This form must be opened in dobe crobat. The Submit Form button will not work from most browser windows. Company: ccount Number: Date: Quote PO Number: RTS: Ship To: ddress: City: State: Zip: Phone: Marked For: Email/Fax: Select if chair uote has: dditional Ki Products with Different Quote/Order Number Quote/Order Number: Catalyst 5Ti K0005 $3615 Effective 04/08/2019 300 lb weight capacity Frame Seat / Seat Select box corresponding to desired Seat and Seat Seat Price HCPCS 14 15 16 17 18 19 20 21 22 N/C N/C N/C N/C N/C $195 $395 $495 $495 E2201 E2201 E2201 14 N/C 15 N/C 16 N/C 17 N/C 18 N/C 19 $195 20 $500 E2203 Heavy Duty Option 350 lb Weight Capacity $500 Reuires minimum 6 caster height ackrest ack Post / Range / ack Select ack in row corresponding to desired ack Post and Range ack Post Standard ngle djustable w/ Push Handle Price N/C $185 Range ack Short 8.5 9.5 10.5 11.5 Medium 12.5 13.5 14.5 15.5 Tall 16.5 17.5 18.5 19.5 Short 14 15 16 Medium 16 17 18 Tall 18 19 20 Transit Option Transit System K0108 $320 Not available with Removable Seat Pan or Heavy Duty Option Cross race luminum Titanium $495 Not available with 21 and 22 Seat s Seat Pan Removable luminum Seat Pan E2231 $245 Not available with Transit System. Pan depth 1/2 shorter than Seat. Wheelchair Drive Ready Chair will ship from Ki Mobility with adaption kit installed for selected lber system. Order system separately from lber US. Select Rear Seat (full profile selections only) in drive wheel size on Rear Seat chart (page 4). Reuires Rear nti-tips. Not available with Spinergy wheels. e-motion Ready N/C twion Ready N/C Standard ack Post Select option below only if a Standard ack Post option is selected on chart at left Straight without Push Handle N/C Straight with Push Handle $50 8º end with Push Handle $80 Not available with Short ack Range Straight with Fold Down Push Handle $125 Not available with Heavy Duty option Push Handle Options Not available with Straight ack Post with Fold Down Push Handle or Heavy Duty Option Low Profile Push Handle $70 2 shorter than standard push handles HCPCS codes provided are based on code verification by the PDC or our interpretation of the code definitions. Proper use of HCPCS codes does not ensure coverage or payment. For coverage information, verify the appropriate payer s coverage policy. DCN0015.27 Pricing and specifications subject to change without notice Page 1 of 13
ackrest continued ack Upholstery Select option below only if Standard or ngle djustable ack Post option is selected on chart on previous page Standard Not available with Short or Medium ack Ranges on 20-22 Seat s Tension djustable E2611 Standard Cover $315 ir Mesh reathable Cover New! $390 Omit ack Upholstery - $10 Footrest Hanger / Front Frame end 70º N/C 80º N/C Not available with 7 or 8 Casters Pro Elevating Leg Rests (PRO ELR) E0990 $295 Omit Hangers - $20 Military Patch ttached only if ordered with Tension djustable ack Upholstery US Military Service Patch $90 rmy Navy Marines ir Force Coast Guard US Purple Heart Patch $90 Purple Heart