Page 1 of 8INFINFB3759/RevB/02OCT2017
Quantum 4Front™ Order Form - Group 3, Contoured Seat
Account Number: ___________ Date: ________________
Provider Name: __________________________________
Contact: ________________________________________
Phone: ___________________ Fax: _________________
Email: __________________________________________
PO Number: _____________________________________
Marked for: _____________________________________
Ship to Address: _________________________________
City: _____________________ State: ______ Zip: ______
Weight:________ Height:________
PATIENT INFORMATION
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
A. Shoulder Width: _______
B. Chest Width: _________
C. Hip Width: ___________
D. Max Sitting Height: ____
E. Shoulder Height: ______
F. Axilla Height: _________
G. Thigh Depth: _________
H. Lower Leg Length: ____
I. Elbow Height: ________
INTRODUCTION
This form is interactive when viewed with Adobe Acrobat Reader and may not function correctly if opened with applica-
tions other than Acrobat. Complete the form by placing checks in the desired boxes and provide information in the interactive
fields. Buttons shown at the bottom of the form may be utilized to print or submit the order form through a desktop email application. To email via a web-based application, please ‘Save As’ and attach the PDF to your email.
If special order requests are needed, be sure that the Patient Information section is completed or include a completed
physical assessment form with this order form.
HCPCS codes provided should not be considered as legal advice and do not guarantee reimbursement. DME providers
are responsible for determining the appropriate billing codes when submitting for insurance reimbursement. Payer coding,
coverage, and bundling guidelines may apply. All prices are MSRP. Prices, specifications, part numbers, and availability are subject to change without notice. Prices and part numbers as shown are only available when configured as a complete power chair. Please contact technical service for accurate parts ordering. Options noted with "XRef" have multiple possible
part numbers based on system configuration. Please see cross-reference spreadsheet for the XRef part numbers.
Thank you for choosing Quantum!
TRU-Balance® 3 Power Lift Seating Shown
Page 2 of 8INFINFB3759/RevB/02OCT2017
Red CorvettePart: DGN1700109-PRD1
Electric BluePart: DGN1700109-PBU9
Back in BlackPart: DGN1700109-PBK1
Night TrainPart: DGN1700109-PBK3
White SatinPart: DGN1700109-PWT2
Pretty in PinkPart: DGN1700109-PPK3
Deep PurplePart: DGN1700109-PPR5
Lime LightPart: DGN1700109-PGN7
Grey StreetPart: DGN1700109-PSL3
Silver BulletPart: DGN1700109-PSL7
Midnight BluePart: DGN1700109-PBU10
Orange CrushPart: DGN1700109-POR6
Yellow BlazePart: DGN1700109-PYL3
Military GreenPart: DGN1700109-PGN8
To Be DeterminedPart: N/A
Quantum 4Front 3S-C .........................................$7,895Part: 4FRONT 3S-C. HCPCS: K0849
Contoured Seat (Captain) standard.
DRIVE WHEELSREQUIRED. Select a type of drive wheels and wheel accent color.
BASE COLORREQUIRED. Select one shroud color. Colors shown here may differ from actual product depending on monitor/printer calibration used.
BASE MODELREQUIRED. Select a power base. 300 lb. weight capacity with standard 6mph programmable motors and 8 amp off board charger. Dimensions of base without legrests: 24.2”Wx45.7”L
PATIENT'S WEIGHTREQUIRED. The patient's weight is required to quote and order the power chair.
Account Number: ___________ Date: ________________ Marked for: _____________________________________
Patient's Weight:________
3”x14” Flat Free Black Tires .............................StandardPart: PTOINDV3525.
3”x14” Pneumatic Black Tires ......................... No ChargePart: WHL1704059
Drive Wheel Accent Color
REQUIRED.
FENDER LIGHTSREQUIRED. Fender lights are standard and will be automatically included unless omitted or if base mounted lights are selected.
