Transit Option. Seat Option E2201 E2201. Cross Brace

Transcription

1 Company: Account Number: Date: q Quote q PO Number: RTS: Marked For: Catalyst 5Vx K0005 $ lb weight capacity Ship To: Address: City: State: Zip: Phone: /Fax: Effective 08/06/2018 Frame Seat Width / Seat Depth Select box corresponding to desired Seat Width and Depth Seat Width Seat Depth Price HCPCS N/C N/C N/C N/C N/C $125 $395 $495 $495 E2201 E2201 E N/C q q q q q q q q q 15 $90 q q q q q q q q q 16 N/C q q q q q q q q q 17 $90 q q q q q q q q q 18 N/C q q q q q q q q q 19 $150 q q q q q q q q q 20 $450 E2203 q q q q q q q q q Heavy Duty Option q 350 lb Weight Capacity $500 Requires minimum 6 caster height Transit Option q Transit System K0108 $320 Not available with Removable Seat Pan or Heavy Duty Option Seat Option q Removable Aluminum Seat Pan E2231 $245 Not available with Transit System. Pan depth 1/2 shorter than Seat Depth. Cross Brace q Standard Cross Braces q Seating System Cross Braces N/C Allows for easy attachment of seating system mounting hardware. Not available with Seat Sling. Wheelchair Drive Ready Chair will ship from Ki Mobility with adaption kit installed for selected Alber system. Order system separately from Alber USA. Select Rear Seat Height (full profile selections only) in drive wheel size on Rear Seat Height chart (page 4). Requires Rear Anti-Tips. Not available with Spinergy wheels. q e-motion Ready N/C q twion Ready N/C HCPCS codes provided are based on code verification by the PDAC 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. DCN Pricing and specifications subject to change without notice Page 1 of 13

2 Backrest Back Post / Height Range / Back Height Select Back Height in row corresponding to desired Back Post and Height Range Back Post Standard Angle Adjustable w/ Push Handle Price N/C $185 Height Range Back Height Short q 8.5 q 9.5 q 10.5 q 11.5 Medium q 12.5 q 13.5 q 14.5 q 15.5 Tall q 16.5 q 17.5 q 18.5 q 19.5 Short q 14 q 15 q 16 Medium q 16 q 17 q 18 Tall q 18 q 19 q 20 Standard Back Post Select option below only if a Standard Back Post option is selected on chart above q Straight with Push Handle q Straight without Push Handle N/C q 8º Bend with Push Handle $25 Not available with Short Back Height Range q Straight with Fold Down Push Handle $125 Not available with Heavy Duty option Push Handle Options Not available with Straight Back Post with Fold Down Push Handle or Heavy Duty Option q Low Profile Push Handle $65 2 shorter than standard push handles Back Upholstery q Standard Not available with Short or Medium Back Height Ranges on Seat Widths q Tension Adjustable E2611 $245 q Omit Back Upholstery - $10 Military Patch Attached only if ordered with Tension Adjustable Back Upholstery US Military Service Patch $90 q Army q Navy q Marines q Air Force q Coast Guard q US Purple Heart Patch $90 Purple Heart with Military Service Patch Combo $145 q Army q Navy q Marines q Air Force q Coast Guard Footrest Hanger / Front Frame Bend q 60º N/C Available only with Extension Tube Hangers q 70º N/C q 80º N/C Not available with 7 or 8 Casters q 90º N/C Available only with Front Mount Hangers. Not available with 7 or 8 Casters. q Pro Elevating Leg Rests (PRO ELR) E0990 $295 q Omit Hangers - $20 Footplate q Composite N/C Not available with Front Mount Hangers or PRO ELR q Composite Angle Adjustable K0040 $185 Not available with Front Mount Hangers or 14 Seat Width q Aluminum Angle Adjustable K0040 $185 q One Piece Flip Up Angle Adjustable K0040 $190 Not available with Front Mount Hangers or PRO ELR DCN Pricing and specifications subject to change without notice Page 2 of 13

