Transcription

1 Effective Date : November 09, 2017 Ministry of Health and Long-Term Care Printed Date: Nov 9, 2017 Page: 1 of 87

2 Ambulation Aids Adult Wheeled Walker Type 1 Airway Surgical Top Release 5051/5051-J MW1AR $82.00 Walker type most suitable for use on hard, flat Drive Medical 10263KDR Travel Folding AA $82.00 surfaces. ADP price includes frame, two or four small wheels (less than 6" diameter) and braking system (if available). See Ambulation Walker Deluxe Folding Wheeled Walker MW1GM $82.00 Aids Options Chart if heavy duty frame and/or forearm attachments required. One Button Or Dual Trigger Release MW1D $82.00 Guardian Red Dot Extra Wide G07767 MW1GU $82.00 Red Dot G07756 MW1GU $82.00 Red Dot Standard G07755 & MW1GU $82.00 G07756 Human Care Canada Deluxe Regular MW1DG $82.00 Inc. Deluxe Small MW1DG $82.00 Invacare Adult MW1IN $82.00 Lumex Dual Release Adult/Junior MW1LU $82.00 Lightweight Adult/Junior MW1LU $82.00 Rubbermaid Deluxe MW1C $82.00 Sunrise Medical Breezy Everyday Folding AA $82.00 Walking Frame with wheels Adult Wheeled Walker Type 2 Airway Surgical 5314 MW2AR $ Walker type most suitable for use on hard, flat Drive Medical Airgo Adventure 6 MW2GM $ surfaces. ADP price includes frame, four small wheels (less than 6" diameter), hand braking Airgo Excursion 6 X20 AA $ system, seat, and back support. See Ambulation Aids Options Chart if heavy duty Airgo Ultra Light MW2GM $ frame and/or forearm attachments required. Duet 795b Rollator MW2D $ Go-Lite Deluxe MW2D $ Evolution Medical Challenger Grande MW2EV $ Challenger Mini MW2EV $ Sprite & Sprite Mini MW2EV $ Sprite Grande MW2EV $ Xpresso Companion Two AA $ Xpresso Trillium Two AA $ Human Care Canada 4200 Dx MW2DG $ Inc Lx MW2DG $ Nexus 1 (Cable Brake) MW2DG $ Invacare Rollite MW2IN $ MEDLINE Translator AA $ INDUSTRIES INC. Nighthawk Ats 902 Handi Lite MW2NM $ Ats 903 Handi Lite MW2NM $ Page: 2 of 87

3 Ambulation Aids Adult Wheeled Walker Type 2 Nighthawk Ats 904 Handi Lite MW2NM $ Walker type most suitable for use on hard, flat Ovation Compact MW2NM $ surfaces. ADP price includes frame, four small wheels (less than 6" diameter), hand braking Prode3 ProDe3 Victr/ 17,19 21 inches AA $ system, seat, and back support. See Ambulation Aids Options Chart if heavy duty Sunburst Medical Freedom Plus MW22S $ frame and/or forearm attachments required. Freedom Plus Short MW22S $ Adult Wheeled Walker Type 3 Access Vital As Active MW3V $ Walker type most suitable for active use on Breeze MW3V $ most terrains. ADP price includes frame,four large wheels (6"/8" diameter), hand braking Airway Surgical 5305 Adult Type 3 Walker AA $ system, seat, and back support. See Ambulation Aids Options Chart if heavy duty 5307 Rollator AA $ frame and/or forearm attachments required. Amg Medical Airgo Vista V20 AA $ Dolomite Alpha Advanced MW3DO $ Alpha Basic MW3DO $ Jazz MW3DO $ Opal Futura Symphony MW3DO $ Opal Legacy MW3DO $ Opal Maxi / Maxi+ MW3DO $ Soprano MW3DO $ Drive Medical AIRGO EXCURSION XWD AA $ Airgo Adventure 8 MW3GM $ Airgo Comfort Plus Xwd MW3GM $ Airgo Comfort-Plus MW3GM $ Airgo Duo MW3GM $ Airgo Excursion MW3GM $ Airgo Fusion Rollator AA $ Airgo Navigator MW3GM $ Diamond 740r Rollator MW3D $ Nitro AA $ Nitro HD Rollator AA $ Nitro Hemi AA $ Nitro Tall AA $ Enkatsu Solutions Prima Rollator MW3EH $ Evolution Medical Challenger Low Wide MW3EV $ Challenger Wide MW3EV $ Evolution Dx, Ldx, Wdx, Lwdx MW3EV $ Horizon Dx, Wdx, Lwdx, Tdx MW3EV $ Piper Dx, Mdx, Smdx, Tdx MW3EV $ Xpresso Companion AA $ Page: 3 of 87

4 Ambulation Aids Adult Wheeled Walker Type 3 Evolution Medical Xpresso Trillium AA $ Walker type most suitable for active use on Xpresso Wide & Low Wide AA $ most terrains. ADP price includes frame,four large wheels (6"/8" diameter), hand braking Xpresso Zero, Zero Mini & Zero AA $ system, seat, and back support. See Ambulation Aids Options Chart if heavy duty frame and/or forearm attachments required. Tall Xpresso, Xpresso Lite MW3EV $ GF HEALTH HYBRID LX Rollator AA $ PRODUCTS Human Care Canada 4200swx MW3DG $ Inc. 4200wx MW3DG $ Nexus Ii (Cable Brake) MW3DG $ Nexus Iii (Cable Free Braking MW3DG $ System) Solo MW3DG $ Nighthawk Ats 906 0vation MW3NM $ Ovation Compact MW3NM $ Ovation Compact MW3NM $ Prode3 ProDe3 Aurora 19/21/23 inches AA $ ProDe3 Balius/21 wide AA $ Sunburst Medical Freedom All Terrain MW32S $ Freedom Xl MW32S $ Freedom Xls MW32S $ Mirage 4900 MW32S $ Mirage 4925 MW32S $ Mirage 4950 MW32S $ Shopper 4700 MW32S $ Titan MW32S $ Sunrise Medical Gemino AA $ Gemino 60 AA $ Topro Olympos MW3TV $ Troja MW3TV $ Triumph Mobility Inc Escape AA $ Wheelzahead USA, LLC Wheelzahead Track III Rollator AA $ Forearm Crutches 1 Pair of Forearm Crutches from the following manufacturers may be billed under this code. Paediatric Specific Walking Frame ADP price includes frame, four wheels, hand grips (including arm supports), and built in ADP Manufacturers Only Forearm Crutches MKZND $ Can-Dan Rehatec Buddy Roamer AA $2, Meywalk 3, Meywalk 4 MW6CD $2, Page: 4 of 87

