mobility devices product catalogue - ministry of health · paediatric specific wheeled walker type...

Mobility DevicesProduct Catalogue

Effective Date : 2011-Jun-13

Assistive Devices ProgramMinistry of Health and Long-Term Care

Printed Date: May 3, 2011 Page: 1 of 75

Ministry of Health and Long-Term Care

Assistive Devices ProgramProduct Catalogue

Mobility Devices Effective From: 2011-Jun-13

Ambulation Aids

Device Type Manufacturer Device ADP Code Max Allowed

Qty.

ADP Approved

Amt.

Adult Wheeled Walker Type 1Walker type most suitable for use on hard, flat surfaces. ADP price includes frame, two or four small wheels (less than 6" diameter) and braking system (if available). See Ambulation Aids Options Chart if heavy duty frame and/or forearm attachments required.

Airway Surgical Top Release 5062tr/5062tj MW1AR0005 1 $82.00

Amg Medical Deluxe Folding Wheeled Walker MW1GM0010 1 $82.00

Dana Douglas Deluxe Regular MW1DG0020 1 $82.00

Deluxe Small MW1DG0025 1 $82.00

Drive Medical One Button Or Dual Trigger Release

MW1D50005 1 $82.00

Guardian Easy Care G30755w & G30756w

MW1GU0025 1 $82.00

Red Dot Extra Wide G7767 MW1GU0020 1 $82.00

Red Dot G7756 & G7810 MW1GU0035 1 $82.00

Red Dot Standard G7755 & G7756

MW1GU0015 1 $82.00

Invacare Adult MW1IN0010 1 $82.00

Lumex Dual Release Adult/Junior MW1LU0020 1 $82.00

Lightweight Adult/Junior MW1LU0010 1 $82.00

Rubbermaid Deluxe MW1C60010 1 $82.00

Adult Wheeled Walker Type 2Walker type most suitable for use on hard, flat surfaces. ADP price includes frame, four small wheels (less than 6" diameter), hand braking system, seat, and back support. See Ambulation Aids Options Chart if heavy duty frame and/or forearm attachments required.

Airway Surgical 5314 MW2AR0010 1 $324.00

Amg Medical Airgo Adventure 6 MW2GM0040 1 $324.00

Airgo Ultra Light MW2GM0050 1 $324.00

Free Spirit Iii Models 700-960 & 700-975

MW2GM0030 1 $324.00

Dana Douglas 4200 Dx MW2DG0010 1 $324.00

4200 Lx MW2DG0005 1 $324.00

Delta MW2DG0035 1 $324.00

Infiniti 260 MW2DG0045 1 $324.00

Nexus 1 (Cable Brake) MW2DG0050 1 $324.00

Drive Medical Duet 795b Rollator MW2D00010 1 $324.00

Go-Lite Deluxe MW2D50005 1 $324.00

Evolution Medical Challenger Grande MW2EV0025 1 $324.00

Challenger Mini MW2EV0010 1 $324.00

Sprite & Sprite Mini MW2EV0005 1 $324.00

Sprite Grande MW2EV0020 1 $324.00

Invacare Rollite 65100 MW2IN0050 1 $324.00

Three Wheels MW2IN0030 1 $324.00

Nighthawk Ats 902 Handi Lite MW2NM0005 1 $324.00

Ats 903 Handi Lite MW2NM0010 1 $324.00

Ats 904 Handi Lite MW2NM0015 1 $324.00

Ats 907-6 Ovation MW2NM0040 1 $324.00

Ats 908-6 Ovation MW2NM0045 1 $324.00

Ovation Compact 807-6 MW2NM1005 1 $324.00

Page: 2 of 75




Ambulation Aids


Qty.

ADP Approved

Amt.

Adult Wheeled Walker Type 2Walker type most suitable for use on hard, flat surfaces. ADP price includes frame, four small wheels (less than 6" diameter), hand braking system, seat, and back support. See Ambulation Aids Options Chart if heavy duty frame and/or forearm attachments required.

Sunburst Medical Freedom Plus MW22S0005 1 $324.00

Freedom Plus Short MW22S0010 1 $324.00

Adult Wheeled Walker Type 3Walker type most suitable for active use on most terrains. ADP price includes frame,four large wheels (6"/8" diameter), hand braking system, seat, and back support. See Ambulation Aids Options Chart if heavy duty frame and/or forearm attachments required.

Access Vital As Active MW3V80005 1 $417.00

Breeze MW3V80010 1 $417.00

Amg Medical Airgo Adventure 8 MW3GM0060 1 $417.00

Airgo Comfort Plus Xwd MW3GM0055 1 $417.00

Airgo Comfort-Plus MW3GM0050 1 $417.00

Airgo Duo MW3GM0040 1 $417.00

Airgo Excursion MW3GM0065 1 $417.00

Airgo Navigator MW3GM0015 1 $417.00

Free Spirit Ergo Plus Models 700-992 & 700-997

MW3GM0020 1 $417.00

Free Spirit Ergo Plus Wide Models 700-993 & 700-998

MW3GM0030 1 $417.00

Free Spirit Iii Models 700-990 & 700-995

MW3GM0010 1 $417.00

Dana Douglas 4200swx MW3DG0035 1 $417.00

4200wx MW3DG0030 1 $417.00

Excel MW3DG0015 1 $417.00

Infiniti 280 MW3DG0025 1 $417.00

Infiniti 500 MW3DG0020 1 $417.00

Nexus Ii (Cable Brake) MW3DG0040 1 $417.00

Nexus Iii (Cable Free Braking System)

MW3DG0045 1 $417.00

Riva MW3DG0005 1 $417.00

Solo MW3DG0010 1 $417.00

Dolomite Alpha Advanced MW3DO1085 1 $417.00

Alpha Basic MW3DO1080 1 $417.00

Jazz MW3DO2000 1 $417.00

Legacy Lite MW3DO0100 1 $417.00

Melody MW3DO1090 1 $417.00

Opal Futura Symphony MW3DO1055 1 $417.00

Opal Legacy MW3DO1040 1 $417.00

Opal Maxi / Maxi+ MW3DO1035 1 $417.00

Soprano MW3DO1095 1 $417.00

Drive Medical Diamond 740r Rollator MW3D50010 1 $417.00

Enkatsu Solutions Prima Rollator MW3EH0005 1 $417.00

Page: 3 of 75




Ambulation Aids


Qty.

ADP Approved

Amt.

Adult Wheeled Walker Type 3Walker type most suitable for active use on most terrains. ADP price includes frame,four large wheels (6"/8" diameter), hand braking system, seat, and back support. See Ambulation Aids Options Chart if heavy duty frame and/or forearm attachments required.

Evolution Medical Challenger Low Wide MW3EV0035 1 $417.00

Challenger Wide MW3EV0030 1 $417.00

Evolution Dx, Ldx, Wdx, Lwdx MW3EV0005 1 $417.00

Horizon Dx, Wdx, Lwdx, Tdx MW3EV0010 1 $417.00

Piper Dx, Mdx, Smdx, Tdx MW3EV0020 1 $417.00

Xpresso, Xpresso Lite MW3EV0040 1 $417.00

Nighthawk Ats 906 0vation MW3NM0015 1 $417.00

Ats 907 Ovation MW3NM0020 1 $417.00



Sunburst Medical Freedom All Terrain MW32S0010 1 $417.00

Freedom Xl MW32S0015 1 $417.00

Freedom Xls MW32S0005 1 $417.00

Mirage 4900 MW32S0030 1 $417.00

Mirage 4925 MW32S0040 1 $417.00

Mirage 4950 MW32S0035 1 $417.00

Shopper 4700 MW32S0020 1 $417.00

Titan MW32S0050 1 $417.00

Topro Olympos MW3TV0020 1 $417.00

Troja MW3TV0010 1 $417.00

Forearm Crutches1 Pair of Forearm Crutches from the following manufacturers may be billed under this code.

Approved ADP Manufacturers Only

Forearm Crutches MKZND0005 1 $121.00

Paediatric Specific Walking FrameADP price includes frame, four wheels, hand grips (including arm supports), and built in sitting support (e.g. sling/saddle seat). See Ambulation Aids Options Chart for adolescent sizes.

Alvema Hopla MW6AL0005 1 $2,578.00

Can-Dan Rehatec Meywalk Mk3, Medium & Large MW6CD0045 1 $2,578.00

Meywalk, Medium & Large MW6CD0040 1 $2,578.00

Mini-Meywalk MW6CD0050 1 $2,578.00

Kids Up Inc Flux Gait Trainer MW6K20005 1 $2,578.00

Ormesa Grillo MW6OA0005 1 $2,578.00

Prime Engineering Kidwalk MW62P0005 1 $2,578.00

Rifton Equipment Pacer Gait Trainer MW6RF0005 1 $2,578.00

Sos Rehab Bronco,Sizes 0,1,2 MW6R80060 1 $2,578.00

Crocodile Reverse Walker MW6R80070 1 $2,578.00

Dynamico MW6R80055 1 $2,578.00

Gator MW6R80005 1 $2,578.00

Pony,Size 0 MW6R80040 1 $2,578.00

Pony,Size 1 MW6R80045 1 $2,578.00

Pony,Size 2 MW6R80050 1 $2,578.00

Pony,Size 3 MW6R80052 1 $2,578.00

Page: 4 of 75




Ambulation Aids


Qty.

ADP Approved

Amt.

Paediatric Specific Wheeled Walker Type 1Walker type most suitable for use on hard, flat surfaces. ADP price includes frame, two or four small wheels, and braking system (if available). See Ambulation Aids Options Chart for adolescent sizes.

Guardian Strider Middler G-7781 MW4GU0025 1 $220.00

Strider Regular G-7780 MW4GU0020 1 $220.00

Strider Tweener G-7783 MW4GU0035 1 $220.00

Strider Tyke G-7782 MW4GU0030 1 $220.00

Tyke G-7751 MW4GU0010 1 $220.00

Kaye Adolescent 2 Wheels MW4KY0065 1 $220.00

Adolescent 4 Wheels MW4KY0070 1 $220.00

Adolescent 4 Wheels/Swivel MW4KY0075 1 $220.00

Child 2 Wheels MW4KY0020 1 $220.00

Child 4 Wheels MW4KY0025 1 $220.00

Child 4 Wheels/Swivel MW4KY0030 1 $220.00

Child Small 2 Wheels MW4KY0005 1 $220.00

Child Small 4 Wheels MW4KY0010 1 $220.00

Child Small 4 Wheels/Swivel MW4KY0015 1 $220.00

Pre-Adolescent 2 Wheels MW4KY0050 1 $220.00

Pre-Adolescent 4 Wheels MW4KY0055 1 $220.00

Pre-Adolescent 4 Wheels/Swivel

MW4KY0060 1 $220.00

Youth 2 Wheels MW4KY0035 1 $220.00

Youth 4 Wheels MW4KY0040 1 $220.00

Youth 4 Wheels/Swivel MW4KY0045 1 $220.00

Paediatric Specific Wheeled Walker Type 2Walker type most suitable for active use on most terrains. ADP price includes all components and options.

Otto Bock Nurmi Neo MW5OB0005 1 $1,524.00

Paediatric Standing Frame Type 1ADP price includes frame, positioning straps, trunk, pelvic, knee and foot supports, and tray. See Ambulation Aids Options Chart for adolescent sizes.