Switch Operated Fender Lights..........................StandardPart: DGN1700033
Omit Fender Lights ....................................... No ChargePart: DGN1700032
Back in Black ....................StandardPart: DGN164245-PBK1
Red Corvette .................. No ChargePart: DGN164245-PRD1
Electric Blue ................... No ChargePart: DGN164245-PBU9
Night Train ..................... No ChargePart: DGN164245-PBK3
White Satin ..................... No ChargePart: DGN164245-PWH2
Pretty in Pink .................. No ChargePart: DGN164245-PPK3
Deep Purple ................... No ChargePart: DGN164245-PPR5
Lime Light ...................... No ChargePart: DGN164245-PGN7
Grey Street ..................... No ChargePart: DGN164245-PSL3
Silver Bullet .................... No ChargePart: DGN164245-PSL7
Midnight Blue .................. No ChargePart: DGN164245-PBU10
Orange Crush .................. No ChargePart: DGN164245-POR6
Yellow Blaze ................... No ChargePart: DGN164245-PYL3
Military Green ................. No ChargePart: DGN164245-PGN8
To Be DeterminedFollow-up required.
FULL LIGHT PACKAGESOptional. Requires Q-Logic 3 Joystick for Full Light Package selection. Select one available package below.
Base Mounted, LED, Full Light Package ...........................................................................................................$995Part: ELE1700035
Fender lights will be ommited with Base Mounted, LED, Full Light Package.
CONTOURED SEAT, SEAT TO FLOORREQUIRED.
Middle Seat to FloorPart: PTOINDV3559
Highest Seat to FloorPart: PTOINDV3560
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Account Number: ___________ Date: ________________ Marked for: _____________________________________
JOYSTICK ELECTRONICSREQUIRED. Select a type of drive control from the following sections.
No Joystick, Setup for Q-Logic 3 ElectronicsPart: Configuration selection.
Q-Logic 3 Joystick ShroudREQUIRED with Q-Logic 3 Joystick selection above. Reference colors shown on page 2.
Black, Soft Touch ...........................................StandardPart: DGN124307
Non-matching Joystick Shroud .................................$50Part: PTOINDV3422
Select color below
Match Joystick Shroud to Base Color ..........................$50Part: PTOINDV3421
Red CorvettePart: DGN124336-PRD1
Electric BluePart: DGN124336-PBU9
Back in BlackPart: DGN124336-PBK1
Night TrainPart: DGN124336-PBK3
White SatinPart: DGN124336-PWH2
Pretty in PinkPart: DGN124336-PPK3
Deep PurplePart: DGN124336-PPR5
Lime LightPart: DGN124336-PGN7
Grey StreetPart: DGN124336-PSL3
Silver BulletPart: DGN124336-PSL7
Midnight BluePart: DGN124336-PBU10
Orange CrushPart: DGN124336-POR6
Yellow BlazePart: DGN124336-PYL3
Military GreenPart: DGN124336-PGN8
Q-Logic 3 Non-Expandable Capacity .... StandardController ModulePart: See XRef
Controls one actuator.
Q-Logic 3 Non-Expandable Capacity .... StandardController HarnessPart: HAR144005-NE
Q-Logic 3 Non-Expandable Capacity
Q-Logic 3 Non-Expandable Required ComponentsQ-Logic 3 non-expandable capacity joysticks require a controller module and harness below.
Q-Logic 3 Non-Expandable Capacity Joystick ........StandardPart: CTL167724-NE
Q-Logic 3 Non-Expandable Capacity Joystick ...... No Chargefor Full Light PackagePart: CTL167725-NE
Q-Logic 3 Joystick
JOYSTICK HANDLESOptional. The standard Q-Logic 3 joystick knob can be seen in the image on the previous page. An optional handle selected below will be mount-
ed to the joystick and the standard handle will be shipped with the unit.
Joystick Handles
Mushroom Handle (B) .............................. $85Part: ACCASMB1860. HCPCS: E2323
Chin Cup (C) ......................................... $85Part: ACCASMB1861. HCPCS: E2323 (E2324 when chin
control)
T-Bar (D) .............................................$120Part: ACCASMB1858. HCPCS: E2323
Medium Ball Handle (E) ............................ $65Part: ACCASMB1859. HCPCS: E2323
Soft Ball Handle (F) ................................. $65Part: ACCASMB1856. HCPCS: E2323
Extended I-Handle (G) ............................. $85Part: ACCASMB1857. HCPCS: E2323
Bodypoint 3” Goal Post Handle .................. $99Part: PLSKNCP1057. HCPCS: E2323
Bodypoint 4” Goal Post Handle .................. $99Part: PLSKNCP1058. HCPCS: E2323
Q-Logic 3 Carrot Handle (A) ............. No ChargePart: DGN124308
JOYSTICK MOUNTING BRACKETSREQUIRED. Select a mount to be used with a joystick selected in previous section.