5 Ambulation Aids sitting support (e.g. sling/saddle seat). See Ambulation Aids Options Chart for adolescent sizes. Paediatric Specific Wheeled Walker Type 1 Walker type most suitable for use on hard, flat surfaces. ADP price includes frame, two or four small wheels, and braking system (if available). See Ambulation Aids Options Chart for adolescent sizes. Can-Dan Rehatec Meywalk, Medium & Large MW6CD $2, Mini-Meywalk MW6CD $2, Hoggi Flux Gait Trainer MW6K $2, Ormesa Dynamico MW6R $2, Grillo MW6OA $2, Prime Engineering Kidwalk MW62P $2, Rifton Equipment Pacer Gait Trainer MW6RF $2, Snug Seat Inc. Bronco,Sizes 0,1,2 MW6R $2, Crocodile Reverse Walker MW6R $2, Gator MW6R $2, Mustang Gait Trainer AA $2, Pony,Size 0 MW6R $2, Pony,Size 1 MW6R $2, Pony,Size 2 MW6R $2, Pony,Size 3 MW6R $2, Drive Medical Nimbo KA1200N AA $ Nimbo KA2200N AA $ Nimbo KA3200N AA $ Nimbo KA4200N AA $ Guardian Strider Tweener G07783 MW4GU $ Strider Tyke G07782 MW4GU $ Tyke G07751 MW4GU $ Kaye Adolescent 2 Wheels MW4KY $ Adolescent 4 Wheels MW4KY $ Adolescent 4 Wheels/Swivel MW4KY $ Child 2 Wheels MW4KY $ Child 4 Wheels MW4KY $ Child 4 Wheels/Swivel MW4KY $ Child Small 2 Wheels MW4KY $ Child Small 4 Wheels MW4KY $ Child Small 4 Wheels/Swivel MW4KY $ Pre-Adolescent 2 Wheels MW4KY $ Pre-Adolescent 4 Wheels MW4KY $ Pre-Adolescent 4 Wheels/Swivel MW4KY $ Youth 2 Wheels MW4KY $ Youth 4 Wheels MW4KY $ Youth 4 Wheels/Swivel MW4KY $ Page: 5 of 87

6 Ambulation Aids Paediatric Specific Wheeled Walker Type 2 Walker type most suitable for active use on most terrains. ADP price includes all components and options. Paediatric Standing Frame Type 1 ADP price includes frame, positioning straps, trunk, pelvic, knee and foot supports, and tray. See Ambulation Aids Options Chart for adolescent sizes. Paediatric Standing Frame Type 2 ADP price includes frame, positioning straps, trunk, pelvic, knee and foot supports, and tray. See Ambulation Aids Options Chart for adolescent sizes. Otto Bock Nurmi Neo MW5OB $1, Yogi Walker AA $1, Sunrise Medical Gemino S AA $ Otto Bock Leckey Totstander AA $1, Vertical Stander MS1HY $1, Prime Engineering Up-Right Stander MS12P $1, Altimate Medical Easy Stand 5000&7000 MS2HC $3, Magician Easy Stand Bantam MS2HC $3, Easy Stand Evolv MS2HC $3, Easystand Zing AA $3, Ormesa Dondolino, Size 1 MS2OA $3, Dondolino, Size 2 MS2OA $3, Dondolino, Size 3 MS2OA $3, Mini Standy MS2OA $3, Standy MS2OA $3, Otto Bock Leckey Horizon Stander AA $3, Leckey Freestander AA $3, Leckey Mygo Stander AA $3, Leckey Pronestander AA $3, Squiggle Stander AA $3, Prime Engineering Kidstand & Grandstand 111 MS22P $3, Superstand,Small & Youth MS22P $3, Symmetry Standing Frame MS22P $3, Snug Seat Inc. Buffalo/ Caribou, all sizes MS2R $3, Gazelle,Size 1 MS2R $3, Gazelle,Size 2 MS2R $3, Gazelle,Size 3 MS2R $3, Synetick ErgoCare Baby,Kid & Junior MS2JP $3, Page: 6 of 87

7 Ambulation Aids OPTIONS: AA - Custom Modifications MOCM 1 The MOCM code may be used when custom modifications are required to an ADP listed ambulation aid or paediatric stander, and there is no ADP code with assigned funding available. The following documentation must be submitted: 1. Authorizer must provide clinical rationale to support the request. 2. Vendor must provide a breakdown of the cost of labour (not to exceed $40.00/hour), and parts. Adolescent Size Paediatric Specific AA5 1 $ Walker Additional funding for adolescent sized paediatric walkers. Authorizer must document clinical requirements. Selected device must meet size requirements. Adolescent Size Paediatric Standing AA7 1 $ Frame Additional funding for adolescent sized paediatric standing frames (device type ms1 & ms2). Authorizer must document clinical requirements. Selected device must meet size requirements. Adolescent Size Paediatric Walking AA6 1 $ Frame Additional funding for adolescent sized paediatric walking frames (device type mw6). Authorizer must document clinical requirements. Selected device must meet size requirements. Extra Wide Adult Wheeled Walker AA8 1 $ Extra wide adult wheeled walker (greater than 18" between push handles) due to client stature. Client weight less than 275lbs. Authorizer must document client's requirements. Forearm Attachments AA1 2 $ Forearm attachments for wheeled walkers. Authorizer must provide clinical rationale to support request (maximum 2). Heavy Duty Package Client Weight AA2 1 $ lbs Heavy duty package for wheeled walkers, client weight lbs. Authorizer must document client weight. Selected device must meet weight requirements. Heavy Duty Package Client Weight lbs AA3 1 $ Page: 7 of 87

8 Ambulation Aids OPTIONS: Heavy duty package for wheeled walkers, client weight lbs. Authorizer must document client weight. Selected device must meet weight requirements. Heavy Duty Package Client Weight AA4 1 $ Exceeded 400 lbs Heavy duty package for wheeled walkers, client weight exceeds 400lbs. Authorizer must document client weight. Selected device must meet weight requirements. Unilateral Hand Brake AA9 1 $ Unilateral hand brake. allows locking/braking of both brakes using one hand. Authorizer must document clinical requirements. (max 1) Page: 8 of 87

9 Back Support Action Products Twister Cb Back 15"-16" Width X 11"-16" Height Twister Cb Back 15"-16" Width X 17"-21" Height Twister Cb Back 17"-18" Width X 11"-16" Height Twister Cb Back 17"-18" Width X 17"-21" Height Twister Cb Back 19"-20" Width X 11"-16" Height Twister Cb Back 19"-20" Width X 17"-21" Height Twister Cb Back 21"-23" Width X 11"-16" Height Twister Cb Back 21"-23" Width X 17"-21" Height Adaptive Engineering Lab Adaptive Equipment Systems (Aes) SEBAN $ SEBAN $ SEBAN $ SEBAN $ SEBAN $ SEBAN $ SEBAN $ SEBAN $ DROP-IN R-BACK CURVED - SUN- SEBE $ MATE OR PUDGEE FOAM Drop-In R-Back Curved With 1.5" Poly SEBE $ Foam Drop-In R-Back Curved With Sun-Mate SEBE $ Or Pudgee Foam Drop-In R-Back With 1" Poly Foam SEBE $ Drop-In R-Back With 1.5" Poly Foam SEBE $ Drop-In R-Back With Sun-Mate Or SEBE $ Pudgee Foam Drop-In T-Back Curved - Sun-Mate Or SEBE $ Pudgee Foam Drop-In T-Back Curved With Sun-Mate SEBE $ Or Pudgee Foam Drop-In T-Back With Sun-Mate Or Pudgee Foam SEBE $ Adjustable Bi-Angular Solid Back Insert, SEB2L $ Includes T-Nuts & Adjustment Brackets. I Or T Or Curved Syle Solid Back Insert, SEB2L $ Includes T-Nuts. Oversize Upcharge For Backs Over 2o" SEB2L $69.00 But Less Than 28". Quick-Fit Contour/Bi-Angular Solid SEB2L $ Back Insert, Incudes T-Nuts. Sculptured Solid Back Insert, Includes SEB2L $ T-Nuts. Page: 9 of 87

