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QUICKIE S636 BC/SC/MPC

No Power, Single Power & Multi Power Seating Option

EIS62 - Effective May 2012 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,State,Zip: Phone:

SUBMIT

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

Definition

Price

Option #

HCPCS

Definition

Price

1. QUICKIE S636 BC/SC/MPC POWER CHAIR

The Inclusion of the previous power wheelchair HCPCS code, K0011, is specifically for those payers that have not adopted the new HCPCS codes for power mobility devices released by CMS in 2006.

Quickie S636 BC No Power (Not HCPC coded)

105PC93 NA Quickie S636 BC $3,995.00 105TO25

Transit

4 Point Transit Pkg (NA over 300lbs) $300.00

Suspension

105SV01 105SV02 105SV10 105SV11 Up to 175 lb Weight Capacity 176 to 250 lb Weight Capacity 251 to 300 lb Weight Capacity 301 to 400 lb Weight Capacity (Not available with solid casters) N/C N/C N/C N/C

Performance Packages

105PF86 105PF84 105PF93 6.5 mph / 300 LB Capacity 5.0 mph High Torque Motors (Required when using 400 lbs. seating.) 8.5 mph / 300 LB Capacity N/C $500.00 $2,000.00

LED Light Package (Requires Rne t)

105LI04 LED Light Package (NA w/recline or Base only) $1,000.00

2. POWERED SEATING

Power Seating System Options

105PT1 105PT3 105PT4 E1002 E1005 E1008 Power CG Tilt - 53° Power Recline System / Pwr Shear 50° Tilt Recline w/Pwr Shear Reduction (MPC Only)

Powered Seat Option Electronics $4,995.00 $5,320.00 $9,620.00

105TN1 105TN2 105EO3 105EO5 E2310 E2311 105EO1 Standard Toggle Switch Activation (select switch on page 4) Toggle Mount Right Toggle Mount Left Thru Drive 1 Actuator Thru Drive 2+ Actuators

N/C N/C N/C $1,375.00 $2,825.00

MPC base can be ordered with any of the above power seating options at initial issue. Expandable controls are required with all MPC Bases

ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.com

Page 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

Definition

Price

Option #

HCPCS

Definition

Price

3. FRAME COLOR OPTIONS

105C2 105C10 105C36 105C35 105C4 105C6 105C38 105C5 105C11 105C8 105C128 105C127 -

Black Black Opal Candy Blue Candy Red Midnight Purple Forest Green Blue Opal Pearl Pink Toxic Green Yellow Copper Fuchsia

N/C N/C N/C N/C N/C N/C N/C N/C N/C N/C N/C N/C

105C126 105C103 105C114 105C113

-

Glow Rootbeer Sparkle Silver Titanium Color Paint Custom Colors Stars & Stripes Mossy Oak Camouflage Desert Camouflage Zebra (Choose above base color)

N/C N/C N/C N/C

105C42 105C43 105C112 105C108

-

$295.00 $295.00 $295.00 $295.00

Std with White unless above base paint is chosen NA with Black.

4. SEATING

Seat Width

105W5 105W6 105W7 105W8 105W9 105W10 105W11 105W13 105W14

14" 15" 16" 17" 18" 19" 20" 22" Wide base (27-3/4") Included. 24" Wide base (27-3/4") Included. Seat Depth

N/C N/C N/C N/C N/C N/C N/C N/C N/C

105FT50

Seat Rail Type Straight Seat Frame (not avail. With power ALR/ELR) Flared Seat Frame (Add 1" ea.side) Seat Height 18" (Add .5" for Power CG Tilt or Tilt and Recline.) 19" (Not available with power seating options. 20" (Add .5" for Power CG Tilt or Tilt and Recline.) 21" (Not available with power seating options.

N/C N/C

105FT47

105HT10

N/C N/C N/C N/C

105HT12

105HT14

105SD7 105SD8 105SD9 105SD10 105SD11 105SD12 105SD13 105SD14 105SD33

14" 15" 16" 17" 18" 19" 20" 21" 22"

N/C N/C N/C N/C N/C N/C N/C N/C N/C

105HT17

Seat Frame Angle

105FA3 105FA4

3° 6° Not avail. w/ 18" seat height. 9° Not avail. w/ 18" seat height.

