F Series CG Tilt System

Transcription

1 F Series CG Tilt System US Price List - Effective January 2015 Date of Order: Dealer Name: Dealer Account #: PO #: Base MFR. PO #: Tag: Purchasing Contact: Phone: Fax: RTS/Therapist: Ship to Address: City: State: Zip: Client Info: Gender: Special Client Conditions: Client Height: Client Weight (lbs): A. Seat to Shoulder: B. Trunk Depth: C. Chest Width: D. Knee to Back: E. Seat to Top of Head: F. Elbow to Hand: G. Seat to Elbow: H. Hip Width: I. Knee to Heel: G A D E F I B C H lbs weight limit. Dependent on weight capacity of the power base. Cushion Thickness: BASE TYPE SELECTION qtdx SI (2) Select STF ((1) : q17.25 q18.25 q19.25 *TDX SI2 weight capacity 250bs qtdx SR Select STF (1) : q17.25 q18.25 q19.25 qtdx SP Select STF (1) : q17.25 q18.25 q19.25 Select TDX-SP Battery Tray qgroup 22 qgroup 24 qtdx SC Select STF (1) : q16.75 q17.25 q18.25 q3g Storm Select STF (1) : q18 q19 q20 qarrow q Torque q RangerX ELECTRONICS Contoller Options: qmk690 qmk690acc Select Joystick: qgtrac qmk6tt qspjacc qspj+ (3) qmpj qmk6 Display (3) Select Drive: qright qleft qspecialty Control* *Please specify: *If controller/joystick not listed above please contact customer service for RFQ. OTHER INFORMATION qshort Base qlong Base qheavy Duty qg-trac Module q4 Pole Motors q2 PoleMotors qsuspension Casters/Shock forks (4) Transport Bracket Option: qyes qno 1. Seat-to-floor height is measured at the front of the seat pan based on a standard seat size. 2. Through Joystick option not available on TDX SI2. 3. For separate switch control only 4. May increase seat to floor height. BASE TYPE SELECTION qq6 Edge Select STF (1) : q17.00 q18.00 q19.00 q600 Select STF (1) : q17.25 q18.25 q19.25 q6000z Select STF (1) : q17.50 q18.50 q19.50 q6400z Select STF (1) : q17.50 q18.50 q19.50 qj6 Select STF (1) : q16.75 q17.25 ELECTRONICS qne 4-Key (2)(3) qne+ 6-Key (2) q Q-Logic EX 4-Key qq-logic EX Display qvr2 4-Key (2)(3) qvr2 6-Key Select Drive: qright qleft qspecialty Control* *Please specify: *If controller/joystick not listed above please contact customer service for RFQ. OTHER INFORMATION Transport Bracket Option: qyes qno 1. Seat-to-floor height is measured at the front of the seat pan based on a standard seat size. 2. Not compatible with 1/4 reduced drive. 3. Not compatible with Through Joystick option. Please note that the HCPCS codes indicated on this order form are our interpretation of the new codes and how we believe our products should be coded. The individual DMERCs will determine if our interpretation is appropriate and whether or not items coded will be accepted or denied. Motion Concepts cannot guarantee that use of the designated codes will ensure coverage or payment. Contact the insurer to confirm compliance with coding and coverage policy. BASE TYPE SELECTION qqm-710select STF (1) : q16.50 q17.50 q18.50 QM-710 weight capacity 250bs qp222 Select STF (1) : q18.75 For 21 seat widths and greater you much select the wide base option when ordering the power base from Sunrise On P222 Base - The harness (#139460) is required with the base for installation of the seating system when using VSI electronics. ELECTRONICS qqtronix/pilot Plus qvsi 6-key qvr2 qr-net Select Joystick: qled qlcd * You must select QR to run the functions through the joystick. Select Drive: qright qleft qspecialty Control* Please specify: OTHER INFORMATION Transport Bracket Option: qyes qno 1. Seat-to-floor height is measured at the front of the seat pan based on a standard seat size. PAGE 1 of 8