10 Back Support Adaptive Equipment Systems (Aes) Advanced Mobility Sculpturefit Back W/Attaching SEB2L $1, Hardware, Custom. Solid Back Insert Package W/Universal SEB2L $ Hardware Or E-Z Mount Mount Hardware & Rotating Hold Downs. Solid Back Insert Package, Li'L Kiddos, SEB2L $ " Wide Or Less. Solid Back Insert Package, Li'L Kiddos, SEB2L $ Contoured, 14" Wide. Solid Back Insert, Includes T-Nuts, Li'L SEB2L $ Kiddos, 14" Wide Or Less. Solid Back Insert, Includes T-Nuts. SEB2L $ Solid Back W/Drop Hooks & Fixed Hold Downs. SEB2L $ Contoured Back SEBAO $ Deep "U" Back SEBAO $ Ez Back Basic SEBAO $ Ez Back System Complete SEBAO $ Pro Back Support SEBAO $ U Form Deep Contour Back Support SEBAO $ Amysystems Contour Back Support For Heavy Duty SEB4P $ Contour Back Support, Non-Standard SEB4P $ Sizes Contour Back Support, Standard Sizes SEB4P $ Blake Medical Silverback Max 16/18/20" wide SE $ Silverback Prime 16/18/20" wide SE $ Body Ryzm Life JazzRX SE $63.00 Sciences / Perspectis, Inc. Broda Back Pad SEBB $58.00 Custom Back With Permanent Lateral Supports, SEBCF114L 1 $ Fabricated Vinyl Cover, Without Mounting Hardware Complex Indirect Molded Back, SEBCF118L 1 $1, Without Cover And Mounting Hardware Complex Molded Back (Foam In Place), SEBCF117L 1 $1, Without Cover And Mounting Hardware Contoured Back (Foam On Rigid Base), Minimal Trunk Support, Vinyl Cover, Without Mounting Hardware SEBCF112L 1 $ Page: 10 of 87

11 Back Support Custom Fabricated Dynamic Health Care Solutions Custom Contoured Back, Moderate SEBCF113L 1 $ Trunk Support, Vinyl Cover, Without Mounting Hardware Custom Shaped Sculptured Back, SEBCF115L 1 $ Includes Cover, Without Mounting Hardware Flat Back/Planar Design, Vinyl Cover SEBCF110L 1 $ Without Mounting Hardware Simple Molded Back (Foam In Place), Without Cover And Mounting Hardware SEBCF116L 1 $ Cushion Size 14" - 21" SEBD $ Cushion Sizes 14" - 21" SEBD $ HAKC Back Support 10" - 14" SE $ MAPS Back Support 14" - 24" SE $ NXT AC BACK 12" TO 20" SE $ NXT ACT Back, Cushion Size 14"- 21" SEBD $ NXT HA AC BACK - 22 " - 24" SE $ NXT HA AC BACK 16" TO 20" SE $ NXT HA PC BACK 16" TO 20" SE $ NXT HA PC BACK 22" -24" SE $ NXT HA SC 22" SE $ NXT PC BACK 12" TO 20" SE $ NXT SC BACK 12" TO 20" SE $ NXT VC BACK SE $ Nxt Carbon Fiber FHAC Back, FM SE $ Nxt Carbon Fiber FHAC Back, QR SE $ Nxt FH AC 22" HD Back SE $ Nxt FH PC 22" HD Back SE $ Nxt Optima FH AC Back SE $ Nxt Optima FH PC Back SE $ Nxt Optima LOW HA AC 12"-20" SE $ Nxt Optima LOW HA AC 22"-24" SE $ Nxt Optima LOW HA PC 12"-20" SE $ Nxt Optima LOW HA PC 22"-24" SE $ Optima FHT AC Back Support 23"-29" SE $ Wide Optima FHT PC Back Support 23"-29" SE $ Wide Optima UFit AC Back Support 14"-20" SE $ Page: 11 of 87

12 Back Support Dynamic Health Care Solutions Wide Optima UFit AC Back Support 22"-24" SE $ Wide Optima UFit PC Back Support 14"-20" SE $ Wide Optima UFit PC Back Support 22"-24" SE $ Wide nxt Armadillo VC Back Support (sizes SE $ "-20") nxt HA SC Back 16" to 20" SE $ nxt Optima Carbon Fiber FHT PC back SE $ support (QR & Fixed Hardware, 14"-20") Future Mobility Custom Lunar Back SE $ Custom Lunar Back HD SE $1, Full Back - Sizes From 14" To 22" - SEBFM $ Lateral Full Back - Sizes From 14" To 22" - SEBFM $ Ultra Lateral Full Back - Sizes From 18" To 24" No SEBFM $ Lateral Full Back Style Heavy Duty SEBFM $ Low Back - Sizes From 14" To 22" - SEBFM $ Lateral Low Back - Sizes From 16" To 20" - No SEBFM $ Lateral Lunar Slim Back SE $ Lunar Slim Back (Bariatric) SE $ Mid Back - Sizes From 14" To 22" - SEBFM $ Lateral Mid Back - Sizes From 14" To 22" - SEBFM $ Ultra Lateral Mid Back - Sizes From 16" To 20" - No SEBFM $ Lateral Mid Back Style Heavy Duty SEBFM $ Orion Back SEBFM $ Prism Air Back - Custom Sizes SEBFM $ Prism Air Back - Non Standard Sizes SEBFM $ Prism Air Back Fits 16,18,20" Wide SEBFM $ W/C Prism Bariatric Air Back 21x16 Though 24x20 SEBFM $ Page: 12 of 87

