a Mark Fr: Dealer Acct #: Dealer Cntact: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Optin # 183FS24 ZIP: Quickie IRIS March 2015 EIZ4-2 Submitting fr: Qute Order Fax Email Ship T Phne: ( ) Fax: ( ) a 1. FRAME STYLE & SETUP Optin # Attentin: Address: The HCPCS CODES prvided are based n cde verificatin thrugh PDAC r ur interpretatin f the cde definitins. The use f HCPCS CODES des nt ensure cverage r payment. Fr cverage infrmatin, verify the apprpriate payer's cverage plicy. HCPCS Pre-Set Tilt Angle (55 range) (Default in Bld) 183TA5 E1161-5 t 50 NA w/ Heavy Duty and 12.5" STFH 183TA6 E1161 0 t 55 183TA7 E1161 +5 t 60 NA w/heavy Duty Package Pre-Set Tilt Angle (40 range) (Default in Bld) 183TA8 E1161-5 t 35 NA w/ Heavy Duty and 12.5" STFH 183TA1 E1161 0 t 40 183TA10 E1161 +5 t 45 NA w/heavy Duty Package 183HV1 Date: Dealer: Dealer Address: Cnfirmatin Email: Cnfirm Via: Definitin Base Mdel 183WM56 E1161 Quickie IRIS with True Fit Grwth Fr 14" sizes use E1233 $2,945.00 183FS23 183FT46 183TT8 183TT12 183TO45 183GY01 183GY02 183W5 183W6 183W7 183W8 183W9 183W10 183W11 PO#: Ship T: Address: Ship T City: HCPCS 183W12 E2201 Frame Struts Fixed (Standard) Frame Width 14" 15" 16" 17" 18" 19" E2201 20" ADDITIONAL SHIPPING INFMATION ST: Definitin Width Adjusting System Avail. range 14"-21". Max grwth 22" NA with Mn Back 21" NA w/ remvable strller handle extensin ZIP: $45.00 $500.00 $500.00 183W13 E2201 22" NA w/ remvable strller handle extensin $500.00 Frame Optins Standard Base and Seat Frame Standard Frame Clr Maximum Weight: 250 lbs. 183C140 Aztec Gld 183C126 Glw 183C2 Black 183C144 Green Apple Heavy Duty Package (Max: 350lbs) $395.00 183C141 Black Cherry 183C147 Ht Pink NA w/ Vent, Battery Tray and Mn Back 183C10 Black Opal 183C148 Mauve Pink Vent/Battery Tray Base NA w/ 183C38 Blue Opal 183C103 Rtbeer E1029 Attendant Wheel Lck, Mn Back and $425.00 183C36 Candy Blue 183C114 Sparkle Silver 14" and 15" frame width; min 17" STFH. 183C14 Candy Purple 183C145 Sunrise Orange Cntracture Seat Frame NA w/ 14" 183C35 Candy Red 183C113 Titanium r 15" frame depths. NA w/ drp seat 183C142 Electric Blue 183C8 Yellw pan. 183C143 Evergreen Matte Frame Clr Tilt Release Optins Ft Release - N Cables 183C116 183C151 Matte Black Matte Black Cherry NA with Vent and Battery Tray. NA 183C150 Matte Electric Blue with 21-22" depth and +5 set-ups. 183C149 Matte Evergreen Left Right (Facing frm rear) 183C152 Matte Purple Backrest Dual trigger cable releases Custm Frame Clr 183C112 Desert Camuflage $295.00 Transit 183C43 Mssy Oak Camuflage $295.00 183C42 Stars & Stripes $295.00 WC-19 Transit Optin Zebra (Chse abve base clr) Std 183C108 with White unless abve base paint is $295.00 chsen NA w/ Black DER INFMATION: Custmer Service: 800-333-4000 Fax: 800-300-7502 www.sunrisemedical.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (9.09) Quickie IRIS March 2015, MK-100051 REV F Page 1