I.D.C.Tectonics Ltd. Prone Stander 130c MS1HM0005 1 $1,219.00

Prime Engineering Up-Right Stander MS12P0015 1 $1,219.00

Vasi Vertical Stander MS1HY0005 1 $1,219.00


Altimate Medical Easy Stand 5000&7000 Magician

MS2HC0005 1 $3,285.00

Easy Stand Bantam MS2HC0015 1 $3,285.00

Easy Stand Evolv MS2HC0010 1 $3,285.00

Ormesa Dondolino, Size 1 MS2OA0010 1 $3,285.00

Dondolino, Size 2 MS2OA0015 1 $3,285.00

Dondolino, Size 3 MS2OA0020 1 $3,285.00

Mini Standy MS2OA0030 1 $3,285.00

Standy MS2OA0035 1 $3,285.00

Prime Engineering Kidstand & Grandstand 111 MS22P0010 1 $3,285.00

Superstand,Small & Youth MS22P0005 1 $3,285.00

Page: 5 of 75




Ambulation Aids


Qty.

ADP Approved

Amt.


Prime Engineering Symmetry Standing Frame MS22P0015 1 $3,285.00

Prodije Baby,Kid & Junior MS2JP0010 1 $3,285.00

Sos Rehab Buffalo,Size 1 MS2R80005 1 $3,285.00

Buffalo,Size 2 MS2R80010 1 $3,285.00

Buffalo,Size 3 MS2R80015 1 $3,285.00

Gazelle,Size 1 MS2R80020 1 $3,285.00

Gazelle,Size 2 MS2R80025 1 $3,285.00

Gazelle,Size 3 MS2R80030 1 $3,285.00

Giraffe MS2SG0005 1 $3,285.00

Page: 6 of 75




Ambulation Aids

OPTIONS:


Qty.

ADP Approved

Amt.

AA - Custom ModificationsThe MOCM code may be used when custom modifications are required to an ADP listed ambulation aid or paediatric stander, and there is no ADP code with assigned funding available. The following documentation must be submitted: 1. Authorizer must provide clinical rationale to support the request. 2. Vendor must provide a breakdown of the cost of labour (not to exceed $40.00/hour), and parts.

MOCM 1

Adolescent Size Paediatric Specific WalkerADDITIONAL FUNDING FOR ADOLESCENT SIZED PAEDIATRIC WALKERS (DEVICE TYPE MW4 & MW5). AUTHORIZER MUST DOCUMENT CLINICAL REQUIREMENTS. SELECTED DEVICE MUST MEET SIZE REQUIREMENTS.

AA5 1 $100.00

Adolescent Size Paediatric Standing FrameADDITIONAL FUNDING FOR ADOLESCENT SIZED PAEDIATRIC STANDING FRAMES (DEVICE TYPE MS1 & MS2). AUTHORIZER MUST DOCUMENT CLINICAL REQUIREMENTS. SELECTED DEVICE MUST MEET SIZE REQUIREMENTS.

AA7 1 $300.00

Adolescent Size Paediatric Walking FrameADDITIONAL FUNDING FOR ADOLESCENT SIZED PAEDIATRIC WALKING FRAMES (DEVICE TYPE MW6). AUTHORIZER MUST DOCUMENT CLINICAL REQUIREMENTS. SELECTED DEVICE MUST MEET SIZE REQUIREMENTS.

AA6 1 $200.00

Extra Wide Adult Wheeled WalkerEXTRA WIDE ADULT WHEELED WALKER (GREATER THAN 18" BETWEEN PUSH HANDLES) DUE TO CLIENT STATURE. CLIENT WEIGHT LESS THAN 275LBS. AUTHORIZER MUST DOCUMENT CLIENT'S REQUIREMENTS.

AA8 1 $100.00

Forearm AttachmentsFOREARM ATTACHMENTS FOR WHEELED WALKERS. AUTHORIZER MUST PROVIDE CLINICAL RATIONALE TO SUPPORT REQUEST (MAXIMUM 2).

AA1 2 $200.00

Heavy Duty Package Client Weight 275-350 lbsHEAVY DUTY PACKAGE FOR WHEELED WALKERS, CLIENT WEIGHT 275-350 LBS. AUTHORIZER MUST DOCUMENT CLIENT WEIGHT. SELECTED DEVICE MUST MEET WEIGHT REQUIREMENTS.

AA2 1 $100.00

Page: 7 of 75




Ambulation Aids

OPTIONS:


Qty.

ADP Approved

Amt.

Heavy Duty Package Client Weight 350-400 lbsHEAVY DUTY PACKAGE FOR WHEELED WALKERS, CLIENT WEIGHT 350-400 LBS. AUTHORIZER MUST DOCUMENT CLIENT WEIGHT. SELECTED DEVICE MUST MEET WEIGHT REQUIREMENTS.

AA3 1 $150.00

Heavy Duty Package Client Weight Exceeded 400 lbsHEAVY DUTY PACKAGE FOR WHEELED WALKERS, CLIENT WEIGHT EXCEEDS 400LBS. AUTHORIZER MUST DOCUMENT CLIENT WEIGHT. SELECTED DEVICE MUST MEET WEIGHT REQUIREMENTS.

AA4 1 $200.00

Unilateral Hand BrakeUNILATERAL HAND BRAKE. ALLOWS LOCKING/BRAKING OF BOTH BRAKES USING ONE HAND. AUTHORIZOR MUST DOCUMENT CLINICAL REQUIREMENTS. (MAX 1)

AA9 1 $100.00

Page: 8 of 75




Seating


Qty.

ADP Approved

Amt.

Back Support Action Products

Twister Cb Back 15"-16" Width X 11"-16" Height

SEBAN0005 1 $450.00


SEBAN0025 1 $450.00


SEBAN0010 1 $450.00


SEBAN0030 1 $450.00


SEBAN0015 1 $530.00


SEBAN0035 1 $530.00


SEBAN0020 1 $530.00


SEBAN0040 1 $530.00

Adaptive Engineering Lab

Drop-In R-Back Curved With 1.5" Poly Foam

SEBE10030 1 $223.00

Drop-In R-Back Curved With Sun-Mate Or Pudgee Foam

SEBE10035 1 $233.00

Drop-In R-Back Curved With Sun-Mate Or Pudgee Foam

SEBE10040 1 $267.00

Drop-In R-Back With 1" Poly Foam SEBE10005 1 $177.00

Drop-In R-Back With 1.5" Poly Foam SEBE10010 1 $195.00

Drop-In R-Back With Sun-Mate Or Pudgee Foam

SEBE10020 1 $195.00

Drop-In T-Back Curved With Sun-Mate Or Pudgee Foam

SEBE10075 1 $289.00

Drop-In T-Back Curved With Sun-Mate Or Pudgee Foam

SEBE10080 1 $254.00

Drop-In T-Back With Sun-Mate Or Pudgee Foam

SEBE10060 1 $251.00

Adaptive Equipment Systems (Aes)

Adjustable Bi-Angular Solid Back Insert, Includes T-Nuts & Adjustment Brackets.

SEB2L1025 1 $438.00

Back Supports Hardware Not Included Solid Back Insert, Includes T-Nuts.

SEB2L1005 1 $183.00

Back Supports Including Upper & Lower Back Mounting Hardware Solid Back Insert Package W/Universal Hardware Or E-Z Mount Mount Hardware & Rotating Hold Downs.

SEB2L0005 1 $643.00

I Or T Or Curved Syle Solid Back Insert, Includes T-Nuts.

SEB2L1015 1 $274.00

Oversize Upcharge For Backs Over 2o" But Less Than 28".

SEB2L1040 1 $80.00

Page: 9 of 75




Seating


Qty.

ADP Approved

Amt.

Back Support Adaptive Equipment Systems (Aes)

Quick-Fit Contour/Bi-Angular Solid Back Insert, Incudes T-Nuts.

SEB2L1030 1 $602.00

Sculptured Solid Back Insert, Includes T-Nuts.

SEB2L1035 1 $999.00

Sculpturefit Back W/Attaching Hardware, Custom.

SEB2L0015 1 $1,236.00

Solid Back Insert Package, Li'L Kiddos, 14" Wide Or Less.

SEB2L0020 1 $733.00

Solid Back Insert Package, Li'L Kiddos, Contoured, 14" Wide.

SEB2L0025 1 $898.00

Solid Back Insert, Includes T-Nuts, Li'L Kiddos, 14" Wide Or Less.

SEB2L1010 1 $247.00

Solid Back W/Drop Hooks & Fixed Hold Downs.

SEB2L0010 1 $267.00

Advanced Mobility

Contoured Back SEBAO0040 1 $300.00

Deep "U" Back SEBAO0035 1 $340.00

Ez Back Basic SEBAO0060 1 $352.00

Ez Back System Complete SEBAO0055 1 $411.00

Pro Back Support SEBAO0065 1 $520.00

U Form Deep Contour Back Support SEBAO0050 1 $863.00

Amysystems Contour Back Support For Heavy Duty SEB4P0020 1 $956.00

Contour Back Support, Non-Standard Sizes

SEB4P0015 1 $607.00

Contour Back Support, Standard Sizes SEB4P0010 1 $513.00

Broda Back Pad SEBB-0010 1 $67.00

Custom Fabricated

Back With Permanent Lateral Supports, Vinyl Cover, Without Mounting Hardware

SEBCF114L 1 $650.00

Complex Indirect Molded Back, Without Cover And Mounting Hardware

SEBCF118L 1 $1,460.00

Complex Molded Back (Foam In Place), Without Cover And Mounting Hardware

SEBCF117L 1 $1,301.00

Contoured Back (Foam On Rigid Base), Minimal Trunk Support, Vinyl Cover, Without Mounting Hardware

SEBCF112L 1 $500.00

Custom Contoured Back, Moderate Trunk Support, Vinyl Cover, Without Mounting Hardware

SEBCF113L 1 $780.00

Custom Shaped Sculptured Back, Includes Cover, Without Mounting Hardware

SEBCF115L 1 $950.00

Page: 10 of 75




Seating


Qty.

ADP Approved

Amt.

Back Support Custom Fabricated

Flat Back/Planar Design, Vinyl Cover Without Mounting Hardware

SEBCF110L 1 $300.00

Simple Molded Back (Foam In Place), Without Cover And Mounting Hardware

SEBCF116L 1 $939.00

Dynamic Health Care Solutions

Nxt Act Back Cushion Sizes 14' - 21" SEBD30010 1 $575.00

Nxt Pc Back Cushion Sizes 14" - 21" SEBD30015 1 $671.00

Nxt Sc Back Cushion Sizes 14" - 21" SEBD30005 1 $551.00

Future Mobility

Full Back - Sizes From 14" To 22" - Lateral

SEBFM3040 1 $636.00

Full Back - Sizes From 14" To 22" - Ultra Lateral

SEBFM3050 1 $684.00

Full Back - Sizes From 18" To 24" No Lateral

SEBFM3020 1 $588.00

Full Back Style Heaby Duty SEBFM3060 1 $840.00

Low Back - Sizes From 14" To 22" - Lateral

SEBFM3035 1 $560.00

Lunar Back Low Back - Sizes From 16" To 20" - No Lateral

SEBFM3010 1 $500.00

Mid Back - Sizes From 14" To 22" - Lateral

SEBFM3030 1 $616.00

Mid Back - Sizes From 14" To 22" - Ultra Lateral

SEBFM3045 1 $664.00

Mid Back - Sizes From 16" To 20" - No Lateral

SEBFM3015 1 $568.00

Mid Back Style Heavy Duty SEBFM3055 1 $800.00

Orion Back SEBFM3005 1 $464.00

Prism Air Back - Custom Sizes SEBFM0045 1 $860.00

Prism Air Back - Non Standard Sizes SEBFM0040 1 $760.00

Prism Air Back Fits 16,18,20" Wide W/C

SEBFM0035 1 $640.00

Prism Bariatric Air Back 21x16 Though 24x20

SEBFM2025 1 $960.00

Prism Bariatric Air Back- Custom Size SEBFM2030 1 $1,060.00

Prism Bariatric Backs Prism Bariatric Basic Back 21x16 Through 42x20

SEBFM2005 1 $800.00

Prism Bariatric Basic Back - Custom Size

SEBFM2010 1 $860.00

Prism Bariatric Ultra Back 21x16 Through 24x20

SEBFM2015 1 $808.00

Prism Bariatric Ultra Back- Custom Size SEBFM2020 1 $920.00

Prism Basic Back - Custom Sizes SEBFM0015 1 $660.00

Prism Basic Back - Non Standard Sizes SEBFM0010 1 $600.00

Prism Basic Back Fits 16,18,20" Wide W/C

SEBFM0005 1 $492.00

Page: 11 of 75




Seating


Qty.

