Quickie P-11 Instrukcja Użytkownika Pobierz pdf (Strona 6)

D D

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.

Price

Definition

HCPCS

Option #

HCPCS

Price

Definition

 

105HE1

E0955

105HE2

E0955

105MH1

E1028

105MH1

E1028



105LM1



105LM1



 



 



 



Drive Wheel Tire

105DT1 Knobby

STD

105DW25 14" Chrome/Black Pneumatic w/Ins.

$140.00

E1018 Suspension Fork Heavy 301-400 lbs.

$260.00

Suspension Fork Options are only available with 8" casters.

N/C

105CF31 Solid Caster Fork

N/C

105CF37

E0956

Lateral Pads Curved

105KE2

13. WHEELS

Wheel Lock

Solid backrest must be selected

Lateral Pad Curved Pair

$270.00

$225.00

Curved Headrest 8" x 4.5"

Removable Mount

Pad Style

105KE1

$495.00

Headrest 8" x 4.5"

11. POSITIONING OPTIONS

14" Chrome/Black Whl Pneumatic

$140.00

105DW15 14" Cast Wheel Pneumatic w/Ins.

N/C

$440.00

E1028

105WL8105DW14 14" Cast Wheel Pneumatic Tire

E1028 Swing Away Mount Pair

Drive Wheel

$225.00

105DW24

Headrest (Included on Specified Specialty Controls)

$225.00

$450.00

12. LATERAL THORACIC SUPPOR

Requires Jay Solid Backrest

105KD2 Lateral Support 4" x 5" (pr)

Swing Away Mount Pair

Pad Size

105KD1 Lateral Support 3" x 6" (pr)

N/C

E0956 Lateral Pad Straight Pair $215.00

Lateral Support 4" x 6" (pr)

N/C

Lateral Pads Straight

$225.00

105KD3

Do Not Mount

N/C

105WL12

Push to Lock

$85.00

105RK2

Front Caster Wheel

14. CASTER

Rear Caster Wheel

105RK1 4" Soft Polyurethane

N/C

Caster Fork

4" Micro Lighted

$60.00

8" Pneumatic w/ Insert

N/C

$85.00

105CW28 9" Pneumatic w/Insert

$85.00

105CW29 9" Pneumatic

105CF34 E1016 Suspension Fork Light 0-150 lbs.

$260.00

105CF35 E1016 Suspension Fork Med. 151-250 lbs.

$260.00

105CF43 E1018 Suspension Fork Heavy 251-300 lbs.

$260.00

105CW21 8" Pneumatic

105CW20

Removable Mount $225.00

Headrest (Included on Specified Specialty Controls)

Headrest 9" x 4.5"

$495.00

Curved Headrest 9" x 4.5" $270.00

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

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