a Optin # HCPCS Definitin a Optin # HCPCS Definitin 2. FRAME DEPTH SET UP (Fill ut either A r B) A. Setup By QUICKIE B. Setup By DEPTH A. User's Seated Height See Figure 1.2, Dimensin B. Distance frm seat surface t tp f the head. 183SJ01 Less than 37" 183SJ02 37" r Greater 183FL91 183FL92 183FL93 B. Frame Depth Range Shrt Seat Frame 14"-18" Medium Seat Frame 16"-20" Lng Seat Frame 18"-22" A. User's Weight (Default in Bld) 251-350 lb ptins nly available w/ HD Package 183BO01 0-250 lbs 183BO02 251-300 lbs 183BO03 301-350 lbs A. Backrest Psitin See FIGURE 1.1 and FIGURE 1.3, Dimensin C. The lcatin f the backrest surface in relatin t the frnt f the backpst. The measurement is taken frm the frnt surface f the backpst t the deepest area f the backrest in cntact with the user's bdy. 183BQ01 183BQ05 183BQ02 183BQ03 183BQ04 183BQ06 +3" +2" +1" Flush -1" -2" 183FD5 183FD6 183FD7 183FD8 183FD9 183FD10 183FD11 183FD16 183FD17 B. Frame Depth 14" recmmend shrt seat frame 15" recmmend shrt seat frame 16" recmmend shrt seat frame 17" recmmend shrt seat frame 18" recmmend medium seat frame 19" recmmend medium seat frame E2203 20" recmmend lng seat frame $550.00 E2203 21" recmmend lng seat frame $550.00 E2204 22" recmmend lng seat frame $900.00 A. Figures fr Setup by Quickie Figure 1.2 A. Tp f Cushin t Seat Rail See FIGURE 1.4 Dimensins A & B. This measurement is taken frm the tp f the cushin t the upper surface f the seat rail. If the cushin has a wedged shape and/r has significant lateral pelvic cntur, then determine the height f the cushin at the pint where the ischial tubersities wuld cntact (nt immerse) the cushin surface. 183CJ01 183CJ02 183CJ03 2 1/2" r Greater Less than 2 1/2" Belw Seat Rail Desired Seat Depth A. Desired Seat Depth See fr pricing, Figure 1.2, Dimensin A fr measurement 183SD7 183SD8 183SD9 14" 15" 16" 183SD10 183SD11 183SD12 183SD13 183SD14 183SD33 E2203 E2203 E2204 17" 18" 19" 20" 21" 22" Figure 1.3 Figure 1.4 3. SEATING 183ST36 183ST35 183ST54 Seat Type Standard Seat Pan E2231 Fr grwth ranges, see Figure 1.5 Drp Seat Pan NA w/ transit, HD, cntracture ftrest system Omit Seat Pan $200.00 $200.00 JAY Cushins (Optinal) T rder any JAY cushins n-chair, please see the JAY price list. Cushin name r part number must be filled ut with desired width and depth. JAY Bundled Cushin 183JC20 Cushin Name/Part #: List Width: Depth: 183QC01 183QC02 Custm Seating Surefit Cnfigurfit Figure 1.5 Frame Width Seat Pan Grwth 14" 14" - 16" 15" 15" - 16" 16" 16" - 18" 17" 17" - 18" 18" 18" - 20" 19" 19" - 20" 20" 20" - 22" 21" 21" - 22" 22" NA DER INFMATION: Custmer Service: 800-333-4000 Fax: 800-300-7502 www.sunrisemedical.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (9.09) Quickie IRIS March 2015, MK-100051 REV F Page 2