N/C N/C N/C

105FA5

ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.com

Page 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

Definition

Price

Option #

HCPCS

Definition

Price

5. BACKS

Back Type

105BU27 105BU26 105BU35 105BU42 105KE22 E0956 E1028 E0956 E0956 E0956 E1028 K0669 E0956 Parapak Upholstery (select back height) Jay Solid Backrest (select back height) Jay Precision Back Tall w/ Laterals Jay Precision Back Tall omit Laterals Lateral Pad Symmetric Swing Away (Not avail. w/ push handles and backrest or Back pad.) Lateral Pad Symmetric Lateral Pad Asymmetric Lateral Pad Asymmetric Swing Away

Back Height N/C N/C $345.00 $345.00 $340.00

105B88 105B95 105B97 15" - 16" (Not avail. on Pwr Recline or Tilt 17" - 18" & Recline) 19" - 20"

N/C N/C N/C

21"-29" Only available on Reclining and Tilt and Recline Systems.When selecting 21"-29 with the Smart Seat only there will be a 7" gap btwn the seat pan & the bottom of the backrest pad when the shear adj. is fully extended. This provides room for the shear compensation to operate. 105B99 105B100 105B112 105B113 21" - 22" 23" - 24" 25" - 26" 27" - 28" 29"

105KE20 105KE19 105KE21

$190.00 $190.00 $340.00

N/C N/C N/C N/C N/C Seat Type

105BU14

Omit Jay Solid Backrest (This option should be selected only when using a Jay 3 or other aftermarket backrests in combination with tilt seating.)

(15.00)

105B114

105PN1 105PN2

Seat Pan Aluminum Omit Seat Pan (not avail. w/Recline Seat)

N/C ($45.00)

Jay 3 Option

105JB01 Jay J3 (select OMIT Backrest above) See J3 OF 90° 105QK1

Power Recline Back Preset Home Angle

95° 105QK2 100° 105QK3

6. SEAT CUSHIONS

105CU1 105JC05 105JC03 105JC09 105JC10 105JC11 E2622 E2623 E2605 E2606 E2603 E2604 E2607 E2608 E2607 E2609 2" Cushion. Jay J2 Deep Contour Jay Soft Combi P Jay GO Jay ION Jay UNION $95.00 See JAY OF 105JC07 See JAY OF See JAY OF See JAY OF See JAY OF 105JC02 105JC01 105JC08 105JC04 E2622 E2623 E2622 E2623 E2607 E2601 E2602 E2607 Jay J2 Jay J3 Jay Easy Jay Basic Jay ZIP See JAY OF See JAY OF See JAY OF See JAY OF See JAY OF

7. ARMRESTS

Armrest (Pair)

105AA30 105AA40 105AA8 105AA60 E0973 E0973 E0973

Armpads - Reclining (Pair) N/C $250.00 $260.00 N/C

Only available on Reclining and Tilt and Recline Systems 105AM17 105AM18 105AM19 K0106 K0106

Dual Post Flip Back Dual Post Flip Back Height Adj. Single Post Height Adjustable Reclining Height Adjustable ( Only

available on Reclining and Tilt and Recline Systems. )

Reclining Arm Pad (16") Otto Bock Med forearm pads (11") Otto Bock Lg forearm pads (13") Otto Bock Hand Pads (Pair)

N/C $240.00 $240.00

105AA60 105AA61 105AA14

Std Height (9" - 12") Tall Height (11" - 14") Omit Armrests Armpads - Non Reclining (Pair)

N/C N/C N/C

To be used with Otto Bock Forearm Pads. Only available on Reclining and Tilt and Recline Systems. 105OB02 105OB01 E2209 E2209

Medium Flat Hand Pads (4-1/2"x 7") Large Flat Hand Pads (5-1/2"x 9")

$105.00 $105.00

105AM7

Desk Length Waterfall (10") (not avail. on Reclining Height Adjustable Armrest) Full Length Waterfall (14") (not avail. on Reclining Height Adjustable Armrest) Desk Length Standard (10") (not avail. on Reclining Height Adjustable Armrest) Full Length Standard (14") (not avail. on Reclining Height Adjustable Armrest)