with Military Service Patch Combo $145 rmy Navy Marines ir Force Coast Guard Footplate Composite N/C Not available with PRO ELR Composite ngle djustable K0040 $185 Not available with 14 Seat luminum ngle djustable K0040 $185 One Piece Flip Up ngle djustable K0040 $190 Not available with PRO ELR Footrest / Extension / Seat to Footrest Length Select Seat to Footrest Length in row corresponding to desired Footrest and Extension. Footrest Length of at least 2.5 shorter than Front Seat recommended. Extension Tube Hangers and Fixed Front Frame measurements are based on 70º Hanger / Front Frame end. Footrest Extension Seat to Footrest Length Extension Tube Hangers (70º, 80º) PRO ELR Low Pivot Setting PRO ELR High Pivot Setting Fixed Front Frame (70º, 80º) Short 11 11.5 12 12.5 13 13.5 14 14.5 15 Medium 13 13.5 14 14.5 15 15.5 16 16.5 17 Long 15.5 16 16.5 17 17.5 18 18.5 19 19.5 Short 12-17.5 Long 15-21 Short 10.5-15.5 Long 13-19 Short 11.5 12 12.5 13 13.5 14 14.5 15 Medium 13 13.5 14 14.5 15 15.5 16 16.5 17 Long 15.5 16 16.5 17 17.5 18 18.5 19 19.5 Hanger Release If no selection is made Classic Hanger Release will be used Classic 4-Way - In line N/C See reference to the right. Not available with PRO ELR. 4-Way - Out N/C See reference to the right. Not available with PRO ELR. Residual Limb Support Residual Limb Support E1020 Left $395 Right $395 Omit Left Hanger - $10 Omit Right Hanger - $10 Cover Smooth ir Mesh Smooth ir Mesh Pad Size 5 x 8 9 x 14 5 x 8 9 x 14 7 x 10 11 x 10 7 x 10 11 x 10 9 x 10 11 x 14 9 x 10 11 x 14 DCN0015.27 Pricing and specifications subject to change without notice Page 2 of 13
Footrest continued Heel Loop Not available with One Piece Flip Up ngle djustable Footplate Heel Loops E0951 $30 djustable Heel Loops E0951 $50 Omit Heel Loops N/C Front Seat and Casters Calf Strap Velcro djustable K0038 $35 Padded Velcro djustable K0038 $68 odypoint Padded eromesh K0038 $102 Caster Size / Front Frame Type / Front Seat Select Front Seat in row corresponding to desired caster size Caster Size Front Seat 4 15 1 15.5 16 16.5 17 17.5 18 18.5 19 19.5 20 5 16 16.5 17 17.5 18 18.5 19 19.5 20 20.5 6 17 17.5 18 18.5 19 19.5 20 20.5 21 7 18 18.5 19 19.5 20 20.5 21 8 19 19.5 20 20.5 21 1 Not availale with 4 x 1 Poly Caster Caster Type.75 Rollerblade N/C vailable only with 4 Caster Size.75 Lighted Rollerblade $70 vailable only with 4 Caster Size 1 Poly N/C 1 Poly luminum $160 vailable only with 4 and 5 Caster Sizes 1 Pneumatic $85 vailable only with 6 and 8 Caster Sizes 1.5 Poly $50 Not available with 7 and 8 Caster Sizes 1.5 Soft Roll luminum $175 Not available with 7 and 8 Caster Sizes 2 Poly $70 vailable only with 6 Caster Size 2 Pneumatic w/ Foam Insert $225 vailable only with 8 Caster Size Caster Housing Standard N/C Performance $35 Maximum Seat Dump Reference (Front Seat minus Rear Seat ) Seat 14 15 16 17 18 19 20 Maximum Dump Standard Caster Housing 1.5 2 2 2 2.5 2.5 2.5 Maximum Dump Performance Caster Housing 3 3 3 3.5 3.5 4 4 Depending on configuration, chairs with Fixed Front Frame Type may achieve