3 Footrest continued 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 Height recommended. Extension Tube Hangers and Fixed Front Frame measurements are based on 70º Hanger / Front Frame Bend. Footrest Extension Seat to Footrest Length Extension Tube Hangers (60º, 70º, 80º) Short q 11 q 11.5 q 12 q 12.5 q 13 q 13.5 q 14 q 14.5 q 15 Medium q 13 q 13.5 q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 Long q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 Front Mount Hangers 1 PRO ELR Low Pivot PRO ELR High Pivot Short (70º, 80º, 90º) Medium (70º, 80º, 90º) Long (70º, 80º) Standard Selections Requires 3 Extension for $35 q 5 q 5.5 q 6 q 6.5 q 7 q 10 q 10.5 q 11 q 7.5 q 8 q 8.5 q 9 q 9.5 q 11.5 q 12 q 12.5 q 5 q 5.5 q 6 q 6.5 q 7 q 7.5 q 8 q 12 q 12.5 q 13 q 8.5 q 9 q 9.5 q 10 q 10.5 q 11 q 11.5 q 13.5 q 14 q 14.5 q 5 q 5.5 q 6 q 6.5 q 7 q 7.5 q 8 q 8.5 q 9 q 14 q 14.5 q 15 q 9.5 q 10 q 10.5 q 11 q 11.5 q 12 q 12.5 q 13 q 13.5 q 15.5 q 16 q 16.5 Short q Long q Short q Long q Fixed Front Frame (70º, 80º) Short q 11.5 q 12 q 12.5 q 13 q 13.5 q 14 q 14.5 q 15 Medium q 13 q 13.5 q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 Long q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q Available only with Aluminum Angle Adjustable Footplates. See Minimum Front Seat Height chart below. Minimum Front Seat Height with Front Mount Hangers Hanger Length Short Medium Long Hanger Bend 70º 80/90º 70º 80/90º 70º 80º Minimum Front Seat Height with Standard Selection Minimum Front Seat Height with 3 Extension Extension Available only with Front Mount Hangers. Provided as parts. q 3 Extension for Front Mount Hanger $35 Hanger Release If no selection is made Classic Hanger Release will be used q Classic q 4-Way - In line N/C See reference A to the right. Not available with PRO ELR. q 4-Way - Out N/C See reference B to the right Residual Limb Support Residual Limb Support E1020 q Left $395 q Right $395 q Omit Left Hanger - $10 q Omit Right Hanger - $10 Cover q Smooth q Air Mesh q Smooth q Air Mesh Pad Size q 5 x 8 q 9 x 14 q 5 x 8 q 9 x 14 q 7 x 10 q 11 x 10 q 7 x 10 q 11 x 10 q 9 x 10 q 11 x 14 q 9 x 10 q 11 x 14 Heel Loop Not available with One Piece Flip Up Angle Adjustable Footplate q Heel Loops E0951 $30 q Adjustable Heel Loops E0951 $50 q Omit Heel Loops N/C A B Calf Strap q Velcro Adjustable K0038 $35 q Padded Velcro Adjustable K0038 $68 q Bodypoint Padded AeroMesh K0038 $102 DCN Pricing and specifications subject to change without notice Page 3 of 13

4 Front Seat Height and Casters Caster Size / Front Frame Type / Front Seat Height Select Front Seat Height in row corresponding to desired caster size. Note: Selections in first three Front Seat Height columns use Super Low Front Frame. Super Low Front Frame not available with Fixed Front Frame. Caster Size Front Seat Height Uses Super Low Front Frame 4 q q 14 q 14.5 q 15 2 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 5 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5 q 21 7 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5 q 21 8 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5 q 21 1 Front Seat Height not available with 4 x 1 Poly Caster 2 Super Low Front Frame required when using 4 x 1 Poly Caster Maximum Seat Dump Reference (Front Seat Height minus Rear Seat Height) Seat Depth Maximum Dump Standard Caster Housing Maximum Dump Performance Caster Housing Depending on configuration, chairs with Fixed Front Frame Type may achieve up to an additional.75 Caster Type q.75 Rollerblade N/C Not available with 5, 6, 7 and 8 Caster Sizes q.75 Lighted Rollerblade $70 Not available with 5, 6, 7 and 8 Caster Sizes q 1 Poly N/C q 1 Poly