Group 3 K0856 Basic Package

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Base Price List and Order Form Effective July 1, 2008 Revised August 15,2008 For ease of ordering, contact Customer Service Toll Free at: 800-333-6900 Fax: 800-678-4682 To order Literature:

1 Base Price List and Order Form Effective July 1, 2008 Revised August 15,2008 For ease of ordering, contact Customer Service Toll Free at: Fax: To order Literature: Company Name Account # Phone P.O. # Date Ship to Name & Address Special Note 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 to the Medicare Program and should consult an attorney or other advisor to discuss specific situations in further detail. Group 3 K0856 Basic Package TDXSP-CG TDXSP for Formula CG with MK6i 300 lb Weight Capacity " X 3" Tires w/foam Filled Inserts... No Charge 4 Pole Motors...Standard Flip Back Fixed Height Arm...Standard MK690ACC Controller w/ Actuator Control...Standard 70NHD 70 Swingaway Footrests...Standard 8 Amp Off Board Battery Charger...Standard 1515 Push Button Style Seat Positioning Strap...Standard Seat Option CGTE Tilt/Elevate (E1002)...$4, E2-TDX Elevate to Assist for Transfers (E2300)...$1, CHAIR TYPE/POWERED SEATING BASE TDXSP-CG TDXSP for Formula CG w/ MK6i (K0856)... 5, CONTEMPORARY BASE 24P Wet Black...No Charge 60P Silver Metallic...No Charge 71P Silver Vein...No Charge OSF Omit Seat Frame for Base Only... Less P Black Prism...No Charge TOO HOT 30P Sunny Yellow...No Charge 61P Electric Red...No Charge U300 User Weight <300 lbs (K0856)... Standard 2 119P Bubblegum Pink...No Charge 120P Grape Madness...No Charge " x 3" w/foam Filled Inserts...No Charge " x 3" Pneumatic Tires... Standard FKPKG One-Sided Fork Package FRAME FINISH OMIT SEAT FRAME 105P Midnight Blue...No Charge USER WEIGHT LIMITS WHEEL OPTIONS (PAIR) FORK OPTION WAY COOL 62P Electric Blue...No Charge 104P Electric Teal...No Charge 121P Lolly Pop Blue...No Charge 122P Cosmic Blue...No Charge 125P Emerald Green...No Charge 127P Grasshopper Green...No Charge 1 Base only to send for aftermarket seating. 2 Package includes 4 Pole Motors and 5.8 mph top speed with <300 lbs user weight limit. Package includes Quiet Stability Lock. For the most current pricing information go to page 1

2 SYSTEM TYPE SEAT CGTE CG Tilt/Elevate (E1002)... 4, E2-TDX Elevate to Assist for Transfers (E2300)... 1, F Full Length Adjustable Height Arms...No Charge CNVACT Conventional Actuator... Standard 29F Desk Length Adjustable Height Arms...No Charge SMTACT Smart Actuator SEAT SELECTION BPO CURV Back Posts Only...No Charge Curved...No Charge CTS OMCU Contoura Seating Omit Contoura Seat Cushion... Less ADJUSTABLE SEAT WIDTH RANGE 1620W 2022W 16" to 20" Seat Width Range...No Charge 20 to 22 Seat Width Range...No Charge ADJUSTABLE ARM TYPE (PAIR) MIXED ADJUSTABLE ARM TYPE (EACH) 19FR 29FR 19FL 29FL Full Length Adjustable Height Arm Right...No Charge Desk Length Adjustable Height Arm Right...No Charge Full Length Adjustable Height Arm Left...No Charge Desk Length Adjustable Height Arm Left...No Charge SEAT POSITIONING STRAPS 1311BK Airline Buckle Seat Pos. Strap Push Button Style Seat Pos. Strap... Standard CHEST POSITIONING STRAPS 7311BK Airline Buckle Chest Pos. Strap (E0960) SEAT WIDTH SETTING Push Button Style Chest Pos. Strap (E0960) W16 16" Seat Width...No Charge 7321BK Hook & Loop Chest Pos. Strap (E0960) W17 17" Seat