up to an additional.75 Fork Stem est Fit Ki Mobility will pick Fork and Stem combination to optimize performance based on Caster Size and Front Seat Standard Fork Stem N/C 3/4 Longer Fork Stem N/C Longer Fork Stem N/C Fork Options Frog Legs Ultra-Sport Fork - lack $425 vailable only with 4, 5 or 6 Caster Sizes. Not available with Caster Pin Locks, Heavy Duty Option, 2 Poly caster or 2 Pneumatic w/ Foam Insert caster. End User Weight Reuired: lbs Frog Legs PHSE 2 Carbon Fork $425 Lightweight shock absorbing fork. vailable only with 4, 5 or 6 Caster Sizes. Not available with Caster Pin Locks, Heavy Duty Option, 2 Poly caster or 2 Pneumatic w/ Foam Insert caster. Caster Pin Locks K0073 $195 Not available with Performance Caster Housing, Longer Fork Stem or Frog Legs Fork DCN0015.27 Pricing and specifications subject to change without notice Page 3 of 13
Wheel Locks Wheel Lock Push to Lock Push to Lock Flush Mount N/C Pull to Lock N/C Low Profile Scissor Lock $45 Not available with Low Poly, Full Poly or Sentinel Solid tires Short Thro Scissor Lock $110 Omit Wheel Locks N/C Rear Seat and Wheels Wheel Lock Options Extension Handles E0961 $70 vailable only with Push to Lock or Pull to Lock Wheel Locks Grade ids E0974 $150 vailable only with Push to Lock Wheel Locks and Pneumatic or Pneumatic with irless Insert tires Wheel Size / Tire Profile / Rear Seat Select Rear Seat in row corresponding to Wheel Size and Tire Profile. 14 Seat not available with 24, 25 or 26 wheel sizes. m Reuires Universal xle Plate ny axle plate can be used (Universal, mputee, One rm Drive) Wheel Size 20 22 24 Tire Profile Rear Seat Low m 11 m 11.5 12 1 m 12.5 13 1 m 13.5 14 m 14.5 15 m 15.5 m 16 m 16.5 Full m 11.5 m 12 12.5 1 m 13 13.5 1 m 14 14.5 m 15 15.5 m 16 m 16.5 m 17 Low m 12 m 12.5 13 1 m 13.5 14 1 m 14.5 15 m 15.5 16 m 16.5 m 17 m 17.5 Full m 12.5 m 13 13.5 1 m 14 14.5 1 m 15 15.5 m 16 16.5 m 17 m 17.5 m 18 Low m 13 m 13.5 14 1 m 14.5 15 1 m 15.5 16 m 16.5 17 m 17.5 m 18 m 18.5 Full m 13.5 m 14 14.5 1 m 15 15.5 1 m 16 16.5 m 17 17.5 m 18 m 18.5 m 19 25 Low m 13.5 m 14 14.5 1 m 15 15.5 1 m 16 16.5 m 17 17.5 m 18 m 18.5 m 19 26 Low m 14 15 1,2 m 15.5 16 1 m 16.5 17 m 17.5 18 m 18.5 m 19 m 19.5 Full m 14.5 m 15 2 15.5 1,2 m 16 16.5 1 m 17 17.5 m 18 18.5 m 19 m 19.5 m 20 1 Not available with mputee xle Plate 2 Not available with djustable Flip ack T-rm One rm Drive One rm Drive E0958 $1095 vailable only with 24 Mag wheel. Not available with 14 Rear Seat in combination with 24 wheel size. Standard Handrim will be luminum nodized. xle not uick release. Drive Handrim Side: Left Right Drive Handrim Type: luminum N/C Poly Coated $200 xle Plate No selection needed with One rm Drive m Universal New! mputee $175 Not available with Swing way rmrests or Wheelchair Drive Ready Option Rear Wheel Type 24 Spoke N/C 24 MXX Performance Spoke New! $99 22 MXX Performance Spoke New! $299 Spoke (20, 22, 25 or 26 ) $220 Mag $50 Not available in 25 or 26 wheel sizes Superlight Spoke $295 vailable only in 24 and 25 wheel sizes. 