ADP Approved

Amt.

Back Support Future Mobility

Prism Max Back Prism Max Back - Upcharge

SEBFM0150 1 $100.00

Prism Phantom Back 12-18" Width X 7" Height

SEBFM0070 1 $319.00

Prism Super Back For Kids - Custom Sizes

SEBFM0090 1 $660.00

Prism Super Back For Kids - Non Standard Sizes

SEBFM0085 1 $572.00

Prism Super Back For Kids Fits 10, 12, 14 And 16" Wide W/C

SEBFM0080 1 $500.00

Prism Truefitt Back - Bariatric Sizes SEBFM0060 1 $1,000.00

Prism Truefitt Back - Custom Sizes SEBFM0065 1 $820.00

Prism Truefitt Back - Non Standard Sizes

SEBFM0055 1 $740.00

Prism Truefitt Back Fits 16,18,20" Wide W/C

SEBFM0050 1 $700.00

Prism Ultra Back - Custom Sizes SEBFM0030 1 $808.00

Prism Ultra Back - Non Standard Sizes SEBFM0025 1 $720.00

Prism Ultra Back Fits 16,18,20" Wide W/C

SEBFM0020 1 $620.00

Handicare Backrest "Plush", Deep Or Active Contour

SEBM90020 1 $532.00

Emineo Manual Wheelchair Smartsit Comfort Back - All Sizes

SEBM90100 1 $636.00

Ibis Manual Wheelchair Back Cushion 16x20,18x20

SEBM90005 1 $196.00

Lateral Support Backrest 16x20,18x20 SEBM90010 1 $344.00

Innovators 1993 Inc

Custom Contour Back SEBI30070 1 $320.00

K Special Back-Custom SEBI30020 1 $176.00

K Special Back-Standard SEBI30010 1 $151.00

K-Combo Back SEBI30060 1 $200.00

K-Combo Back Custom SEBI30065 1 $222.00

Key-Hole Back SEBI30030 1 $176.00

Key-Hole Back Custom SEBI30040 1 $196.00

Key-Hole Back Custom Adjustable Top SEBI30045 1 $196.00

Invacare Bariatric Builder Size SEBNS0058 1 $762.00

Contour U Backs Includes All Modifications & Vacuum/Vinyl Upholstery

SEBNS1030 1 $1,340.00

Curved Backs Fits 10" To 20" Wide W/C

SEBNS0030 1 $501.00

Dualflex 10 Max Contour, Fits 14" To 16" Wide W/C

SEBNS4050 1 $769.00

Page: 12 of 75




Seating


Qty.

ADP Approved

Amt.

Back Support Invacare Dualflex 10 Max Contour, Fits 17" To 19" Wide W/C

SEBNS4055 1 $769.00

Dualflex 10 Max Contour, Fits 20" To 22" Wide W/C

SEBNS4060 1 $814.00

Dualflex 10 Mild Contour, Fits 14" To 16" Wide W/C

SEBNS4005 1 $698.00


SEBNS4010 1 $698.00


SEBNS4015 1 $743.00

Dualflex 10 Mixed Contour, Fits 14" To 16" Wide W/C

SEBNS4095 1 $769.00


SEBNS4105 1 $769.00


SEBNS4110 1 $814.00

Dualflex 10 Short Max Contour, Fits 14" To 16" Wide W/C

SEBNS4065 1 $769.00


SEBNS4070 1 $769.00


SEBNS4075 1 $814.00

Dualflex 10 Short Mild Contour, Fits 14" To 16" Wide W/C

SEBNS4020 1 $698.00


SEBNS4025 1 $698.00


SEBNS4030 1 $743.00

Dualflex 10 Short Mixed Contour, Fits 14" To 16" Wide W/C

SEBNS4115 1 $769.00


SEBNS4120 1 $769.00


SEBNS4125 1 $814.00

Dualflex 10 Tall Max Contour, Fits 14" To 16" Wide W/C

SEBNS4080 1 $858.00


SEBNS4085 1 $858.00


SEBNS4090 1 $902.00

Dualflex 10 Tall Mild Contour, Fits 14" To 16" Wide W/C

SEBNS4035 1 $787.00


SEBNS4040 1 $787.00


SEBNS4045 1 $832.00

Page: 13 of 75




Seating


Qty.

ADP Approved

Amt.

Back Support Invacare Dualflex 10 Tall Mixed Contour, Fits 14" To 16" Wide W/C

SEBNS4130 1 $858.00

Dualflex 10 Tall Mixed Contour, Fits 17" To 19" Wide W/C

SEBNS4135 1 $858.00

Dualflex 10 Tall Mixed Contour, Fits 20" To 22" Wide W/C

SEBNS4140 1 $902.00

Naked Contour U Back, Includes All Modifications & Vacuum/Moisture Proof Coating/Removable Cover & Cover Pattern.

SEBNS1035 1 $1,594.00

Personal Back 10 Fits 16", 18", 20" Wide W/C

SEBNS0052 1 $515.00

Plus - Bariatric Builder Size SEBNS0088 1 $894.00

Plus - Fits 16", 18", 20" Wide W/C SEBNS0062 1 $647.00

Pneumatic Fits 10" To 20" Wide W/C SEBNS0040 1 $550.00

Pneumatic Special Size & Modifications SEBNS0045 1 $652.00

Silouette Back Support SEBNS1020 1 $632.00

Special Size SEBNS0057 1 $515.00

Special Size & Modifications SEBNS0035 1 $602.00

Special Size Modular Plus SEBNS0067 1 $647.00

Jay Medical 18"-14" Rigid Mount SEBJA1015 1 $391.00

18"/16" Tall Quick Release Mount SEBJA1012 1 $459.00

20" Tall SEBJA1014 1 $538.00

20-23", 23-26" Back Assembly For 0 To 8 Degree Backposts, With Headrest Mounting Kit

SEBJA0310 1 $1,220.00

Adjustable Aluminum Shell 20" SEBJA3002 1 $742.00

Adjustable Contour Back For 14" Or 16" Frame Width, Various Back Heights

SEBJA4010 1 $380.00

Adjustable Contour Back For 18" Frame Width, Various Back Heights

SEBJA4015 1 $424.00

Custom Contoured Insert 20" SEBJA3055 1 $806.00

Encompass Back Encompass Back SEBJA8200 1 $360.00

Foam Back SEBJA5040 1 $115.00

Focus Point Back Focus Point Back, All Sizes

SEBJA8100 1 $626.00

Includes Mounting Hardware ("K" Or "G" Type), Cover & Lumbar Supports (20")

SEBJA0110 1 $649.00

Includes Mounting Hardware, Cover & Lumbar Supports (12"/13")

SEBJA0105 1 $581.00

Page: 14 of 75




Seating


Qty.

ADP Approved

Amt.

Back Support Jay Medical J2 Back Includes Mounting Hardware ("K" Or "G" Type), Cover & Lumbar Supports (14"-19")

SEBJA0100 1 $581.00

J2 Deep Contour Back 20wx20h, Includes Mounting Hardware, Cover, Lumbar Supports & Lateral Wedges

SEBJA7005 1 $646.00

J2 Deep Contour Back J2 Deep Contour Back 14w-19w, Includes Mounting Hardware, Cover, Lumbar Supports & Lateral Wedges

SEBJA7000 1 $606.00

J2 Plus Back 20-23", 23-26" J2 Back Assembly For 0 Or 8 Degree Backposts

SEBJA0300 1 $1,138.00

J3 Back J3 Lower Thoracic Back, All Sizes

SEBJA0900 1 $440.00

J3 Mid Thoracic Back, All Sizes SEBJA0905 1 $592.00

J3 Shoulder Height Back, All Sizes SEBJA0915 1 $716.00

J3 Upper Thoracic Back, All Sizes SEBJA0910 1 $696.00

Jay 3 Heavy Duty Sizes 12 Height To 26 Width Sizes 15 Height To 26 Width

SEBJA8205 1 $1,220.00

Jay 3 Heavy Duty Sizes 18 Height To 24 Width

SEBJA8210 1 $1,300.00

Jay 3 Heavy Duty Sizes 21 Height To 22 Width

SEBJA8215 1 $1,416.00

Jay Active Back 18"-14" Quick Release Mount

SEBJA1010 1 $422.00

Jay Active Back With Permanent Mount (Large)

SEBJA1019 1 $501.00

Jay Basic Back Jay Basic Back, Fixed Strap Style, All Sizes

SEBJA2020 1 $373.00

Jay Basic Back, Fixed Clamp Style, All Sizes

SEBJA2025 1 $406.00

Jay Care Back 19-20" Plus Width SEBJA5010 1 $611.00

Jay Care Back Foam Large Size SEBJA5045 1 $158.00

Jay Care Back Jay Care Back 15-18" Wide

SEBJA5000 1 $510.00

Jay Care Back Shell Large Size SEBJA5055 1 $327.00

Jay Fit Back Adjustable Contour Back For 10" Or 12" Frame Width, Various Back Heights

SEBJA4005 1 $336.00

Jay Modular Back Adjustable Aluminum Shell (18",16",14")

SEBJA3000 1 $640.00

Jay Modular Back Custom Contoured Insert 18"/16"/14"

SEBJA3050 1 $698.00

Page: 15 of 75




Seating


Qty.

ADP Approved

Amt.

Back Support Jay Medical Jay Precision Back Precision Back SEBJA8005 1 $683.00

Standard Insert 18"/16"/14" SEBJA3005 1 $416.00

Standard Insert 20" SEBJA3010 1 $544.00

Tall Back Includes Mounting Hardware, Cover & Lumbar Supports (14"/16"/17"/18")

SEBJA0120 1 $666.00

Tall Back Includes Mounting Hardware, Cover & Lumbar Supports (20")

SEBJA0130 1 $768.00

Xtreme Xtreme Back Fits 13" To 18" Wide W/C

SEBJA6005 1 $424.00

Kid Kart I-Back Cushion Tlc SEBKT2015 1 $117.00

Xpress T-Back 1" Short, Regular, Or Tall

SEBKT2025 1 $130.00

Xpress T-Back 2.5" Short, Regular, Or Tall

SEBKT2030 1 $130.00

Kids Up Inc Adjustable Height Back System SEBK20060 1 $340.00

Back Cushion - All Sizes SEBK20005 1 $300.00

Xps Adaptive Back Cushion SEBK20050 1 $300.00

Lpa Medical Inc.

