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

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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
Page 1 and 2: QUICKIE S636 BC/SC/MPCNo Power, Sin
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