13 Back Support Future Mobility Prism Bariatric Air Back- Custom Size SEBFM $ Prism Bariatric Basic Back - Custom SEBFM $ Size Prism Bariatric Basic Back 21x16 SEBFM $ Through 42x20 Prism Bariatric Ultra Back 21x16 SEBFM $ Through 24x20 Prism Bariatric Ultra Back- Custom Size SEBFM $ Prism Basic Back - Custom Sizes SEBFM $ Prism Basic Back - Non Standard Sizes SEBFM $ Prism Basic Back Fits 16,18,20" Wide SEBFM $ W/C Prism Max Back - Upcharge SEBFM $86.00 Prism Phantom Back 12-18" Width X 7" SEBFM $ Height Prism Super Back For Kids - Custom SEBFM $ Sizes Prism Super Back For Kids - Non SEBFM $ Standard Sizes Prism Super Back For Kids Fits 10, 12, SEBFM $ And 16" Wide W/C Prism Truefitt Back - Bariatric Sizes SEBFM $ Prism Truefitt Back - Custom Sizes SEBFM $ Prism Truefitt Back - Non Standard SEBFM $ Sizes Prism Truefitt Back Fits 16,18,20" Wide SEBFM $ W/C Prism Ultra Back - Custom Sizes SEBFM $ Prism Ultra Back - Non Standard Sizes SEBFM $ Prism Ultra Back Fits 16,18,20" Wide SEBFM $ W/C Hoggi Back Cushion Shaped SE $ Back Cushion trough Shaped SE $ Xps Adaptive Back Cushion SEBK $ Innovators 1993 K Special Back-Custom SEBI $ Inc K Special Back-Standard SEBI $ K-Combo Back SEBI $ K-Combo Back Custom SEBI $ Key-Hole Back SEBI $ Key-Hole Back Custom SEBI $ Page: 13 of 87

14 Back Support Innovators 1993 Inc Invacare Invacare - Matrx Key-Hole Back Custom Adjustable Top SEBI $ Contour U Back Includes All SEBNS $1, Modifications & Vacuum/Vinyl Upholstery Curved Back Fits 10" To 20" Wide W/C SEBNS $ Curved Back Pneumatic Fits 10" To 20" SEBNS $ Wide W/C Curved Back Pneumatic Special Size & SEBNS $ Modifications Curved Back Special Size & SEBNS $ Modifications Naked Contour U Back, Includes All SEBNS $1, Modifications & Vacuum/Moisture Proof Coating/Removable Cover & Cover Pattern. Personal Back Bariatric Builder Size SEBNS $ Personal Back Fits 16", 18", 20" Wide SEBNS $ W/C Personal Back Plus - Bariatric Builder SEBNS $ Size Personal Back Plus - Fits 16", 18", 20" SEBNS $ Wide W/C Silhoutte Back Support SEBNS $ Deep Heavy Duty Posture Back, All SEB1M $ Sizes Deep Posture Back, All Sizes SEB1M $ Genera Back SEB1M $ Heavy Duty Posture Back Fits W/C SEB1M $ "-25" Width & 16"-20" Height Matrx Elite HD, greater than 24" SE $1, Matrx Elite HD, up to 24" SE $ Matrx Elite TR - Adult SE $ Matrx High Back Fits W/C 16" - 21" SEB1M $ Width & 20" - 30" Height Matrx MX1 Superlite, 12" SE $ Matrx MX1 Superlite, 16" SE $ Matrx MX1 Superlite, 9" SE $ Matrx Mini - Paediatric SE $ PB Elite Deep All Sizes SEB1M $ PB Extra Wide Deep Heavy Duty Backs SEB1M $1, Page: 14 of 87

15 Back Support Invacare - Matrx From 16 To 20 Inches PB Extra Wide Heavy Duty Backs Sizes SEB1M $1, To 20 Inches PB Posture Back Elite, Posture Back SEB1M $ Elite Full Back, All Sizes Posture Back Fits W/C 13"-20" Width & SEB1M $ "-20"Height Trx Rehab Back, Fits W/C 18" - 25" SEB1M $ Width Jay Medical Foam Back SEBJA $99.00 J2 Deep Contour Back 14w-19w, SEBJA $ Includes Mounting Hardware, Cover, Lumbar Supports & Lateral Wedges J2 Deep Contour Back 20wx20h, SEBJA $ Includes Mounting Hardware, Cover, Lumbar Supports & Lateral Wedges J3 Lower Thoracic Back, All Sizes SEBJA $ J3 Mid Thoracic Back, All Sizes SEBJA $ J3 Shoulder Height Back, All Sizes SEBJA $ J3 Upper Thoracic Back, All Sizes SEBJA $ JAY 2 Plus 20-23", 23-26" J2 Back SEBJA $ Assembly For 0 Or 8 Degree Backposts JAY Zip Back All Sizes SE $ Jay 2 Back Includes Mounting SEBJA $ Hardware (""K"" Or ""G"" Type), Cover & Lumbar Supports (14""-19"") Jay 2 Back Includes Mounting SEBJA $ Hardware, Cover & Lumbar Supports (12"/13") Jay 2 Back- Includes Mounting SEBJA $ Hardware (""K"" Or ""G"" Type), Cover & Lumbar Supports (20"") Jay 2 Plus 20-23", 23-26" Back SEBJA $1, Assembly For 0 To 8 Degree Backposts, With Headrest Mounting Kit Jay 2 Tall Back- Includes Mounting SEBJA $ Hardware, Cover & Lumbar Supports (20") Jay 2 Tall Back- Includes Mounting Hardware, Cover & Lumbar Supports (14"/16"/17"/18") SEBJA $ Page: 15 of 87

16 Back Support Jay Medical Jay Active Back 18"-14" Quick Release SEBJA $ Mount Jay Active Back 18"-14" Rigid Mount SEBJA $ Jay Active Back 18"/16" Tall Quick SEBJA $ Release Mount Jay Active Back 20" Tall SEBJA $ Jay Active Back With Permanent Mount SEBJA $ (Large) Jay Basic Back, Fixed Clamp Style, All SEBJA $ Sizes Jay Basic Back, Fixed Strap Style, All SEBJA $ Sizes Jay Care Back 15-18" Wide SEBJA $ Jay Care Back 19-20" Plus Width SEBJA $ Jay Care Back Foam Large Size SEBJA $ Jay Care Back Shell Large Size SEBJA $ Jay Encompass Back SEBJA $ Jay Fit Back Adjustable Contour Back SEBJA $ For 10" Or 12" Frame Width, Various Back Heights Jay Fit Back Adjustable Contour Back SEBJA $ For 14" Or 16" Frame Width, Various Back Heights Jay Fit Back Adjustable Contour Back SEBJA $ For 18" Frame Width, Various Back Heights Jay Focus Point Back, All Sizes SEBJA $ Jay Modual Back Custom Contoured SEBJA $ Insert 18"/16"/14" Jay Modual Back Custom Contoured SEBJA $ Insert 20" Jay Modual Back Standard Insert SEBJA $ "/16"/14" Jay Modual Back Standard Insert 20" SEBJA $ Jay Modular Back Adjustable SEBJA $ Aluminum Shell 20" Jay Modular Back Adjustable Aluminum SEBJA $ Shell (18",16",14") Jay Union Back Standard with 4 point SE $ hardware Jay Union Back Standard with standard SE $ hardware Jay Union Back Tall with 4 point SE $ Page: 16 of 87