Omit Joystick Mounting Bracket.
Fixed, In-line, Bracket ...........................................................................................................................StandardPart: FRMASMB10617
Left Side MountPart: PTOINDV1225
Right Side MountPart: PTOINDV1226
Fixed, In-line Joystick Bracket
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Swing-away, Inline, Left Side Mount .......... $245Contour Seat: ACC148356. HCPCS: E1028
Swing-away, Inline, Right Side Mount ........ $245Contour Seat: ACC148357. HCPCS: E1028
Swing-away, 1” Offset, Left Side Mount ..... $245Contour Seat: ACC148358. HCPCS: E1028
Swing-away, 1” Offset, Right Side Mount .... $245Contour Seat: ACC148359. HCPCS: E1028
Swing-Away (Retractable) BracketAllows the joystick to retract to the side of the armrest while maintaining the same joystick orientation. "Inline brack-
et" will be offset 1" when used with tube style arms. Select "Offset Bracket" to have the joystick inline with armpad on tube style armrests.
Swing Away Joystick
Inline Mount (Right)
Swing Away Joystick
Offset Mount (Right)
Account Number: ___________ Date: ________________ Marked for: _____________________________________
Multi-Axis Joystick
Mount
Retract4
Retract4 Mount ................................... $350Part: MEC138860. HCPCS: E1028
Full 180° of movement that translates into multi-position
use, straight, right offset, left offset, or fold away. Joy-
stick orientation varies as bracket is adjusted.
Multi-axis Mount ...................................$100Part: ACC131216. HCPCS: E1028
Allows height adjustment of joystick.
Stealth Swing-Away/Flip Down Bracket ....$294.25Part: ST-TWBM480QL-Q. HCPCS: E1028
Allows the joystick to pivot to side of armrest, or flip-down if bracket is adjusted.
Specialty Joystick MountsSelect a bracket and side to mount it.
Left Side MountPart: PTOINDV1225
Right Side MountPart: PTOINDV1226
Specialty Mount Side
ELECTRONICS ACCESSORIESOptional.
Q-Logic PC Programming Disk with Cable .................. $750Part: ELEASMB5216
JOYSTICK MOUNTING BRACKETSREQUIRED. Select a mount to be used with a joystick selected in previous section.
CONTOURED SEATINGREQURED. Select only one seat. Special order seat sizes can be requested by completing the seat type and writing in the seat size in the special
order seat section.
16”Wx16”D .................. No ChargePart: SETASMB2770
16”W18”D ................... No ChargePart: SETASMB2771
16”Wx20”D ................. No ChargePart: SETASMB2772
16”Wx22”D ................. No ChargePart: SETASMB4887
18”Wx16”D .................. No ChargePart: SETASMB2775
18”Wx22”D ................. No ChargePart: SETASMB4888
20”Wx16”D ................. No ChargePart: SETASMB2780
20”Wx22”D ................. No ChargePart: SETASMB4889
18”Wx18”-20”D with 60" Lap Belt .................... No ChargePart: SETASMB6895
20”Wx18”-20”D with 60" Lap Belt .................... No ChargePart: SETASMB6896
22”Wx20”-22”D with 70" Lap Belt .................... No ChargePart: SETASMB6897
Black Vinyl High Back with Limited Recline
Black Vinyl, Depth Adjustable High Back with Limited ReclineSeat is standard with a lap belt and full length armrests.
Page 5 of 8INFINFB3759/RevB/02OCT2017
Account Number: ___________ Date: ________________ Marked for: _____________________________________
16”Wx16”D .................. No ChargePart: SETASMB3178
16”W18”D ................... No ChargePart: SETASMB3179
16”Wx20”D ................. No ChargePart: SETASMB3180
16”Wx22”D ................. No ChargePart: SETASMB5006
18”Wx16”D .................. No ChargePart: SETASMB3181
18”Wx22”D ................. No ChargePart: SETASMB5007
20”Wx16”D ................. No ChargePart: SETASMB3183
20”Wx22”D ................. No ChargePart: SETASMB5008
Black Vinyl High Back with Limited Recline and Solid Seat Pan
Special Order Contoured Seat/ Solid Seat PanComplete information below. Contact inside sales specialist for pricing.
