel105CF35 E1016 Suspension Fork Med. 151-250 lbs. $260.00105CW208" Pneumatic w/ Insert N/C105CF43 E1018 Suspension Fork Heavy 251-300 lbs. $260.00105CW218" PneumaticN/C105CF37E1018 Suspension Fork Heavy 301-400 lbs. $260.00105CW28 9" Pneumatic w/Insert $85.00105CW299" Pneumatic$85.00ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.comPage 6

The HCPCS CODES provided are based on code verification through PDAC or our interpretation of the code definitions.The use of HCPCS CODES does not ensure coverage or payment. For coverage information, verify the appropriate payer's coverage policy.Option # HCPCS DefinitionPriceOption #HCPCSDefinitionPrice15. ACCESSORIESWheelchair Tray Table (Size based on seat width chosen)Specialty Driver Control Options (requires expandable controls)Note: Available only with Std armpads 14-20"All packages must be added to the specialty control on-chair package. 105A31 E0950 Medium Tufftak (15"-17-")$250.00 Not available with Upholstered backs 105A32 E0950 Large Tufftak (18"-20") $250.00 Quickie Sip n' Puff System$2,795.00105ID26 E2325 Sip N' Puff Kit$1,870.00Backpack105EA3 E0955 Headrest$265.00 105A1 Black Utility $55.00105EA1 E1028 Headrest Removable Mount$210.00 105A2 Black/Charcoal Kids $50.00105EA4 E2326 Sip n' Puff Tubing and Hardware$450.00Positioning Belt - Select for any style seat ASL Head Array Package (Adult) 105A142 1.5" Auto Style Buckle N/C105ID31 E2330 ASL Proximity Head Array (Adult) 105A12 E0978 Belt 2" Aircraft Buckle $110.00105EA1 E1028 Headrest Removable Mount 105A13 E0978 Belt 2" Aircraft Buckle Padded$120.00 ASL Head Array Package (Ped)Electronic Programmers105ID30 E2330 ASL Proximity Head Array (Ped) 105PR2VR-2 Hand Held Programmer (HHP) $250.00105EA1 E1028 Headrest Removable Mount105PR3105PR4R-net PC Programmer with DongleR-net Hand Held (DTT)$400.00$1,000.00 Switch-It Head Array Package (Adult)105ID13 E2330 Switch-it Proximity Head ArrayAttendant Control105EA1 E1028 Headrest Removable Mount105A465105A450E2331E2331Attendant Control for VR-2Attendant Control for R-net$995.00$995.00 Switch-It Head Array Package (Pediatric) 105DN1 MOUNTING LOCATION: Right Back Cane N/C105ID14 E2330 Switch-it Proximity Head Array 105DN2MOUNTING LOCATION: Left Back CaneN/C105EA1 E1028 Headrest Removable Mount$5,795.00$5,585.00$210.00$5,795.00$5,585.00$210.00$4,390.00$4,180.00$210.00$4,390.00$4,180.00$210.00Single Switch (pick a switch to operate your tilt or recline with toggle HMC Proportional Mini Joystick Chin/Lip Control Pkg. 105SW6Ribbon Switch $95.00105ID28 E2312 Mini Joystick 105SW1 Buddy Button Switch $75.00105EA3 E0955 Headrest 105SW2 Disc Switch $160.00105EA1 E1028 Headrest Removable Mount 105SW9Wobble Switch $500.00 105SW4Micro Light Switch $75.00 HMC Proportional Mini Joystick Midline w/Gatlin Pkg. 105SW10Egg Switch-Black $95.00105ID32 E2312 Mini joystick105EA5 E1028 Swing Away MountSingle Switch Mount Bracket 105SW11Switch Mount Bracket $195.00 Proportional Chin Control Package$3,795.00105ID12 E2312 Proportional Joystick$3,585.00Seat Pouch105EA1 E1028 Removable Mount$210.00 105A8Black/Charcoal $45.00Miscellaneous105A82 Caddy $45.00Weight:Overall WidthOverall Length:Range:105VT2Top Speed:Vent Options128 lbs (without batteries)29-1/2" (Without Footrests)Up to 6.5 mph for 6.5 + package$4,595.00$4,120.00$210.00$4,595.00$4,385.00$210.00E1030 Articulating Vent Tray $1,395.00Additional Specifications25-3/4" (Standard Width Base); 27-3/4" (Wide Base)(Measured at drive wheels)$265.00As far as 12.4 miles (With Group 24 batteries dependingon conditions and user environment)ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.comPage 7