17 Back Support Jay Medical Hardware Jay Union Back Tall with Standard SE $ Hardware Kid Kart I-Back Cushion Tlc SEBKT $ Xpress T-Back 1" Short, Regular, Or SEBKT $ Tall Xpress T-Back 2.5" Short, Regular, Or SEBKT $ Tall Lpa Medical Inc. Adjustable Tension Back SEBO $ Contour Back Cushion SEBO $93.00 Maple Leaf Contour Padded Personal Back SEBWM $ Wheelchair ML Deep SE $ ML Kyphothic SE $ ML Mid SE $ ML Shallow SE $ ML Shape SE $ ML Slim Custom SE $ ML Slim Short SE $ ML Slim Standard SE $ ML Slim Tall SE $ The Fusion Essential (Bariatric) SE $ The Fusion Essential (Non-Standard, SE $ All Sizes) The Fusion Essential (Standard, All SE $ Sizes) The Fusion1 (Bariatric) SE $ The Fusion1 (Non-Standard, All Sizes) SE $ The Fusion1 (Standard, All Sizes) SE $ Motion Concepts MX1 Dual Mount wide x 9 hgh SE $ MX1 Dual Mount x 16 high SE $ MX1 Dual mount wide x 12 high SE $ MX1 Mono Mount wide x 16 high SE $ MX1 Mono Mount wide x 9 high SE $ MX1 Mono mount wide x 12 high SE $ MX1 Quick Release Dual Mount SE $ wide x 16 high MX1 Quick Release Dual Mount SE $ x 12 high MX1 Quick Release Dual Mount SE $ Page: 17 of 87

18 Back Support Motion Concepts x 9 high Trx Contour Back, For Trx Systems, 16, SEBZG $ , 22" Wide Wheelchairs, Height Adjustable 18-26" Trx Onyx Contour Back & Trx Single SEBZG $ Post Cloth Contour Back, For Trx Systems Trx Single Post Onyx Contour Back For SEBZG $ Trx Systems Nighthawk Key-Hole Back SEBNM $ Relaxed Back High SEBNM $ Relaxed Back High With Flap SEBNM $ Relaxed Back Low SEBNM $ Orthofab High Profile Contoured 14-20"Width, SEBOF $ " Height High Profile Contoured Non Standard SEBOF $ Sizes High Profile Tall Contoured 14-20" SEBOF $ Width, 18-22" Height High Profile Tall Contoured Non SEBOF $ Standard Sizes & Options Low Profile Contoured 14-20" Width, SEBOF $ " Height Low Profile Contoured Non Standard SEBOF $ Sizes Modular Mild Or Deep Contour 14-20" SEBOF $ Width & 16,18,20" Height Modular Mild Or Deep Contour Non SEBOF $ Standard Sizes Otto Bock Back System 1, 15" To 17" & 18" To SEBOB $ " Back System 2, 15" To 17" & 18" To SEBOB $ " Back System 3, 15" To 17" & 18" To SEBOB $ " Back System 4, 15" - 20" Sizes SEBOB $ Back-Finished With Spray SEBOB $1, Coating,Cover,Sewing Pattern Back-Itemized Cushion (Unfinished) SEBOB $1, OBSS Ortho-Shape Back (All Sizes) SE $2, Performance V-Trak Ax-Sb Back Support Connisting SEBP $ Health Products Of 1 Insert, All Sizes V-Trak Ax-Sb Back Support Consisting SEBP $ Page: 18 of 87

19 Back Support Performance Health Products Of 2 Inserts, All Sizes V-Trak Ax-Sb Back Support Consisting SEBP $1, Of 3 Inserts, All Sizes V-Trak Axh Back Support, All Sizes SEBP $ V-Trak Axs Back Support, All Sizes SEBP $ Permobil Ergo Back - Fixed - All Sizes SEB1P $ Ergo Back - Recline - All Sizes SEB1P $ ROHO Agility Carbon Back System with SE $1, Air Only (items greater than 10 high) ROHO Agility Carbon Back System with SE $ Air Only (items up to 10 high) Rectangular Back - All Sizes SEB1P $1, Physipro HP2 Back Support, all models, all sizes SE $ Premium Back Support, all sizes SE $ Positech BACKUS (oversize) with SE $1, Innovation Inc. detachable/waterproof foam cushion backrest (all sizes) including laterals and standard or swing-away anchors BACKUS with detachable/waterproof SE $1, foam cushion backrest (all sizes) including laterals and standard or swing-away anchors CURVUS (oversize) with SE $1, detachable/waterproof foam cushion backrest (all sizes) including laterals and standard or swing-away anchors CURVUS with detachable waterproof SE $1, foam cushion backrest (all sizes) including laterals and standard or swing-away anchors FLEXUS (complete system, one-sizefits-all) SE $2, with height adjustable foam cushion backrest including laterals and standard or swing-away anchors Power Plus Relax Form Fit SEBWM $ Mobility Relax Full Fit SEBWM $ Relax Full Fit (custom) SEBWM $ Relax Gentle Fit SEBWM $ Relax Gentle Fit (Custom) SEBWM $ Relax Snug Fit SEBWM $ Relax Spiral Fit SEBWM $ Upcharge For Custom Height SEBWM $ Upcharge For Custom Width SEBWM $ Page: 19 of 87

20 Back Support Precision Rehab Manufacturing Pride Mobility Products Quickie Ride Designs Roho Back Sewn Cover Waterproof Foam, SEBWB $1, Includes Labour For Digitizing Or Plastering Back Vacuum Formed, Includes Labour SEBWB $1, For Digitizing Or Plastering Base Cushion Back, Includes All SEBWB $1, Modifications & Labour For Digitizing Or Plastering Precision - Fit Back Cushion Upcharge, SEBWB $ Extra Wide Or Extra Tall, 20" - 24" Precision - Fit Back Cushion, Subtle, Moderate Or Aggresive Positioning. Includes Hinged Or Fixed Laterals And Cover. SEBWB $ Synergy Standard Back Support, up to SE $ ". For additional sizing see SEBND0015. Synergy Tru Comfort Back Standard, SEBX $ Reclining Or Tilt And Recline Back Greater Than 20" Wide Synergy Tru-Comfort Back Synergy Tru SEBX $ Comfort Back Standard, Reclining Or Tilt And Recline Back Up To 20" Wide BREEZY RELAX2 COMFORT BACK SE $1, ANATOMICAL SHAPE Contour Back - Tilt Fx SEBQU $ Corbac Adjustable Contour Back SEBR $ Support, All Sizes Ride Custom Back Support SEBR $2, Ride Decaf, all sizes SE $ Ride Java Back 12", 14", 15", 18" SE $ Ride Java Back Grande SE $ Ride Java Back Grande Deep SE $ Ride Java Back Regular/Tall Deep SE $ Agility Back - Custom Design - All SE $1, Variation Agility Back Support SE $ Agility Max Contour Back - all sizes SE $ Low Back (10" Height) All Standard SEBRO $1, Sizes 14" - 18" Lumbar Support Cushion (Made To SEBRO $ Page: 20 of 87