Full Length, Left Armrest ........................................$85Part: FRMASMB8614. HCPCS: E0973
Desk Length, Left Armrest ......................................$85Part: FRMASMB8612. HCPCS: E0973
No ArmrestPart: Configuration selection
Full Length, Right Armrest ......................................$85Part: FRMASMB8615. HCPCS: E0973
Desk Length, Right Armrest .....................................$85Part: FRMASMB8613. HCPCS: E0973
Depth:______Width:______Type of Seat:________________________________________
Contoured Seat, Flip-Up, Height Adjustable, Removable ArmrestsREQUIRED except with Depth Adjustable High Back. Select a Left and Right Armrest or to Omit.
CONTOURED SEATING continued
60°-90° Swing-Away Legrest .......................$81 ea.Pair part: RIG120062. Left part: FRMASMB17558.
Right part: FRMASMB17559
Not available with 11"-13" extensions.
60°-90° Swing-Away Legrest, Short ..............$81 ea.Pair part: RIG136481. Left part: RIG132607.
Right part: RIG132609.
For use only with 11"-13" lower extensions.
60°-90° Swing-Away LegrestsAdjustable in 5° increments. Select a configuration, a legrest upper, a legrest extension, and type of footplate. Pair (P), left (L), and right (R) configurations are selected by checking the appropriate boxes. Select legrest length in following section.
Swing-Away Legrest Upper
Left and Right Legrests will match Left and Right Legrests will not match One Legrest (Left or Right as Marked)
Configuration Verification
LEGRESTSOptional. All efforts will be made to accommodate legrest length selection, but minor changes may need to be made to meet shipping guide-
lines. Some adjustments may be needed upon receipt of the unit. Reference the section’s compatibility matrix for legrest interference.
Extruded Footplate(s)
7.25”Wx6”D Extruded Footplate ...............StandardPart pair: FRMASMB7847. Left: FRMASMB7861.
Right: FRMASMB7862
8.5”Wx6”D Extruded Footplate .................StandardPart pair: FRMASMB7848. Left: FRMASMB7863.
Right: FRMASMB7864
May cause interference on seat widths less than 18.”
11”-13” LengthPart: See XRef
N/A with Multi-axis.
11”-16.5” LengthPart: See XRef
N/A with Angle Adjustable.
13”-16.5” LengthPart: See XRef
N/A with Multi-Axis.
15.5”-19.5” LengthPart: See XRef
Lower Extension
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LEGRESTS continued
Account Number: ___________ Date: ________________ Marked for: _____________________________________
4”Wx6”D ...............................................$85 ea.Pair part: FRMASMB10564. Left: RIG133537. Right: RIG133560.
HCPCS: K0040
5”Wx6”D ...............................................$85 ea.Pair part: FRMASMB10565. Left: RIG133538. Right: RIG133561.
HCPCS: K0040
5”Wx8”D ...............................................$85 ea.Pair part: FRMASMB10566. Left: RIG133539. Right: RIG133562.
HCPCS: K0040
6”Wx8”D1 ..............................................$85 ea.Pair part: FRMASMB10567. Left: RIG133540. Right: RIG133563.
HCPCS: K0040
6”Wx11”D1 .............................................$85 ea.Pair part: FRMASMB10568. Left: RIG133541. Right: RIG133564.
HCPCS: K0040
8”Wx11”D2 .............................................$85 ea.Pair part: FRMASMB10569. Left: RIG133542. Right: RIG133565.
HCPCS: K0040
Angle Adjustable Footplates with Heel Loops¹The 6”x11” footplates may cause interference with seat widths less than 18”. ²The 8”x11” footplates may cause interference with seat widths less than 20”.
4”Wx6”D ......................................... $247.50 ea.Pair part: FRMASMB9456. Left: RIG133531. Right: RIG133552.
HCPCS: K0040
5”Wx6”D ......................................... $247.50 ea.Pair part: FRMASMB9457. Left: RIG133532. Right: RIG133553.
HCPCS: K0040
5”Wx8”D ......................................... $247.50 ea.Pair part: FRMASMB9458. Left: RIG133533. Right: RIG133554.
HCPCS: K0040
6”Wx8”D1 ........................................ $247.50 ea.Pair part: FRMASMB9459. Left: RIG133534. Right: RIG133555.
HCPCS: K0040
6”Wx11”D1 ....................................... $247.50 ea.Pair part: FRMASMB9460. Left: RIG133535. Right: RIG133558.
HCPCS: K0040
8”Wx11”D2 ....................................... $247.50 ea.Pair part: FRMASMB9461. Left: RIG133536. Right: RIG133559.