N/C N/C N/C N/C

105AM8

105AM1

105AM2

ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.com

Page 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

Definition

Price

Option #

HCPCS

Definition

Price

8. FOOTRESTS

Hanger (Pair)

105H2 105H37 70° Swing Away Hanger

90° Swing Away (Only available with kids

angle adjustable footplates) E0990

N/C N/C $280.00

Foot Plate (Pair) Adult Angle Adjust. w/ heel loop

105F282 105HL10 K0040 E0951 Adult Angle Adjustable Footplate Heel Loop

$210.00

$165.00 $45.00

105H14

105H38

E1010

Manual Elevating Hanger (Req. aluminum footplate or angle adj. and Med. Extension Tubes) Power Elevating (Pair) Order with Power ELR/ALR extension tubes. Maximum rider weight limit 250 lbs. Only available with seat widths 16" and greater. Power Articulating (Pair) Order with Power ELR/ALR extension tubes. Maximum rider weight limit 250 lbs. Only available with seat widths 16" and greater.

Omit Hangers

Kids Angle Adj. w/ Leg Strap (Only available with 90° hangers)

105F283 105LS13 105F5 K0040 K0038 K0042 Kids Angle Adjustable Footplate Leg Strap

$195.00

$1,440.00

$165.00 $30.00

Aluminum (Only avail. w/manual ELR)

Two-piece Locking w/Heel Loop (Only avail. w/ 70° SA Hangers) $1,880.00

105F61 105HL10 K0040 E0951 Two-piece Locking Footplate Heel Loop

$30.00 $210.00

$165.00 $45.00

105H39

E1010

Multi-Positional w/Heel Loop

Not avail. w/med. Ext. tubes. Avail. for use only on the 70° swing-away hanger and the Power ALR and ELR.

$215.00

105H32

($15.00)

105F47 105HL10 105F6

K0040 E0951

Multi-Positional Footplate Heel Loop

$170.00 $45.00

Extension Tube Not available with 90° hangers.

105E1 105E2

Omit Foot Plate w/Heel Loop Footrest Accessories

N/C

Short (13" - 15") Medium (15" - 18") Not available with multi-position footplate. Long (18" - 20") Power ELR/ALR Med (15.5" to 18")

Use Multi-positional Footplates for shorter leg lengths (13" - 15-1/2").

N/C N/C N/C N/C

105LS3 105A110

K0038 E0952

105E5 105E33

Extra Leg Strap, Black Toe Loop (Only available with angle adjustable footplates)

$30.00 $45.00

105E34

Power ELR/ALR Long (17.5" to 20")

N/C

ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.com

Page 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

Definition

Price

Option #

HCPCS

Definition

Price

9. ELECTRONICS

Drive Control

105J57 90A VR2 Non-Expandable Controller

R-net OMNI and Output Options STD

105J91 105J89 E2373 Omni* Only Compact Joystick with Omni* Output Module w/ Omni* E2351 Output Module w/o Omni* (ECM) Rnet Bluetooth Mouse-mover

$975.00 $1,050.00 $1,050.00 $995.00 $850.00

Drive Controller Upgrade Options

R-Net Expandable Drive Control Upgrade (90A) 105EX01 105EX02 E2377 E2313 Expandable Controller - R-net Harnessing for Expandable Controller

105J90

$950.00

$525.00 $425.00

105A401 105A602

* Omni is always mounted on the opposite side of the joystick

R-net Joystick and Expandable Options

105J70 105J93 Std LED Joystick for Expandable Ctrls

Addition of Second Joystick to Specialty Input N/C $200.00 $395.00

105J88 105A404 E2351 Joystick w/Toggle/Speed Pot /Color Disp. 2nd Output module for additional ports

$395.00 $1,050.00

Joystick w/mono jacks and monochrome display

Joystick W/Toggle, Spd Pot & Color Disp.