25 wheel size available only with Superlight and Plastic Coated Handrims. Not available with Heavy Duty Option. Spinergy Spox $820 Not available in 20 wheel size Color: lack Red White lue Yellow Handrim: Short Tab Long Tab vailable only with luminum nodized and Plastic Coated Handrims Spinergy LX $1025 Not available in 20 wheel size Color: lack Red White lue Yellow Pink Green Orange Purple New! Handrim: Short Tab Long Tab vailable only with luminum nodized and Plastic Coated Handrims DCN0015.27 Pricing and specifications subject to change without notice Page 4 of 13
Rear Seat and Wheels continued Rear Tire Type Full Profile Street Pneumatic 1 3/8 E2211, E2212 Not available on 25 wheel size Full Poly 1 3/8 E2218 $95 Not available on Superlight wheel or 25 or 26 wheel sizes Pneumatic with irless Insert 1 3/8 E2211, E2213 $125 Not available on Superlight wheel or 25 wheel size Schwalbe HS-127 1 3/8 E2211, E2212 $125 vailable only on 24 wheel size. Not available on Mag wheel. Euro Trek Knobby 1 3/8 E2211, E2212 $95 vailable only on 24 wheel size Handrim No selection needed with One rm Drive Standard Handrims luminum nodized Superlight luminum nodized $50 vailable only on 24 and 25 wheel sizes. vailable only on MXX Performance, Superlight or Spinergy wheels. Not available with Heavy Duty Option. Plastic Coated $95 Projection (8 Vertical Projections) $295 vailable only with full profile tires in combination with MXX Performance, 22-26 Spoke, or 24 Mag wheel Spinergy Flex Rim $650 vailable only on 24 and 25 Spinergy LX wheels Omit Handrim N/C Low Profile Low Poly 1 E2218 $75 Not available on Superlight wheel, 25 or 26 wheel sizes or Heavy Duty Option Sentinel Solid Tire 1 E2218 $95 Not available on Superlight wheel or 20 and 22 Mag wheels High Pressure 1 E2211, E2212 $95 Not available on Mag wheel Schwalbe One 1 E2211, E2212 $125 Not available on Mag wheel, 20, 22 or 26 wheel sizes Schwalbe Marathon Plus Evolution 1 E2211, E2212 $135 Not available on Mag wheel, 20 or 22 wheel sizes Natural Fit Handrims Not available on 20 wheel size or 22 Mag wheel. Not recommended with Mag wheel. Natural Fit LT Regular Grip $445 Natural Fit Standard Regular Grip $445 Natural Fit LT Super Grip $495 Natural Fit Standard Super Grip $495 Natural Fit LT Omit Grip $345 Natural Fit Standard Omit Grip $345 Handrim Option 3M Micro Grip $65 Not available on Plastic Coated or Projection Handrims xles xle No selection needed with One rm Drive Quick Release Quad Quick Release $175 Not available with Mag or Spinergy wheels xle Position Rear Wheel Camber: 0º 2º 4º No selection needed with One rm Drive Center of Gravity: Rear Center Forward DCN0015.27 Pricing and specifications subject to change without notice Page 5 of 13