Width (not available w/contoura)...no Charge W18 18" Seat Width...No Charge W19 19" Seat Width (not available w/contoura)...no Charge BACK HEIGHT W20 20" Seat Width...No Charge TSBH16 Back Height 16"...No Charge W21 21 Seat Width (not available w/contoura)...no Charge TSBH17 Back Height 17"...No Charge W22 22 Seat Width...No Charge TSBH18 Back Height 18"...No Charge TSBH19 Back Height 19"...No Charge TSBH20 Back Height 20"...No Charge ADJUSTABLE SEAT DEPTH RANGE TSBH21 Back Height 21"...No Charge 1619D 16" to 19" Seat Depth Range...No Charge TSBH22 Back Height 22"...No Charge 2022D 20" to 22" Seat Depth Range...No Charge TSBH23 Back Height 23"...No Charge CONTOURA TSBH24 Back Height 24"...No Charge 1618D 1921D 22D 16" to 18" Seat Depth Range...No Charge 19" to 21" Seat Depth Range...No Charge 22" Seat Depth...No Charge TSBH25 TSBH26 CONTOURA Back Height 25"...No Charge Back Height 26"...No Charge TSBH25 Back Height 25"...No Charge SEAT DEPTH SETTING TSBH295 Back Height 29.5"...No Charge D16 16" Seat Depth...No Charge 6 D17 17" Seat Depth...No Charge 7 Back Height Chart D18 18" Seat Depth...No Charge Back Type Back Height D19 19" Seat Depth...No Charge CTS Contoura 25" & 29" D20 20" Seat Depth...No Charge BPO Back Posts Only 16" 24" D21 21" Seat Depth...No Charge 7 CURV Curved 16" 26" D22 22" Seat Depth...No Charge 8 SEAT TILT 0SA 0 Seat Tilt... Standard 3 Must choose the E2-TDX option with the CGTE. If you want the Formula CG Tilt only (CGT), see form no Formula CG Tilt Only pricelist. 4 Selected seat depth on Contoura assumes 1" of back cushion compression. For example: When choosing an 18" depth the measurement from the front of the back cushion to the front of the seat pan equals 17". The Contoura back cushion is 2" thick. 5 Contoura is only available in even widths. Please see chart on page 5. 6 Not available with Contoura seat cushion on 22" wide. 7 Not available with Contoura seat cushion on 16" or 18" wide. For the most current pricing information go to page 2

3 POSITIONING ACESSORIES HEADREST TYPE (OPTIONAL) MK6i CONTROLLER ELECTRONICS TAR Curved Headrest (E0955) MK690ACC Controller w/ Actuator Control... Standard TAR27700HW Removable & Adj Hardware (E1028) TAR Two-Step Headrest (E0955) EXPANDABLE CONTROLLER SYSTEMS (REQUIRED) TAR12800HW Removable & Adj Hardware (E1028) PWH Harness req. for Expandable Electronics (E2313) T Lg Headrest (E0955) MPJM6 MPJ + Multiple Drive Joystick (E2377) TAR22400HW Removable & Adj Hardware (E1028) PSFM6 Personal Joystick, Inductive on Front (E2399). 1, T Small Headrest (E0955) PSRM6 Personal Joystick, Inductive on Rear (E2399).. 1, TAR22600HW Removable & Adj Hardware (E1028) PBOD Push Button On/Off w/pb Drive Select...No Charge 11 PBSS Push Button On/Off w/speed Select...No Charge CP Multi Axis Headrest (E0955) OR On/Off Mounted Right...No Charge 11 CP175HW Removable & Adj Hardware (E1028) OL On/Off Mounted Left...No Charge 11 CP275 CP275HW 10 Multi Axis Headrest (E0955) Removable & Adj Hardware (E1028) ASLRDYM6 MK6 Display Only (No Driver Control) (E2377) CP180 CP180HW 14 TWB Headrest (E0955) Removable & Adj Hardware (E1028) FOR YOUR ASL DRIVE SYSTEM NEEDS CP TWB Headrest (E0955) PLEASE REFER TO THE FOLLOWING: CP280HW Removable & Adj Hardware (E1028) ASL SINGLE INVOICE PRICE LIST FORM # STEALTH HEADRESTS OTTO BOCK ARM PADS (PAIR) 8 ALTERNATIVE PROPORTIONAL CONTROL SYSTEMS OB20400 One Piece Channel Armpads (E2209) OB20500 Lg Forearm Pads M6 Prop RIM Head Control w/display (E2327)... 