Aluminum $160 Not available with 6, 7 and 8 Caster Sizes q 1 Pneumatic $80 Not available with 4, 5 and 7 Caster Sizes q 1.5 Poly $50 Not available with 7 and 8 Caster Sizes q 1.5 Soft Roll Aluminum $175 Not available with 7 and 8 Caster Sizes q 2 Poly $70 Not available with 4, 5, 7 and 8 Caster Sizes q 2 Pneumatic w/ Foam Insert $225 Not available with 4, 5, 6 and 7 Caster Sizes Caster Housing q Standard N/C q Performance $35 Fork Stem q Best Fit Ki Mobility will pick optimal Fork Stem based on Caster Size and Front Seat Height q Standard Fork Stem N/C q 3/4 Longer Fork Stem N/C q Longer Fork Stem N/C Fork Options q Frog Legs Ultra-Sport Fork - Black $425 Available only with 4, 5 or 6 Casters. Not available with Caster Pin Locks, Heavy Duty Option, 2 Poly caster or 2 Pneumatic w/ Foam Insert caster. End User Weight Required: lbs q Frog Legs PHASE2 Carbon Fork $425 Lightweight shock absorbing fork. Available only with 4, 5 or 6 Casters. Not available with Caster Pin Locks, Heavy Duty Option, 2 Poly caster or 2 Pneumatic w/ Foam Insert caster. q Caster Pin Locks K0073 $195 Not available with Performance Caster Housing, Longer Fork Stem or Frog Legs Fork Wheel Locks Wheel Lock q Push to Lock q Push to Lock Flush Mount N/C q Pull to Lock N/C q Low Profile Scissor Lock $45 Not available with Low Poly, Full Poly or Sentinel Solid tires q Short Thro Scissor Lock $110 q Omit Wheel Locks N/C Wheel Lock Options q Extension Handles E0961 $67 Available only with Push to Lock or Pull to Lock Wheel Locks q Grade Aids E0974 $150 Available only with Push to Lock Wheel Locks and Pneumatic or Pneumatic with Airless Insert Rear Tire Types DCN Pricing and specifications subject to change without notice Page 4 of 13

5 Rear Seat Height and Wheels Wheel Size / Tire Profile / Rear Seat Height Select Rear Seat Height in row corresponding to desired Wheel Size and Tire Profile. 14 Seat Depth not available with 24, 25 or 26 Rear Wheels. Wheel Size Tire Profile Rear Seat Height Low q 11.5 q 12.5 q 13.5 q 14.5 q 15.5 q 16.5 Full q 12 q 13 q 14 q 15 q 16 q 17 Low q 12.5 q 13.5 q 14.5 q 15.5 q 16.5 q 17.5 Full q 13 q 14 q 15 q 16 q 17 q 18 Low q 13.5 q 14.5 q 15.5 q 16.5 q 17.5 q 18.5 Full q 14 q 15 q 16 q 17 q 18 q Low q 14 q 15 q 16 q 17 q 18 q Low q 14.5 q 15.5 q 16.5 q 17.5 q 18.5 q 19.5 Full q 15 q 16 q 17 q 18 q 19 q 20 Rear Wheel Type q Assembled 24 Six-Spoke Mag with Treaded Tire and Composite Handrim - $25 No substitutions available. Do not select Rear Tire Type or Handrim. Measures as Full Tire. q 24 Spoke N/C q Spoke (20, 22, 25 or 26 ) $200 q Mag N/C Not available in 25 or 26 rear wheels q Superlight Spoke $295 Available only in 24 and 25 rear wheels. Not available with Heavy Duty option. q Omit - $45 Omits rear wheels, tires, handrims and axles. Selection required in Wheel Size / Tire Profile / Rear Seat Height chart above. Handrim Standard Handrims q Aluminum Anodized q Superlight Aluminum Anodized $50 Available only on 24 and 25 Superlight wheels. Not available with Heavy Duty Option. q Plastic Coated $95 q Projection (8 Vertical Projections) $295 Available on 22, 24, 25 and 26 Spoke wheels & 24 Mag wheels w/full tires q Omit Handrim N/C Handrim Option q 3M Micro Grip $65 Not available on Plastic Coated or Projection Handrims Rear Tire Type Full Profile q Street Pneumatic 1 3/8 E2211, E2212 Not available on 25 rear wheel q Full Poly 1 3/8 E2218 N/C Not available on Superlight or 25 rear wheel q Pneumatic with Airless Insert 1 3/8 E2211, E2213 $95 Not available on Superlight or 25 rear wheel q Schwalbe HS /8 E2211, E2212 $125 Available only on 24 rear wheel. Not available on Mag wheels. q Euro Trek Knobby 1 