rmrests rmrest Please select rm Pad option djustable T-rm (8.5-13.5 ) E0973 $375 djustable T-rm Low (7.5-11.5 ) E0973 $375 djustable Flip ack T-rm (9.5-13.5 ) E0973 $275 Flip ack (10.5 ) $425 Not available with Seat s less than 16 or ngle djustable ack Posts ccessories Removable Side Guard vailable only with Swing way rmrests Composite Side Guards K0108 $140 luminum djustable Fender with Foam Pad - lack Matte K0108 $275 Carbon Fiber djustable Fender K0108 $485 nti-tip Rear nti-tips E0971 $140 Swing-In nti-tip E0971 New! Not available with Heavy Duty Option Single - Left $150 Not available with left side O 2 Holder Single - Right $150 Not available with right side O 2 Holder Pair $300 Not available with Cane and Crutch Holder or O 2 Holder Positioning elt uto uckle E0978 $70 Padded uto uckle E0978 $155 2 irline uckle E0978 $110 odypoint Evoflex - Pelvic Stabilizer E0978 $183 Size: Small (16-24 ) Medium (19-29 ) Large (25-37 ) rm Pad Not available with Swing way rmrests Standard rm Pad N/C Desk Full Waterfall rm Pad $25 Desk Full vailable only with djustable T-rm and djustable T-rm Low rmrest continued Swing way (10.5-12.5 ) E0973 $195 Not available with ngle djustable ack Posts or rm Pads Omit rmrests N/C O 2 Holder O 2 Holder E2208 $295 Right Side Left Side Other ccessories Tool Kit $45 Removable Underseat Pouch $50 Pediatric Ki Mobility ackpack $50 Ki Mobility ackpack $65 Luggage Carrier $85 Not available with PRO ELR or Residual Limb Support lack Neoprene Impact Guards $85 Clear Spoke Guards K0065 $115 Not available with Mag wheel lack Spoke Guards K0065 $115 Not available with 20 wheel size or Mag wheel Cane and Crutch Holder $195 IV Pole $265 vailable only with Standard Straight ack Posts odypoint elt Mounting Kit $105 Style: racket and Clamp 1 DCN0015.27 Pricing and specifications subject to change without notice Page 6 of 13
Catalyst Front Seat Matrix 4 Caster 5 Caster 6 Caster 7 Caster 8 Caster FSH Stem Fork FSH Stem Fork FSH Stem Fork FSH Stem Fork FSH Stem Fork 15 1 16.5 2 16 17 18 19 15.5 16.5 3/4 4 18 3/4 5 18.5 20 3/4 16 2 17.5 18.5 19 20.5 3/4 4 3/4 6 16.5 16 17 19.5 19 16.5 17.5 19.5 19.5 17 17 18 20 20 3/4 5 15.5 17.5 18 18.5 20.5 16 17.5 18.5 3/4 6 19 19.5 16.5 18 19 19.5 20 3/4 5 3/4 17 16.5 18.5 20 20.5 6 7 17 17 19 19 21 17.5 17.5 19.5 19.5 7 20.5 3/4 17 17.5 18 20 21 17.5 18 3/4 6 18.5 20.5 8 x 2 caster not available with 6 fork 17.5 18.5 19 20 3/4 6 18 18 19.5 20.5 18.5 18.5 18.5 19 19 19 18 18 19.5 18.5 18.5 20 3/4 7 21 19 19 19.5 3/4 7 19.5 18.5 20 19.5 19 3/4 7 20.5 20 19.5 21 19.5 20 20.5 6 x 2 caster not available with 5 fork 1 Front Seat not available with 4 x 1 Poly Caster 2 Not available with 4 x 1 Poly, 4 x 1.5 Poly or 4 x 1.5 Soft Roll luminum ctual seat height may vary depending upon configuration. DCN0015.27 Pricing and specifications subject to change without notice Page 7 of 13
xiom G, S and P Cushions Select size in chart at right. Weight capacity: 350 lbs. Cushions Under 22 Wide xiom G E2601 $120 xiom S E2603 $199 xiom P E2605 $340 22 Wide Cushions xiom G E2602 $199 xiom S E2604 $299 xiom P E2606 $440 xiom G, S or P Cushion Quantity: 1 2 If no selection is made, uantity 1 will be selected xiom SP Cushions Select size in chart at right. Weight capacity: 350 lbs. Cushions Under 22 Wide xiom SP - Visco E2607 $410 xiom SP - Fluid E2607 $449 22 Wide Cushions xiom SP - Visco E2608 $499 xiom SP - Fluid E2608 $549 xiom SP Cushion