HCPCS: K0040
Multi-Axis Footplates¹The 6”x11” footplates may cause interference with seat widths less than 18”. ²The 8”x11” footplates may cause interference with seat widths less than 20”.
Heel Loops (pair) ..................................................$50Part: FRMASMB7873. HCPCS: E0951
Standard on angle adjustable and multi-axis footplates.
Wheel Bumper ............................................$12.50 ea.Part: See XRef.
Gel Neoprene Footrest Sleeve (pair) ..........................$80Part: INDPART2243. HCPCS: K0108
60°-90° Swing-Away Legrest Accessories
Amputee Supports with Swing-Away UpperEnter a quantity for the amputee supports and covers. A 60°-90° legrest upper must be selected with the amputee support. The support will be
configured with the legrest upper side that does not have a lower extension and footplate selected with it.
Therafin 31515 Multi-Axis Amputee Support ..... $230 ea.Part: INDPART2822. HCPCS: E1020
Therafin 32387 Amputee Support Gel Cover ..... $155 ea.Part: INDPART2823. HCPCS: K0108
11”-14” LengthPair: FRMASMB4755
Left: RIG138026
Right: RIG138030
For reinforced only
12”-14.5” LengthPart: See XRef
For angle adjustable only
14”-17” LengthPair: FRMASMB4756
Left: RIG138033
Right: RIG138035
For reinforced only
14.5”-18” LengthPart: See XRef
For angle adjustable only
Lower Extension
Elevating Legrest Assembly ........................................................................................................$162.50 ea.Pair part: FRMASMB6483. Left part: RIG138012. Right part: RIG138013. HCPCS: E0990
Select lower extension and footplates
Elevating LegrestsSelect a configuration, a legrest upper, a legrest extension, and type of footplate. Pair (P), left (L), and right (R) configurations are selected by checking the appropriate boxes. Select legrest length in following section.
Elevating Legrest
Left and Right Legrests will match Left and Right Legrests will not match One Legrest (Left or Right as Marked)
Configuration Verification
Page 7 of 8INFINFB3759/RevB/02OCT2017
LEGRESTS continued
Account Number: ___________ Date: ________________ Marked for: _____________________________________
Reinforced Cast Footplate(s)
7.25”Wx6”D Reinforced Footplate .............StandardPair part: FRMASMB4748. Left: RIG138055. Right: RIG138056
8.5”Wx6”D Reinforced Footplate ...............StandardPair part: FRMASMB4747. Left: RIG138060. Right: RIG138062
May cause interference on seat widths less than 18.”
4”Wx6”D ...............................................$85 ea.Pair part: FRMASMB8812 x2. HCPCS: K0040
5”Wx6”D ...............................................$85 ea.Pair part: FRMASMB8811 x2. HCPCS: K0040
5”Wx8”D ...............................................$85 ea.Pair part: FRMASMB4735. Left: RIG137791. Right: RIG137792.
HCPCS: K0040
6”Wx8”D1 ..............................................$85 ea.Pair part: FRMASMB4738. Left: RIG137793. Right: RIG137795
HCPCS: K0040
6”Wx11”D1 .............................................$85 ea.Pair part: FRMASMB4741. Left: RIG137796. Right: RIG137797
HCPCS: K0040
8”Wx11”D2 .............................................$85 ea.Pair part: FRMASMB4744. Left: RIG137798. Right: RIG137799
HCPCS: K0040
Angle Adjustable Footplates with Heel Loops¹The 6”x11” footplates may cause interference with seat widths less than 18”. ²The 8”x11” footplates may cause interference with seat widths less than 20”. 4"x6" and 5"x6" footplates are only available in pairs.
Elevating Legrest Accessories
Heel Loops (pair) ..................................................$50Part: FRMASMB7873. HCPCS: E0951
Standard on angle adjustable footplates.
Falcon Gel Padded Knee Adductor Buttons (KBE)(pair) ... $125Part: INDPART2242. HCPCS: K0108
Wheel Bumper ............................................$12.50 ea.Part: See XRef.
Available on angle adjustable footplates.
SET LEGREST LENGTHREQUIRED with matching left and right legrest configuration. All efforts will be made to accommodate legrest length selection, but minor changes may need to be made to meet shipping guidelines. Some adjustments may be needed upon receipt of the unit. Reference the section’s
compatibility matrix for legrest interference. Non-matching or individual legrest configurations lengths are not set by the manufacturer.