a Optin # HCPCS Definitin a Optin # HCPCS Definitin 4. BACKREST 183BT101 Dynamic Backrest Dynamic Backrest NA w/ Reclining Backrest r 19"-22" seat depths $1,195.00 183JB01 JAY J3 Back JAY J3 Back NA w/ O2 Hlder See OF Backpst Style - (Chse ONE Optin - A, B, C, r D) 183BP9 183BP10 183BP11 183BP13 A. Strller Handle Backpst (Fixed) Lw (18") Medium (21") Tall (24") Remvable Extensin NA w/ 21"- 22" frame width, height adj back with adj strller handles A C. Reclining Backrest (0-40 ) Only available with 40 degree tilt range. NA w/ 22" Deep Frame. 183BT21 E1225 Reclining Backrest $850.00 183B5 183B9 Medium Tall C B. Height Adjustable Back w/ Adj. Strller Handles Select desired Push Handle 183PH8 Standard Push Handle 183PH9 Lng Push Handle Recmmended in cmb w/ vent & battery tray AND select desired Back Cane 183B200 Standard 15"-21" 183B201 Tall 18"-24" B D. Mn Back System Must select JAY J3 r JAY Custm Back when rdering Mn Back System. Select One 183MO1 Mn Backrest System $395.00 183MO2 Mn Backrest System w/dynamic Backrest $995.00 AND Select desired Push Handle 183PH8 Standard Push Handle D 183PH9 Lng Push Handle Reclining/Fixed Handle Ht. Diagram Height Adj. Handle Height Diagram Mn Height Adj. Handle Height Diagram DER INFMATION: Custmer Service: 800-333-4000 Fax: 800-300-7502 www.sunrisemedical.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (9.09) Quickie IRIS March 2015, MK-100051 REV F Page 3
a Optin # HCPCS Definitin a Optin # HCPCS Definitin Mn Backrest Optins ONLY- (Chse ONE Optin - A r B) NA n HD, Vent/Battery Tray Base(LTV nly), Reclining Backrest, Desk Length Armpads and Canpy. A. JAY J3 Back fr Mn Backrest System A. JAY J3 Back fr Mn Backrest System Cnt. 183JB04 JAY J3 Back Mn See OF Select desired Headrest Munt (ptinal) 183JB05 JAY J3 Backrest Cntur JAY J3 via JAY Yur Way See OF 183MH10 183MH15 E1028 E1028 Axys Munt & Bracket Cbra Flip Back Munt and Bracket $230.00 $280.00 183JP01 183JP02 E2613 E2614 J3 PA Back (2.2" f Cntur Depth) 183MH16 E1028 Onyx Munt and Bracket $200.00 $535.00 14"-20" Wide J3 PA Back (2.2" f Cntur Depth) 183MH17 Omit $795.00 22" Wide Select desired Headrest Pad (ptinal) 183JP03 183JP04 183JP05 J3 PL Back (3.0" f Cntur Depth) 183HE65 E0955 Plush Head Supprt Pad 8" $230.00 E2615 $620.00 14"-20" Wide 183HE66 E0955 Plush Head Supprt Pad 10" $230.00 J3 PDL Back (6.0" f Cntur Depth) 183HE78 E0955 Plush Head Supprt Pad 14" $230.00 E2620 $745.00 14"-20" Wide 183HE87 E0955 HeadsUp Lrg: 5.3" Lng Arms $310.00 J3 PDC Back (6.0" f Cntur Depth) 183HE88 E0955 HeadsUp Med: 4.1" Sht Arms $310.00 E2620 $745.00 14"-20" Wide 183HE89 E0955 HeadsUp Sml: 3.5" Sht Arms $310.00 JAY J3 Backrest Height 183HE83 E0955 Adjust-A-Plush Standard $260.00 183JR07 183JR08 183JR09 UT Standard 16.5" shell height 183HE82 E0955 Adjust-A-Plush Narrw $260.00 