Transcript
Quickie QRi December 2015
SUBMIT
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ADDITIONAL SHIPPING INFORMATION
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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.
a
Option #
HCPCS
Definition
Price
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Option #
HCPCS
Definition
Price
1. FRAME STYLE & SETUP Base Model QRi (265 lbs) K0005 Classic Frame Style E1236 Applies with certain sizes
Figure 1
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202WM81
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202TO1
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202FA1 202FA8 202FA2
Frame Angle (see Figure 1) 75° 80° 85°
NC NC NC
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202FF1 202FF2
Frame Inset Per Side (See Figure 2) 0" 1" (NA w/ 12" wide)
NC NC
Figure 2
$1,895.00
Transit Transit
Frame Inset 0 1"
$315.00
Seat Depth
Footrest Width Subtract 0 from Frame Width Subtract 2" from Frame Width Seat Width
Measure from outside of seat tube to outside of opposite seat tube. 202S3 12" o 202S4 13" o 202S5 14" o 202S6 15" o 202S7 16" o 202S8 17" o 202S9 18" o 202S10 19" o 202S48 E2201 20" o
NC NC NC NC NC NC NC NC $500.00
Measures from front of back post to front edge of seat sling. Seat sling will be 1" shorter than depth ordered, but actual seat depth will remain the same as ordered.
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202SD5 202SD6 202SD7 202SD8 202SD9 202SD10 202SD11 202SD12 202SD13
12" 13" 14" 15" 16" 17" 18" 19" E2203 20"
ORDER INFORMATION: Customer Service: 800-333-4000 Fax: 800-300-7502 www.sunrisemedical.com Specifications are subject to change without notice. Copyright © 2012 Sunrise Medical (US) LLC. (11.05) Quickie QRi, MK-100050 REV D Page 1
NC NC NC NC NC NC NC NC $550.00
2. FRONT SEAT HEIGHT SET UP Fram e Depth 12"/13" 14"/15" 16"/17" 18"/19" 20"
Front Seat Height See Figure 3 202SH12 o 202SH13 o 202SH14 o 202SH15 o 202SH16 o 202SH17 o 202SH18 o
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15.0" 15.5" 16.0" 16.5" 17.0" 17.5" 18.0"
NC NC NC NC NC NC NC
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145SH20 145SH21 145SH23 145SH24
18.5" 19.0" 19.5" 20.0"
Caster Wheels 4" Low Profile Polyurethane 4" x 1.25" Semi Pneumatic 4" x 1.5" Aluminum Soft Roll 5" Low Profile Polyurethane 5"x 1" Aluminum Polyurethane 5"x 1.5" Semi Pneumatic 5"x 1.5" Aluminum Soft Roll 6" Polyurethane 6"x 1.5" Semi Pneumatic 6"x 1.5" Aluminum Soft Roll
202CW3 202CW44 202CW64 202CW5 202CW65 202CW7 202CW66 202CW34 202CW35 202CW68
NC NC NC NC
NC $55.00 $175.00 NC $110.00 $85.00 $185.00 NC $85.00 $195.00
Max Seat Squeeze 2.5" 3.0" 3.5" 4.0" 4.5"
Figure 3
Caster Fork Frog Legs NA w/ 6" casters 202CF26 o 202CF53 E1015 o 202CF54 E1015 o 202CF55 E1015 o
Standard Frog Legs 0 weight to 100 lbs Frog Legs 101 lbs weight to 190 lbs Frog Legs 191 lbs weight to 265 lbs
NC $425.00 $425.00 $425.00
3. FOOTPLATE OPTIONS Footrest Leg strap not included, see Footplate Option section 202F308 Aluminum Tubular o 202F309 Aluminum Tubular w/ Snap on Cover o 202F310 K0040 Aluminum Platform (Ang. Adj.) o
NC NC $95.00
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202DI19 202A54 202DI06 202A500
Footrest Options K0038 Leg Strap K0038 Extra Leg Strap Positioning Plates for Platform Footrest Gel Cover Hanger/Frame
Adaptive Platform Spacer Tubular and Platform Footrest Caster/Fork Availability Adaptive Platform 2" Spacer Adaptive Platform 4" Spacer Adaptive Platform 6" Spacer
$95.00 $95.00 $95.00
Lower Leg Length Range FSH Range FSH Range 15"-17" 17.5"-20" Inset 0" 1" 0" 1" Min 12.3 12.3 14.3 14.3 Platform Max 16.0 16.0 18.0 18.0 Min 12.3 12.3 14.3 14.3 Tubular 75° Max 15.5 15.5 17.5 17.5 Min 12.3 13.9 14.3 14.3 Long Platform and Tubular Max 17.5 17.5 19.5 19.5 Min 12.2 12.1 14.2 14 Platform Max 16.1 16.1 18.1 18.1 Min 12.2 12.2 14.2 14.2 Tubular 80° Max 15.6 15.6 17.6 17.6 Min 12.2 14.2 14.2 14.2 Long Platform and Tubular Max 17.8 17.8 19.8 19.8 Min 12.2 12.5 14.2 14 Platform Max 16.1 16.1 18.1 18.1 Min 12.2 12.5 14.2 14.2 Tubular 85° Max 15.5 15.5 17.5 17.5 Min 12.2 14.5 14.2 14.5 Long Platform and Tubular Max 17.7 17.7 19.7 19.7 Quote or order acknowledgement will display standard or long footrest used with configuration of chair. Subtract appropriate length if using platform spacers.