21 Back Support Roho Order) Recliner Wheelchair Cushion Made To SEBRO $1, Order (One Piece Back & Seat- 2 Sections,2 Valves) Recliner Wheelchair Cushion-Custom SEBRO $1, (More Than 2 Sections And/Or 2 Halves) Standard Back (16" Height) All SEBRO $1, Standard Sizes 14" - 18" Starkey - Butterfly Back System SEBV $ Viennatone Stealth Products ADI - AL and AFT Backrest - Active SE $ Contour, all sizes ADI - AL and AFT Backrest - Deep, SE $ Contour, all sizes ADI - AL and AFT Backrest - Extra SE $ Deep contour, all sizes ADI - CF Backrest - Active Contour, all SE $ sizes ADI - CF Backrest - Deep Contour, all SE $ sizes Sunrise Medical Back Cushion 16x20,18x20, 20x20 SEBM $ Backrest "Plush", Deep Or Active SEBM $ Contour Lateral Support Backrest 16x20,18x20 SEBM $ Mid Thoracic Posterior Deep Jay 3 SEBJA $1, Back - Sizes 12 Height To 26 Width Sizes 15 Height To 26 Width Sedeo Pro-Comfort Backrest 16"w to SE $ "w x 20"h Sedeo Pro-Comfort Backrest 20"w x SE $ "h Sedeo Pro-comfort Backrest 22"w x 20" SE $ h Sedeo Pro-deep Backrest 16"w to SE $ "w x to 20"h Sedeo Pro-deep Backrest 20"w x 20"h SE $ Sedeo Pro-deep Backrest, Active cut SE $ "w to 18"w x 20"h Sedeo Pro-deep Backrest, Active cut SE $ " w x 20"h Sedeo Pro-deep Backrest, Active cut 22"w x 20" h SE $ Page: 21 of 87

22 Back Support Sunrise Medical Sedeo Pro-deep backrest 22"w x 20 h SE $ Shoulder Height Posterior Deep Jay 3 SEBJA $1, Back Smartsit Comfort Back - All Sizes SEBM $ Upper Thoracic Posterior Deep Jay 3 SEBJA $1, Back - Sizes 18 Height To 24 Width Supracor Stimulite Lumbar Support SEBRR $ The Comfort Acta Relief Back - All Variations SE $ Company Acta-Back, All Variations, All Sizes SEB7C $ Acta-Back, All Variations, Custom Sizes SEB7C $1, Incrediback, Modable, Tall, Deep, Tall- SEB7C $1, Deep, Custom Sizes Incrediback, Moldable, Tall, Deep, Tall- SEB7C $ Deep, All Sizes Toronto Tops Back Cushion (10" & 12" Width) SEBTP $ Orthopedic Ltd. Varilite Medical Evolution Back - Regular SEBVP $ Products Evolution Back - Regular Bariatric SEBVP $ Evolution Back - Tall SEBVP $ Evolution Deep Back - All Sizes SEBVP $ Icon Back - Bariatric SEBVP $ Icon Back - Deep SEBVP $ Icon Back - Low SEBVP $ Icon Back - Tall SEBVP $ Icon Back -Mid SEBVP $ Junior Backs SE $ Talon Back - All Sizes SEBVP $ Vision Wheelchair Viscount Tall Back Support For 16' Or 18" W/C SEBVC $1, Systems Viscount Tall Back Support, Custom Inc. Sizes SEBVC $1, Viva Contoured Postural Back 14"-16" W/C Or 16"-18" W/C SEBVC $ Complete Assembly Adaptive Engineering Lab Adaptive Equipment Systems (Aes) Contoured Seat System (Includes Seat, Back, Support Pads, Hardware) Basis Contoured Seat & Back Including Connecting Hinge (Select Type). Does Not Include Mounting Hardware. SECE $1, SEC2L $ Page: 22 of 87

23 Complete Assembly Adaptive Equipment Systems (Aes) Amysystems Broda Custom Fabricated Hoggi Invacare Kid Kart Basis Contoured Seat & Back Including SEC2L $ Connecting Hinge Package. Li'L Kiddos,14" Wide Or Less. Does Not Include Mounting Hardware. Basis Seat & Back Including SEC2L $ Connecting Hinge (Select Type). Does Not Include Mounting Hardware. Basis Seat & Back Including Connecting Hinge Package. Li'L Kiddos,14" Wide Or Less. Does Not Include Mounting Hardware. SEC2L $ Bariatric Power Recline With Integrated SEC4P $6, Shear Reduction (Isr) Hsp Padding Package SECB $ (Includes Short Wing Cover, Extended Shoulder Bolsters, Full Extension Foot Pad, F-2 Foot Rest, Thigh Belt) Modify Or Refurbish Existing Custom SEMCF900L 1 $ System. Includes Parts,Hardware,Labour Changes To Head Rest,Back Support,Seat, & Footrest Etc. Adjustible Height Back System Planar SE $ Back Cushion Bingo Ius Or Xps Seat Frame Size 1 SECK $1, Bingo Ius Or Xps Seat Frame Size 2 SECK $1, Configurable Adjustible Height I Back SE $ System Ius Adaptive Seat And Back Cushions SECK $ With Airflex Ius Adaptive Seat And Back Cushions - SECK $ Breathable Kinesthetic System Fits 10" To SECNS $1, " Wide W/C, (Includes Basic Headrest, Lateral Supports, Padded Lap Belt, Ulti-Mate Base, Curved Back & Growth Bracket) Kinesthetic System Fits 16" To SECNS $1, " Wide W/C, (Includes Basic Headrest, Lateral Supports, Padded Lap Belt, Ulti-Mate Base & Curved Back) Tlc Shell Assembly With Contour SECKT $ Page: 23 of 87

24 Complete Assembly Kid Kart Tlc Shell Assembly With Planar SECKT $ Xpress Adjustable Contour SECKT $ Package Xpress Shell Assembly With Contour SECKT $ Xpress Shell Assembly With Planar SECKT $ Otto Bock Kimba Neo Basic Seat - Size 2 - SE $1, Includes Elevating Legrests, Flip-Up Footrest, Laterals, Adjustable Hip Pads & Padding. Kimba Spring Multifunctional SECOB $1, Unit - Size 1 Includes Elevating Legrests, Flip-Up Footrest, Laterals, Adjustable Hip Pads & Padding. Kimba Spring Multifunctional SECOB $1, Unit - Size 2 Includes Elevating Legrests, Flip-Up Footrest, Laterals, Adjustable Hip Pads & Padding. Kimba Spring Plus Adjustable SECOB $1, System - Size 1 Includes Armrests, Elevating Legrests, Adjustable Footplates & Recline. Kimba Spring Plus Adjustable SECOB $1, System - Size 2 Includes Armrests, Elevating Legrests, Adjustable Footplates & Recline. Kimbo Neo Basic Seat - Size 1 - SE $1, Includes Elevating Legrests, Flip-Up Footrest, Laterals, Adjustable Hip Pads & Padding. Mygo Seat Shell Size 1 SECOB $1, Includes Seat Shell And Cushions Mygo Seat Shell Size 2 SECOB $1, Includes Seat Shell Cushions And Shoulder Support OBSS Ortho-Shape SE $3, OBSS Ortho-Shape, greater than 20" SE $4, wide and/or deep OBSS Ortho-Shape, including SE $3, additional liner for growth Squiggle System SE $1, Spenco Silicore Wheelchair Seat With Back and SECSO $ Page: 24 of 87