2 NEW SINGLE FUNCTION SYSTEM Systems Include Seat Pan, Back Pan, Push Button Style Seat Belt, Standard Armrests and Front Rigging. They are designed for use with a 2"-3" cushion. q F-Series CG Tilt Only System (50 Tilt) (HCPCS code E1002) $4,700 q5 Pre-Tilt (1) N/C 1. This option increases seat-to-floor height by approximately minimum. Please call for confirmation. ELEVATING SEAT MODULE qelevating Scissor Lift Module (1)(2)(3) (Scissor Mechanism) 12 Elevation - 250lbs max $2,995 qelevating Seat Module (2)(4)(5) Select Elevation: q7 Elevation - 225lbs max $2,550 q6 HD Elevation - 280lbs max $2,995 BELOW AVAILABLE ON TDX SP, STORM, Q600 AND Q6000 (lower STF elevating module) q6 Elevation - 225lbs max $2, Uses an integrated Tilt/Lift mechanism, tilt is 45 and the seat to floor height is not affected by the Elevating Lift Seat. 2. Not available on seat sizes greater than 20" wide by 20" deep, call for RFQ. 3. For weights greater than 175lbs no tilt while elevated is available, call Customer Service for details. 4. These systems use manufacturers stock battery tray. 5. The seat-to-floor height may increase on the lowest available STF, see page 1 or call for specific details. STANDARD SEAT SPECIFICATIONS Seat Width q15 q16 q17 q18 q19 q20 q21 q $595 Width adjustable range is Seat Depth q15 q16 q17 q18 q19 (1) q20 (2) q21 (2) q22 (2)...$595 Select depth adjustability range:qfrom 15 to 19 qfrom 18 to We highly recommend a 3G Long Base for optimal maneuverability. 2. 3G Long base must be used for these seat depths. SEAT CUSHION OPTIONS qmatrx-libra Seat Cushion* 16 w-20 w(hcpcs Code E2624) $485 qmatrx-libra Seat Cushion* 21 w(hcpcs Code E2624)....$525 qmatrx-libra Seat Cushion* 22 w(hcpcs Code E2625)....$595 *comes standard with Startex fabric, optional Spacetex fabric available below qmatrx-ps Seat Cushion 15 w-20 w (HCPCS Code E2605).$345 qmatrx-vi Seat Cushion 15 w-20 w (HCPCS Code E2607)..$425 qmatrx-vi Seat Cushion 21 w-22 w (HCPCS Code E2608)..$475 qmatrx-flo-tech Cushion 14 w-22 w(hcpcs Code K0734) $475 q ON-CHAIR Cushion Credit ($20) FABRIC OPTIONS FOR CUSHIONS q Spacetex Fabric Option for Libra Cushion N/C q Onyx Fabric Upgrade for Matrx-Vi or PS Cushion....$100 BACK OPTIONS qstandard Rehab Back and Back cushion finished height for 18 to STD qmatrx Fabric Upcharge -for Standard rehab back......$100 qomit: Rigid Back Pan & Cushion ($75) qomit: Back Cushion Only ($25) FINISHED BACK HEIGHT MUST BE COMPLETED Measurement in Inches Actual back pan height Gap (space between seat pan to bottom of back pan) 4-5" gap is required for Tilt systems 6-7" gap is required for systems with Recline/ESR or Recline/PSB. Finished Back Height (Seat pan to top of back pan) Finished Back height for Tilt Systems (1) q18"q19" q20" q21" q22" q23" q24" q25" 1. Comes with standard cane height. (ADD TO ABOVE) (Actual Pan Height + Gap = Finished Back Height) (TOTAL) UPGRADEABLE BACK OPTIONS (1) qcontour Back wide (HCPCS Code E2613).....