Frame Angle
Footrest Type
Range
Caster
Fork
Inset 0"
1" Standard Fork 3 Frog Legs Standard Fork 4 Frog Legs Standard Fork 5 Frog Legs Standard Fork 6 Frog Legs NA NA Standard Fork 3 Frog Legs Standard Fork 4 Frog Legs Standard Fork 5 Frog Legs NA Standard Fork NA w/1.5 6 Frog Legs NA NA Standard Fork 3 Frog Legs NA Standard Fork 4 Frog Legs NA NA w/1.5 Standard Fork NA w/1.5 5 Frog Legs NA NA Standard Fork NA NA 6 Frog Legs NA NA NA w/ 1.5 = NA with the 1.5" wide caster. Blank = available. No Go's may still apply that are not listed based on actual configuration of the chair.
85° Frame Angle 80° Frame Angle 75° Frame Angle
NA with Tubular Footrest 202AD1 o 202AD2 o 202AD3 o
ORDER INFORMATION: Customer Service: 800-333-4000 Fax: 800-300-7502 www.sunrisemedical.com Specifications are subject to change without notice. Copyright © 2012 Sunrise Medical (US) LLC. (11.05) Quickie QRi, MK-100050 REV D Page 2
$30.00 $30.00 $50.00 $105.00
4. REAR SEAT HEIGHT SET UP Rear Seat Height 14" and 14.5" only availble w/ 22" rear wheels 14.0" o 202RH13 14.5" o 202RH14 15.0" o 202RH15 15.5" o 202RH16 16.0" o 202RH17 16.5" o 202RH18 17.0" o 202RH19 17.5" o 202RH26 18.0" o 202RH20 18.5" o 202RH27 19.0" o 202RH21 19.5" o 202RH37 20.0" o 202RH22
Rear Tire & Wheel Matrix NC NC NC NC NC NC NC NC NC NC NC NC NC
Rear Wheel Size Ultra Lightweight Wheels only available with aluminum anondized handrim Contact Built 4 Me for Spinergy color options 22" Mag Wheel NC o 202RW8 24" Mag Wheel NC o 202RW1 22" Lite Spoke Wheel $200.00 o 202RW91 24" Lite Spoke Wheel NC o 202RW92 25" Lite Spoke Wheel NC o 202RW93 26" Lite Spoke Wheel $80.00 o 202RW94 22" Ultra Lightweight Spoke Wheel 2.0 $250.00 o 202RW06 24" Ultra Lightweight Spoke Wheel 2.0 $250.00 o 202RW10 25" Ultra Lightweight Spoke Wheel 2.0 $250.00 o 202RW16 22" Spinergy SPOX Black $795.00 o 202RW28 24" Spinergy SPOX Black $795.00 o 202RW95 25" Spinergy SPOX Black $795.00 o 202RW96 26" Spinergy SPOX Black $795.00 o 202RW97 22" Spinergy LX Black $995.00 o 202RW32 24" Spinergy LX Black $995.00 o 202RW98 25" Spinergy LX Black $995.00 o 202RW99 26" Spinergy LX Black $995.00 o 202RW40 Rear Wheel Tire See Availability Matrix E2211 o 202RT1 E2212 E2211 o 202RT2 E2213 E2218 o 202RT3 E2211 o 202RT6 E2212 E2211 o 202RT27 E2212 E2211 o 202RT21 E2212 E2218 o 202RT38
Pneumatic
NC
Pneumatic w/ Airless Insert
$80.00 NC
Full Poly High-Pressure Clincher
$95.00
Knobby V- Trak
$95.00
Schwalbe Marathon Plus Evolution
$125.00 $95.00
SHOX Performance Poly
Wheel Tire Pneumatic Pneumatic w/ Airless Insert
Full Poly
Mag
Lite Spoke
22,24 22,24 22,24
22,24,26 22,24 22,24 22,24,25,26
High-Pressure Clincher
Ultra Lightweight
22,24,26 22,24,26 22,24,25
Knobby V Trak by Kenda Schwalbe Marathon SHOX Performance Poly
22" = 489
24 24" = 540
24,25,26 24,25 25" = 559
Spinergy
22,24,25,26 24 24,25,26 24,25
26" = 590