Adjustable Tension Back SEBO12010 1 $199.95

Contour Back Cushion SEBO12005 1 $108.00

Maple Leaf Power Plus

Contour Padded Personal Back SEBWM0005 1 $288.00

Deep U Back Custom Sizes SEBWM0015 1 $720.00

Deep U Deep U Back Standard Sizes SEBWM0010 1 $608.00

Kyphotic Tension Kyphotic Tension Back Rest - Shallow Or Deep U

SEBWM0030 1 $832.00

Mid U Back Mid U Back Standard Sizes SEBWM0027 1 $700.00

Shallow U Back Custom Sizes SEBWM0025 1 $608.00

Shallow U Shallow U Back Standard Sizes

SEBWM0020 1 $544.00

Shape U Back Shape U Back Standard Sizes

SEBWM0026 1 $820.00

Upcharge For Custom Height SEBWM0040 1 $176.00

Upcharge For Custom Width SEBWM0035 1 $176.00

Matrx Seating All Sizes Pb Elite Deep Back SEB1M0026 1 $716.00

Deep Heavy Duty Posture Back, All Sizes

SEB1M0020 1 $1,069.00

Deep Posture Back, All Sizes SEB1M0015 1 $789.00

Extra Wide Deep Heavy Duty Backs From 16 To 20 Inches

SEB1M0040 1 $1,437.00

Genera Back Genera Back SEB1M0050 1 $443.00

Heavy Duty Posture Back Fits W/C 20"-25" Width & 16"-20" Height

SEB1M0010 1 $929.00

Page: 16 of 75




Seating


Qty.

ADP Approved

Amt.

Back Support Matrx Seating Matrx High Back High Back Fits W/C 16" - 21" Width & 20" - 30" Height

SEB1M1005 1 $649.00

Matrx Posture Backs Extra Wide Heavy Duty Backs Sizes 16 To 20 Inches

SEB1M0035 1 $1,314.00

Matrxpb Posture Backs Posture Back Fits W/C 13"-20" Width & 12"-20"Height

SEB1M0005 1 $649.00

Posture Back Elite Ls, All Sizes SEB1M0030 1 $677.00

Posture Back Elite, Posture Back Elite Full Back, All Sizes

SEB1M0025 1 $677.00

Trx Rehab Back Rehab Back, Fits W/C 18" - 25" Width

SEB1M1050 1 $236.00

Motion Concepts

Trx Contour Back, For Trx Systems, 16, 18, 22" Wide Wheelchairs, Height Adjustable 18-26"

SEBZG0005 1 $275.00

Trx Onyx Contour Back & Trx Single Post Cloth Contour Back, For Trx Systems

SEBZG0020 1 $369.00

Trx Single Post Onyx Contour Back For Trx Systems

SEBZG0025 1 $369.00

Nighthawk Key-Hole Back SEBNM0050 1 $228.00

Relaxed Back High SEBNM0010 1 $184.00

Relaxed Back High With Flap SEBNM0020 1 $195.00

Relaxed Back Low SEBNM0005 1 $184.00

Relaxed Back Low With Flap SEBNM0015 1 $195.00

Orthofab "G" Back Mild Contour 14-20" Width & 16,18,20" Height

SEBOF1025 1 $520.00

"G" Mild Contour Non Standard Sizes & Options

SEBOF1030 1 $576.00

"K" For Kyphosis Deep Contour 15-18" Width & 16,18" Height

SEBOF1015 1 $520.00

"K" For Kyphosis Deep Contour Non Standard Sizes & Options

SEBOF1020 1 $400.00

Apex Backs Modular Mild Or Deep Contour 14-20" Width & 16,18,20" Height

SEBOF1005 1 $520.00

Harmoni Backs High Profile Contoured 14-20"Width, 16-20" Height

SEBOF2005 1 $426.00

High Profile Contoured Non Standard Sizes

SEBOF2010 1 $472.00

High Profile Tall Contoured 14-20" Width, 18-22" Height

SEBOF2015 1 $400.00

High Profile Tall Contoured Non Standard Sizes & Options

SEBOF2020 1 $472.00

Low Profile Contoured 14-20" Width, 16-20" Height

SEBOF2025 1 $400.00

Page: 17 of 75




Seating


Qty.

ADP Approved

Amt.

Back Support Orthofab Low Profile Contoured Non Standard Sizes

SEBOF2030 1 $472.00

Modular Mild Or Deep Contour Non Standard Sizes

SEBOF1010 1 $576.00

Otto Bock Back System 2, 15" To 17" & 18" To 20"

SEBOB9600 1 $508.00

Back System 3, 15" To 17" & 18" To 20"

SEBOB9605 1 $606.00

Back System 4, 15" - 20" Sizes SEBOB9610 1 $793.00

Back-Itemized Cushion (Unfinished) SEBOB9655 1 $1,453.00

Procontour Backs Back System 1, 15" To 17" & 18" To 20"

SEBOB9555 1 $397.00

Procontour Custom (Obss) Back-Finished With Spray Coating,Cover,Sewing Pattern

SEBOB9650 1 $1,983.00

Performance Health Products

V-Trak Ax-Sb Back Support Connisting Of 1 Insert, All Sizes

SEBP00015 1 $644.00

V-Trak Ax-Sb Back Support Consisting Of 2 Inserts, All Sizes

SEBP00020 1 $1,016.00

V-Trak Ax-Sb Back Support Consisting Of 3 Inserts, All Sizes

SEBP00025 1 $1,336.00

V-Trak Axh Back Support, All Sizes SEBP00010 1 $872.00

V-Trak Axs Back Support, All Sizes SEBP00005 1 $780.00

Permobil Ergo Back - Fixed - All Sizes SEB1P0005 1 $802.00

Ergo Back - Recline - All Sizes SEB1P0010 1 $802.00

Rectangular Back - All Sizes SEB1P0015 1 $1,220.00

Precision Rehab Manufacturing

Back Sewn Cover Waterproof Foam, Includes Labour For Digitizing Or Plastering

SEBWB0010 1 $1,711.00

Back Vacuum Formed, Includes Labour For Digitizing Or Plastering

SEBWB0005 1 $1,439.00

Base Cushion Back, Includes All Modifications & Labour For Digitizing Or Plastering

SEBWB0015 1 $2,079.00

Precision - Fit Back Cushion Upcharge, Extra Wide Or Extra Tall, 20" - 24"

SEBWB0022 1 $240.00

Precision - Fit Back Cushion, Subtle, Moderate Or Aggresive Positioning. Includes Hinged Or Fixed Laterals And Cover.

SEBWB0020 1 $1,078.00

Pride Mobility Products

Sizes 20x19 And 22x19 SEBX10050 1 $435.00

Standard, Reclining Or Tilt And Recline Back Greater Than 20" Wide

SEBX10025 1 $600.00

Synergy Shape 2 Back - Standard SEBX10035 1 $575.00

Page: 18 of 75




Seating


Qty.

ADP Approved

Amt.

Back Support Pride Mobility Products

Synergy Shape 2 Back - Tall SEBX10040 1 $594.00

Synergy Shape 2 Back Synergy Shape 2 Back - Low

SEBX10030 1 $522.00

Synergy Shape Back Sizes 16x19, 18x19, 20x19

SEBX10010 1 $639.00

Synergy Shape Back Synergy Shape Back Sizes 14x19 & 22x19

SEBX10005 1 $639.00

Synergy Shape Deep Backs Synergy Shape Deep Standard Sizes

SEBX10055 1 $660.00

Synergy Shape Deep Tall Sizes SEBX10060 1 $680.00

Synergy Shape Gp Sizes 14x19 16x19 18x19

SEBX10045 1 $396.00

Synergy Tru Comfort Back Standard, Reclining Or Tilt And Recline Back Up To 20" Wide

SEBX10020 1 $556.00

Quickie Contour Back - Tilt Fx SEBQU0400 1 $416.00

Ride Designs Corbac Adjustable Contour Back Support, All Sizes

SEBR40005 1 $392.00

Custom Back Support Ride Custom Back Support

SEBR40010 1 $2,613.00

Roho Jetstream Pro Back System Standard Back (16" Height) All Standard Sizes 14" - 18"

SEBRO3005 1 $1,495.00

Low Back (10" Height) All Standard Sizes 14" - 18"

SEBRO3010 1 $1,195.00

Lumbar Support Cushion (Made To Order)

SEBRO2015 1 $395.00

Recliner Wheelchair Cushion-Custom (More Than 2 Sections And/Or 2 Halves)

SEBRO2010 1 $1,400.00

Special Application Cushions Recliner Wheelchair Cushion Made To Order (One Piece Back & Seat- 2 Sections,2 Valves)

SEBRO2005 1 $1,200.00

Starkey - Viennatone

Back Butterfly Back System SEBV10005 1 $340.00

Supracor Stimulite Lumbar Support SEBRR0010 1 $127.00

The Comfort Company

Acta-Back, All Variations, All Sizes SEB7C0010 1 $754.00

Acta-Back, All Variations, Custom Sizes SEB7C0015 1 $1,339.00

Incrediback, Modable, Tall, Deep, Tall-Deep, Custom Sizes

SEB7C0025 1 $1,520.00

Incrediback, Moldable, Tall, Deep, Tall-Deep, All Sizes

SEB7C0020 1 $747.00

Page: 19 of 75




Seating


Qty.

ADP Approved

Amt.

Back Support Toronto Orthopedic Ltd.

Tops Back Cushion (10" & 12" Width) SEBTP0005 1 $246.00

Varilite Medical Products

E Back - Regular SEBVP0090 1 $555.00

E Back - Regular Bariatric SEBVP0092 1 $737.00

E Back - Tall SEBVP0095 1 $583.00

Evolution Back - Regular SEBVP0050 1 $781.00

Evolution Back - Regular Bariatric SEBVP0055 1 $1,092.00

Evolution Back - Tall SEBVP0060 1 $865.00

Evolution Deep Back - All Sizes SEBVP0070 1 $1,134.00

Icon Back - Bariatric SEBVP0120 1 $1,119.00

Icon Back - Deep SEBVP0115 1 $1,025.00

Icon Back - Low SEBVP0100 1 $717.00

Icon Back - Tall SEBVP1110 1 $839.00

Icon Back -Mid SEBVP0105 1 $746.00

Talon Back - All Sizes SEBVP0080 1 $555.00

Vicair Academy Back System SEBV10010 1 $929.00

Vision Wheelchair Seating Systems Inc.

Virtuoso Contoured Positioning Back For 16" Or 18" W/C

SEBVC0005 1 $491.00

Virtuoso Contoured Positioning Back, Custom

SEBVC0010 1 $639.00

Viscount Tall Back Support For 16' Or 18" W/C

SEBVC0030 1 $1,201.00

Viscount Tall Back Support, Custom Sizes

SEBVC0035 1 $1,517.00

Viva Contoured Postural Back 14"-16" W/C Or 16"-18" W/C

SEBVC0015 1 $229.00

Viva Contoured Postural Back, Custom SEBVC0020 1 $311.00

Complete Assembly Adaptive Engineering Lab

Contoured Seat System (Includes Seat, Back, Support Pads, Hardware)

SECE10020 1 $1,225.00


Basis Contoured Seat & Back Including Connecting Hinge (Select Type). Does Not Include Mounting Hardware.

SEC2L0010 1 $860.00

Basis Contoured Seat & Back Including Connecting Hinge Package. Li'L Kiddos,14" Wide Or Less. Does Not Include Mounting Hardware.