Quantity: 1 2 If no selection is made, uantity 1 will be selected xiom Cushion ccessories Outer Covers xiom G Extra Outer Cover $70 xiom S Extra Outer Cover $80 xiom P Extra Outer Cover $90 xiom SP Extra Visco Outer Cover $100 xiom SP Extra Fluid Outer Cover $100 Outer Cover Quantity: 1 2 If no selection is made, uantity 1 will be selected Inner Covers xiom SP Extra Visco Inner Cover $100 xiom SP Extra Fluid Inner Cover $100 Inner Cover Quantity: 1 2 If no selection is made, uantity 1 will be selected 14 15 16 17 18 19 20 21 22 14 15 16 17 18 19 20 14 15 16 17 18 19 20 21 22 14 15 16 17 18 19 20 Solid Seat Insert Select size in chart below. Weight capacity: 350 lbs. Solid Seat Insert $55 14 15 16 17 18 19 20 21 22 14 15 16 17 18 19 20 Solid Seat Insert Quantity: 1 2 If no selection is made, uantity 1 will be selected DCN0015.27 Pricing and specifications subject to change without notice Page 8 of 13
xiom ack New! Hardware is included with back. Low ack selections are not available with headrests. Weight capacity: 300 lbs. xiom Posterior ack (P) Low 12 14 16 18 20 22 Retail $555 $555 $555 $555 $555 $791 HCPC E2613 E2613 E2613 E2613 E2613 E2614 8 XP1208 XP1408 XP1608 XP1808 XP2008 10 XP1410 XP1610 XP1810 XP2010 XP2210 12 XP1212 XP1412 XP1612 XP1812 XP2012 14 XP1414 XP1614 XP1814 XP2014 XP2214 16 XP1216 XP1416 XP1616 XP1816 XP2016 18 XP1418 XP1618 XP1818 XP2018 XP2218 4.1 4.1 xiom Posterior ack Measurement Reference ack Shell Contour 8 10 6.5 Low 10 12 8.5 12 14 10.5 14 16 8.5 16 18 9.5 18 20 10.5 2.25 xiom Posterior ack - Low xiom Posterior ack - xiom Posterior Lateral ack (PL) Low Tall 12 14 16 18 20 22 Retail $636 $636 $636 $636 $636 $862 HCPC E2615 E2615 E2615 E2615 E2615 E2616 8 XPL1208 XPL1408 XPL1608 XPL1808 XPL2008 10 XPL1410 XPL1610 XPL1810 XPL2010 XPL2210 12 XPL1212 XPL1412 XPL1612 XPL1812 XPL2012 14 XPL1414 XPL1614 XPL1814 XPL2014 XPL2214 16 XPL1216 XPL1416 XPL1616 XPL1816 XPL2016 18 XPL1418 XPL1618 XPL1818 XPL2018 XPL2218 20 XPL1220 XPL1420 XPL1620 XPL1820 XPL2020 22 XPL1422 XPL1622 XPL1822 XPL2022 XPL2222 5.5 5.5 5.5 xiom Posterior Lateral ack Measurement Reference ack Shell Contour 8 10 6.5 Low 10 12 8.5 12 14 10.5 14 16 8.5 16 18 9.5 18 20 10.5 3.65 xiom Posterior Lateral ack - Low xiom Posterior Lateral ack - xiom Posterior Lateral ack - Tall Tall 20 22 11.5 22 24 12.5 DCN0015.27 Pricing and specifications subject to change without notice Page 9 of 13
xiom ack continued Hardware is included with back. Low ack selections are not available with headrests. Weight capacity: 300 lbs. xiom Lateral ack (L) Low Tall 12 14 16 18 20 22 Retail $735 $735 $735 $735 $735 $813 HCPC E2620 E2620 E2620 E2620 E2620 E2621 8 XL1208 XL1408 XL1608 XL1808 XL2008 10 XL1410 XL1610 XL1810 XL2010 XL2210 12 XL1212 XL1412 XL1612 XL1812 XL2012 14 XL1414 XL1614 XL1814 XL2014 XL2214 16 XL1216 XL1416 XL1616 XL1816 XL2016 18 XL1418 XL1618 XL1818 XL2018 XL2218 20 XL1220 XL1420 XL1620 XL1820 XL2020 22 XL1422 XL1622 XL1822 XL2022 XL2222 5.5 5.5 5.5 xiom Lateral ack Measurement Reference ack Shell Contour 8 10 6.5 Low 10 12 8.5 12 