3/8 E2211, E2212 $95 Available only on 24 rear wheel Low Profile q Low Poly 1 E2218 $50 Not available on Superlight, 25 or 26 rear wheels q Sentinel Solid Tire 1 E2218 $95 Not available on Superlight wheels or 20 and 22 Mag wheels q High Pressure 1 E2211, E2212 $95 Not available on Mag wheels q Schwalbe Marathon Plus Evolution 1 E2211, E2212 $125 Not available on Mag, 20 or 22 rear wheels Natural Fit Handrims Not available on 20 rear wheel or 22 Mag wheels. Not recommended with Mag wheels. q Natural Fit LT Regular Grip $445 q Natural Fit Standard Regular Grip $445 q Natural Fit LT Super Grip $495 q Natural Fit Standard Super Grip $495 q Natural Fit LT Omit Grip $345 q Natural Fit Standard Omit Grip $345 DCN Pricing and specifications subject to change without notice Page 5 of 13

6 Axles Axle No selection needed with Wheelchair Drive Ready Option q Quick Release q Quad Quick Release $175 Not available with Mag wheels Camber Combination of Standard and Adjustable Camber cannot exceed 4º. Selection will default to a max of 4º combined if exceeded. Standard Camber N/C Chair will be set up with this camber selection q 0º q 1º q 2º q 3º q 4º Axle Position If no selection is made position 3 will be used. Position 4 is 7/8 forward of the back cane. Center of Gravity q 1 q 2 q 3 q 4 Adjustable Camber N/C Extra camber spacers mounted to the inside of the rear frame for later use q 1º q 2º q 3º q 4º Armrests Armrest Please select Arm Pad option q Height Adjustable T-Arm ( ) E0973 $265 q Height Adjustable T-Arm Low ( ) E0973 $265 q Height Adjustable Flip Back T-Arm ( ) E0973 $275 q Flip Back (10.5 ) $50 Not available with Seat Depths less than 16 or Angle Adjustable Back Posts Armrest continued q Swing Away ( ) E0973 $195 Not available with Angle Adjustable Back Posts or Arm Pads q Swing Away with Side Guard ( ) E0973 $285 Not available with Angle Adjustable Back Posts or Arm Pads q Omit Armrests N/C Arm Pad Not available with Swing Away Armrests Standard Arm Pad N/C q Desk q Full Waterfall Arm Pad $25 q Desk q Full Available only with Height Adjustable T-Arms Accessories Removable Side Guard Not available with T-Arms, Flip Back or Swing Away with Side Guard Armrests q Composite Side Guards K0108 $140 Fixed Mount Fender Side Guards K0108 Not available with 24 rear wheel in combination with 14 Rear Seat Height q Aluminum $150 q Carbon Fiber $475 Aluminum Adjustable Fender with Foam Pad K0108 New! q Black Matte $275 q Match Frame Color $325 Not available with Graphic Image Transfer Anti-Tip q Rear Anti-Tips E0971 $140 Swing-In Anti-Tip E0971 Not available with Heavy Duty Option q Single - Left $150 Not available with left side O 2 Holder q Single - Right $150 Not available with right side O 2 Holder q Pair $300 Not available with Cane and Crutch Holder or O 2 Holder q Carbon Fiber Adjustable Fender K0108 New! $485 DCN Pricing and specifications subject to change without notice Page 6 of 13

7 Accessories Positioning Belt q Auto Buckle E0978 $70 q Padded Auto Buckle E0978 $155 q 2 Airline Buckle E0978 $110 Bodypoint Evoflex - Pelvic Stabilizer E0978 $183 Size: q Small (16-24 ) q Medium (19-29 ) q Large (25-37 ) Bodypoint Belt Mounting Kit $105 Color Style: q Bracket q Band Clamp 1 Transit Wheels q Transit Wheels K0108 $145 Not available with Step Tube, Rear Seat Heights less than 14 or Heavy Duty Option O 2 Holder O 2 Holder E2208 $295 q Right Side q Left Side Gloss Finish q Black N/C q Blue Skies N/C q Bubblegum Pink N/C q Candy Blue N/C q Candy Purple N/C q Candy Red N/C q Copper N/C q Fuchsia N/C q Granny Smith N/C q Metallic Orange N/C q Yellow N/C Matte Finish q Army Green N/C q Charcoal Gray N/C q