Select desired Lateral (ptinal) UT Medium 18" shell height LAT 4X4 S/A MOUNTS includes 1" OFFSET - PR $805.00 183ZV14 E0956 LATERAL 4X4 W/ 1" OFFSET - PAIR $260.00 UT Tall 19.5" shell height 183ZS07 E1028 LATERAL SWING AWAY MOUNT - PAIR $545.00 A LAT 4X5 S/A MOUNTS includes 1" OFFSET - PR $805.00 183JR10 SH Standard 21" Shell Height 183ZV15 E0956 LATERAL 4X5 W/ 1" OFFSET - PAIR $260.00 183ZS07 E1028 LATERAL SWING AWAY MOUNT - PAIR $545.00 183JR11 183JR12 SH Medium 22.5" SH Tall 24" LAT 4X6 S/A MOUNTS includes 1" OFFSET - PR $805.00 183ZV16 E0956 LATERAL 4X6 W/ 1" OFFSET - PAIR $260.00 183ZS07 E1028 LATERAL SWING AWAY MOUNT - PAIR $545.00 LAT 6X4 S/A MOUNTS includes 1" OFFSET - PR $805.00 JAY J3 Backrest Width 183ZV17 E0956 LATERAL 6X4 W/ 1" OFFSET - PAIR $260.00 Sme interference with armrest may exist when rdering a Backrest 183ZS07 E1028 LATERAL SWING AWAY MOUNT - PAIR $545.00 with greater than 4" wider than the base. LAT 6X5 S/A MOUNTS includes 1" OFFSET - PR $805.00 183JQ06 183JQ01 12" Backrest Width 14" Backrest Width 183ZV18 183ZV07 E0956 LATERAL 6X5 W/ 1" OFFSET - PAIR E1028 LATERAL SWING AWAY MOUNT - PAIR $260.00 $545.00 183JQ02 16" Backrest Width LAT 6X6 S/A MOUNTS includes 1" OFFSET - PR $805.00 183JQ03 183JQ04 183JQ05 JAY J3 Backrest Clr 18" Backrest Width 20" Backrest Width 22" Backrest Width 183ZV19 183ZS07 E0956 LATERAL 6X6 W/ 1" OFFSET - PAIR E1028 LATERAL SWING AWAY MOUNT - PAIR $260.00 $545.00 183GZ01 183GZ02 183GZ03 Black Matching Frame- Standard Clrs Matching Frame- Custm Clr $50.00 B. Custm Seating JAY Cnfigure Fit r Surefit 183QC05 Add Custm Seating rder after IRIS See OF cnfiguratin. Must be n the same rder Select desired Custm Seating Back Height 183QF01 Shrt (12"-18") 183QF02 Medium (16"-20") 183QF03 Tall (18"-22") A B DER INFMATION: Custmer Service: 800-333-4000 Fax: 800-300-7502 www.sunrisemedical.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (9.09) Quickie IRIS March 2015, MK-100051 REV F Page 4
a Optin # HCPCS Definitin a Optin # HCPCS Definitin 5. ARMREST Armrest Heavy Duty Optin nly available w/ Dual Pst Armrest 183AA63 183AA43 183AA62 183AA48 183AA11 183AA29 E0973 E0973 E0973 E0973 Dual Pst Height Adjustable Dual Pst Flip Back Dual Pst Dual Pst Flip Back Height Adj Single Pst Height Adjustable - Std Single Pst Height Adjustable - Lw $270.00 $295.00 $285.00 $285.00 183AA7 E0973 Length Adjustable Lcking Flip-Up NA w/ Cntur Armpad $265.00 183AA1 183AA154 183AA14 E0973 Adjustable Lcking Flip-Up Height Adj. Cantilever Armrest E0973 Available with Mn Back nly. NA w/ 20", 22" and 24" rear wheels. Omit Armrest $255.00 Armrest Size Armrest Matrix fr Single Pst Classic Pad Transfer Tube Receiver Pad Length L Length D H Range Desk Full 8" 5 1/4" Receiver 10 3/4" t 15 3/4" 8 3/4" t 13 3/4" 9" t 13" 7 1/4" t 11 1/4" Cntur Pad Pad Length L H Range