Invacare TDX Spree Rehab Seat Power Wheelchair Price List and Order Form

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Price List and Order Form TRANSACTION TYPE: Order Quote Date Account # P.O. # Company Name Phone # Address City State Zip Code Country Contact Name Comments Special Note HCPCS codes are not intended to be, nor should be considered billing or legal advice.

1 Price List and Order Form TRANSACTION TYPE: Order Quote Date Account # P.O. # Company Name Phone # Address City State Zip Code Country Contact Name Comments 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. CHAIR TYPE TDXSPREE TDX Spree with MK6i TM... $6, K0848 TDX Spree comes standard with: 165 lb user weight capacity, 4.8 mph top speed, 2-pole motor package, MK660ACC Controller and Quiet Stability Lock. TDXSPREESEAT TDX Spree Seat Only... $ Group 3 - K0848 Basic Package TDX Spree with MK6i 165 lbs. Weight Capacity DW1053FF 10 1/2" x 3 1/2" Flat Free Tires 2 Pole Motors Flip Back Fixed Height Arm MK660ACC 60 Amp Controller SPJAP SPJ TM + Single Drive Joystick PH93M2 Swingaway Footrests 8 Amp Off Board Battery Charger 1515 Push Button Style Seat Positioning Strap TRANSPORT TIE-DOWN* TRRO includes four factory-installed transport brackets and a wheelchair anchored pelvic belt. TRRO has been crash-tested in accordance with ANSI/RESNA WC Vol 1. Section 19 Frontal Impact Test requirements for wheelchairs with a 168 lbs. crash dummy, which corresponds to a person with a weight of 114 lbs. to 209 lbs. TRBKTS includes four factory-installed wheelchair transport brackets. TRBKTS has not been crash-tested in accordance with WC19. Use these transport brackets only to secure an unoccupied wheelchair during transport. As of this date, the Department of Transportation has not approved any tie-down systems for transportation of a user while in a wheelchair, in a moving vehicle of any type. It is Invacare's position that users of wheelchairs should be transferred into appropriate seating in vehicles for transportation and use be made of the restraints made available by the auto industry. Invacare cannot and does not recommend any wheelchair transportation systems. * Transport Tie-Down option is not retrofittable to existing models and is not field serviceable. TRRO Features for TDX SPREE Required Features Optional Features TDX Spree Adjustable Angle Flip Up Manual Center Mount Front Riggings Footplates, Flip-Up Composite T-Arms Footplates or Aluminum 19F,29F with 16-18" deep only Footplates-Deluxe Adjustable Rehab Seat with Wheel Locks Adjustable Seat Tilt and Back Angle Calf Strap Sectional or Straight Rear Heel Loops with Ankle Straps Uprights or No Push Handles Impact Guards 10 1/2" x 3 1/2" Tires with Foam One Sided Fork Package Filled Inserts SPJ+, CMPJ+ Joystick 90 or 95 Back Angle All PSR+ / PSF+ Joysticks 18" - 22" ASBA Back Height Proportional Attendant Control Any Seat Width "T" Handle Flex. Joystick Ext. Any Seat Depth Left Hand Mounted Joystick 165 lbs. user weight limit Straight Handle Flexible Low Seat-to-Floor Height Joystick Ext. U1 Batteries Easy Remote Programmer Any Color Frame Finish Reinforced Back Upholstery Manual Tilt Please note that all TRRO chairs are set at 0 degree seat angle USER WEIGHT LIMIT U165 User Weight <165 lbs.... WHEEL OPTION (PAIR) DW10535FF 10 1/2" x 3 1/2" Flat Free Tires... FORK OPTION BASE SELECTIONS TRANSPORT TIE-DOWN Must select either TRRO or TRBKTS. TRRO Transport Ready Option... No Charge TRBKTS Wheelchair Transport Brackets... No Charge FKPKG One-Sided Fork Package... $ Page 2 of 6