Emerald Green N/C q Iridescent Burgundy N/C q Iridescent Navy N/C q Retro Red N/C q Royal Blue N/C q Shadow Black N/C q Smooth White N/C Other Accessories q Tool Kit $45 q Removable Underseat Pouch $50 q Pediatric Ki Mobility Backpack $50 q Ki Mobility Backpack $65 q Luggage Carrier $85 Not available with PRO ELR or Residual Limb Support q Black Neoprene Impact Guards $85 q Clear Spoke Guards K0065 $115 Not available with Mag wheels q Black Spoke Guards K0065 $115 Not available with 20 rear wheel or Mag wheels q Cane and Crutch Holder $195 q IV Pole $265 Available only with Standard Straight Back Posts Step Tube $40 Not available with Transit Wheels or Heavy Duty Option q Right Side q Left Side Graphic Image Transfer Visit for current graphic image transfer options Note selection below q $595 Colored Anodizing Package Select desired color. If no selection is made, black will be used. Standard Caster Housing 2 $75 Caster Fork 3 $75 Axle Plate $75 Black 1 q q q Blue q q q Bright Green q q q Gold q q q Orange q q q Pewter q q q Pink q q q Purple q q q Red q q q 1 Black is no charge 2 Available only if corresponding option selection was made 3 Not available with 2 wide casters, Frog Legs Ultra-Sport or PHASE 2 Carbon Forks DCN Pricing and specifications subject to change without notice Page 7 of 13

8 Catalyst Front Seat Height Matrix 4 Caster 5 Caster 6 Caster 7 Caster 8 Caster FSH Super Low Stem Fork FSH Super Low Stem Fork FSH Super Low Stem Fork FSH Super Low Stem Fork FSH Super Low Stem Fork / / / n/a 3/4 4 3/ / / /4 5 3/ n/a n/a / n/a / n/a 8 x 2 caster not available with 6 fork 3/ / n/a / / n/a x 2 caster not available with 5 fork Front Seat Height 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 Aluminum Seat heights with FSH heading available with Standard Front Frame. Seat heights with Super Low heading available with Super Low Front Frame. Actual seat height may vary depending upon configuration. DCN Pricing and specifications subject to change without notice Page 8 of 13

9 Axiom G, S and P Cushions Select size in chart at right. Weight capacity: 350 lbs. Cushions Under 22 Wide q Axiom G E2601 $120 q Axiom S E2603 $199 q Axiom P E2605 $ Wide Cushions q Axiom G E2602 $199 q Axiom S E2604 $299 q Axiom P E2606 $440 Axiom G, S or P Cushion Quantity: q 1 q 2 If no selection is made, quantity 1 will be selected Axiom SP Cushions Select size in chart at right. Weight capacity: 350 lbs. Cushions Under 22 Wide q Axiom SP - Visco E2607 $410 q Axiom SP - Fluid E2607 $ Wide Cushions q Axiom SP - Visco E2608 $499 q Axiom SP - Fluid E2608 $549 Axiom SP Cushion Quantity: q 1 q 2 If no selection is made, quantity 1 will be selected Axiom Accessories Outer Covers q Axiom G Extra Outer Cover $70 q Axiom S Extra Outer Cover $80 q Axiom P Extra Outer Cover $90 q Axiom SP Extra Visco Outer Cover $100 q Axiom SP Extra Fluid Outer Cover $100 Outer Cover Quantity: q 1 q 2 If no selection is made, quantity 1 will be selected Inner Covers q Axiom SP Extra Visco Inner Cover $100 q Axiom SP Extra Fluid Inner Cover $100 Inner Cover Quantity: q 1 q 2 If no selection is made, quantity 1 will be selected Depth Depth Width q 15 q q q 16 q q q q q q q 17 q q q q q q 18 q q q q q q q 19 q q q 20 q q q q q Width q q q 15 q q q q q 16 q q q q q q q q 17 q q q q q q q q 18 q q q q q q q q q 19 q q q q q q q q 20 q q q q q q q q Solid Seat Insert Select size in chart below. Weight capacity: 350 lbs. Solid Seat Insert $55 Depth Width q 15 q q q 16 q q q q q q q 17 q q q q q q 18 q q q q q q q 19 q q q 20 q q q q q Solid Seat Insert Quantity: q 1 q 2 If no selection is made, quantity 1 will be selected DCN Pricing and specifications subject to change without notice Page 9 of 13