Desk Full 10" t 15" 8 1/4" t 12 1/2" 8 1/2" t 12 1/2" 6 3/4" t 10 3/4" 10 1/4" 14" 10 1/2" 14 1/4" Armrest Receiver (Single Pst Height Adjustable Only) 183AR17 Lw 183AR18 Std 183AM23 183AM21 183AM24 183AM22 183AM9 183AM10 Armpad Desk Length Classic Desk Length Cntur Full Length Classic Full Length Cntur Fam Shrt Optin fr Length Adj Lcking Flip Up Fam Lng Optin fr Length Adj Lcking Flip Up JAY Arm Trughs NA with Length Adj. Lcking Flip Up and Adj Lcking Flip Up armrests and Single Pst Height Adj Armrests. Full Lentgh Classic Armpads will autmatically be selected when chsing nly ne side Arm Trugh. 183JL01 E2209 Arm Trugh - 14" lng - Left $205.00 183JL04 E2209 Arm Trugh - 14" lng - Right $205.00 183JL05 E2209 Arm Trugh - 14" lng - Pair $410.00 183JL02 E2209 Arm Trugh - 18" lng - Left $205.00 183JL06 E2209 Arm Trugh - 18" lng - Right $205.00 183JL07 E2209 Arm Trugh - 18" lng - Pair $410.00 183JL03 E2209 Arm Trugh - 22" lng - Left $205.00 183JL08 E2209 Arm Trugh - 22" lng - Right $205.00 183JL09 E2209 Arm Trugh - 22" lng - Pair $410.00 JAY Arm Trugh - Hardware 183JN01 Fixed (EA) 183JN03 Fixed (Pair) 183JN02 E1028 Swing Away - Rtatinal (EA) 183JN04 E1028 Swing Away - Rtatinal (Pair) $500.00 DER INFMATION: Custmer Service: 800-333-4000 Fax: 800-300-7502 www.sunrisemedical.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (9.09) Quickie IRIS March 2015, MK-100051 REV F Page 5
a Optin # HCPCS Definitin a Optin # HCPCS Definitin 6. HANGER AND FOOTPLATE OPTIONS Ftrest (Chse ONE Optin - A, B, r C) A. Hanger Munted Ftrest Extensin Tubes NA w/ 12.5" seat height 2" NA w/ 90 swing away, 90 lift ff 183E23 hangers 183H140 183H142 183H158 183H146 183H132 183H147 183H161 183E24 183F8 183A7 E0990 K0040 A. Hanger Munted Ftrest 70 Swing In/Swing Out -Frnt Munt 80 Swing In/Swing Out -Frnt Munt 90 Swing In/Swing Out -Frnt Munt 70 Heavy Duty Frnt Munt Lift Off 80 Heavy Duty Frnt Munt Lift Off NA w/ 4" casters 90 Heavy Duty Frnt Munt Lift Off NA w/ 4" casters Elevating Hanger - Frnt Munt NA 90 ftbard, sme interference with casters if nt tilted K0040 Adult Angle Adj - Frnt Munt Omit Ftplate $55.00 4" NA w/ 90 swing away, 90 lift ff $55.00 A. Hanger Munted Ftrest Ftplates Heel lp r leg strap nt included, See Ftplate Optins Sectin 183F4 Kids Angle Adj Available w/ 14" t 16" frame width nly $295.00 $185.00 $185.00 A C. Cntracture Ftrest System Multi-Adjustable Padded Hangers & Angle Adjustable Aluminum Ftrests Cntracture Ftrest System NA w/ 183H26 $325.00 drp seat pan. NA w/ 15" frame depth 183FP02 183FP01 Outside Munt Center Munt Select Extensin Height Belw fr Shrt 183E25 Shrt 183EP1 183EP2 183EP3 183EP4 10.5" Extensin Height 11.0" Extensin Height 11.5" Extensin Height 12.0" Extensin Height 183EP5 12.5" Extensin Height 183EP6 13.0" Extensin Height Select Extensin Height Belw fr Regular 183E26 