SEC2L0020 1 $1,040.00

Basis Seat & Back Including Connecting Hinge (Select Type). Does Not Include Mounting Hardware.

SEC2L0005 1 $592.00

Page: 20 of 75




Seating


Qty.

ADP Approved

Amt.

Complete Assembly Adaptive Equipment Systems (Aes)

Basis Seat & Back Including Connecting Hinge Package. Li'L Kiddos,14" Wide Or Less. Does Not Include Mounting Hardware.

SEC2L0015 1 $690.00

Amysystems Bariatric Bariatric 45 Cg Power Tilt SEC4P0060 1 $7,462.00

Cg Power Tilt And Power Recline With Integrated Shear Reduction (Isr)

SEC4P0070 1 $12,128.00

Power Recline With Integrated Shear Reduction (Isr)

SEC4P0065 1 $8,115.00

Broda Hsp Padding Package (Includes Short Wing Cover, Extended Shoulder Bolsters, Full Extension Foot Pad, F-2 Foot Rest, Thigh Belt)

SECB-0005 1 $563.00

Convaid Mountee Seating System SECCO0020 1 $497.00

Custom Fabricated

Complete Seating Systems Modify Or Refurbish Existing Custom Seating System. Includes Parts,Hardware,Labour Changes To Head Rest,Back Support,Seat, & Footrest Etc.

SEMCF900L 1 $500.00

Invacare Kinesthetic Seating System Fits 16" To 20" Wide W/C, (Includes Basic Headrest, Lateral Supports, Padded Lap Belt, Ulti-Mate Base & Curved Back)

SECNS0010 1 $1,311.00

Kinesthetic Seating System Kinesthetic Seating System Fits 10" To 14" Wide W/C, (Includes Basic Headrest, Lateral Supports, Padded Lap Belt, Ulti-Mate Base, Curved Back & Growth Bracket)

SECNS0005 1 $1,311.00

Kid Kart Tlc Shell Assembly With Contour Seating

SECKT2010 1 $1,148.00

Tlc Shell Assembly With Planar Seating SECKT2005 1 $916.00

Xpress Adjustable Contour Seating Package

SECKT3005 1 $896.00

Xpress Shell Assembly With Contour Seating

SECKT3015 1 $896.00

Xpress Shell Assembly With Planar Seating

SECKT3010 1 $643.00

Kids Up Inc Bingo Ius Or Xps Seat Frame Size 1 SECK20005 1 $1,568.00

Bingo Ius Or Xps Seat Frame Size 2 SECK20010 1 $1,592.00

Ius Adaptive Seat And Back Cushions With Airflex

SECK20105 1 $704.00

Ius Adaptive Seat And Back Cushions - Breathable

SECK20100 1 $260.00

Page: 21 of 75




Seating


Qty.

ADP Approved

Amt.

Complete Assembly Motion Concepts

Trx Single Pivot Systems, Sp, Super Low Power Tilt Only For Invacare, Quantum, And Quickie Bases.

SECZG2005 1 $5,250.00

Otto Bock Kimba Spring Multifunctional Seating Unit - Size 1 Includes Elevating Legrests, Flip-Up Footrest, Laterals, Adjustable Hip Pads & Padding.

SECOB3005 1 $1,516.00

Kimba Spring Multifunctional Seating Unit - Size 2 Includes Elevating Legrests, Flip-Up Footrest, Laterals, Adjustable Hip Pads & Padding.

SECOB3010 1 $1,596.00

Kimba Spring Plus Adjustable Seating System - Size 1 Includes Armrests, Elevating Legrests, Adjustable Footplates & Recline.

SECOB4005 1 $1,456.00

Kimba Spring Plus Adjustable Seating System - Size 2 Includes Armrests, Elevating Legrests, Adjustable Footplates & Recline.

SECOB4010 1 $1,640.00

Mygo Seat Shell Size 1 Includes Seat Shell And Cushions

SECOB4015 1 $1,808.00

Mygo Seat Shell Size 2 Includes Seat Shell Cushions And Shoulder Support

SECOB4020 1 $2,079.00

Squiggles Seat Shell Includes Seat Shell And Cushions

SECOB4025 1 $1,712.00

Spenco Silicore Chair Seat With Back SECSO0010 1 $122.00

Toronto Orthopedic Ltd.

Tops Seating System Includes Butterfly Chest Strap, Combination Head/Neckrest Tilt Tray, Stroller Interface, Back And Seat

SECTP0005 1 $1,562.00

Headrest/Neckrest Adaptive Engineering Lab

Curved Headrest SEHE10015 1 $102.00

Tri-Pad Headrest SEHE10005 1 $315.00


Curved Hr Pad Or Contoured Hr Pad Or Bell Curved Hr Pad, Cobra Headrest Bracket, Flip-Down.

SEH2L0035 1 $527.00

Curved Hr Pad Or Contoured Hr Pad Or Bell Curved Hr Pad, Cobra Headrest Bracket.

SEH2L0030 1 $442.00

Lateral-Posterior Head Support, Adjustable Depth Bracket, 6-1/2"W X 7"H.

SEH2L0015 1 $412.00

Lateral-Posterior Head Support, Adjustable Depth Bracket, Hinged.

SEH2L0005 1 $450.00

Page: 22 of 75




Seating


Qty.

ADP Approved

Amt.

Headrest/Neckrest Adaptive Equipment Systems (Aes)

Lateral-Posterior Head Support, Adjustable Depth Bracket, Paediatric 4" X 4" Or 5"X 5" Or 6"X 6".

SEH2L0010 1 $391.00

Lateral-Posterior Head Support, Cobra Headrest Bracket, 5" X 5"Or 6" X 6" Or 7" X 7"Or 8" X 8".

SEH2L0020 1 $538.00

Lateral-Posterior Head Support, Cobra Style Headrest Bracket, Flip-Down 5" X 5"Or 6"X6" Or 7"X7" Or 8" X8".

SEH2L0025 1 $622.00

Advanced Mobility

Custom Headrest SEHAO0015 1 $200.00

Deep "U" Headrest SEHAO0020 1 $156.00

Large Padded Headrest SEHAO0025 1 $116.00

Macintosh Oxbow Headrest SEHAO0010 1 $200.00

So Soft Oval Headrest SEHAO0030 1 $156.00

Standard Curved Padded Headrest SEHAO0005 1 $116.00

Amysystems Curved Headrest, All Sizes SEH4P0010 1 $187.00

Broda Neckrest Cushion SEHB-0010 1 $47.00

Convaid Mountee Cushioned Headrest Support SEHCO0020 1 $633.00

Custom Fabricated

Adjustable Headrest With Neckrest, Vinyl Cover, Without Hardware

SEHCF080L 1 $420.00

Complex Headrest/Contoured Or Molded, Vinyl Cover, Without Hardware

SEHCF060L 1 $310.00

Contoured Headrest/Curved Surface, Vinyl Cover, Without Hardware

SEHCF050L 1 $200.00

Flat Headrest/Planar Head Support, Vinyl Cover, Without Hardware

SEHCF040L 1 $125.00

Head Or Neckrest Incorporated With Mobility Switches, Vinyl Cover, Without Hardware

SEHCF090L 1 $310.00

Neckrest With Vinyl Cover, Without Hardware

SEHCF070L 1 $190.00

Daher Specialty Foam Products

Combination Headrest SEHDH0010 1 $58.00

Full Support Headrest SEHDH0015 1 $77.00

Large Headrest SEHDH0005 1 $58.00

Danmar Products Inc.

Large Mounted Hensinger SEHDM0300 1 $225.00

Medium Hensinger With High Back SEHDM1550 1 $203.00

Medium Mounted Hensinger SEHDM0250 1 $212.00

Medium Unmounted Hensinger SEHDM0050 1 $173.00

Small Unmounted Hensinger SEHDM0010 1 $160.00

Page: 23 of 75




Seating


Qty.

ADP Approved

Amt.

Headrest/Neckrest Future Mobility

Large Headrest With Multi-Axial Hardware

SEHFM0015 1 $284.00

Large Padded Headrest SEHFM0005 1 $220.00

Small Headrest With Multi-Axial Hardware

SEHFM0020 1 $280.00

Small Padded Headrest SEHFM0010 1 $216.00

Handicare Emineo Advanced Headrest SEHM90105 1 $360.00

Emineo Manual Wheelchair Emineo Basic Headrest

SEHM90100 1 $236.00

Ibis Manual Wheelchair Small Headrest Assesmbly

SEHM90005 1 $132.00

Large Headrest SEHM90015 1 $148.00

Lateral Support Headrest SEHM90010 1 $140.00

Offset Headrest Large SEHM90030 1 $212.00

Offset Headrest Lateral SEHM90025 1 $204.00

Offset Headrest Small SEHM90020 1 $196.00

Invacare Basic Headrest - Adult SEHNS1010 1 $221.00

Comfort Plus Headrest Systems Comfort Plus, Large 14" Pad/Standard Hardware

SEHNS3005 1 $280.00

Comfort Plus, Large 14" Pad /Multi Axis Hardware

SEHNS3020 1 $338.00

Comfort Plus, Medium 10" Pad/Multi Axis Hardware

SEHNS3030 1 $338.00

Comfort Plus, Medium 10" Pad/Standard Hardware

SEHNS3010 1 $280.00

Comfort Plus, Swingaway Both Sides, Standard Lateral Pad/Spot Pad/Long Lateral Pad

SEHNS3060 1 $494.00

Comfort Plus, Swingaway Left Side, Standard Lateral Pad/Spot Pad/Long Lateral Pad

SEHNS3070 1 $375.00

Comfort Plus, Swingaway R1ght Side, Standard Lateral Pad/Spot Pad/Long Lateral Pad

SEHNS3065 1 $375.00

Curved Adjustable Headrest System SEHNS1030 1 $329.00

Large 14" Comfort Pad Only (With Ring)

SEHNS3015 1 $165.00

Large Adjustable Headrest System SEHNS1020 1 $354.00

Large Combo With Large Sub Occipital SEHNS2007 1 $1,026.00

Medium 10" Comfort Pad Only (With Ring)

SEHNS3025 1 $165.00

Otto Bock Style, Swing Away Both Sides, Standard Lateral Pad/Spot Pad/Long Lateral Pad

SEHNS3075 1 $557.00

Page: 24 of 75




Seating


Qty.

ADP Approved

Amt.