$495 Specify actual back height dimension:q12 q15 q17 q21 qcontour Back 22 wide (HCPCS Code E2614) $595 Specify actual back height dimension: q15 q17 q21 q High Back wide (HCPCS Code E2620) $595 Specify actual back height dimension::q16 q18 q20 qmatrx PB Elite Back wide (3 Contour)....$625 (HCPCS Code E2620) Specify actual back height dimension: q10 q12 q14 q16 q18 q20 qmatrx PB Elite HD Back wide $795 (HCPCS Code E2620 for 21 w E2621 for 22 w) Actual back height dimension: q16 q20 qmatrx PB Elite TR Back wide (HCPCS Code E2620)$650 Actual back height dimension: q16 q18 q20 qmatrx PB Elite Deep Back wide (6 contour).$760 (HCPCS Code E2620) Specify actual back height dimension: q12 q16 q18 q20 qmatrx PB Back wide (5 Contour) $625 (HCPCS Code E2620) Specify actual back height dimension: q12 q16 q20 qmatrx PB Deep Back (7 Contour) (HCPCS Code E2615)$645 Specify actual back height dimension:q12 q16 q20 qmatrx PB Heavy Duty Back (5 Contour) $835 (For Systems wide and over 300lbs)(HCPCS Code E2615 for 20 w E2616 for 22 w) Specify actual back height dimension: q16 q20 qmatrx PB Heavy Duty Deep Back (7 Contour).....$935 (For Systems wide and over 300lbs)(HCPCS Code E2615 for 20 w E2616 for 22 w) Specify actual back pan dimensions: q16 q20 q ON-CHAIR Matrx Back Credit ($50) q Super Soft Foam for Elite Back Upgrade $100 q Onyx Fabric Upgrade qcontour BackqHigh Back $ " gap is recommended for Tilt systems to allow for the seat cushion. PAGE 2 of 8

3 TILT ONLY BACK CANE SPECIFICATIONS Select Back Cane Height (1) - Measured from Seat pan to top of back cane q22 q n/c Select Back Cane Angle q76 q79 q86 q96 q101 q112 q116 qangled (5 )Tilt Back Canes N/C Select Back Cane Angle q81 q84 q91 q101 q106 q117 q121 qendomorph Back Canes Select: q1 q2 q4 Narrower $ Back angle is adjustable in 5 degreeincrements. ARMPADS qstandard Pads STD Select: Full (2.25 x14 ) qleft qright Desk (2.25 x10 ) qleft qright qmodular Arm Pad Tray only* - (Pair) $30 Select: Full ( x14 )qleft qright Desk (3-4 x10 ) qleft qright HEADRESTS & MOUNTING HARDWARE (1) Headrests with Fixed Mounting Hardware (HCPCS code E0955) qconcepts Standard Headrest $345 qelan Standard Pad 6 (ESP-6) $305 qelan Standard Pad 10 (ESP-10) $305 qelan Standard Pad 14 (ESP-14) $305 qelan Occipital Headrest Pad 9 x 7 (EOP9) $305 qelan Occipital Headrest Pad 12 x 8 (EOP12)......$305 qstealth All Positioning Headrest Large (TRM1046).....$315 qstealth All Positioning Headrest X-Large (TRM1047)....$315 qnino Comfort Plus 6 (TRM1040) $315 qstealth Comfort Plus 8 (TRM1041) $315 qstealth Comfort Plus 10 (TRM1042) $315 qstealth Comfort Plus 14 (TRM1043) $315 qonyx Auto Style Headrest $435 Headrest Swing Aways and Mounts - Does not include the Headrest (HCPCS code E1028) qconcepts Detachable Mounting Hardware (MAHW)....$250 qelan Headrest Hardware - Multi-Axis Removable (MEHW)..$280 qstealth s World s Best Headrest Hardware (TWB485)....$285 qomit: Headrest N/C 1. Unless selecting a Removable hdwr option, this Headrest will come standard w/ Fixed Straight Mounting Hardware (non-removable). ARMRESTS qadult Dual Post Adjustable Height (Single Button Release).STD Addq Quick Height Adjustment Lever $330 Select Size: q( )q( )q( ) Select : qflat pouch qglove Boxes (*requires interchangeable pad insert below) qselect Pad Insert (Pair) q Iskin - Integrated soft skin foam $45 q Dartx - Dartex Covered Visco foam $45 qwaterfall Arm Pads-(Pair) $45 Select: Full (2.25 x14 ) qleft qright Desk (2.25 x10 ) qleft qright qflat Pads- (Pair) $75 Select: Full (3 x14 ) qleft qright Desk (3 x10 ) qleft qright qgel Pads- (Pair) $200 Select: Narrow (2 x12 ) qleft qright Wide (3.5 x12 ) qleft qright Long (3.5 x14 ) qleft qright qergonomic Arm Trough - LEFT (4.5 x13 ) $110 (HCPCS Code E2209) qergonomic Arm Trough - RIGHT (4.5 x13 ) $110 (HCPCS Code E2209) qflat Hand Pad - LEFT (4.5 x5 ) (HCPCS Code K0108)....