105J88

-

OMNI Mount (If used with Joystick must be mounted opposite side)

105DK2 Left Side Mount Right Side Mount

N/C N/C

Joystick Mount (Fixed or Swing Away)

105JM1 105JM2 E1028 Fixed Mount Swing Away Mount N/C $235.00

105DK1

Battery Charger

105BJ19 8 A Battery Charger CTE Omit Charger

N/C -$40.00

Joystick Mount (Location)

Height Adjustable. 105HM1 105HM2 Right Side Mount Left Side Mount N/C N/C

105BJ3

Batteries

105A47 105A48 E2361 E2363 Battery 22NF Gel Pair Battery GP-24 Gel Pair (for best range)

$320.00 $390.00

Joystick Handle

105JH1 105JH2 105JH4 105JH6 E2323 E2323 E2323 E2323 Ball Handle Foam Ball Handle T-Handle Goalpost

$75.00 $75.00 $75.00 $75.00

105BK2 105BK1

Battery Straps

Battery Strap and Insert 22NF Battery Strap GP-24

N/C N/C

10. SPECIALTY INPUT INDIVIDUAL COMPONENTS

Specialty Input Device - Requires USCM

105ID6 105ID9 105ID10

Specialty Input Device - Single Switch (cont) $150.00 $780.00 $200.00

105SW4 105SW6 105SW9 105SW11

CA-5 Interface Box Mini Proportional Joystick Penta Switch Specialty Input Device - Single Switch

Micro Light Switch Ribbon Switch Wobble Switch Switch Mount Bracket (Not available with wobble switch)

$75.00 $95.00 $500.00 $195.00

105SW1 105SW2 105SW10

Buddy Button Switch Disc Switch Egg Switch-Black

$75.00 $160.00 $95.00

ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.com

Page 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

Definition

Price

Option #

HCPCS

Definition

Price

11. POSITIONING OPTIONS

Solid backrest must be selected

Headrest (Included on Specified Specialty Controls)

Headrest 8" x 4.5" 105HE1 105MH1 E0955 E1028 Curved Headrest 8" x 4.5" Removable Mount

Headrest (Included on Specified Specialty Controls) $495.00

$270.00 $225.00 Headrest 9" x 4.5" 105HE2 105MH1 E0955 E1028 Curved Headrest 9" x 4.5" Removable Mount

$495.00

$270.00 $225.00

12. LATERAL THORACIC SUPPORT

Requires Jay Solid Backrest

Pad Style Lateral Pads Curved

105KE1 105LM1 105KE2 105LM1 E0956 E1028 Lateral Pad Curved Pair Swing Away Mount Pair

Pad Size $450.00

$225.00 $225.00 105KD1 105KD2 105KD3 Lateral Support 3" x 6" (pr) Lateral Support 4" x 5" (pr) Lateral Support 4" x 6" (pr)

N/C N/C N/C

Lateral Pads Straight

E0956 E1028 Lateral Pad Straight Pair Swing Away Mount Pair

$440.00

$215.00 $225.00

13. WHEELS

Drive Wheel

105DW14 105DW15 105DW24 105DW25 14" Cast Wheel Pneumatic Tire 14" Cast Wheel Pneumatic w/Ins. 14" Chrome/Black Whl Pneumatic 14" Chrome/Black Pneumatic w/Ins.

Wheel Lock N/C N/C $140.00 $140.00

105WL8 105WL12 Push to Lock Do Not Mount

$85.00 N/C

Drive Wheel Tire

105DT1 Knobby

STD

14. CASTERS

Rear Caster Wheel

105RK1 105RK2 4" Soft Polyurethane 4" Micro Lighted

Caster Fork N/C $60.00

Suspension Fork Options are only available with 8" casters. 105CF31 105CF34 E1016 E1016 E1018 E1018 Solid Caster Fork Suspension Fork Light 0-150 lbs. Suspension Fork Med. 151-250 lbs. Suspension Fork Heavy 251-300 lbs. Suspension Fork Heavy 301-400 lbs.