Handrim Plastic not available on all wheels in all sizes. Natural Fits are NA w/ 26" Aluminum Anodized o 202HR1 Plastic o 202HR4 Natural Fit - Standard Grip o 202HR22 Natural Fit - Super Grip o 202HR23 Natural Fit LT - Standard Grip o 202HR30 Natural Fit LT - Super Grip o 202HR31 Center of Gravity Preset Measure from front of back post to center of rear axle o 202CC2 1.0" o 202CC3 1.5" o 202CC4 2.0" o 202CC5 2.5" o 202CC6 3.0"
NC $95.00 $375.00 $410.00 $375.00 $410.00
NC NC NC NC NC
Camber o o
202CI1 202CI2
0° 3°
NC NC
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202AX1
NC
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202AX13
Axle Quick Release Steel Quad Quick Release Only available with Mag wheels
Axle Plates See Short Axle Plate Matrix for RSH Availability o 202AL40 Standard Short (COG 1" to 3") o 202AL43 Standard Long (COG 1" to 3")
$125.00
NC NC
Wheel Lock Not all wheel locks available in all seat depths, wheel sizes and COG settings NC o 202WL1 High Mount Push NC o 202WL2 High Mount Pull NC o 202WL45 Ergo Scissor $125.00 o 202WL30 Compact NC o 202WL10 Omit Wheel Lock NC o 202WL12 Do Not Mount
Rear Seat to Floor Height
Short Axle Plate/Wheel Size Matrix 22" 14.0 14.5 16.0 16.5 17.0 17.5
24"
25"
26"
15.0 15.5 17.0 17.5 18.0
15.0 15.5 17.0 17.5 18.0
16.0 17.5 18.0 18.5 19.0
Extension Handle Only available w/ High Mount Push or Pull Wheel Locks E0961 Extension handles (Pair) o 202EH7
ORDER INFORMATION: Customer Service: 800-333-4000 Fax: 800-300-7502 www.sunrisemedical.com Specifications are subject to change without notice. Copyright © 2012 Sunrise Medical (US) LLC. (11.05) Quickie QRi, MK-100050 REV D Page 3
$65.00
5. ARMREST Armrest - Padded Swing Away Preset to 10". Some limitations may exist with integral and folding push handles Range 9"-13". 202AA18 E0973 Padded Swing-Away - Standard $210.00 o
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202AA11 202AA29
Armrest - Height Adjustable E0973 Single Post Ht. Adjust. Std (8.5"-13.5") E0973 Single Post Ht. Adjust. Low (7"-11")
Armpad - For Height Adjustable Desk Length - Classic (10") Full Length - Classic (14")
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202AM23 202AM24
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202AA14
Omit Armrest Omit Armrest
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2028A05
Armrest Accessories Gel Cover Swing Away Arm
$105.00
202JB01
JAY J3 Back JAY J3 Back
See OF
$285.00 $285.00
NC NC
NC
6. BACKREST
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202BT82 202BT3
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202PH6
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202PH5
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202PH2
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202B110 202B127 202B111 202B137
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202BU1
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202BU70
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202BU71
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202BU14
Back Type Folding Lock Down Angle Adj Non-Folding Backrest Push Handles Integral Push Handles Fold-Down Push Handles NA w/ 1014" Back Height or Standard Upholstery.