2, OB20600 Med Forearm Pads SMHD Small Headrest...No Charge OB20700 Small Forearm Pads LGHD Large Headrest...No Charge 1558MM6 Compact Joystick w/display (E2373)... 1, OTTO BOCK HAND PADS (PAIR) 8 ALTERNATIVE DIGITAL CONTROL SYSTEMS OB23000 OB23300 Lg Flat Hand Pads Med Flat Hand Pads SNPM6 Sip-N-Puff Dig Interface Box (E2325)... 1, LATERALS (PAIR) 5018M6 Wafer Board & Dig Interface Box (E2322)... 1, M6 Mini Tash Jstck & Dig Interface Box (E2321). 1, BPO/CURVED BACK TCSLM Swingaway Laterals Medium (E0956) SIP-N-PUFF KIT TCSLMHW Removable & Adj Hardware (E1028) PKG32666 Therafin Sip-N-Puff Breath Tube Kit (E2326) TCSLL Swingaway Laterals Large (E0956) TCSLLHW Removable & Adj Hardware (E1028) ADDITIONAL CONTROL CHOICES STEALTH LATERALS FOR BPO/CURVED BACK 1558M6 Compact Joystick - Less std Mount TWB-RPR RPRHW Adj. Swing Channel Laterals Med (E0956) Removable & Adj Hardware (E1028) Wafer Board Mini Tash Joystick TWB-RPRL Adj. Swing Channel Laterals Lg (E0956) PACM6 Prop. Attendant Control w/quick release mount RPRLHW Removable & Adj Hardware (E1028) M Digital Attendant Control CONTOURA SEATING CSLM Swingaway Contoura Laterals Med (E0956) JOYSTICK MOUNTING HARDWARE CSLMHW Removable & Adj Hardware (E1028) QLAM6 Quad Link Retract. Joystick Mnt MPJ+ (E1028) CSLL Swingaway Contoura Laterals Lg (E0956) ARM250 Stealth Height Adj Joystick Mount (E1028) CSLLHW Removable & Adj Hardware (E1028) LEFT Left Handed Mounted Joystick...No Charge STEALTH LATERALS FOR CONTOURA RIMHW RIM Hardware For 1500 (E1028) TWB-CPR Adj. Swing Contoura Laterals Med (E0956) PKG32669 Complete Bib Assembly (Tash/1558) CPRHW Removable & Adj Hardware (E1028) GATMPJM6 Gatlin Midline for MPJ (E1028) TWB-CPRL Adj. Swing Contoura Laterals Lg (E0956) GAT1812 Gatlin Midline for 1812 (E1028) CPRLHW Removable & Adj Hardware (E1028) RCM Rear Cane Mount for Compact Joystick Not compatible with quadlink retractable joystick mount. If selecting an Otto Bock hand pad a large, medium or small forearm pad must be selected. 9 Harness is required to interface joystick or MK6i display with expandable controllers. Option is located under Electronic Accessories in configurator. 10 TOD-SS: Toggle On/Off Drive Select, Speed Potentiometer standard. 11 PSRM6 Only. 12 Drive Select through mode switch, or mode switch and Joystick Commands. 13 Display Only, No Driver control. Allows choice from order form. 14 Must also use either a Multiple Drive Joystick or MK6i Display. 15 Requires SNPM6 Sip-N-Puff Interface Box 16 QLAM6 include ARM250 standard For the most current pricing information go to page 3

4 ELECTRONIC ACCESSORIES 1813M6 MK6i Programmer w/pro Memory Card SD Pro Memory Card (USBReady) "T" Handle Flexible Joystick Ext. (E2323) Straight Handle Flexible Joystick Ext. (E2323) Chin Cup (E2324) A24VPS 24V MK6 Auxiliary Power Source AUX12M6 Auxiliary Module for 1 & AUX34M6 Auxiliary Module for 3 & PB Dual Push Button SW Dual Toggle POWERED SEATING ACCESSORIES 4WSB S4WSB Four Way Switch Box...No Charge Multiple Actuator Interface Box (E2311)... 