Headrest/Neckrest Invacare Otto Bock Style, Swingaway Left Side, Standard Lateral Pad/Spot Pad/Long Lateral Pad

SEHNS3085 1 $426.00

Otto Bock Style, Swingaway Right Side, Standard Lateral Pad/Spot Pad/Long Lateral Pad

SEHNS3080 1 $426.00

Pindot Headrests Basic Headrest - Child

SEHNS1005 1 $221.00

Small Adjustable Headrest System SEHNS1015 1 $354.00

Small Combo With Large Sub Occipital SEHNS2009 1 $1,026.00

Stealth Combo Headrest With Multi Axis Hardware, Large & Small Sizes

SEHNS2050 1 $536.00

Stealth I2i Headrest System - All Sizes SEHNS2060 1 $822.00

Stealth Ultra Channel With Ring, Large & Small Sizes

SEHNS2020 1 $647.00

Stealth Ultra Headrest Systems Stealth Occipital/Sub Occipital & Laterals, Adult & Paediatric Sizes (Specify Swingaway)

SEHNS2005 1 $1,133.00

Stealth Ultra Occipital & Laterals, Small & Large Sizes (Specify Swingaway)

SEHNS2015 1 $803.00

Stealth Ultra Occipital Large/Small SEHNS2030 1 $330.00

Stealth Ultra Small & Occipital/Sub Occipital

SEHNS2010 1 $659.00

Stealth Ultra Sub Occipital Large/Small SEHNS2025 1 $330.00

Stealth Ultra Swing Both Sides, Standard Lateral Pad/Spot Pad/Long Lateral Pad

SEHNS2035 1 $474.00

Stealth Ultra Swingaway Standard & Long Lateral Pad, Or Spot Pad

SEHNS2045 2 $375.00

Stealth Ultra-Ac Adjustable Channel SEHNS2040 1 $313.00

Two Step Adjustable Headrest System SEHNS1025 1 $329.00

Jay Medical Four Pad Headrest - Junior SEHJA0016 1 $294.00

Four Pad Rotational Headrest - Junior SEHJA0018 1 $440.00

Four Pad Rotational Headrest - Standard

SEHJA0017 1 $440.00

Full Width Headrest SEHJA0020 1 $147.00

Jay Fit Single Pad Headrest - Small SEHJA0005 1 $84.00

Single Pad Headrest - Large SEHJA0006 1 $84.00

Three Pad Headrest - Large SEHJA0011 1 $210.00

Three Pad Headrest - Large Junior SEHJA0013 1 $210.00

Three Pad Headrest - Small SEHJA0010 1 $210.00

Page: 25 of 75




Seating


Qty.

ADP Approved

Amt.

Headrest/Neckrest Jay Medical Three Pad Headrest - Small Junior SEHJA0012 1 $210.00

Three Pad Rotational Headrest - Large SEHJA0027 1 $352.00

Three Pad Rotational Headrest - Large Junior

SEHJA0029 1 $352.00

Three Pad Rotational Headrest - Small SEHJA0026 1 $352.00

Three Pad Rotational Headrest - Small Junior

SEHJA0028 1 $352.00

Kid Kart Xpress Micro Adjustable Head Support SEHKT3010 1 $245.00

Xpress Planar Head Support SEHKT3015 1 $160.00

Xpress Tri-Wing Adjustable Head Support

SEHKT3005 1 $124.00

Kids Up Inc Ius Headrest SEHK20005 1 $288.00

Lpa Medical Inc.

Cervical Support SEHO12005 1 $42.00

Contour Headrest SEHO12010 1 $100.00


Contour Headrest Including Brackets SEHWM0005 1 $256.00

Metalcraft Industries

Contoured Headrest With Mounting Hardware Small, Large, Xlarge

SEHNG0005 1 $301.00

Occipital Ring With Mounting Hardware Small & Large Child Or Adult

SEHNG0015 1 $345.00

Occipital Ring, Add-On, With Mounting Hardware Small & Large Child Or Adult

SEHNG0020 1 $301.00

Motion Concepts

Onyx Auto Style Headrest SEHZG0005 1 $187.00

Orthofab Padded Contour Support Without Mounting Hardware, Small, Medium, Or Large

SEHOF1005 1 $106.00

Otto Bock Adjustable Wing Headrest (Size 1 & 2) SEHOB6020 1 $562.00

Fixed Wing Headrest (Size 1 & 2) SEHOB6015 1 $396.00

Headrest - Large/Small SEHOB0100 1 $84.00

Headrest - Lateral Control SEHOB0050 1 $136.00

Headrest Headrest - Combination SEHOB0010 1 $83.00

Kimba Spring Headrests Headrest Support (Size 1 & 2)

SEHOB6005 1 $286.00

Kimba Spring Plus Headrests Contoured Headrest (Size 1 & 2)

SEHOB6010 1 $160.00

Neckrest - All Sizes SEHOB0250 1 $95.00

Soft Headrest - Large/Small SEHOB0110 1 $120.00

X-Style Headrest/Neckrest Combination, Adult & Paediatric Sizes.

SEHOB0015 1 $125.00

Page: 26 of 75




Seating


Qty.

ADP Approved

Amt.

Headrest/Neckrest Performance Health Products

V-Trak Headrest, All Sizes, All Configurations

SEHP00005 1 $360.00

Permobil Headrest - For Ergo Back SEH1P0005 1 $470.00


Headreast - Large (14") Or Small (10") Pad

SEHWB0010 1 $120.00

The Comfort Company

Headrest - Moldable, Includes Cover SEH7C0015 1 $218.00


Vector Head N Neck Support, 11"W X 8"D Pad

SEHVC0005 1 $232.00

Vector Head N Neck Support, Custom Pad

SEHVC0010 1 $328.00

Whitmyer Biomechanix

10" Plush Occipital Pad & Single Sub-Occipital Pad With Onyx Vertical/Horizontal Mount

SEHWH7020 1 $393.00

10" Plush Occipital Pad & Single Sub-Occipital Pad With Pro Verticial/Horizontal Mount

SEHWH7035 1 $430.00

14" Plush Pad With Linx Vertical/Horizontal Mount

SEHWH5010 1 $228.00

14" Plush Pad With Onyx Vertical/Horizontal Mount

SEHWH5030 1 $228.00

14" Plush Pad With Pro Vertical/Horizontal Mount

SEHWH5040 1 $244.00

19" Plush Pad With Link Vertical/Horizontal Mount

SEHWH5015 1 $334.00

19" Plush Pad With Onyx Vertical/Horizontal Mount

SEHWH5032 1 $302.00

19" Plush Pad With Pro Vertical/Horizontal Mount

SEHWH5045 1 $339.00

4"X6" Occipital Pad & Single Sub-Occipital Pad With Onyx Vertical/Horizontal Mount

SEHWH7025 1 $334.00

4"X6" Occipital Pad & Single Sub-Occipital Pad With Pro Vertical/Horizontal Mount

SEHWH7040 1 $371.00

4"X6"Occipital Pad & Single Sub-Occipital Pad With Lynx Vertical/Horizontal Mount

SEHWH7010 1 $366.00

4"X6"Occipital Pad With Size 1/2 Sub-Occipital Pads With Onyx Vertical/Horizontal Mount

SEHWH7065 1 $344.00

4"X6"Occipital Pad With Size 1/2 Sub-Occipital Pads With Pro Vertical/Horizontal Mount

SEHWH7080 1 $482.00

8" Or 10" Plush Pad With Lightweight Vertical/Horizontal Mount

SEHWH5020 1 $218.00

Page: 27 of 75




Seating


Qty.

ADP Approved

Amt.

Headrest/Neckrest Whitmyer Biomechanix

8" Or 10" Plush Pad With Onyx Vertical/Horizontal Mount

SEHWH5025 1 $218.00

8" Or 10" Plush Pad With Pro Vertical/Horizontal Mount

SEHWH5035 1 $234.00

8"/10" Plush Occipital Pad With Size 1 Sub-Occipital Pads With Pro Vertical/Horizontal Mount

SEHWH7085 1 $541.00

8"/10" Plush Occipital Pad With Size 1sub-Occipital Pads With Lynx Vertical/Horizontal Mount

SEHWH7055 1 $498.00

8"/10" Plush Occipital Pad With Size 1sub-Occipital Pads With Onyx Vertical/Horizontal Mount

SEHWH7070 1 $525.00

Adjust-A-Plush Headrest System SEHWH7260 1 $272.00

Bilateral Lfc With Pads And Interface Plate For Plush & Contoured Cradle Systems

SEHWH7235 1 $461.00

Contoured Cradle Single Pad Headrest Systems Small Pad With Linx Vertical/Horizontal Mount

SEHWH5050 1 $143.00

Large Pad With Lightweight Vertical/Horizontal Mount

SEHWH5075 1 $165.00

Large Pad With Linx Vertical/Horizontal Mount

SEHWH5060 1 $165.00

Large Pad With Onyx Vertical/Horizontal Mount

SEHWH5090 1 $212.00

Large Pad With Pro Vertical/Horizontal Mount

SEHWH5110 1 $228.00

Medium Pad With Lightweight Vertical/Horizontal Mount

SEHWH5070 1 $154.00

Medium Pad With Lightweight Vertical/Horizontal Mount

SEHWH5085 1 $202.00

Medium Pad With Linx Vertical/Horizontal Mount

SEHWH5055 1 $154.00

Medium Pad With Pro Vertical/Horizontal Mount

SEHWH5105 1 $175.00

Occipital Pad With Size 3/4 Sub-Occipital Pads 1"X4",4"X6",1"X4" With Onyx Vertical/Horizontal Mount

SEHWH7115 1 $456.00

Occipital Pad With Size 3/4 Sub-Occipital Pads 1"X4",4"X6",1"X4" With Pro Vertical/Horizontal Mount

SEHWH7125 1 $482.00

Plush Headrest Systems 8" Or 10" Plush Pad With Linx Vertical/Horizontal Mount

SEHWH5005 1 $218.00

Page: 28 of 75




Seating


Qty.

ADP Approved

Amt.


Plush Lateral Facial Support Options Unilateral Lfc With Pads And Interface Plate For Plush & Contoured Cradle Systems

SEHWH7230 1 $250.00

S.O.F.T. Adult Head Support Sysytems 4"X6"Occipital Pad With Size 1/2 Sub-Occipital Pads With Lynx Vertical/Horizontal Mount

SEHWH7050 1 $440.00

S.O.F.T. Head Support Systems 10" Plush Occipital Pad & Single Sub-Occipital Pad With Linx Vertical/Horizontal Mount

SEHWH7005 1 $419.00

S.O.F.T. Lateral Facial Support Options Lateral Facial Component With Pad

SEHWH7250 2 $212.00

S.O.F.T. Paediatric Head Support Systems Occipital Pad With Size 3/4 Sub-Occipital Pads 1"X4",4"X6",1"X4" With Lynx Vertical/Horizontal Mount

SEHWH7105 1 $440.00

Single Pad Anterior Support Options Single Pad Dynamic Forehead Strap System All Sizes

SEHWH7200 1 $292.00

Single Pad Static Forehead Strap System All Sizes

SEHWH7205 1 $308.00

Small Pad With Lightweight Vertical/Horizontal Mount

SEHWH5065 1 $143.00

Small Pad With Onyx Vertical/Horizontal Mount

SEHWH5080 1 $191.00

Small Pad With Pro Vertical/Horizontal Mount

SEHWH5095 1 $165.00

T-Bar Occipital Pads & Single Sub-Occipital Pad 2.25"X7" & 2.25"X5" With Linx Vertical/Horizontal Mount

SEHWH7015 1 $652.00

T-Bar Occipital Pads & Single Sub-Occipital Pad 2.25"X7" & 2.25"X5" With Onyx Vertical/Horizontal Mount

SEHWH7030 1 $620.00

T-Bar Occipital Pads & Single Sub-Occipital Pad 2.25"X7" & 2.25"X5" With Pro Vertical/Horizontal Mount

SEHWH7045 1 $663.00

T-Bar Occipital Pads With Size 1 Sub-Occipital Pads 2.25"X7" With Pro Vertical/Horizontal Mount

SEHWH7090 1 $737.00

T-Bar Occipital Pads With Size 1sub-Occipital Pads 2.25"X7" With Linx Vertical/Horizontal Mount

SEHWH7060 1 $694.00

Page: 29 of 75




Seating


Qty.

ADP Approved

Amt.