$75 qflat Hand Pad - RIGHT (4.5 x5 ) (HCPCS Code K0108)....$75 qomit: Armpads (7/8 diameter tube) ($25) Select: Full size (14 ) qleft qright Desk size(10 )qleft qright Addq Outback Armrest (each) Specify: Rightq Left q $285 Allows outward rotation while flipping back armrest q1 Offset Armrest Spacer (pair) $250 (Allows seat width to increase by 2 ) q1/2 Offset Armrest Spacer (pair) $250 (Allows seat width to increase by 1 ) PAGE 3 of 8

4 ARMPADS ACCESSORIES qarm Pad Storage/Cup Holder LEFT (1)...$225 qarm Pad Storage/Cup Holder RIGHT (1)...$225 qelbow Block RIGHT (2)...$260 Select Pad Size: qxs(3.25 x4.25 )qs(3.5 x5.25 )qm(3.75 x5.75 )ql(4.25 x6.5 ) Select Extension Vertical: qs(3 ) ql(5 ) Horizontal:qS(5 ) ql(7 ) qelbow Block LEFT (2)...$260 qxs(3.25 x4.25 )qs(3.5 x5.25 )qm(3.75 x5.75 )ql(4.25 x6.5 ) Select Extension Vertical: qs(3 ) ql(5 ) Horizontal:qS(5 ) ql(7 ) qmulti Axis Upper Extremity Support (3) (each)...$260 With Quick Adjustment Lever 1. Not available on the same side as the joystick is mounted. Only available with a flat arm pad. 2. Prevents arm from slipping. 3. Allows rotation of the armpad, only compatible with Gel pad, Flat pad or Ergonomic Arm Troughs. FIXED LATERALS (1) - FOR MATRX PB ELITE AND MATRX PB ELITE FULL BACKS q Standard Fixed LEFT - PBLS-L (HCPCS code E0956)......$120 Select pad :q Standard (7.5 x 5 ) )qsmall (5.5 x3 ) q Standard Fixed RIGHT - PBLS-R(HCPCS code E0956).....$120 Select pad :q Standard (7.5 x 5 ) )qsmall (5.5 x3 ) q Offset Fixed LEFT - PBOL-L (HCPCS code E0956) $130 q Offset Fixed RIGHT - PBOL-R (HCPCS code E0956)......$ These laterals are not available with Matrx PB Backs. SWING AWAY LATERALS (1) - FOR MATRX PB ELITE AND MATRX PB ELITE FULL BACKS qlateral Trunk Support Left pad (each) (HCPCS code E0956)...$115 Select Size: q XS(3.25 x4.25 )qs(3.5 x5.25 )qm(3.75 x5.75 )ql(4.25 x6.5 ) qlateral Trunk Support Right pad (each) (HCPCS code E0956).$115 Select Size: q XS(3.25 x4.25 )qs(3.5 x5.25 )qm(3.75 x5.75 )ql(4.25 x6.5 ) SELECT SWING AWAY HARDWARE TO CONVERT ABOVE: q Elite Back Swing Away Hardware q LEFT (HCPCS code E1028) $215 q RIGHT (HCPCS code E1028) $215 q Offset Elite Swing Away Hardware q LEFT (HCPCS code E1028) $215 q RIGHT (HCPCS code E1028) $ These laterals are not available with Matrx PB Backs. LATERALS - FOR ALL OTHER BACKS (EXCLUDING MATRX PB ELITE AND PB BACKS) qlateral Trunk Support with Fixed Mounting LEFT (1) Pad Size:qS(3.5 x5.25 )qm(3.75 x5.75 )ql(4.25 x6.5 ) Select Offset q0-3 q3-6 (HCPCS code E0956)...$115 qlateral Trunk Support with Fixed Mounting RIGHT (1) Pad Size:qS(3.5 x5.25 )qm(3.75 x5.75 )ql(4.25 x6.5 ) Select Offset q0-3 q3-6 (HCPCS code E0956)...$ These laterals are not available with Matrx PB Elite Deep and PB Deep Backs. STEALTH LATERALS q FMTWB-L Stealth Laterals (1) -Fixed (pair)...$230 Pad Size: qs(3 X5 ) ql(4 X6 ) (HCPCS code E0956) SELECT SWING AWAY HARDWARE TO CONVERT ABOVE: qtwb-l Stealth Adjustable Swingaway Hardware(pair) (HCPCS code E1028)...