Regular 183EP5 12.5" Extensin Height 183EP6 13.0" Extensin Height 183EP7 13.5" Extensin Height 183EP8 14.0" Extensin Height 183EP9 14.5" Extensin Height 183EP10 15.0" Extensin Height Additinal Hanger and Ftplate Optins C B. Extensin Tube Munted Ftrests Ftrests munt t extensin tubes 183H145 60 Swing In/Swing Out 183H139 70 Swing In/Swing Out 183H141 80 Swing In/Swing Out NA w/ 8" casters 183H160 183H159 B. Extensin Tube Munted Ftrests 183E1 Shrt 183E2 Medium NA with 12.5" seat height 183E5 Lng NA with 12.5" seat height 183E16 K0037 High Munt Only available with adult r kids angle adj. ftplates B. Extensin Tube Munted Ftrest Ftplates Heel lp r leg strap nt included, See Ftplate Optins Sectin 183F48 K0040 183F1 183F5 183F3 K0040 Adult Angle Adjustable - Ext Munt 183F7 E0990 K0053 Elevating Hanger - Ext Munt NA w/ Platfrm Flip Up and Alum Angle Adj Frnt Munt ftplates. Articulating Hanger NA w/ Platfrm Flip Up and Alum Angle Adj Frnt Munt ftplates. Cmpsite Aluminum Platfrm Flip-Up NA w/ med ext tubes. Only available w/elr $295.00 $350.00 $55.00 $185.00 $190.00 Omit Ftplate and Ext. Tube -$15.00 B Hanger Munts 1" Offset NA with -5-50 and -5-35 preset tilt angle and pssible interference with 80 & 90 hangers 183MZ02 Standard Hanger Munt 183MZ01 1" Offset Hanger Munt Single Ft Bx 183JX01 Standard Height - Left $225.00 183JX02 Tall Height - Left $225.00 183JX03 Standard Height - Right $225.00 183JX04 Tall Height - Right $225.00 183JX05 Standard Height - Pair $450.00 183JX06 Tall Height - Pair $450.00 Full Ft Bx 183JX07 Full Ft bx Std Height $350.00 183JX08 Full Ft bx Tall Height $350.00 183JX09 Full Ft bx w/ Divider Std Ht $400.00 183JX10 Full Ft bx w/ Divider Tall Ht $400.00 183HL1 183HL5 183IG2 183H32 183HL4 183HL6 E0951 K0038 Ftrest Optins Heel Lp Leg Strap Impact Guard Neprene Only available w/ 60 r 70 ext. munt hanger Omit Hanger Omit Heel Lp Omit Single Leg Strap $30.00 $35.00 -$15.00 JAY FOOT BOXES Only available with Swing Away, Lift-ff Hangers, Adult Angle Adj Ftplates and ELR / ALR.Single Ft Bx pairs NA with 14"-15" frame widths. Full Ft Bxes NA with Heel Lp r Leg Strap, Tall Height Full Ftbx w/ 14"-15" frame width and ELR / ALR. DER INFMATION: Custmer Service: 800-333-4000 Fax: 800-300-7502 www.sunrisemedical.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (9.09) Quickie IRIS March 2015, MK-100051 REV F Page 6
a Optin # HCPCS Definitin a Optin # HCPCS Definitin Rear Wheel Size 12" Mag 12" Lw Ply 16" Mag 20" Mag 22" Mag 24" Mag & Spke Frnt Seat Height Rear Wheel Tire 183RT3 Full Plyurethane CASTER SIZE Lw Plyurethane 183RT4 4" 5" 6" 8x1" 8x1.5" 8x2" Only available w/ 12" Mag Wheel 12.5" 13.5" 16.5" 16.5" E2211 183RT1 16.5" 17.0" 17.0" 17.0" E2212 17.0" 17.5" 17.5" 17.5" 17" E2213 183RT2 17.5" 18.0" 18.0" 18.0" E2211 Pneumatic Pneumatic Airless Insert $80.00 16.0" 16.0" 