10 Elite Back HCPCS Code: E2620 Weight Capacity: 300 lbs. STEP 1: Choose Back Size Quick Ship Quick Ship products are stocked q Matrx Elite Back 14 x 14 - PBE1414 $625 q Matrx Elite Back 14 x 16 - PBE1416 $625 q Matrx Elite Back 14 x 18 - PBE1418 $625 q Matrx Elite Back 15 x 14 - PBE1514 $625 q Matrx Elite Back 15 x 16 - PBE1516 $625 q Matrx Elite Back 15 x 18 - PBE1518 $625 q Matrx Elite Back 16 x 12 - PBE1612 $625 q Matrx Elite Back 16 x 14 - PBE1614 $625 q Matrx Elite Back 16 x 16 - PBE1616 $625 q Matrx Elite Back 16 x 18 - PBE1618 $625 q Matrx Elite Back 16 x 20 - PBE1620 $625 q Matrx Elite Back 17 x 16 - PBE1716 $625 q Matrx Elite Back 17 x 18 - PBE1718 $625 q Matrx Elite Back 17 x 20 - PBE1720 $625 q Matrx Elite Back 18 x 14 - PBE1814 $625 q Matrx Elite Back 18 x 16 - PBE1816 $625 q Matrx Elite Back 18 x 18 - PBE1818 $625 q Matrx Elite Back 18 x 20 - PBE1820 $625 q Matrx Elite Back 19 x 16 - PBE1916 $625 q Matrx Elite Back 19 x 18 - PBE1918 $625 q Matrx Elite Back 20 x 16 - PBE2016 $625 q Matrx Elite Back 20 x 18 - PBE2018 $625 q Matrx Elite Back 20 x 20 - PBE2020 $625 On Demand On Demand products are ordered with an extended lead time q Matrx Elite Back 12 x 10 - PBE1210 $625 q Matrx Elite Back 12 x 12 - PBE1212 $625 q Matrx Elite Back 12 x 14 - PBE1214 $625 q Matrx Elite Back 12 x 16 - PBE1216 $625 q Matrx Elite Back 12 x 18 - PBE1218 $625 q Matrx Elite Back 13 x 10 - PBE1310 $625 q Matrx Elite Back 13 x 12 - PBE1312 $625 q Matrx Elite Back 13 x 14 - PBE1314 $625 q Matrx Elite Back 13 x 16 - PBE1316 $625 q Matrx Elite Back 13 x 18 - PBE1318 $625 q Matrx Elite Back 14 x 10 - PBE1410 $625 q Matrx Elite Back 14 x 12 - PBE1412 $625 q Matrx Elite Back 14 x 20 - PBE1420 $625 q Matrx Elite Back 15 x 10 - PBE1510 $625 q Matrx Elite Back 15 x 12 - PBE1512 $625 q Matrx Elite Back 15 x 20 - PBE1520 $625 q Matrx Elite Back 16 x 10 - PBE1610 $625 q Matrx Elite Back 17 x 10 - PBE1710 $625 q Matrx Elite Back 17 x 12 - PBE1712 $625 q Matrx Elite Back 17 x 14 - PBE1714 $625 q Matrx Elite Back 18 x 10 - PBE1810 $625 q Matrx Elite Back 18 x 12 - PBE1812 $625 q Matrx Elite Back 19 x 10 - PBE1910 $625 q Matrx Elite Back 19 x 12 - PBE1912 $625 q Matrx Elite Back 19 x 20 - PBE1920 $625 q Matrx Elite Back 20 x 10 - PBE2010 $625 q Matrx Elite Back 20 x 12 - PBE2012 $625 STEP 2: Choose Back Hardware (Selection Required) Back Hardware q Easy Set Hardware - PBMH N/C Not available with Angle Adjustable Locking Flip Up or Tubular Flip Up Armrests, O2 Holder or welded rigidizer bar q Split Mounting Hardware - SMHU N/C DCN Pricing and specifications subject to change without notice Page 10 of 13

11 Elite Deep Back Weight Capacity: 300 lbs. STEP 1: Choose Back Size Quick Ship Quick Ship products are stocked q Matrx Elite Deep Back 14 x 16 - EDB1416 $760 q Matrx Elite Deep Back 14 x 18 - EDB1418 $760 q Matrx Elite Deep Back 15 x 16 - EDB1516 $760 q Matrx Elite Deep Back 15 x 18 - EDB1518 $760 q Matrx Elite Deep Back 16 x 16 - EDB1616 $760 q Matrx Elite Deep Back 16 x 18 - EDB1618 $760 q Matrx Elite Deep Back 16 x 20 - EDB1620 $760 q Matrx Elite Deep Back 17 x 16 - EDB1716 $760 q Matrx Elite Deep Back 17 x 18 - EDB1718 $760 q Matrx Elite Deep Back 17 x 20 - EDB1720 $760 q Matrx Elite Deep Back 18 x 16 - EDB1816 $760 q Matrx Elite Deep Back 18 x 18 - EDB1818 $760 q Matrx Elite Deep Back 18 x 20 - EDB1820 $760 q Matrx Elite Deep Back 19 x 18 - EDB1918 $760 q Matrx Elite Deep Back 19 x 20 - EDB1920 $760 q Matrx Elite Deep Back 20 x 16 - EDB2016 $760 q Matrx Elite Deep Back 20 x 18 - EDB2018 $760 q Matrx Elite Deep Back 20 x 20 - EDB2020 $760 STEP 2: Choose Back