N/C $260.00 $260.00 $260.00 $260.00

Front Caster Wheel

105CW20 105CW21 105CW28 105CW29 8" Pneumatic w/ Insert 8" Pneumatic 9" Pneumatic w/Insert 9" Pneumatic

105CF35

N/C N/C $85.00 $85.00

105CF43 105CF37

ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.com

Page 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

Definition

Price

Option #

HCPCS

Definition

Price

15. ACCESSORIES

Wheelchair Tray Table (Size based on seat width chosen)

Note: Available only with Std armpads 14-20" 105A31 105A32 E0950 E0950 Medium Tufftak (15"-17-") Large Tufftak (18"-20") Specialty Driver Control Options (requires expandable controls) All packages must be added to the specialty control on-chair package.

$250.00 $250.00

Not available with Upholstered backs Quickie Sip n' Puff System 105ID26 E2325 Sip N' Puff Kit Headrest Headrest Removable Mount Sip n' Puff Tubing and Hardware

$2,795.00

$1,870.00 $265.00 $210.00 $450.00

Backpack

105A1 105A2 Black Utility Black/Charcoal Kids

105EA3 E0955

$55.00 $50.00

105EA1 E1028 105EA4 E2326

Positioning Belt - Select for any style seat

105A142 105A12 105A13 E0978 E0978 1.5" Auto Style Buckle Belt 2" Aircraft Buckle Belt 2" Aircraft Buckle Padded

ASL Head Array Package (Adult)

$5,795.00

$5,585.00 $210.00

N/C $110.00 $120.00

105ID31 E2330 105EA1 E1028

ASL Proximity Head Array (Adult) Headrest Removable Mount

ASL Head Array Package (Ped)

$5,795.00

$5,585.00 $210.00

Electronic Programmers

105PR2 105PR3 105PR4 VR-2 Hand Held Programmer (HHP) R-net PC Programmer with Dongle R-net Hand Held (DTT)

105ID30 E2330

ASL Proximity Head Array (Ped) Headrest Removable Mount

$250.00 $400.00 $1,000.00

105EA1 E1028

Switch-It Head Array Package (Adult) 105ID13 E2330 Switch-it Proximity Head Array Headrest Removable Mount

$4,390.00

$4,180.00 $210.00

Attendant Control

105A465 105A450 105DN1 105DN2 E2331 E2331 Attendant Control for VR-2 Attendant Control for R-net MOUNTING LOCATION: Right Back Cane MOUNTING LOCATION: Left Back Cane

105EA1 E1028

$995.00 $995.00 N/C N/C

Switch-It Head Array Package (Pediatric) 105ID14 E2330 105EA1 E1028 Switch-it Proximity Head Array Headrest Removable Mount

$4,390.00

$4,180.00 $210.00

Single Switch (pick a switch to operate your tilt or recline with toggle

105SW6 105SW1 105SW2 105SW9 105SW4 105SW10 Ribbon Switch Buddy Button Switch Disc Switch Wobble Switch Micro Light Switch Egg Switch-Black

HMC Proportional Mini Joystick Chin/Lip Control Pkg. 105ID28 E2312 105EA3 E0955 105EA1 E1028 Mini Joystick Headrest Headrest Removable Mount

$4,595.00

$4,120.00 $265.00 $210.00

$95.00 $75.00 $160.00 $500.00 $75.00 $95.00

HMC Proportional Mini Joystick Midline w/Gatlin Pkg. 105ID32 E2312 105EA5 E1028 Mini joystick Swing Away Mount

$4,595.00

$4,385.00 $210.00

Single Switch Mount Bracket

105SW11 Switch Mount Bracket

$195.00

Proportional Chin Control Package 105ID12 E2312 E1028 Proportional Joystick Removable Mount

$3,795.00

$3,585.00 $210.00

Seat Pouch

105A8 Black/Charcoal

105EA1

$45.00 Vent Options

105VT2 E1030 Articulating Vent Tray

Miscellaneous

105A82 Caddy

$1,395.00

$45.00 Additional Specifications Weight: Overall Width Overall Length: Range: Top Speed:

128 lbs (without batteries)

25-3/4" (Standard Width Base); 27-3/4" (Wide Base) (Measured at drive wheels)

29-1/2" (Without Footrests)

As far as 12.4 miles (With Group 24 batteries depending on conditions and user environment)

Up to 6.5 mph for 6.5 + package

ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.com

Page 7

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