16.0" 16.5" 16.5" 16.5" 16.5" 16.5" Handrim 17.0" 17.0" 17.0" 17.0" 17.0" 12" and 16" wheels nt available with hand rims. 17.5" 17.5" 183HR1 Aluminum Andized 13.5" 183HR4 Plastic Cated 14.0" 183HR7 Omit Handrim 14.5" 14.5" 15.0" 15.0" Prjectins 18.0" 18.0" 18.0" 18.0" 18.0" Nt available n plastic cated. Only available with 24" rims. 18.5" 18.5" 18.5" 18.5" 183HR8 8 Oblique $325.00 19.0" 19.0" 19.0" 19.0" 19.5" Axle 16.0" 16.0" 16.0" 16.5" 16.5" 16.5" 16.5" 16.5" 183AX1 17.0" 17.0" 17.0" 17.0" 17.0" 17.5" 17.5" 183AX17 17.0" 17.0" 17.0" 17.0" 17.5" 17.5" 17.5" 17.5" 18.0" 18.0" 18.0" 18.0" 18.0" 183AL33 18.5" 18.5" 18.0" 18.0" 18.0" 18.0" 183AL17 18.5" 18.5" 18.5" 18.5" 183OA2 19.0" 19.0" 19.0" 19.0" 19.5" Casters 183CW73 4" x 1.25" Semi Pneumatic NA w/ Heavy Duty Optin 183CW53 183CW7 183CW45 5" x 1" Plyurethane 5" x 1.5" Semi Pneumatic 6" x 1" Plyurethane 183CW35 6" x 1.5" Semi Pneumatic 183CW46 8" x 1" Plyurethane 183CW39 8"x 1.5" Semi Pneumatic 183CW36 E2214 E2215 8"x 2" Pneumatic $145.00 183CW37 E2214 K0108 8"x 2" Pneumatic w/insert $225.00 Rear Wheel 7. SEAT HEIGHT SETUP Quick Release Axles NA w/ ne arm drive Threaded Axles NA w/ 24" spke wheels Axle Plate Standard Axle Plate E0958 One Arm Drive Axle Plate NA w/ 12" & 16" mag, 24" spke wheels. $850.00 One Arm Drive Standard Handrim 183HM1 Right Hand Munt 183HM2 Left Hand Munt 183OA1 One Arm Drive Small Handrim NA w/ 20" mag wheels 183HM1 183HM2 Right Hand Munt Left Hand Munt Hub Lck Only available w/ 12" r 16" wheels. NA w/ ne arm drive. 183LK01 12" Hub Lck $100.00 183LK02 16" Hub Lck $100.00 Wheel Lck 183WL8 Push t Lck Attendant Wheel Lck (Ft Lck) 183WL41 E2206 NA w/ ext handles. NA w/ ne arm $80.00 drive 183WL10 Omit Wheel Lck 183RW13 12" Mag Wheel NA w/ hand rims and full ply tires. With attendant wheel lck NA w/ +5-60 tilt angle. 183EH7 E0961 Extensin Handle 6" Pair $65.00 183RW14 16" Mag Wheel NA w/ hand rims. Only avail w/pneumatic r pneumatic w/ airless inserts tires. 183RW3 20" Mag Wheel NA w/ prjectin handrims. 183RW8 22" Mag Wheel NA w/ prjectin handrims. 183RW1 183RW51 24" Mag Wheel 24" Spke Wheel $200.00 DER INFMATION: Custmer Service: 800-333-4000 Fax: 800-300-7502 www.sunrisemedical.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (9.09) Quickie IRIS March 2015, MK-100051 REV F Page 7
a Optin # HCPCS Definitin a Optin # HCPCS Definitin 8. KEY OPTIONS AND ACCESSIES Anti Tips Included with vent tray ptin. Nt rdered as separate line item. 183AT1 E0971 Anti Tips (Pair) Miscellaneus Accessries 183A1 Black Utility Backpack $55.00 183A8 Black Seat Puch $45.00 183A54 Extra Leg Strap Black $30.00 183A82 Caddy Only available w/ extentin tube munted ftrests $45.00 183A601 Utility hk has weight a limit f 15 lbs. 183LF12 183LF13 E2208 E1029 E1029 O2 Hlder NA w/ Height Adj Strller Handles. NA w/ Reclining Backrest, Mn