2 FRAME FINISH 24P 60P 30P 61P 119P 120P 62P 127P MANUAL TILT Wet Black... No Charge Silver Metallic... No Charge Sunny Yellow... No Charge Electric Red... No Charge Bubblegum Pink... No Charge Grape Madness... No Charge Electric Blue... No Charge Grasshopper Green... No Charge MT Manual Tilt 45 degrees... $ SEAT-TO-FLOOR HEIGHT Due to variation in options the listed seat-to-floor heights have a tolerance of +/- 0.5" LOW 14.5" at 0... MED 16.5" at 0... No Charge TALL 18.5" at 0... No Charge SEAT SELECTION ADJASBA Adj. Rehab Seat with Adj. Seat Tilt and Back Angle... CNB Conventional Back... $ Only available with seat widths and depths 12" - 15". CURV Curved... No Charge Only available with seat width 16". ADJUSTABLE SEAT WIDTH RANGLE 1216W W12 W13 W14 W15 W16 12" to 16" Seat Width Range... No Charge ADJASBA SEAT WIDTH 1218D 12" Seat Width... No Charge 13" Seat Width... No Charge 14" Seat Width... No Charge 15" Seat Width... No Charge 16" Seat Width... No Charge ADJUSTABLE SEAT DEPTH RANGE D12 D13 D14 D15 D16 D17 D18 SEAT 12" to 18" Seat Depth Range... No Charge ADJASBA SEAT DEPTH SETTING 12" Seat Depth... No Charge 13" Seat Depth... No Charge 14" Seat Depth... No Charge 15" Seat Depth... No Charge 16" Seat Depth... No Charge 17" Seat Depth... No Charge 18" Seat Depth... No Charge ADJUSTABLE ARM TYPE (PAIR) 19F Full Length Adjustable Height Arm... $ F Desk Length Adjustable Height Arm... $ TADM T-arms Desk Length Adj Hgt (8" - 12")... $ T-Arms not available with Conventional Back. TAFM T-arms Full Length Adj Hgt (8" - 12")... $ T-Arms not available with Conventional Back. FLIP UP MIXED ADJUSTABLE ARM TYPE (EACH) All arms are detachable. Right Arm 19FR 29FR Left Arm 19FL 29FL SEAT BACK TYPE SRUP Straight Rear Uprights... L8661 Omit Rear Uprights... Less $20.00 SEAT BACK ANGLE DEGREE 90BA 95BA BACK HEIGHT BH12 BH13 BH14 BH15 BH16 BH17 BH18 BH19 BH20 Full Length Adj. Hgt. Right... No Charge Desk Length Adj. Hgt. Right... No Charge Full Length Adj. Hgt. Left... No Charge Desk Length Adj. Hgt. Left... No Charge 90 degrees degrees... No Charge 12" Back Height... No Charge 13" Back Height... No Charge 14" Back Height... No Charge 15" Back Height... No Charge 16" Back Height... No Charge 17" Back Height... No Charge 18" Back Height... No Charge 19" Back Height... No Charge 20" Back Height... No Charge Conventional Back Height Chart Height Width 12" 13" 14" 15" 16" 17" 18" 19" 20" 12" - 13" X X X X X 14" - 15" X X X X X = Not Available SEAT POSITIONING STRAPS 1311BK Airline Buckle Seat Positioning Strap... $50.00 Not available with 12" - 15" seat widths Push Button Style Seat Positioning Strap... CHEST POSITIONING STRAPS 7311BK Airline Buckle Seat Positioning Strap... $ E0960 Not available with 12" - 15" seat widths Push Button Style Chest Positioning Strap... $ E BK Hook and Loop Chest Positioning Strap... $ E0960 HEADREST TYPE (OPTIONAL) Hardware is packaged with equipment and cannot be ordered separately. TAR Curved Headrest... $ E0955 TAR27700HW Removable & Adjustable Hardware... $ E1028 TAR Two-Step Headrest... $ E0955 TAR128000HW Removable & Adjustable Hardware... $ E1028 T Large Headrest... $ E0955 T HW Removable & Adjustable Hardware... $ E1028 T Small Headrest... $ E0955 T HW Removable & Adjustable Hardware... $ E1028 Page 3 of 6