25 Complete Assembly Headrest/Neckrest Sides THOMASHILFEN EasyS or EasyS Modular SE $1, Thevo Twist SE $1, Toronto Orthopedic Ltd. Tops System Includes Butterfly Chest Strap, Combination Head/Neckrest Tilt Tray, Stroller Interface, Back And Seat SECTP $1, Adaptive Curved Headrest SEHE $88.00 Engineering Lab Tri-Pad Headrest SEHE $ Adaptive Curved Hr Pad Or Contoured Hr Pad Or SEH2L $ Equipment Bell Curved Hr Pad, Systems (Aes) Cobra Headrest Bracket, Flip-Down. Curved Hr Pad Or Contoured Hr Pad Or SEH2L $ Bell Curved Hr Pad, Cobra Headrest Bracket. Lateral-Posterior Head Support, SEH2L $ Adjustable Depth Bracket, 6-1/2"W X 7"H. Lateral-Posterior Head Support, SEH2L $ Adjustable Depth Bracket, Hinged. Lateral-Posterior Head Support, SEH2L $ Adjustable Depth Bracket, Paediatric 4" X 4" Or 5"X 5" Or 6"X 6". Lateral-Posterior Head Support, Cobra SEH2L $ Headrest Bracket, 5" X 5"Or 6" X 6" Or 7" X 7"Or 8" X 8". Lateral-Posterior Head Support, Cobra SEH2L $ Style Headrest Bracket, Flip-Down 5" X 5"Or 6"X6" Or 7"X7" Or 8" X8". Advanced Custom Headrest SEHAO $ Mobility Deep "U" Headrest SEHAO $ Large Padded Headrest SEHAO $ Macintosh Oxbow Headrest SEHAO $ So Soft Oval Headrest SEHAO $ Standard Curved Padded Headrest SEHAO $ Amysystems Curved Headrest, All Sizes SEH4P $ Broda Neckrest Cushion SEHB $41.00 Custom Adjustable Headrest With Neckrest, SEHCF080L 1 $ Fabricated Vinyl Cover, Without Hardware Complex Headrest/Contoured Or SEHCF060L 1 $ Page: 25 of 87

26 Headrest/Neckrest Custom Fabricated Daher Specialty Foam Products Dynamic Health Care Solutions Future Mobility Molded, Vinyl Cover, Without Hardware Contoured Headrest/Curved Surface, SEHCF050L 1 $ Vinyl Cover, Without Hardware Flat Headrest/Planar Head Support, SEHCF040L 1 $ Vinyl Cover, Without Hardware Head Or Neckrest Incorporated With SEHCF090L 1 $ Mobility Switches, Vinyl Cover, Without Hardware Neckrest With Vinyl Cover, Without Hardware SEHCF070L 1 $ Combination Headrest SEHDH $50.00 Full Support Headrest SEHDH $66.00 Large Headrest SEHDH $50.00 MultiFit Headrest SE $ Large Headrest With Multi-Axial SEHFM $ Hardware Large Padded Headrest SEHFM $ Small Headrest With Multi-Axial SEHFM $ Hardware Small Padded Headrest SEHFM $ Hoggi Ius Headrest SEHK $ Invacare Basic Headrest - Adult SEHNS $ Basic Headrest - Child SEHNS $ Curved Adjustable Headrest System SEHNS $ Large Adjustable Headrest System SEHNS $ Small Adjustable Headrest System SEHNS $ Two Step Adjustable Headrest System SEHNS $ Invacare - Matrx Matrx Elan 4 Point Headrest Pad (w/ SE $ Infection Control) with removable cover Matrx Elan 4 Point Headrest Pad with SE $ standard removable cover Matrx Elan Occipital Headrest Pad w/ SE $ removable Infection Control cover 9" x 7" or 12" x 8" Matrx Elan Occipital Headrest Pad with SE $ removable cover - 9" x 7" or 12" x 8" Matrx Elan Standard Headrest Pad with removable Infection Control cover - 6" x 3.5", 10" x 5" or 14" x 5" SE $ Page: 26 of 87

27 Headrest/Neckrest Invacare - Matrx Matrx Elan Standard Headrest Pad with removable cover - 6" x 3.5", 10" x 5" or 14" x 5" SE $ Jay Medical Four Pad Headrest - Junior SEHJA $ Four Pad Rotational Headrest - Junior SEHJA $ Four Pad Rotational Headrest - SEHJA $ Standard Full Width Headrest SEHJA $ Single Pad Headrest - Large SEHJA $72.00 Single Pad Headrest - Small SEHJA $72.00 Three Pad Headrest - Large SEHJA $ Three Pad Headrest - Large Junior SEHJA $ Three Pad Headrest - Small SEHJA $ Three Pad Headrest - Small Junior SEHJA $ Three Pad Rotational Headrest - Large SEHJA $ Three Pad Rotational Headrest - Large SEHJA $ Junior Three Pad Rotational Headrest - Small SEHJA $ Three Pad Rotational Headrest - Small SEHJA $ Junior Kid Kart Xpress Micro Adjustable Head Support SEHKT $ Xpress Planar Head Support SEHKT $ Xpress Tri-Wing Adjustable Head SEHKT $ Support Lpa Medical Inc. Cervical Support SEHO $36.00 Contour Headrest SEHO $86.00 Maple Leaf ML Contour SE $ Wheelchair Metalcraft Contoured Headrest With Mounting SEHNG $ Industries Hardware Small, Large, Xlarge Occipital Ring With Mounting Hardware SEHNG $ Small & Large Child Or Adult Occipital Ring, Add-On, With Mounting SEHNG $ Hardware Small & Large Child Or Adult Motion Concepts Onyx Auto Style Headrest SEHZG $ Orthofab Padded Contour Support Without SEHOF $91.00 Mounting Hardware, Small, Medium, Or Large Otto Bock Adjustable Wing Headrest (Size 1 & 2) SEHOB $ Page: 27 of 87

28 Headrest/Neckrest Otto Bock Contoured Headrest (Size 1 & 2) SEHOB $ Fixed Wing Headrest (Size 1 & 2) SEHOB $ Headrest - Combination SEHOB $72.00 Headrest - Large/Small SEHOB $72.00 Headrest - Lateral Control SEHOB $ Headrest Support (Size 1 & 2) SEHOB $ Neckrest - All Sizes SEHOB $82.00 Soft Headrest - Large/Small SEHOB $ X-Style Headrest/Neckrest SEHOB $ Combination, Adult & Paediatric Sizes. Performance V-Trak Headrest, All Sizes, All SEHP $ Health Products Configurations Permobil Headrest - For Ergo Back SEH1P $ Physipro Headrest SE $ Positech SUMMUS (all sizes) including hardware SE $ Innovation Inc. (support holder and fastener) Power Plus Mobility Contour Headrest Including Brackets SEHWM $ Precision Rehab Manufacturing Pride Mobility Products Stealth Products Headreast - Large (14") Or Small (10") Pad TRU-Comfort 2 Including Mounting Hardware Stealth Combo Headrest With Multi Axis Hardware, Large & Small Sizes Stealth Comfort Plus Large 14" Comfort Pad Only (With Ring) Stealth Comfort Plus Medium 10" Comfort Pad Only (With Ring) Stealth Comfort Plus, Large 14" Pad /Multi Axis Hardware Stealth Comfort Plus, Large 14" Pad/Standard Hardware Stealth Comfort Plus, Medium 10" Pad/Multi Axis Hardware Stealth Comfort Plus, Medium 10" Pad/Standard Hardware Stealth Comfort Plus, Swingaway Both Sides, Standard Lateral Pad/Spot Pad/Long Lateral Pad Stealth Comfort Plus, Swingaway Left Side, Standard SEHWB $ SE $ SEHNS $ SEHNS $ SEHNS $ SEHNS $ SEHNS $ SEHNS $ SEHNS $ SEHNS $ SEHNS $ Page: 28 of 87