Omit Push Handles Height Adjustable Backrest 10" - 14" Back Height 12" - 16" Back Height 14" - 18" Back Height 16" - 20" Back Height Back Upholstery Standard Upholstery Backrest Tension Adj Ballistic Nylon E2611 *reference 186BU70 for billing Backrest Tension Adj 3DX Vented E2611 *reference 186BU71 for billing Omit Upholstery (Use w/ JAY Backs)
NC NC
NC $100.00 NC
NC NC NC NC
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Military Service Patches Only available on tension adjustable upholstery and Jay 3 Back o 202VU1 US Marines Patch o 202VU2 US Army Patch o 202VU3 US Navy Patch o 202VU4 US Air Force Patch o 202VU12 US Coast Guard o 202VU5 Purple Heart o 202VU8 Purple Heart with Marines Patch o 202VU9 Purple Heart with Army Patch o 202VU10 Purple Heart with Navy Patch o 202VU11 Purple Heart with Air Force Patch o 202VU13 Purple Heart with Coast Guard
$90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $145.00 $145.00 $145.00 $145.00 $145.00
NC $315.00 $330.00 -$15.00 7. SEATING
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202SL1 202SL6
Seat Sling Standard Seat Sling Omit Seat Sling
NC -$15.00
JAY Cushions (Optional) To order any JAY cushions on-chair, please see the JAY price list. Cushion name or part number must be filled out with desired width and depth JAY Bundled Cushion o 202JC20 Cushion Name or Part # Price List Width: Depth:
ORDER INFORMATION: Customer Service: 800-333-4000 Fax: 800-300-7502 www.sunrisemedical.com Specifications are subject to change without notice. Copyright © 2012 Sunrise Medical (US) LLC. (11.05) Quickie QRi, MK-100050 REV D Page 4
8. Key Options & Accessories
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202AT1 202AT3
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202SG33 202SG29
Anti Tips E0971 Anti Tips (Pair) Omit Rear Anti Tip
$140.00 NC
Side Guards K0108 Plastic - Standard (8.5" High) K0108 Plastic - Low (6.5" High)
$125.00 $125.00
Aluminum o
202SG35
K0108
NA w/ height adj arms, push/pull wheel locks only available in black
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202SG36
K0108
202A1 202A2 202A8
Pack Accessories Quickie Backpack Black Quickie Kids Backpack Black Seat Pouch Black
$55.00 $50.00 $45.00
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202A142 202A120
Positioning Belt E0978 1.5" Auto Buckle Universal w/clamps Positioning Belt Slide Clamps
$70.00 $50.00
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202A302 202A23
Spoke Guards K0065 Quickie Clear Spoke Guard K0065 Quickie Black Spoke Guard
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202DI07
$235.00
Aluminum w/ Fender
NA w/ height adj arms, push/pull wheel locks only available in black
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$245.00
Miscellaneous Neoprene Impact Guards
$115.00 $115.00
$85.00
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202A2100
E2207 Crutch Holder Only available with
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202A85 202A83
Bolt-On Push Handles Tool Kit
$115.00 $45.00
NC NC NC NC NC
Integral or Fold Down push handles
$195.00
10. COLOR Standard Frame Colors Aztec Gold Black (Not avail as base w/Zebra) Black Cherry Black Opal Blue Opal Candy Blue
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202C116 202C151 202C150 202C149 202C152
Matte Frame Colors Matte Black Matte Black Cherry Matte Electric Blue Matte Evergreen Matte Purple
NC
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202C112
Desert Camouflage
$295.00
Electric Blue
NC
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202C43
Mossy Oak Camouflage
$295.00
Evergreen
NC
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202C42
Stars & Stripes Zebra (Choose above base color) Std
$295.00
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202C108
NC NC NC NC NC NC
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202C140 202C2 202C141 202C10 202C38 202C36
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202C14 202C35
Candy Purple Candy Red
NC
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202C142
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202C143
Custom Frame Color
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202C126
Glow
NC
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202C144
Green Apple
NC
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202C147
Hot Sparkle Pink
NC
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202C148
Mauve Pink
NC
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202C103
Rootbeer
NC
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202C114
Sparkle Silver
NC
Additional Options Through Built for Me
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202C145
Sunrise Orange
NC
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202C113
Titanium Color Paint
NC
To inquire about any unique customization for Quickie products, contact: Phone: (800) 333 - 4000, Fax: (800) 333 9011
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202C8
Yellow
NC
with White unless above base paint is chosen NA w/ Blk, Matte Black, Blk Opal, Titanium)
ORDER INFORMATION: Customer Service: 800-333-4000 Fax: 800-300-7502 www.sunrisemedical.com Specifications are subject to change without notice. Copyright © 2012 Sunrise Medical (US) LLC. (11.05) Quickie QRi, MK-100050 REV D Page 5
$295.00