3 MK6I CONTROLLERS ELECTRONICS MK660ACC 60 Amp Controller... GTRAC G-Trac Module... $ K0108 G-Trac provides improved tracking capabilities and enhanced traction. Does not require special motors. Not compatible with SPJ+ joysticks. STANDARD DRIVER CONTROL SPJAP SPJ+ for Power Seating... No Charge Includes Egg Switch with 611 mount to operate single actuator. ACTUATOR CONTROL THROUGH SPJ+ SPJAPM SPJ+ with Joystick Acctuator Control... $1, Allows actuator operation through Driver Control. Includes port for attendant switch. EXPANDABLE CONTROLLER SYSTEM E2310 PWH Harness req. for Expandable Electronics... $ E2313 Required to interface joystick or MK6i display with expandable controllers. CMPJM6U MPJ+ Multiple Drive Joystick with Color Display.. $ E2377 ASLRDYM6 MK6 Display Only (No Driver Control)... $ Display only, No Driver Control. Allows choice from order form. MCD Mini Color Display... $ E2377 No port for remote On/Off switch. Stereo port only. E2377 FOR YOUR ASL DRIVE SYSTEM NEEDS PLEASE REFER TO THE FOLLOWING: ASL SINGLE INVOICE PRICE LIST FORM # ALTERNATIVE PROPORTIONAL CONTROL SYSTEMS 1500M6 Prop RIM Head Control with MK6i Display.. $2, E2327 SMHD Small Headrest... No Charge LGHD Large Headrest... No Charge 1558MM6 Compact Joystick with Display... $1, E2373 ALTERNATIVE DIGITAL CONTROL SYSTEMS Must also use either a Multiple Drive Joystick or MK6 Display. SNPM6 Sip-N-Puff Digital Interface Box... $1, M6 Mini Tash Joystick and Digital Interface Box... $1, SIP-N-PUFF KIT E2325 E2321 PKG32666 Therafin Sip-N-Puff Breath Tube Kit... $ E2326 ADDITIONAL CONTROL CHOICES 1558M6 Compact Joystick - Less Std Mount... $ Mini Tash Joystick... $ Requires SNPM6 Sip-N-Puff Interface Box. PACM6 Prop Attendant Control with quick release mount... $ M Digital Attendant Control... $ Requires SNPM6 Sip-N-Puff Interface Box. JOYSTICK MOUNTING HARDWARE QLAM6 Quad Link Retract. Joystick Mnt CMPJ+... $ E1028 Include ARM250 standard. Not available with TRRO QLA Quad Link Retract. Joystick Mnt SPJ+... $ E1028 Include ARM250 standard. Not available with TRRO ARM250 Stealth Height Adj Joystick... $ E1028 LEFT Left Handed Mounted Joystick... No Charge RIMHW RIM Hardware For $ E1028 PKG32669 Complete Bib Assembly (Tash/1558)... $ GATMPJM6 Gatlin Midline for CMPJ+... $ E1028 GAT1812 Gatlin Midline for $ E1028 RCM Rear Cane Mount for Compact Joystick... $ Page 4 of 6

4 ELECTRONIC ACCESSORIES 1813M6 MK6i Programmer with Pro Memory Card... $ SD Pro Memory Card (USB Ready)... $ "T'' Handle Flexible Joystick Ext.... $77.00 E Straight Handle Flexible Joystick Ext.... $77.00 E Chin Cup... $48.00 E2324 AUX12M6 Auxiliary Module For 1 and 2... $ AUX34M6 Auxiliary Module For 3 and 4... $ MPY Monoport "Y" Cable for CMPJ+ or Display... $ PB Dual Push Button... $ 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. 2SW Dual Toggle... $ 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. PBMT Push Button Mounting Kit... $ RFM Wireless (RF) Mouse Only Module... $ RFM includes Transmitter, USB Radio Frequency Mouse Dongle (Receiver), and Stereo Switch with hook and loop mount for mouse clicks. Not compatible with SPJ+. IR Infrared Module with Wireless RF Mouse Control... $ Capable of operating up to six remote Infra-Red controlled devices. Also allows wireless (RF) Mouse operation through the driver control. Compatible with RFM module for control of two wireless mice from one chair. Includes two button stereo switch (with hook/ loop mount) for mouse clicks. Not compatible with SPJ+ Joysticks. POWERED SEATING ACCESSORIES SANODE One Act. Oper. through Driver Ctrl... $1, E2310 For tilt operation through the drive control with expandable controller systems. Not compatible with SPJ+ joystick. Not standard with egg switch. ASL OPTIONAL ACCESSORIES EGSBLK Egg Switch - Black... $ ASL304A Light Wobble Switch with 611 Mount... $ ASL202J Fiber Optic Switch... $ Not available with SPJ+ joystick. Must add ASL804M6. ASL208J Adj Proximity Switch... $ Not available with SPJ+ joystick. Must add ASL804M6. ASL504M6 Remote Emergency Stop Switch... $1, ASL611 Adjustable Switch Mounting Bracket... $ ASL804M6 24 Volt Power Source Adaptor... $ BACK ACCESSORIES L8601 RBP MISCELLANEOUS Omit Back Upholstery... No Charge Reinforced Back Upholstery... No Charge MISCELLANEOUS ACCESSORIES 1303 Wheel Locks... $45.00 ADDUCTORS Hardware is packaged with equipment and cannot be ordered separately. ADD Adductors Small... $ ADDHW Hardware for ADD... $ BATTERY CHARGER OPTION 110CHARGER 110 Volt Battery Charger... No Charge LESTR Lester 8 AMP Battery Charger... $ L8900 Omit Battery Charger... Less $80.00 BATTERY (REQUIRED) E0956 E1028 ADDL Adductors Large... $ E0956 ADDHWL Hardware for ADDL... $ E1028 E2367 U1INSTALL U1 Battery Installation (On Chair)... $ ASB PSB FRONT RIGGINGS HANGER BRACKET TYPE Center Pivot Style Bracket... No Charge Pin Style Bracket... No Charge CENTER MOUNT For a 13.25" " extension range, available through special #SM with Tall STF Only and 5 Degree Seat-Tilt Angle. CTMT-F Center Mount Adj. Knee Angle (12 1/4" - 15")... $ Allows 60 to 90 static knee angle positioning with a drop back lever for easier transferring. Extension range 12 1/2" - 15". Footplates are adjustable angle. Must choose either SM, MED or LRG footplate. SM Small Footplates (5 1/4" x 7 1/2")... No Charge MED Medium Footplates (5 1/2" x 9 1/2")... No Charge LRG Large Footplates (5.90" x 11 1/2")... No Charge CALF Calf Pads For Center Mount... $ CTMT-FJ Jr. Center Mount Adj. Knee Angle (9 1/4" - 12")... $ Allows 60 to 90 static knee angle positioning with a drop back lever for easier transferring. Extension range 9 1/4"- 12". Footplates are adjustable angle. Available on low seat-to-floor only. Must choose either SM, MED or LRG footplate. SM Small Footplates (5 1/4" x 7 1/2")... No Charge MED Medium Footplates (5 1/2" x 9 1/2")... No Charge LRG Large Footplates (5.90" x 11 1/2")... No Charge CALF Calf Pads For Center Mount... $ Page 5 of 6