$ These laterals are not available with Matrx PB Backs. HIP SUPPORTS q Lateral Hip Support Pad with Fixed Mounting LEFT...$145 Select Size: q(5.5 W x 4.5 H)q(7 W x 5.75 H)q(9 W x 4.5 H)q(13 W x 4.5 H) (HCPCS code E0956) q Lateral Hip Support Pad with Fixed Mounting RIGHT..$145 Select Size: q(5.5 W x 4.5 H)q(7 W x 5.75 H)q(9 W x 4.5 H)q(13 W x 4.5 H) (HCPCS code E0956) q Onyx Fabric Upgrade...$100 HARDWARE TO CONVERT ABOVE HIP SUPPORT TO RE- MOVABLE/SWINGAWAY HIP OR KNEE SUPPORTS qlift Off, Removable Hardware for Hip Supports q LEFT (HCPCS code E1028)...$205 q RIGHT (HCPCS code E1028)...$205 qswingaway Removable Hardware for Hip Supports q LEFT (HCPCS code E1028)...$265 q RIGHT (HCPCS code E1028)...$265 Select Mounting Position:qHip qknee or qboth... Add $215 per side PAGE 4 of 8

5 STANDARD FRONT RIGGING CALL TO CONFIRM ON SEAT SIZES BELOW 16 W X 16 D qlegrest Receivers Only STD **Please Specify Front rigging to be used on TRx System (1) qfixed Center Mount Footplate Mount (2) q70 q90.n/c Seat pan to footplate: qs (9-15 )ql (16-21 ) Set at OR qinvacare 70 Swingaway Footrests (Pair) (3) N/C 1. Standard receivers will be provided. Please provide front rigging or order separately from legrest section. 2. Comes with tapered footplate 12" x 10.75" made of steel 1/8" thick with built in heel wells. 3. Includes composite footplates and are not covered by Motion Concepts Lifetime warranty. POWER CENTER MOUNT FOOT PLATFORM OPTIONS MUST BE COMPLETED Knee to Heel: Cushion Thickness: (Subtract) Cushion Compession:(Add) Seat Pan to Footplate:(Total) Measurement in Inches ***CENTER MOUNTS ARE RESTRICTED TO SEAT DEPTHS 16 AND GREATER***** qlnx Power Center Mount Foot Platform (1)(2)(3) $2,795 (HCPCS code E1012 ) q13-19 unlimited adjustability n/c Add: qindividual Calf pads for LNX Foot Platform $ Includes as standard a one piece maleable calf panel and a cast aluminum 1/4" thick foot platform 12" x 9" with rubber mat. There is 8" of anti-shear extension " of ground clearance is required. 3. The front rigging will be set at approximately 80 on the Storm series. POWER FOOT PLATFORM OPTIONS qpower Flip up Foot Platform for LNX.....Suggested Retail$2, RFQ Required 1. Available with one piece calf panel only and not available with a finished knee-to-heel of 13" or less. Requires 2-6 function electronics. Not available with Split Footplates POWER FRONT RIGGING OPTIONS qswing Away Power Elevating Pivot Plus Legrests (1).. $2,750 (Includes Swing Away Receivers, Pivot Plus Legrests & Actuators - legs swing away manually)(hcpcs code E1010 ) Select Receivers: q Straight qflared outward 1 Select Function: qindividual (2) qcombinedqsynchronized W/Recline Seat pan to footplate: qs (12-16 ) qm (15-19 )ql (18-21 ) Select Footplates on page 6 under Foot plate options: 1. Under normal usage Power Legrest actuators tend to be louder than Tilt Actuators. 