Hardware (Selection Required) Back Hardware q Easy Set Hardware - PBMH N/C Not available with Angle Adjustable Locking Flip Up or Tubular Flip Up Armrests, O2 Holder or welded rigidizer bar q Split Mounting Hardware - SMHU N/C On Demand HCPCS Code: E2620 On Demand products are ordered with an extended lead time q Matrx Elite Deep Back 14 x 12 - EDB1412 $760 q Matrx Elite Deep Back 14 x 20 - EDB1420 $760 q Matrx Elite Deep Back 15 x 10 - EDB1510 $760 q Matrx Elite Deep Back 15 x 12 - EDB1512 $760 q Matrx Elite Deep Back 15 x 20 - EDB1520 $760 q Matrx Elite Deep Back 16 x 10 - EDB1610 $760 q Matrx Elite Deep Back 16 x 12 - EDB1612 $760 q Matrx Elite Deep Back 17 x 10 - EDB1710 $760 q Matrx Elite Deep Back 17 x 12 - EDB1712 $760 q Matrx Elite Deep Back 18 x 10 - EDB1810 $760 q Matrx Elite Deep Back 18 x 12 - EDB1812 $760 q Matrx Elite Deep Back 19 x 10 - EDB1910 $760 q Matrx Elite Deep Back 19 x 12 - EDB1912 $760 q Matrx Elite Deep Back 19 x 16 - EDB1916 $760 q Matrx Elite Deep Back 20 x 10 - EDB2010 $760 q Matrx Elite Deep Back 20 x 12 - EDB2012 $760 DCN Pricing and specifications subject to change without notice Page 11 of 13

12 MX2 Back Weight Capacity: 250 lbs. HCPCS Code: E2615 The MX2 Back is On Demand only. On Demand products are ordered with an extended lead time. MX2 Back with Fixed Hardware Hardware included q Matrx MX2 Back w/ Fixed Hardware 14 x 06 - IMX21406-CFH $795 q Matrx MX2 Back w/ Fixed Hardware 14 x 09 - IMX21409-CFH $835 q Matrx MX2 Back w/ Fixed Hardware 14 x 12 - IMX21412-CFH $875 q Matrx MX2 Back w/ Fixed Hardware 14 x 16 - IMX21416-CFH $915 q Matrx MX2 Back w/ Fixed Hardware 15 x 06 - IMX21506-CFH $795 q Matrx MX2 Back w/ Fixed Hardware 15 x 09 - IMX21509-CFH $835 q Matrx MX2 Back w/ Fixed Hardware 15 x 12 - IMX21512-CFH $875 q Matrx MX2 Back w/ Fixed Hardware 15 x 16 - IMX21516-CFH $915 q Matrx MX2 Back w/ Fixed Hardware 16 x 06 - IMX21606-CFH $795 q Matrx MX2 Back w/ Fixed Hardware 16 x 09 - IMX21609-CFH $835 q Matrx MX2 Back w/ Fixed Hardware 16 x 12 - IMX21612-CFH $875 q Matrx MX2 Back w/ Fixed Hardware 16 x 16 - IMX21616-CFH $915 q Matrx MX2 Back w/ Fixed Hardware 17 x 06 - IMX21706-CFH $795 q Matrx MX2 Back w/ Fixed Hardware 17 x 09 - IMX21709-CFH $835 q Matrx MX2 Back w/ Fixed Hardware 17 x 12 - IMX21712-CFH $875 q Matrx MX2 Back w/ Fixed Hardware 17 x 16 - IMX21716-CFH $915 q Matrx MX2 Back w/ Fixed Hardware 18 x 06 - IMX21806-CFH $795 q Matrx MX2 Back w/ Fixed Hardware 18 x 09 - IMX21809-CFH $835 q Matrx MX2 Back w/ Fixed Hardware 18 x 12 - IMX21812-CFH $875 q Matrx MX2 Back w/ Fixed Hardware 18 x 16 - IMX21816-CFH $915 MX2 Back with Quick Release Hardware Hardware included q Matrx MX2 Back w/ QR Hardware 14 x 06 - IMX21406-QRH $820 q Matrx MX2 Back w/ QR Hardware 14 x 09 - IMX21409-QRH $860 q Matrx MX2 Back w/ QR Hardware 14 x 12 - IMX21412-QRH $900 q Matrx MX2 Back w/ QR Hardware 14 x 16 - IMX21416-QRH $940 q Matrx MX2 Back w/ QR Hardware 15 x 06 - IMX21506-QRH $820 q Matrx MX2 Back w/ QR Hardware 15 x 09 - IMX21509-QRH $860 q Matrx MX2 Back w/ QR Hardware 15 x 12 - IMX21512-QRH $900 q Matrx MX2 Back w/ QR Hardware 15 x 16 - IMX21516-QRH $940 q Matrx MX2 Back w/ QR Hardware 16 x 06 - IMX21606-QRH $820 q Matrx MX2 Back w/ QR Hardware 16 x 09 - IMX21609-QRH $860 q Matrx MX2 Back w/ QR Hardware 16 x 12 - IMX21612-QRH $900 q Matrx MX2 Back w/ QR Hardware 16 x 16 - IMX21616-QRH $940 q Matrx MX2 Back w/ QR Hardware 17 x 06 - IMX21706-QRH $820 q Matrx MX2 Back w/ QR Hardware 17 x 09 - IMX21709-QRH $860 q Matrx MX2 Back w/ QR Hardware 17 x 12 - IMX21712-QRH $900 q Matrx MX2 Back w/ QR Hardware 17 x 16 - IMX21716-QRH $940 q Matrx MX2 Back w/ QR Hardware 18 x 06 - IMX21806-QRH $820 q Matrx MX2 Back w/ QR Hardware 18 x 09 - IMX21809-QRH $860 q Matrx MX2 Back w/ QR Hardware 18 x 12 - IMX21812-QRH $900 q Matrx MX2 Back w/ QR Hardware 18 x 16 - IMX21816-QRH $940 DCN Pricing and specifications subject to change without notice Page 12 of 13

