SILVER SPORT II
PRICE LIST AND ORDER FORM
Date:
____________________Account Number: ______________________________________________________________
Company Name: ____________________________________________Contact: ______________________________________
Address: ______________________________________________________________________________________________
_________________________________________________________Phone Number: _________________________________
PRECONFIGURED AND READY TO SHIP VIA DRIVE MEDICAL RAPID DELIVERY PROGRAM - RDP
HCPCS codes are not intended to be, nor should be considered billing or legal advice. Providers are responsible for determining the appropriate billing codes
when submitting claims. Referenced HCPCS codes are also not a guarantee of payment.
ITEM #
DESCRIPTION
MSRP
SSP216FA-SF
16" x 16", Fixed Full Length Arms, Swingaway Footrests
$415.00
SSP216DDA-SF
16" x 16", Fixed Height Detachable Desk Arm, Swing Away Footrests
$465.00
SSP216DFA-SF
16" x 16", Fixed Height Detachable Full Arm, Swing Away Footrests
$465.00
SSP218FA-SF
18" x 16", Fixed Full Length Arms, Swingaway Footrests
$415.00
SSP218DDA-SF
18" x 16", Fixed Height Detachable Desk Arm, Swing Away Footrests
$465.00
SSP218DFA-SF
18" x 16", Fixed Height Detachable Full Arm, Swing Away Footrests
$465.00
SSP220DDA-SF
20" x 16", Fixed Height Detachable Desk Arm, Swing Away Footrests
$465.00
SSP220DFA-SF
20" x 16", Fixed Height Detachable Full Arm, Swing Away Footrests
$465.00
SSP216FA-ELR
16" x 16", Fixed Full Length Arms, Elevating Legrests
$460.00
SSP216DDA-ELR
16" x 16", Fixed Height Detachable Desk Arm, Elevating Legrests
$510.00
SSP216DFA-ELR
16" x 16", Fixed Height Detachable Full Arm, Elevating Legrests
$510.00
SSP218FA-ELR
18" x 16", Fixed Full Length Arms, Elevating Legrests
$460.00
SSP218DDA-ELR
18" x 16", Fixed Height Detachable Desk Arm, Elevating Legrests
$510.00
SSP218DFA-ELR
18" x 16", Fixed Height Detachable Full Arm, Elevating Legrests
$510.00
SSP220DDA-ELR
20" x 16", Fixed Height Detachable Desk Arm, Elevating Legrests
$510.00
SSP220DFA-ELR
20" x 16", Fixed Height Detachable Full Arm, Elevating Legrests
$510.00
LIMB SUPPORTMSRP HCPCS
WASR
Right$55.44 E0959
WASL
Left$55.44 E0959
GENERAL USE SEAT CUSHION
14880
16” (w) x 16” (d) x 1.75” (h)
14907
16” (w) x 18” (d) x 2 (h)
14887
18” (w) x 16” (d) x 1.75” (h)
14908
18” (w) x 18” (d) x 2 (h)
14888
18” (w) x 16” (d) x 2” (h)
14881
20” (w) x 16” (d) x 1.75” (h)
14909
20” (w) x 18” (d) x 2 (h)
$90.87
$60.02
$90.87
$60.02
$66.30
$80.04
$80.04
E2601
E2601
E2601
E2601
E2601
E2601
E2601
Auto Clasp Type
Velcro® Type Closure
Bariatric Auto Clasp Type
Bariatric Velcro® Type Closure
$29.08
$25.44
$49.14
$40.95
UNIVERSAL OXYGEN “E” CYLINDER HOLDER
STDS803$73.71 E2208
STDS804
with I.V. Pole Attachment
$159.61 E2208
WHEELCHAIR CANE/CRUTCH HOLDER
STDS1034$25.66 E2207
ANTI TIPPERS WITH WHEELS
STDS829$117.39 E0971
STDS818$111.93 E0971
TELESCOPING I.V. POLE ATTACHMENT
STDS820$84.63 K0105
SEAT EXTENSION KIT
STDSCS1618V16” x 18”$125.58
STDSCS1818V18” x 18”$125.58
STDSCS2018V
20” x 18”
$125.58
SEAT BELTS
STDS850
STDS851
STDS855
STDS856
ANTI FOLD BAR MSRP HCPCS
STDS806$54.60
E0978
E0978
E0978
E0978
OVERHEAD ANTI THEFT DEVICE
STDS823$177.45
STDS821
(With I.V. Hooks)
$171.99
STDS834
(Single Pole)
$103.30
CHART CARRY POCKET
STDS835
$40.70
GENERAL USE BACK CUSHION
14906
16” x 17”$325.00 E2611
14889
18” x 17”$325.00 E2611
14920
20” x 17”$112.44 E2611
Drive DeVilbiss Healthcare
99 Seaview Boulevard, Port Washington, NY | t: 877.224.0946 | f: 516.998.4601 | www.drivemedical.com