14 10.5 14 16 8.5 16 18 9.5 18 20 10.5 3.65 xiom Lateral ack - Low xiom Lateral ack - xiom Lateral ack - Tall Tall 20 22 11.5 22 24 12.5 xiom Deep Lateral ack (DL) Tall 12 14 16 18 20 22 Retail $735 $735 $735 $735 $735 $813 HCPC E2620 E2620 E2620 E2620 E2620 E2621 14 XDL1214 XDL1414 XDL1614 XDL1814 XDL2014 XDL2214 16 XDL1416 XDL1616 XDL1816 XDL2016 18 XDL1218 XDL1418 XDL1618 XDL1818 XDL2018 XDL2218 20 XDL1220 XDL1420 XDL1620 XDL1820 XDL2020 22 XDL1422 XDL1622 XDL1822 XDL2022 XDL2222 7.75 7.75 xiom Deep Lateral ack Measurement Reference ack 1 12 14 16 18 20 22 Shell Contour Tall 14 16 8.25 8.25 8.25 8.25 8.25 8.25 16 18 9.25 9.25 9.25 9.25 9.25 9.25 18 20 10.25 10.25 10.25 10.25 10.25 10.25 20 22 9.5 9.75 10 10.25 10.25 10.5 22 24 10.75 11 11.25 11.5 11.5 11.75 1 Measurement based on back width 6 xiom Deep Lateral ack - xiom Deep Lateral ack - Tall DCN0015.27 Pricing and specifications subject to change without notice Page 10 of 13
xiom ack ccessories Headrest and Hardware Choose headrest and hardware combination in chart below. vailable only on or Tall CP450 P250 TCP205 CP250 CP150 P350 P450 TCP105 HMO400 HMO475-1 TW480-1 Hardware Standard Straight ack Multi xis Removable Headrest Hardware with Mount Hardware with 1 Hardware with 1 1 all all Horizontal ar HMO400 HMO475-1 TW480-1 Description Item Code HCPC Kio Code Retail Kio Code Retail Kio Code Retail Comfort Plus Headrest 8 CP450 E0955 HDR001 $277 HDR009 $313 HDR017 $388 Comfort Plus Headrest 10 CP250 E0955 HDR002 $277 HDR010 $313 HDR018 $388 Headrest Pad Comfort Plus Headrest 14 CP150 E0955 HDR003 $277 HDR011 $313 HDR019 $388 Small ll Positioning Headrest Pad and Ring Only Medium ll Positioning Headrest Pad and Ring Only Large ll Positioning Headrest Pad and Ring Only P250 E0955 HDR004 $277 HDR012 $313 HDR020 $388 P350 E0955 HDR005 $277 HDR013 $313 HDR021 $388 P450 E0955 HDR006 $277 HDR014 $313 HDR022 $388 Tri-Comfort Plus Headrest 14 TCP205 E0955 HDR007 $288 HDR015 $324 HDR023 $399 Tri-Comfort Plus Headrest 19 TCP105 E0955 HDR008 $288 HDR016 $324 HDR024 $399 Universal Mounting Hardware For use with other manufacturer headrests Description Item Code HCPC Retail Universal Mounting Plate UMP K0108 $40 DCN0015.27 Pricing and specifications subject to change without notice Page 11 of 13
xiom ack ccessories continued Lateral Support Sold in pairs Description Item Code HCPC Retail Laterals for Posterior ack 3 x 4 Lateral Pads with Fixed Mounting Hardware for xiom Posterior ack LF3x4P E0956 $305 4 x 5 Lateral Pads with Fixed Mounting Hardware for xiom Posterior ack LF4x5P E0956 $305 3 x 4 Lateral Pads with Swing way Mounting Hardware for xiom Posterior ack LS3x4P E0956, E1028 $650 4 x 5 Lateral Pads with Swing way Mounting Hardware for xiom Posterior ack LS4x5P E0956, E1028 $650 Laterals for Posterior Lateral ack and Lateral ack 3 x 4 Lateral Pads with Fixed Mounting Hardware for xiom Posterior Lateral and xiom Lateral acks LF3x4L E0956 $305 4 x 5 Lateral Pads with Fixed Mounting Hardware for xiom Posterior Lateral and xiom Lateral acks LF4x5L E0956 $305 3 x 4 