29 Headrest/Neckrest Stealth Products Lateral Pad/Spot Pad/Long Lateral Pad Stealth Comfort Plus, Swingaway Right SEHNS $ Side, Standard Lateral Pad/Spot Pad/Long Lateral Pad Stealth I2i Headrest System - All Sizes SEHNS $ Stealth Occipital/Sub Occipital & SEHNS $ Laterals, Adult & Paediatric Sizes (Specify Swingaway) Stealth Otto Bock Style, Swing Away SEHNS $ Both Sides, Standard Lateral Pad/Spot Pad/Long Lateral Pad Stealth Otto Bock Style, Swingaway SEHNS $ Left Side, Standard Lateral Pad/Spot Pad/Long Lateral Pad Stealth Otto Bock Style, Swingaway SEHNS $ Right Side, Standard Lateral Pad/Spot Pad/Long Lateral Pad Stealth Ultra Channel With Ring, Large SEHNS $ & Small Sizes Stealth Ultra Large Combo With Large SEHNS $ Sub Occipital Stealth Ultra Occipital & Laterals, SEHNS $ Small & Large Sizes (Specify Swingaway) Stealth Ultra Occipital Large/Small SEHNS $ Stealth Ultra Small & Occipital/Sub SEHNS $ Occipital Stealth Ultra Small Combo With Large SEHNS $ Sub Occipital Stealth Ultra Sub Occipital Large/Small SEHNS $ Stealth Ultra Swing Both Sides, SEHNS $ Standard Lateral Pad/Spot Pad/Long Lateral Pad Stealth Ultra Swingaway SEHNS $ Standard & Long Lateral Pad, Or Spot Pad Stealth Ultra-Ac Adjustable Channel SEHNS $ Sunrise Medical Emineo Advanced Headrest SEHM $ Emineo Basic Headrest SEHM $ Large Headrest SEHM $ Lateral Support Headrest SEHM $ Offset Headrest Large SEHM $ Offset Headrest Lateral SEHM $ Page: 29 of 87

30 Headrest/Neckrest Sunrise Medical Offset Headrest Small SEHM $ The Comfort Company Vision Wheelchair Systems Inc. Whitmyer Biomechanix Sedeo Pro Flexible Headrest Pad SE $93.00 Sedeo Pro Large Headrest Pad SE $ Sedeo Pro small headrest pad SE $69.00 Small Headrest Assesmbly SEHM $ Headrest - Moldable, Includes Cover SEH7C $ Vector Head N Neck Support, 11"W X 8"D Pad Vector Head N Neck Support, Custom Pad 10" Plush Occipital Pad & Single Sub- Occipital Pad With Linx Vertical/Horizontal Mount 10" Plush Occipital Pad & Single Sub- Occipital Pad With Onyx Vertical/Horizontal Mount 10" Plush Occipital Pad & Single Sub- Occipital Pad With Pro Verticial/Horizontal Mount 14" Plush Pad With Linx Vertical/Horizontal Mount 14" Plush Pad With Onyx Vertical/Horizontal Mount 14" Plush Pad With Pro Vertical/Horizontal Mount 19" Plush Pad With Link Vertical/Horizontal Mount 19" Plush Pad With Onyx Vertical/Horizontal Mount 19" Plush Pad With Pro Vertical/Horizontal Mount 4"X6" Occipital Pad & Single Sub- Occipital Pad With Onyx Vertical/Horizontal Mount 4"X6" Occipital Pad & Single Sub- Occipital Pad With Pro Vertical/Horizontal Mount 4"X6"Occipital Pad & Single Sub- Occipital Pad With Lynx Vertical/Horizontal Mount 4"X6"Occipital Pad With Size 1/2 Sub- Occipital Pads With Lynx Vertical/Horizontal Mount SEHVC $ SEHVC $ SEHWH $ SEHWH $ SEHWH $ SEHWH $ SEHWH $ SEHWH $ SEHWH $ SEHWH $ SEHWH $ SEHWH $ SEHWH $ SEHWH $ SEHWH $ Page: 30 of 87

31 Headrest/Neckrest Whitmyer Biomechanix 4"X6"Occipital Pad With Size 1/2 Sub- SEHWH $ Occipital Pads With Onyx Vertical/Horizontal Mount 4"X6"Occipital Pad With Size 1/2 Sub- SEHWH $ Occipital Pads With Pro Vertical/Horizontal Mount 8" Or 10" Plush Pad With Lightweight SEHWH $ Vertical/Horizontal Mount 8" Or 10" Plush Pad With Linx SEHWH $ Vertical/Horizontal Mount 8" Or 10" Plush Pad With Onyx SEHWH $ Vertical/Horizontal Mount 8" Or 10" Plush Pad With Pro SEHWH $ Vertical/Horizontal Mount 8"/10" Plush Occipital Pad With Size 1 SEHWH $ Sub-Occipital Pads With Pro Vertical/Horizontal Mount 8"/10" Plush Occipital Pad With Size SEHWH $ sub-Occipital Pads With Lynx Vertical/Horizontal Mount 8"/10" Plush Occipital Pad With Size SEHWH $ sub-Occipital Pads With Onyx Vertical/Horizontal Mount Adjust-A-Plush Headrest System SEHWH $ Bilateral Lfc With Pads And Interface SEHWH $ Plate For Plush & Contoured Cradle Systems Heads Up Pad All Sizes - SE $ Add On Occipital Pads Optional Large Pad With Lightweight SEHWH $ Vertical/Horizontal Mount Large Pad With Linx Vertical/Horizontal SEHWH $ Mount Large Pad With Onyx SEHWH $ Vertical/Horizontal Mount Large Pad With Pro Vertical/Horizontal SEHWH $ Mount Lateral Facial Component With Pad SEHWH $ Medium Pad With Lightweight SEHWH $ Vertical/Horizontal Mount, LWS-CCS3 Medium Pad With Lightweight SEHWH $ Vertical/Horizontal Mount, ONYX-CCS3 Medium Pad With Linx SEHWH $ Vertical/Horizontal Mount Medium Pad With Pro SEHWH $ Page: 31 of 87