Set Legrest Length at:______ Part: PTOINDV#, see below
7” L(#3470)
7.5” L(#3471)
8” L(#3472)
8.5” L(#3473)
9” L(#3474)
9.5” L(#3475)
10” L(#3476)
10.5” L(#3477)
11” L(#3478)
11.5” L(#3479)
12” L(#3480)
12.5” L(#3481)
13” L(#3482)
13.5” L(#3483)
14” L(#3484)
14.5” L(#3485)
15” L(#3486)
15.5” L(#3487)
16” L(#3488)
16.5” L(#3489)
17” L(#3490)
17.5” L(#3491)
18” L(#3492)
18.5” L(#3493)
19” L(#3494)
19.5” L(#3495)
20” L(#3496)
20.5” L(#3497)
21” L(#3498)
21.5” L(#3600)
22” L(#3669)
22.5” L(#3670)
CUSHION QUICK PICKOptional. General size selections are shown below. Refer to the specific cushion order form for detailed pricing, sizes, codes, and part numbers. Check the non-matching box and attached a cushion order form for a size other than the previously selected seat width and depth, or for a cushion not shown here.
Cushion SelectionSee cushion order form for detailed sizing and pricing.
Match seat selection width and depthPart: Configuration selection
Non-matching cushion size, see cushion order form orcushion part number:
Simplicity Cushion (General Use) ................................$98HCPCS: E2601
Solution® Cushion (Skin Protection and Positioning) ......$430-$480HCPCS: E2607-E2608
Solution® 1 Cushion (Skin Protection) ..................$430-$480HCPCS: E2603-E2604
Spectrum® Gel Cushion (Positioning) ...................$530-$580HCPCS: E2605-E2606
Spectrum® Foam Cushion ...............................$530-$580(Skin Protection and Positioning)HCPCS: E2607-E2608
TRU-Comfort 2 Cushion (Skin Protection) ............ $400-$500HCPCS: E2603-E2604
TRU-Comfort Sport Seat CoverAvailable as an additional cover option for TRU-Comfort seat cushions. Only available in sizes below.
16”Wx16”D ......................... $100Part: CUS133843
18”Wx18”D ........................ $100Part: CUS133848
20”Wx20”D ........................ $100Part: CUS133849
Account Number: ___________ Date: ________________ Marked for: _____________________________________
BATTERIESREQUIRED. Select a type of battery below, or to omit the batteries. The powerchair requires 2 batteries.
Install Batteries ........................................... No ChargePart: PTOINDV1675
Do Not Install Batteries .................................. No ChargePart: PTOINDV2008
Battery InstallationPlease choose if batteries will be installed, if selected above.
Group 24, 75 Ah AGM Cell Battery ...................... $385 ea.Part: BAT121347. HCPCS: E2363
Group 34, 60 Ah Gel Cell Battery ....................... $395 ea.Part: BATGEL1006. HCPCS: E2359
No batteries. Provider will assume responsibility of batteries.Part: Configuration selection
Air Force Patch .....................................................$20Part: ACC140240
Army Patch ..........................................................$20Part: ACC140241
Coast Guard Patch .................................................$20Part: ACC140239
Marines Patch ......................................................$20Part: ACC140243
Navy Patch ..........................................................$20Part: ACC140244
Purple Heart Patch ................................................$20Part: ACC140239
BRANCH PATCHESOptional.
Air Force Army Coast Guard Marines Navy Purple Heart
©2017 Quantum Rehab - A Pride Mobility Products Corporation company. All rights reserved.
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Medium, Black Weather Cover ................................ $168Part: ACCCOVR1022
Large, Black, Weather Cover .................................. $168Part: ACCCOVR1021
Oxygen Holder ....................................................$118Part: ACCASMB2292, HCPCS: E2208
Contoured Seat Cup Holder .....................................$20
Part: ACCASMB2287
Rear Basket ........................................................$118Part: ACCASMB1914
Walker Holder .................................................... $103Part: ACCASMB1912
Saddle Bag ..........................................................$35Part: DWR1020D010
Flag Holder ..........................................................$25Part: ACCASMB1930
Cane/Crutch Holder ............................................. $110Part: ACCASMB2294, HCPCS: E2207
PROVIDER INSTALLED CONTOURED SEAT ACCESSORIESOptional.