2. Individual legs count as two functions and require appropriate electronics. MANUAL ELEVATING LEGRESTS qpivot Plus Manual Elevating Legrests (Pair) $720 Select Receivers: q Straight qflared outward1 Seat pan to footplate: qs (12-16 ) qm (15-19 ) ql (18-21 ) Select Footplates on page 6 under Foot plate options: SWING AWAY FRONT RIGGING OPTIONS qheavy Duty 70 Swingaway Footrests (Pair) (1) $495 Select Receivers: q Straight qflared outward1 Seat pan to footplate: qs (12-16 ) qm (15-19 )ql (18-22 ) Select Footplates on page 6 under Foot plate options: qdynamic Coil Springs (Pair) for Heavy Duty 70 Swingaway Footrests $ Heavy duty durable construction (4.5lbs ea.). MANUAL CENTER MOUNT FRONT RIGGING qadjustable Fixed Center Mount Foot platform (1)(2) $595 Select Seat pan to footplate: qs (9-15 )ql (16-21 ) Set at qinvacare Split Foot Platform Interface Bracket (2) $595 (Invacare CTMT-T Foot Platform is included - does not include calf pads) Seat pan to footplate: qs ( ) qm (12-16 ) 1. Depth and height adjustable. Includes individual flat calf pads and a 12" x 10.75" footplate made of durable aluminum 1/4" thick. 2. The front rigging will be set at approximately 80 on the Storm series. 90 FRONT RIGGING/CENTER MOUNTED OPTIONS NOT RECOMMENDED ON STORM SERIES AND P222 BASES. PAGE 5 of 8

6 FOOT PLATFORM OPTIONS qstandard Flip-up Foot Platform (1) (12"W x 10.75"D) $180 qmedium Flip-up Foot Platform (1) (14.5"W x 13 "D) $250 qlarge Flip-up Foot Platform (1) (17"W x 13 "D) $250 CALF PAD AND STRAP OPTIONS qflat Calf pads (pair) $290 Select: qhd Swing Away Footrests qfixed Center Mount Foot platform qcurved Calf pads (inside width is 6 )(pair) $290 Select: qhd Swing Away Footrests qpivot Plus Legrests qfixed Center Mount Foot platform qone piece calf pad for Fixed or Adjustable Center Mount Foot platform $290 qairmesh Calf Strap for chairs wide pad height BP-CS-M $135 qextra Large Flip-up Foot Platform (1) (21"W x 13"D) $250 *May cause interference with certain bases and seat widths call to confirm configuration. FOOT PLATE OPTIONS FOR CENTER MOUNTS qindividual Footplates for LNX and Fixed & Adjustable Centermount Foot platform. In cast aluminum with built in heel cups and rubber mat Select: Left: qs(5 W x 7.5 D)qM(5.5 Wx9.5 D)qL(6 Wx11.5 D)....$175 Right:qS(5 W x 7.5 D)qM(5.5 Wx9.5 D)qL(6 Wx11.5 D) $175 FOOT PLATE OPTIONS FOR ELEVATING AND SWING AWAY FRONT RIGGING (1) SELECT FOOTPLATE SIZE FOR BELOW HARDWARE: L qs(4.25 W x 8 D) qm(5.25 Wx8 D)qL(6.25 Wx8 D) qxl(9 Wx11 D) R qs(4.25 W x 8 D) qm(5.25 Wx8 D)qL(6.25 Wx8 D) qxl(9 Wx11 D) INCLUDES CASTER CUTOUT Left qs(7.25 W x 9 D) qm(7.5 W x 11 D) ql(10 W x 14 D) Right qs(7.25 W x 9 D) qm(7.5 W x 11 D) ql(10 W x 14 D) qadjustable Angle Footplates(Each)(HCPCS code K0040) $175 qmulti-axis Adjustable Angle Footplates(Each)(HCPCS code K0040)..$225 qheel Loops (Each)QUANTITY ( ) (HCPCS code E0951)......$20 1. Certain footplate sizes may not fit all seat widths depending on legrests selected. qairmesh Calf Strap for chairs wide-3.5 pad height BP-CS-L $135 qairmesh Calf Panel for chairs wide 35.5 w x 9 h pad BP-CP-MD $195 qairmesh Calf Panel for chairs wide 38.5 w x 9 h pad BP-CP-LG $210 ADDITIONAL OPTIONS AND ACCESSORIES qconcepts Back Pack - Single $160 qconcepts Back Pack - Double $255 qtransfer Handles (Height Adjustable) $455 Select: q4-6.5 q qd-loops (set of 2) (1) $325 qflip & Fold Away 1/2 Lap Tray (2) (14"W x 10"D).....$795 Select Mounting: qleft qright 1. May increase seat to floor heights on the certain bases and are for un occupied use. 2. Not available on joystick side and only available with a flat arm pad or modular arm pad. LAP BELTS q Push Button Style Seat Belt q48 q60 q71....std q Padded Lap Belt 2 point (1) - BP-PLB2 (HCPCS code E0978).$195 q Padded Lap Belt 4 point (1) - BP-PLB4 (HCPCS code E0978).$ " length only option. PAGE 6 of 8