Back r Transit Optin. Vent Tray - Back Cane Munt Dvetail Vertical Frame Munted Hardware fr LTV Ventilatrs includes 1 utility hk Dvetail Vertical Frame Munted Hardware fr Trilgy Ventilatrs includes 1 utility hk $140.00 $150.00 IV Ple 183A701 K0105 $275.00 NA w/ Mn Back r transit ptin $495.00 $495.00 183JY01 183JY02 183JY03 183JY04 183JY05 183JZ01 183JZ02 183JZ03 183JZ04 183JA04 JAY Anterir Thracic Supprt Style Classic Dynamic Classic Structure Cntur Dynamic Cntur Structure Center Opening with Buckle Size Small Medium Large X-Large Additinal Optins Thrugh Built fr Me T inquire abut any unique custmizatin fr Quickie prducts, cntact: Phne: (800) 333-4000, Fax: (800) 333 9011 JAY Padded Trunk Strap 183JA01 Padded Trunk Strap - Small 183JA02 Padded Trunk Strap - Medium 183JA03 Padded Trunk Strap - Large Padded Trunk Strap - XL 183A158 183A141 183A117 183A118 183A120 E0978 E0978 E0978 E0978 K0108 Psitining Belt 183SG3 K0108 Plastic Regular 2" Dual Pull Squeeze Pad w/clamp 1.5" Aut Buckle Universal w/clamp 2" Aircraft Buckle w/clamps $70.00 $110.00 2" Aircraft Buckle Pad w/clamp $120.00 Psitining Belt Clamps Only $50.00 Side Guard Only available w/ length adj lcking flip-up, adj lcking flip-up and armrest styles. NA w/ Mn Back. $125.00 183SG4 K0108 Plastic Kids $125.00 Cmmnly Requested Optins Include: 23" & 24" Seat Widths Angle Adjustable Handle fr Reclining Backrest Frg Legs Lnger Wheel Lck Extensins Reverse Cnfiguratin Dual Munt Wheel Lcks - Attendant Ft Lck Dynamic Back n Frame Depth up t 20" Spke Guards Nt available with 12" and 16" mag wheels r prjectin handrims. 183A24 183A23 K0065 K0065 Clear Black NA w/ prjectin handrims $115.00 $115.00 Wheelchair Tray Table Only available if armrests are included. NA with JAY Arm Trughs. 183A30 183A31 183A32 183A33 E0950 E0950 E0950 E0950 Small (13"-14") Medium (15"-17") Large (18"-20") X-Large (21"-22") Canpy (SunShade) Need 2" back pst clearance t munt canpy hardware. May require next height based n seating. Sme interferance may ccur with sme height cnfiguratins. NA with Mn Back. 1838A06 K0108 Canpy (Sunshade) 10 "- 14" wide $275.00 1838A07 K0108 Canpy (Sunshade) 15" - 20" wide $275.00 DER INFMATION: Custmer Service: 800-333-4000 Fax: 800-300-7502 www.sunrisemedical.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (9.09) Quickie IRIS March 2015, MK-100051 REV F Page 8
a Optin # HCPCS Definitin a Optin # HCPCS Definitin 9. APPENDIX Lwer Leg Length Matrix Frnt seat height must be at least 2" taller than lwer leg length n all swing in/ut hangers. Frnt seat height must be at least 2" taller than maximum lwer leg length n all frnt munt hangers. DER INFMATION: Custmer Service: 800-333-4000 Fax: 800-300-7502 www.sunrisemedical.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (9.09) Quickie IRIS March 2015, MK-100051 REV F Page 9