T-Bar Occipital Pads With Size 1sub-Occipital Pads 2.25"X7" With Onyx Vertical/Horizontal Mount

SEHWH7075 1 $710.00

T-Bar Occipital Pads With Size 3 Single Sub-Occipital Pads 2.25"X5" With Linx Vertical/Horizontal Mount

SEHWH7110 1 $694.00

T-Bar Occipital Pads With Size 3 Single Sub-Occipital Pads 2.25"X5" With Onyx Vertical/Horizontal Mount

SEHWH7120 1 $710.00

T-Bar Occipital Pads With Size 3 Single Sub-Occipital Pads 2.25"X5" With Pro Vertical/Horizontal Mount

SEHWH7130 1 $737.00

Seat Cushion Action Products

Centurian Cushion 16x16,16x81,18x16,18x18

SESAN2205 1 $265.00

Centurian Cushion 18x20,20x18,20x20 SESAN2210 1 $468.00

Centurian Cushion Large Custom Sizes SESAN2225 1 $491.00

Centurian Cushion Small Custom Sizes SESAN2215 1 $402.00

Centurian Cushion Xlarge Custom Sizes

SESAN2230 1 $612.00

Commuter Cushion 16x16,16x18,18x16,18x18

SESAN4405 1 $240.00

Commuter Cushion 18x20,20x18,20x20 SESAN4410 1 $468.00

Commuter Cushion Large Custom Sizes

SESAN4425 1 $459.00

Commuter Cushion Medium Custom Sizes

SESAN4420 1 $407.00

Commuter Cushion Small Sizes SESAN4415 1 $370.00

Pilot Cushion 16x16,16x18,18x16,18x18

SESAN3305 1 $310.00

Pilot Cushion 18x20,20x18,20x20 SESAN3310 1 $431.00

Pilot Cushion Large Custom Sizes SESAN3325 1 $558.00

Pilot Cushion Medium Custom Sizes SESAN3320 1 $482.00

Pilot Cushion Small Custom Sizes SESAN3315 1 $418.00

Pilot Cushion Xlarge Sizes SESAN3330 1 $647.00

Pilot Cushion Xxxlarge Custom Sizes SESAN3340 1 $916.00

Professional Cushion 16x16,16x18,18x16,18x18

SESAN1105 1 $310.00

Professional Cushion 18x20,20x18,20x20

SESAN1115 1 $665.00

Professional Cushion Large Custom Sizes

SESAN1130 1 $698.00

Page: 30 of 75




Seating


Qty.

ADP Approved

Amt.

Seat Cushion Action Products

Professional Cushion Medium Custom Sizes

SESAN1125 1 $597.00

Shear Smart Pad 16x16,16x18,18x16,18x18

SESAN5505 1 $210.00

Shear Smart Pad 18x20, 20x18, 20x20 SESAN5510 1 $250.00

Xact Classic Cushion 10x10,16x14,17x17,16x20,18x20,20x20

SESAN9905 1 $695.00

Xact Classic Cushion 16x16,16x18,18x16,18x18

SESAN9910 1 $595.00

Xact Individual Cushion All Custom Sizes

SESAN9915 1 $1,195.00

Xact Individual Cushion Custom Sizes SESAN9920 1 $1,195.00

Xact Integrated Cushion With Drop Seat 16x20,18x20, 20x20

SESAN9010 1 $750.00

Xact Integrated Drop Base Sizes 10x10 To 18x18

SESAN9005 1 $695.00

Xact Lite Cushion 16x16 - 18x18 SESAN9015 1 $425.00

Xact Lite Cushion 18x20 - 20x20 SESAN9020 1 $450.00

Xact Soft Foam Cushion 16x16, 16x18, 18x16, 18x18

SESAN9980 1 $595.00

Xact Soft Foam Cushion 16x20,18x20, 20x16, 20x18, 20x20

SESAN9985 1 $750.00

Xact Soft Foam Cushion With Integrated Drop Seat, All Sizes

SESAN9990 1 $750.00

Adaptive Engineering Lab

Drop-In Seat With 1.5" Sun-Mate Or Pudgee Foam

SESE10030 1 $213.00

Drop-In Seat With Contour One Foam SESE10035 1 $303.00

Drop-In Seat With Poly Foam SESE10020 1 $194.00

Full-Width Seat With 1.5" Sun-Mate Or Pudgee Foam

SESE10065 1 $376.00

Full-Width Seat With 1.5" Un-Mate Or T-Foam

SESE10055 1 $213.00

Full-Width Seat With Contour-One Foam

SESE10070 1 $303.00


Full Width Solid Seat Package With J Or Flush Or Drop Hooks & Hold Downs.

SES2L0010 1 $648.00

Offset, T Style, I Style, Anti-Thrust Or Medial Thigh Support Solid Seat Insert, Includes T-Nuts.

SES2L1015 1 $269.00

Oversize Upcharge For Seats Over 2o" But Less Than 28".

SES2L1035 1 $80.00

Quick Fit Anti-Thrust Or Contour Solid Seat Insert, Includes T-Nuts.

SES2L1020 1 $491.00

Page: 31 of 75




Seating


Qty.

ADP Approved

Amt.

Seat Cushion Adaptive Equipment Systems (Aes)

Quick-Fit Contoured, Adjustable Split, Or Foam Form Solid Seat Insert, Incudes T-Nuts.

SES2L1030 1 $569.00

Sculptured Solid Set Insert, Includes T-Nuts, Custom.

SES2L1025 1 $999.00

Sculpturefit Seat Package 2/Attaching Hardware, Custom.

SES2L0015 1 $1,236.00

Seats Hardware Not Included Solid Seat Insert, Includes T-Nuts.

SES2L1005 1 $183.00

Seats Including Front & Rear Mounting Hardware Solid Seat Package W/Universal Or E-Z Mount Hardware.

SES2L0005 1 $542.00

Solid Seat Insert Package, Li'L Kiddos, 14" Wide Or Less.

SES2L0020 1 $635.00

Solid Seat Insert Package, Li'L Kiddos, Contoured, 14" Wide Or Less.

SES2L0025 1 $821.00

Solid Seat Insert, Includes T-Nuts, Li'L Kiddos, 14" Wide Or Less.

SES2L1010 1 $247.00

Advanced Mobility

All Star Cushion Custom Sizes Includes Cover

SESAO0080 1 $583.00

All Star Cushion Includes Cover And Sizes 16x16 16x18 16x18 17x17 18x16 18x18

SESAO0085 1 $516.00

All Star Drop Base, Custom Sizes Includes Cover, Base, 4 Drop Hooks

SESAO0095 1 $661.00

All Star Drop Base, Includes Cover, Base, 4 Drop Hooks

SESAO0090 1 $575.00

Comfort Contoured Cushion SESAO0030 1 $140.00

Darlexx Covered Cushion SESAO0010 1 $116.00

Gel Flotation Pad SESAO0110 1 $324.00

Multi Density Seat Cushion SESAO0020 1 $140.00

Pro Custom Cushion With Built In Drop Base

SESAO0070 1 $615.00

Pro-Custom Cushion With Covers SESAO0075 1 $564.00

Sunmate Cushion SESAO0005 1 $156.00

Superstar Cushion Includes Cover 16x16, 16x18, 18x16, 18x18

SESAO0100 1 $600.00

Superstar Drop Base, Size 17x17, Includes Cover, Base, 4 Drop Hooks

SESAO0105 1 $700.00

Upcharge For Custom Sizes Other Than 17x17

SESAO0115 1 $79.00

Airerx Gu - All Sizes SESUA0005 1 $350.00

Page: 32 of 75




Seating


Qty.

ADP Approved

Amt.

Seat Cushion Airerx Sp - All Sizes SESUA0010 1 $595.00

Spp - All Sizes SESUA0015 1 $775.00

Amysystems Contour Seat Cushion, Non-Standard Sizes

SES4P0015 1 $607.00

Contour Seat Cushion, Standard Sizes SES4P0010 1 $513.00

Contour Seat For Heavy Duty SES4P0020 1 $716.00

Bioform Reha Foundation Cushion - All Sizes SESZB0005 1 $484.00

Blake Medical Geomatrix Geomatrix Bronze SESG00005 1 $427.00

Geomatrix Gold, Gold+ SESG00015 1 $613.00

Geomatrix Gold, Gold+ Custom Sizes SESG00020 1 $720.00

Geomatrix Hybrid Or Hybrid Deep SESG00030 1 $652.00

Geomatrix Platinum SESG00025 1 $872.00

Geomatrix Silver SESG00010 1 $560.00

Broda Seat Pad SESB-0010 1 $61.00

Calko Rehab Canada

Standard Sizes 12x12 To 20x20 SESK90005 1 $767.00

Standard Sizes 12x12 To 20x20 SESK90010 1 $913.00

Standard Sizes 12x12 To 20x20 SESK90015 1 $1,000.00

Clearview Healthcare Products

Debbonair Dynamics/Cushionair Cushion - Greater Than 20" Width Or Depth

SESGC0015 1 $676.00

Debbonair Dynamics/Cushionair Cushion - Up To 20" Width Or Depth

SESGC0010 1 $583.00

Debbonair Dynamics/Cushionair Cushion Debbonair Dynamics/Cushionair Cushion - Standard Sizes

SESGC0005 1 $546.00

Custom Fabricated

Complex Indirect Molded Seat, Without Cover & Mounting Hardware

SESCF105L 1 $1,460.00

Contoured Seat, Includes Cover, Without Hardware

SESCF103L 1 $600.00

Flat Seat/Rigid Base, Includes Cover, Without Hardware

SESCF101L 1 $300.00

Sculptured Seat, Includes Cover, Without Hardware

SESCF104L 1 $720.00

Wedged Seat (Thigh Bar), Includes Cover, Without Hardware

SESCF102L 1 $450.00

Future Mobility

Prism Elite Cushion 16x16-20x20 SESFM0060 1 $300.00

Prism Elite Cushion Custom Sizes SESFM0065 1 $340.00

Prism Ideal Cushion All Sizes SESFM0050 1 $184.00

Prism Supreme Air Cushion 18x18 Through 20x20

SESFM0030 1 $580.00

Page: 33 of 75




Seating


Qty.

ADP Approved

Amt.

Seat Cushion Future Mobility

Prism Supreme Air Cushion 18x19 Through 20x19

SESFM0035 1 $600.00

Prism Supreme Air Cushion Custom Sizes

SESFM0040 1 $628.00

Prism Supreme Cushion 14x14 Through 18x20

SESFM0015 1 $460.00

Prism Supreme Cushion 15x16 Through 20x20

SESFM0020 1 $480.00

Prism Supreme Cushion Custom Sizes SESFM0025 1 $548.00

Prism Supreme Gel Cushion 14x14 Through 18x20

SESFM0110 1 $540.00

Prism Supreme Gel Cushion 15x16 Through 20x20

SESFM0115 1 $560.00

Prism Supreme Gel Cushion Custom Sizes

SESFM0120 1 $620.00

Prism Supreme Heavy Duty Cushion SESFM0125 1 $640.00

Prism Supreme Ii Plus Cushion 14x14 Through 18x20

SESFM0070 1 $460.00

Prism Supreme Ii Plus Cushion 15x16 Through 20x20

SESFM0075 1 $480.00

Prism Supreme Ii Plus Cushion Custom Sizes

SESFM0080 1 $548.00

Super Cushion For Kids 10x10 Through 16x16

SESFM0090 1 $460.00

Super Cushion For Kids 10x12 Through 16x12

SESFM0095 1 $480.00

Super Cushion For Kids Custom Sizes SESFM0100 1 $548.00

Handicare Emineo Manual Wheelchair Smartsit Basic Cushion - All Sizes

SESM90100 1 $260.00

Ibis Manual Wheelchair Seat Cushion -Sellaskin 16x16,16x18,18x16,18x18

SESM90005 1 $156.00

Smartsit Comfort Cushion - All Sizes SESM90105 1 $436.00

Support Seat Cushion SESM90020 1 $300.00

Invacare Contour U Seats Includes All Modifications & Vacuum/Vinyl Upholstery

SESNS0075 1 $1,340.00

Custom Sizes SESNS2015 1 $647.00

Essential Cushions Fits 16" To 20" Wide W/C

SESNS0005 1 $86.00

Extra - Fits 14" To 22" Wide W/C SESNS0037 1 $166.00

Extra - Special Size Modifications SESNS0039 1 $166.00

Fits 10" To 14" Wide W/C SESNS0050 1 $350.00



Page: 34 of 75




Seating


Qty.