7 ELECTRONICS SWITCH MOUNTING Select: qleft hand qright hand qprovide Mounting Hardware qdo Not Mount SINGLE FUNCTION ELECTRONICS qsingle Function through Switch (1) STD Select: qsingle Push Button qsingle Toggle qenhanced Single Functions through Switches $500 Select: qsingle Push Button qdual Push Button qlow Amp Toggle qsingle Function Control Module (2) $1,200 (HCPCS code E2310) qthrough Joystick qthrough Specialty Control-Fill out Specialty control configuration sheet on page 8 Additional Switch: qsingle Push Button qdual Push Button....$97 O2 HOLDERS - ADULT SEAT SIZES ONLY qnon-articulating O 2 Gas Holder (Cylinder Style)....$ 465 qarticulating O 2 Holder $1,650 Please Select One: qo 2 Gas (Cylinder Style) qliquid O 2 (6.5 x 4.5 ) BATTERIES qmk U1 Battery (MU-1 SLD G)Each Quantity ( )(HCPCS code E2365) $205 qmk GROUP 22NF Battery (M22NF SLD G) Each Quantity ( )(HCPCS code E2361) $298 qmk GROUP 24 Battery (M24 SLD G) Each Quantity ( )(HCPCS code E2363) $405 qmk GROUP 34 Battery (M34 SLD G) Each Quantity ( ) (HCPCS code E2359) $330 qmk GROUP 40 Battery Each Quantity ( ) $ These electronics do not include attendant control, reduced drive, drive lock-out, tilt limit and actuator speed control and switch configuration. 2. These electronics include attendant control, reduced drive, drive lockout, tilt limit and actuator speed control and switch configuration. Exception no attendant control with VR2 electronics. MULTIPLE ELECTRONIC FUNCTIONS MULTI-FUNCTION SYSTEM - (IE: TILT/POWER LEGS) qmulti Functions through Switches/Toggle (1) $1,550 Select: qdual Push Button qdualtoggle qquad Push Button qfour-way Toggle Add: q Reduced Drive with Elevating Seat.....$400 qenhanced 2-6 Function Control Module (1) $2,600 (HCPCS code E2311) qthrough Joystick qthrough Specialty Control-Fill out Specialty control configuration sheet on page 8 Includes: Reduced Drive with Elevating Seat qYes qno Additional Switch: qquad Push Button qfour-way Toggle....$97 INSTALLATION qinstallation by Motion Concepts (1) N/C qdealer Installation (Subject to approval) (2) ($100) - Existing Base Serial Number 1. Batteries may be required at time of installation, please call to confirm. 2. Elevating seat systems must be installed by Motion Concepts. Total Retail Value $ 1. These electronics include attendant control, drive lock-out, tilt/recline limit and actuator speed control ELECTRONICS OPTIONS qm16 Splitter $165 (Allows for multiple switch options with phono plug connection) qfeather Touch Switch - Single function $130 q Dime Size q Quarter Size qfeather Touch Switch Multi function $180 q Dual Dime Size qquad Dime Size qstealth Egg Switch q Green q Black $105 (For use with Single function & Enhanced Single Function electronics only) qpower Shut Off Switch - Toggle Switch Only $230 qlazarus Jump Starter $195 qaccessory Port Power Supply $265 ( 3 amp capacity) PAGE 7 of 8

8 SPECIALTY CONTROLS SHEET INVACARE STANDARD Tilt SPECIALTY Pre selected from Factory Legs (Left Leg) Leg) Elevate (Right Leg) Recline PRIDE/ SUNRISE STANDARD SPECIALTY Activate Function Forward Scroll Scroll through Function Activate Function Backward PAGE 8 of 8