Lateral Pads with Swing way Mounting Hardware for xiom Posterior Lateral and xiom Lateral acks LS3x4L E0956, E1028 $650 4 x 5 Lateral Pads with Swing way Mounting Hardware for xiom Posterior Lateral and xiom Lateral acks LS4x5L E0956, E1028 $650 Lumbar Pads vailable only with xiom Lateral ack and xiom Deep Lateral back Description Item Code HCPC Retail Lumbar Pad 12 L12 K0108 $48 Lumbar Pad 14 L14 K0108 $48 Lumbar Pad 16 L16 K0108 $48 Lumbar Pad 18 L18 K0108 $48 Lumbar Pad 20 L20 K0108 $48 Lumbar Pad 22 L22 K0108 $48 Privacy Flap Description Item Code HCPC Retail Privacy Flap 12 PF12 K0108 $45 Privacy Flap 14 PF14 K0108 $45 Privacy Flap 16 PF16 K0108 $45 Privacy Flap 18 PF18 K0108 $45 Privacy Flap 20 PF20 K0108 $45 Privacy Flap 22 PF22 K0108 $45 DCN0015.27 Pricing and specifications subject to change without notice Page 12 of 13
xiom ack ccessories continued Therafin Posture Support Description Item Code HCPC Retail Small Static Therafit 2-Piece Chest Strap with H & L dj and 1 Safety Strap 60153T E0960 $144 Medium Static Therafit 2-Piece Chest Strap with H & L dj and 1 Safety Strap 60154T E0960 $144 Large Static Therafit 2-Piece Chest Strap with H & L dj and 1 Safety Strap 60155T E0960 $144 Small Dynamic Therafit Chest Strap with Dual D-Ring djustment 60110T E0960 $113 Medium Dynamic Therafit Chest Strap with Dual D-Ring djustment 60111T E0960 $113 Large Dynamic Therafit Chest Strap with Dual D-Ring djustment 60112T E0960 $113 Small Dynamic Therafit Comfortfit Full Vest 30589T E0960 $167 Medum Dynamic Therafit Comfortfit Full Vest 30590T E0960 $167 Large Dynamic Therafit Comfortfit Full Vest 30591T E0960 $167 XLarge Dynamic Therafit Comfortfit Full Vest 30592T E0960 $167 XXLarge Dynamic Therafit Comfortfit Full Vest 30593T E0960 $167 Small Dynamic Therafit Comfortfit Trim Vest 30618T E0960 $169 Medum Dynamic Therafit Comfortfit Trim Vest 30619T E0960 $169 Large Dynamic Therafit Comfortfit Trim Vest 30620T E0960 $169 XLarge Dynamic Therafit Comfortfit Trim Vest 30621T E0960 $169 XXLarge Dynamic Therafit Comfortfit Trim Vest 30622T E0960 $169 xiom ack Modifications Extended lead times will apply for all modifications xiom ack Modifications Description Item Code HCPC Retail Modification for 4 Point Harness XM4PT K0108 N/C Modification for 2 Point Chest Strap XM2PT K0108 N/C Modification for Shoulder Guides Includes shoulder guides XMSG K0108 $50 Painted ack Shell Modification If no selection is made, standard Shadow lack will be used with no additional lead time Gloss Finish Item Code Retail lack XMLK N/C lue Skies XMSKY N/C ubblegum Pink XMPNK N/C Candy lue XMCL N/C Candy Purple XMPUR N/C Candy Red XMRED N/C Copper XMCOP N/C Granny Smith XMGSM N/C Metallic Fuchsia XMMTF N/C Metallic Orange XMMOR N/C Yellow XMYLW N/C Matte Finish Item Code Retail rmy Green XMGM N/C Charcoal Gray XMCGM N/C Emerald Green XMEGM N/C Iridescent urgundy XMIM N/C Iridescent Navy XMINM N/C Retro Red XMRRM N/C Royal lue XMRM N/C Smooth White XMSWM N/C DCN0015.27 Pricing and specifications subject to change without notice Page 13 of 13