2, FWT 4 Way Toggle...No Charge QPB 4 Push Buttons...No Charge For all systems with two or more actuators you must choose 4WSB at No Charge or the S4WSB with an Up-Charge. S4WSB Replaces the Four Way Switch Box and allows multiple actuator operation through the driver control. CENTER PIVOT STYLE (PAIR) 24 70NHD 70 Swingaway Footrests 13.5"-17.5"... Standard 25 70STAPER 70 Tapered Footrests 13"-17"...No Charge 26 AT5544 Manual Elevating Legrests (E0990) FWT or QPB is required when choosing the 4WSB or S4WSB Composite Flip-Up Footplates...No Charge 32 ASL OPTIONAL ACCESSORIES 1350 Extra Lg Aluminum Footplates...No Charge 33 EGSBLK Egg Switch - Black ASL304 Light Wobble Switch w/611 Mount AT5543 Adj Angle Flip-Up Footplates CTMTFB Footboard for Center Mount...No Charge 34 ASL202J Fiber Optic Switch ASL208J Adj Proximity Switch FOOTREST/LEGREST ACCESSORIES ASL504M6 Remote Emergency Stop Switch... 1, Calf Strap (E0038) BK Heel Loops w/ankle Straps (E0951) MISCELLANEOUS IMPACTG Impact Guards LPT2 Longer Pivot Slide Tube For BATTERY TRAY TYPE ALPT Longer Pivot And Slide Tube TRYELEV 22NF Style Tray/Elevate...No Charge ALPT4 Longer Pivot And Slide Tube 4" BATTERIES (REQUIRED) 19 22ELEVBATT 22NF Battery (Elevate On Chair) (E2361) BATTERY CHARGER OPTION 110CHARGER 110 Volt Charger... No Charge LESTR Lester 8 AMP Battery Charger L8900 Omit Battery Charger... Less MISCELLANEOUS ACCESSORIES 1303 Wheel Locks FRONT RIGGING OPTIONS PIN STYLE-HEMI (PAIR) PHW93 70 Swingaway Footrests 13.5'' - 19''...No Charge PHAL4A Smartleg Art. Legrests 17.25" 21.5 (K0053) POWER ELEVATING LEGRESTS-ARTICULATING MPCTMT Power Center Mnt. Foot Platform(E1010)... 2, MPCTMT-L Power Center Mnt. Foot Platform Long(E1010)2, IFP Individual Footplates ELRPW Power ELR w/articulation 20" Ext (E1010)... 1, ELRPW22 Power ELR w/articulation 22" Ext (E1010)... 1, Motion Power Center Mount Knee to Heel STF Pick STF at 0 deg KTH w/ifp on MPCTMT KTH with Footboard Low 17.5" 10.5" " 12" " MPCTMT only Med 18.5" 11.5" " 12" " MPCTMT only High 19.5" 11.5" " 12" " MPCTMT or 14"-19" MPCTMT-L FOOTPLATE OPTIONS (PAIR) 24 Provides up to 1 ½" of depth adjustment in ½" increments. 25 FRONT RIGGING 20 With seat widths of 21" to 24" and depth of 16", must pick footplate The AT5543 is not available.. CENTER MOUNT Standard with impact guards. Not available with widths 19" to 24" and 16" CTMT-F CTMT-FJ Center Mount Adjustable Knee Angle Jr. Center Mount Adjustable Knee to Heel deep seat. Not available with 16" wide by 16" to 18" deep or 17" wide by 16" deep and low seat-to-floor. 28 Includes a standard, single footboard. 29 Individual footplate option for Power Center Mount. This option is only 17 Option to replace Mono Port "Y" cable when requiring two switch functions of the mode switch port on expandable controller systems. Not compatible with SPJ+ Joystick options. 18 Must add MK6 Auxiliary Power Source. 19 Sealed Gel Batteries highly recommended for use in Invacare power available on MPCTMT. 30 Independent powered elevating legrests including elevating and articulating legrests with angle adjustable footplates. Not available with the 16" or 17" seat depths. Extension range 13"-20". Sold as pair. 31 Independent powered elevating legrests including elevating and articulating legrests with angle adjustable footplates. Not available with the 16" or 17" seat depths. Extension range 15"-22". Sold as pair. wheelchairs. 20 All front riggings include a standard footplate. 21 Allows 60 to 90 static knee angle positioning with a drop back lever for easier 32 Not available with AT5544 and 17" wide by 16" deep and low seat-to-floor. transferring. 33 Not available with AT5544 and 16" wide by 16"-18" deep or 17" wide by 16" 22 Extension range 12.5"-15". deep and low seat-to-floor. 23 Extension range 9.25"-12". 34 One piece footboard for Center Mount (CTMT-F) Riggings. For the most current pricing information go to page 4