13 Matrx Elan Headrest HCPCS Code: Hardware E0128 / Pad E0955 Quick Ship Quick Ship products are stocked q Elan Hardware - MEHW $220 q Elan Mini Hardware - MEMH $220 q Elan Standard Pad 6 W x 3.5 H w/ Cover - ESP6 $235 q Elan Standard Pad 10 W x 5 H w/ Cover - ESP10 $235 q Elan Standard Pad 14 W x 5 H w/ Cover - ESP14 $235 Matrx Elite/Mini Laterals On Demand On Demand products are ordered with an extended lead time q Elan Standard Pad 6 W x 3.5 H w/ Infection Control Cover - ESP6-IC $235 q Elan Standard Pad 10 W x 5 H w/ Infection Control Cover - ESP10-IC $235 q Elan Standard Pad 14 W x 5 H w/ Infection Control Cover - ESP14-IC $235 q Elan Occipital Pad 9 W x 7 H w/ Cover - EOP9 $235 q Elan Occipital Pad 9 W x 7 H w/ Infection Control Cover - EOP9-IC $235 q Elan Occiptal Pad 12 W x 8 H w/ Cover - EOP12 $235 q Elan Occipital Pad 12 W x 8 H w/ Infection Control Cover - EOP12-IC $235 q Elan 4 Point Pad 11 W x 10 H w/ Cover - E4POINT $325 q Elan 4 Point Pad 11 W x 10 H w/ Infection Control Cover - E4POINT-IC $325 HCPCS Code: Swing Away Hardware, Offset Hardware E1028 / Fixed Hardware, Pad E0956 Quick Ship Quick Ship products are stocked Elite Swing Away Lateral Hardware Only - SAHEB q Quantity 1 $225 q Quantity 2 $450 q Elite Offset Swing Away Lateral Hardware Only (Left) - OSAH-L $225 q Elite Offset Swing Away Lateral Hardware Only (Right) - OSAH-R $225 Pad for Swing Away Lateral Medium 3.75 H x 5.75 L - EPAD-M q Quantity 1 $110 q Quantity 2 $220 Pad for Swing Away Lateral Large 4.25 H x 6.5 L - EPAD-L q Quantity 1 $110 q Quantity 2 $220 Hardware Options On Demand On Demand products are ordered with an extended lead time q Easy Set Hardware (Pair) - PBMH $225 q Split Mounting Hardware (Pair) - SMH $200 q Heavy Duty Easy Set Hardware (Pair) - HDMH $325 q Extended Range Mounting Hardware (Pair) - ERMH $225 q Fixed Space Saver Mounting Hardware (Pair) - FSSH $200 q Carbon Fiber Fixed Mount Hardware for MX2 Back - IMX2CFH $245 q Quick Release Hardware for MX2 Back - IMX2QRH $270 On Demand On Demand products are ordered with an extended lead time q Elite Lateral Fixed Standard Pad 5 H x 7.5 L (Left) - PBLS-L $110 q Elite Lateral Fixed Standard Pad 5 H x 7.5 L (Right) - PBLS-R $110 q Elite Lateral Fixed Small Pad 3 H x 5.5 L (Left) - PBSS-L $110 q Elite Lateral Fixed Small Pad 3 H x 5.5 L (Right) - PBSS-R $110 q Elite Lateral Fixed Offset Pad 5 H x 7.5 L (Left) - PBOL-L $110 q Elite Lateral Fixed Offset Pad 5 H x 7.5 L (Right) - PBOL-R $110 Mini Swing-Away Lateral Hardware Only - SAHMINI q Quantity 1 $225 q Quantity 2 $450 Pad for Swing Away Lateral X Small 3.25 H x 4.25 L - EPAD-XS q Quantity 1 $110 q Quantity 2 $220 Pad for Swing Away Lateral Small 3.5 H x 5.25 L - EPAD-S q Quantity 1 $110 q Quantity 2 $220 Other Matrx Products On Demand On Demand products are ordered with an extended lead time q Chest Harness Interface Kit for Elite Back - CHIEB $95 q Chest Harness Interface Kit for Mini Back - HIMINI $85 q Extended Mounting Pins for Mounting to Backs 2 Wider - EMP $60 q Privacy Flap X Small (Fits 12 to 14 Backs) - PFLAP-XS $40 q Privacy Flap Small (Fits 15 to 16 Backs) - PFLAP-S $40 q Privacy Flap Medium (Fits 17 to 18 Backs) - PFLAP-M $40 q Privacy Flap Large (Fits 19 to 20 Backs) - PFLAP-L $40 q Privacy Flap X Large (Fits 21 to 22 Backs) - PFLAP-XL $40 DCN Pricing and specifications subject to change without notice Page 13 of 13