5 PIN STYLE-HEMI (PAIR) PHW93 70 Swingaway Footrests 13 1/2'' - 19''... No Charge with aluminum footplates. PHAL4A Manual Articulating/ELR 17 1/4'' /2''... $ K0053 PH93M2 Swingaway Footrests 5" - 10''... CENTER PIVOT STYLE (PAIR) 90SWING 90 Swingaway Footrests 3'' - 10''... No Charge Only available with AT5543 Adjustable Angle Flip-up footplates. FOOTPLATE OPTIONS (PAIR) AT5543 Adj Angle Flip-Up Footplates... $ CTMTFB Footboard for Center Mount... No Charge One piece footboard for Center Mount (CTMT-F) Riggings only. FOOTREST/LEGREST ACCESSORIES 1337 Calf Strap... $27.00 HLOOP Heel Loops (pair)... $45.00 IMPACTG Impact Guards... $51.00 Seating and Positioning For your seating needs, please refer to the following rehab seating and positioning products: Price List Form No Memory Card - BASIC with ALL Expandable Control Systems (CMPJ+, 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. K0040 E0038 E0951 TDXSR Specifications Seat Width Range (in 1" increments) 12" - 16" Seat Depth Range 12" - 18" Back Height Range (in 1"increments) 12" - 20" Back Angle Range 85 to 105 in 5" increments Seat-to-Floor (approx) 14 1/2" at 0 Medium 16 1/2" at 0 Tall 18 1/2" at 0 Overall Width of Base 24" (without Joystick) Overall Height (with 20" back height and 0 seat angle) 34 1/2" Medium 36 1/2" Tall 38 1/2" Overall Length without Front Rigging 34" with 90 Front Rigging 39" Weight 2 Pole Motor without U1 Batteries, 183 lbs. with 2 U1 Batteries, 230 lbs. Drive Axle Non-Adjustable Drive Wheels/Tires (foam filled) 10 1/2" x 3 1/2" Foam-Filled Memory Card - PROFESSIONAL with ALL MK6i Programmers. Available also with USB Card Reader on Order Form. Contains advanced diagnostics, help screens, software upgrades, file storage / retrieval Used to back up multiple chairs and programming settings. Intended for use by qualified providers only. Not compatible with SPJ+ Joysticks. Comments Invacare Corporation 2013 Invacare Corporation All rights reserved. Trademarks are identified by the symbols and. All trademarks are owned by or licensed to Invacare Corporation unless otherwise noted. Specifications and prices are subject to change without notification. Page 6 of 6

Company Name Account # Phone P.O. # Date. Ship to Name & Address

Company Name Account # Phone P.O. # Date. Ship to Name & Address 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 order Literature: 800-828-6282 www.invacare.com Company Name