5 Battery Boxes *Standard Battery Tray 22NF with Elevate Feature *Sealed Gel Cell Batteries Recommended Batteries 22NF batteries with terminal configuration (positive on the left and negative on the right) MUST be used. 22NF batteries that have the reverse terminal configuration MUST not be used. Terminals MUST have a cross hole for proper battery connection. Contoura Seat Sizes D16 D17 D18 D19 D20 D21 D22 W16 X X X X X * * W18 X X X X X * * W20 X X X X X X X W22 * * X X X X X *Not available with Contoura Seat Cushion Back 25" or 29.5" Heights Curved or BPO Seat Sizes Seat Widths 16"-22" Seat Depths 16"-22" Back Heights 16"-26" TDXSP Tilt/Elevate Features and Specifications Standard with 300 lb weight capacity. Tilt range from 0 to 55 Elevate range of 7". Curved or Contoura style seating. Adjustable seat frame with Conventional style. Seat-to-floor height of 18.5 at 0 tilt. Speed inhibit feature of 20% of maximum speed while elevated. MEMORY CARD - BASIC Standard with ALL Expandable Control Systems (MPJ+, PSR+, PSF+, MK6i Display). Used to Back Up/Restore Programmed Settings for Only One Chair. May be given to user or kept with provider's files for safe keeping. Does not Contain Advanced Diagnostics/Help Screens/File Structure. Not compatible with SPJ+ Joysticks. MEMORY CARD - PROFESSIONAL Standard with ALL MK6i Programmers. Available also with USB Card Reader on Order Form. Contains Advanced Diagnostics, Help Screens, Software Updates, File Storage/Retrieval. Used to back up multiple chairs and programming settings. Intended for use by qualified providers only. Not compatible with SPJ+ Joysticks. Tech Tips Operating Powered Seating through the Driver's Control All chairs require adding or replacing one component to allow actuator operation through the driver control. SPJ+ with PSS: Replace joystick with SPJ+ with ACC (Actuator Control) -E2310 Single Actuator Systems with MPJ+, PSR+, PSF+ MK6i Display: Add a SANODE (Single Actuator Node) to the system - E2310 Multiple Actuator Systems: Replace the standard 4 Way Switch box with a Multiple Actuator Interface Box S4WSB (E2311). SEATING & POSITIONING FOR YOUR SEATING NEEDS PLEASE REFER TO THE FOLLOWING REHAB SEATING & POSITIONING PRODUCTS See Price List Form TDXSP for Formula Tilt/Elevate Specifications Maximum Speed MPH 4 Pole 5.8 Seat-To-Floor at 0 Low 18.5 " Invacare Corporation USA One Invacare Way Elyria, OH USA All rights reserved. Trademarks are identified by the symbols and. All trademarks are owned by or licensed to Invacare Corporation unless otherwise noted. Therafin is a registered trademark of W/R Medical Electronics Co. Otto Bock is a trademark of Otto Bock Orthopaedische Industries GMBH & Co. Freedom Designs is a registered trademark of Freedom Designs, Inc. Specifications and prices are subject to change without notification Invacare Corporation Form No Rev 0808

Group 3 K0861 Basic Package

Group 3 K0861 Basic Package Invacare Formula CG Tilt/Recline/Elevate for TDX SP Base Price List and Order Form Effective May 18, 2009 For ease of ordering, contact Customer Service Toll Free at: 800-333-6900 Fax: 800-678-4682 To