ADP Approved

Amt.

Seat Cushion Invacare Gentle Contour (Gc) With Flo Gel, 20"W X 16"D To 22"W X 20"D

SESNS0150 1 $505.00

Gentle Contour (Gc) With Flo Gel, Builder Size (Custom)

SESNS0155 1 $552.00

Gentle Contour (Gc) With Flo Gel, 14"W X 16"D To 18"W X 20"D

SESNS0145 1 $505.00

Gentle Contour (Gc) With Visco Foam, 14"W X 16"D To 18"W X20"D

SESNS0130 1 $505.00

Gentle Contour (Gc) With Visco Foam, 20"W X 16"D To 22"W X 20"D

SESNS0135 1 $505.00

Gentle Contour (Gc) With Visco Foam, Builder Size (Custom)

SESNS0140 1 $552.00

Infinity Airflo Fits 14 To 18" Wide W/C SESNS2005 1 $567.00

Infinity Cushions Lo Contour (Lc) With Visco Foam, 14"W X 16"D To 18"W X 20"D

SESNS0100 1 $505.00

Intouch Stabilite, All Sizes, Includes Cover

SESNS1085 1 $289.00

Lo Contour (Lc) With Flo Gel, 14"W X 16"D To 18"W X 20"D

SESNS0115 1 $505.00

Lo Contour (Lc) With Flo Gel, 20"W X 16"D To 22"W X 20"D

SESNS0120 1 $505.00

Lo Contour (Lc) With Flo Gel, Builder Size (Custom)

SESNS0125 1 $552.00

Lo Contour (Lc) With Visco Foam, Builder Size (Custom)

SESNS0110 1 $552.00

Lo Contour (Lc) With Visco Foam, 20"W X 16"D To 22"W X 20"D

SESNS0105 1 $505.00

Max Contour (Mc) With Flo Gel, 14"W X 16"D To 18"W X 20"D

SESNS0175 1 $528.00

Max Contour (Mc) With Flo Gel, 20"W X 16"D To 22"W X 20"D

SESNS0180 1 $528.00

Max Contour (Mc) With Flo Gel, Builder Size (Custom)

SESNS0185 1 $575.00

Max Contour (Mc) With Visco Foam, 14"W X 16"D To 18"W X 20"D

SESNS0160 1 $528.00

Max Contour (Mc) With Visco Foam, 20"W X 16"D To 22"W X 20"D

SESNS0165 1 $528.00

Max Contour (Mc) With Visco Foam, Builder Size (Custom)

SESNS0170 1 $575.00

Naked Contour U Seat, Includes All Modifications & Vacuum/Moisture Proof Coating/Removable Cover & Cover Pattern.

SESNS0080 1 $1,594.00

Page: 35 of 75




Seating


Qty.

ADP Approved

Amt.

Seat Cushion Invacare Silouette Cushions Silhouette Seat Cushion

SESNS0070 1 $632.00

Single Density Cushions Non Standard Size

SESNS0015 1 $105.00

Special Adult Size & Modifications SESNS0045 1 $531.00

Special Adult Size & Modifications SESNS1035 1 $670.00

Special Junior Size & Modifications SESNS0055 1 $449.00

Special Junior Size & Modifications SESNS1045 1 $670.00

Ulti-Mate Bases Fits 16" To 20" Wide W/C

SESNS1030 1 $529.00

Ulti-Mate Cushions Fits 16" To 20" Wide W/C

SESNS0040 1 $433.00

Jay Medical 14x14/12x12 With Back Support SESJA3200 1 $225.00

14x16 With Standard Cover SESJA0425 1 $546.00

15.5x 16, 15.5 X 18 With Standard Cover

SESJA0420 1 $546.00

16x16, 16x18, 18x16,18x18,20x18 With Solid Drop Base

SESJA9120 1 $347.00

16x20, 18x20 With 2 Covers SESJA9040 1 $424.00

17x16, 17x18 Includes Solid Seat, 2 Covers & Hardware

SESJA8017 1 $410.00

17x17 SESJA0485 1 $546.00

17x17 With Incontinent Cover SESJA0462 1 $550.00

17x17 With Air Exchange Cover SESJA0442 1 $558.00

18/15.5x20 With Incontinent Cover SESJA1375 1 $704.00

18x16 To 10x10 With Incontinent Cover SESJA1350 1 $640.00

18x18, 15.5x18, SESJA0100 1 $612.00

18x18, 16x18, SESJA2100 1 $606.00

18x20, 15.5x20 SESJA0250 1 $678.00

18x20, 15.5x20 SESJA1100 1 $718.00

18x20, 15.5x20 With Air Exchange Cover

SESJA0450 1 $640.00

18x20, 15.5x20 With Incontinent Cover SESJA0470 1 $630.00

18x20, 15.5x20 With Standard Cover SESJA0410 1 $630.00

20x16 SESJA0480 1 $630.00

20x16 Includes Solid Seat, 2 Covers & Hardware

SESJA8015 1 $464.00

20x16, 20x18 With Air Exchange Cover SESJA0441 1 $640.00

20x16, 20x18 With Incontinent Cover SESJA0461 1 $630.00

20x16, 20x18, 16x20, 18x20 SESJA0505 1 $620.00

20x16, 20x18, 16x20, 18x20, Solid Drop Seat Attached

SESJA0605 1 $666.00

Page: 36 of 75




Seating


Qty.

ADP Approved

Amt.

Seat Cushion Jay Medical 20x18 SESJA0490 1 $618.00

20x18 SESJA9106 1 $347.00

20x18 With Back Support SESJA3100 1 $212.00

20x18 With Solid Drop Seat SESJA9125 1 $453.00

20x18, 18x20, 16x20, With Adductor Wedges

SESJA2200 1 $666.00

20x20 SESJA9505 1 $794.00

20x20 With 2 Covers SESJA9030 1 $653.00





20x20, 22x16, 22x18 SESJA0507 1 $718.00

20x20, 22x16, 22x18, Solid Drop Seat Attached

SESJA0610 1 $729.00

20x20, 24x20 SESJA0200 1 $816.00

20x20,24x20 With Quadrant Pads SESJA1200 1 $855.00

24x18 SESJA0510 1 $758.00

24x20 SESJA9515 1 $841.00





Adjustable Contour Seat For 14" Or 16" Frame Width, Various Seat Depths

SESJA9705 1 $398.00

Adjustable Contour Seat For 18" Frame Width, Various Seat Depths

SESJA9710 1 $442.00

Bases Jay Foam Base 20" Deep SESJA6050 1 $235.00

Combi Base 18x16 To 15.5x20 SESJA6400 1 $43.00

Combi Base 20x18 SESJA6500 1 $82.00

Cushion With Flat Or Curved Bottom Sizes 18x20 Through 20x20

SESJA9810 1 $470.00

Dual Valve - W X D .gt.21 Inches Jay 3 Air Cushion- Dual Valve -Width X Depth .gt.21 Inches

SESJA9920 1 $884.00

Dual Valve Jay 3 Air Cushion - Dual Valve

SESJA9910 1 $716.00

Foam Base With Flat Or Curved Bottom Sizes 14x16 Through 18x18

SESJA9815 1 $118.00

Page: 37 of 75




Seating


Qty.

ADP Approved

Amt.

Seat Cushion Jay Medical Foam Base With Flat Or Curved Bottom Sizes 18x20 Through 20x20

SESJA9820 1 $134.00

Foam Cushion 16x16, 16x18, 18x16, 18x18

SESJA8040 1 $191.00

Foam Cushion 17x16, 17x18 SESJA8057 1 $191.00

Foam Cushion 20x16 SESJA8055 1 $225.00

Foam Cushion 20x18 SESJA8050 1 $225.00

J-Gel Base SESJA6830 1 $216.00

J-Gel Cushion 16" & 18" Deep SESJA0700 1 $429.00

J-Gel Cushion 20" Deep SESJA0705 1 $429.00

J2 Base Large Sizes SESJA6810 1 $262.00

J2 Base Standard Sizes SESJA6800 1 $207.00

J2 Cushions 18x16, 18x18 With Standard Cover

SESJA0400 1 $546.00

J2 Deep Contour Cushion Standard Sizes

SESJA0500 1 $571.00

J2 Deep Contour Cushion With Solid Drop Seat Standard Sizes With Solid Drop Seat

SESJA0600 1 $598.00

J2 Plus Cushion Foam Base SESJA6835 1 $166.00

J2 Plus Cushion J2 Plus Cushion, Ae Cover With Foam Kit

SESJA0750 1 $656.00

J2 Plus Cushion, Ae Cover With Custom Foam Kit

SESJA0755 1 $690.00

J2 Plus Cushion, Ae Cover With Fluid Pad

SESJA0760 1 $864.00

J2 Plus Cushion, Ls Inc. Cover With Custom Foam Kit

SESJA0770 1 $692.00

J2 Plus Cushion, Ls Inc. Cover With Fluid Pad

SESJA0775 1 $864.00

J2 Plus Cushion, Ls Inc. Cover With Foam Kit

SESJA0765 1 $706.00

J2 Recline Cushions Standard Sizes SESJA9500 1 $602.00

J3 Cushion J3 Cushion SESJA0800 1 $700.00

Jay Active 18x16, 16x16, 14x16 SESJA2010 1 $606.00

Jay Active Foam Base 20" Deep SESJA6325 1 $262.00

Jay Care Cushion 18x16, 18x8, 16x16, 16x18

SESJA5500 1 $406.00

Jay Combi Cushion 18x16 To 15.5x20 SESJA3010 1 $225.00

Jay Cushions 18x16, 15.5x16, 14x16 SESJA0010 1 $612.00

Jay Duo 16x16,16x18, 18x16, 18x18 Includes Solid Seat, 2 Covers & Hardware

SESJA8005 1 $410.00

Page: 38 of 75




Seating


Qty.

ADP Approved

Amt.

Seat Cushion Jay Medical Jay Easy Cushions Cushion With Flat Or Curved Bottom Sizes 14x16 Through 18x18

SESJA9805 1 $449.00

Jay Fit Cushions Adjustable Contour Seat For 10" Or 12" Frame Width, Various Seat Depths

SESJA9700 1 $357.00

Jay G.S. Cushion 10x13,12x15,14x17,16x19,18x20

SESJA5000 1 $594.00

Jay Lite Cushion Jay Lite Cushion - All Sizes

SESJA4200 1 $560.00

Jay Recliner Cushions 18x16, 18x18, 15.5x16, 15.5x18, 14x16

SESJA1010 1 $638.00

Jay Solution Jay Solution, Sizes 14 X 14 -17 X 18, Includes Cover

SESJA0360 1 $479.00

Jay Solution With Solid Drop Seat Jay Solution With Solid Drop Seat, Sizes 14 X 14 - 18 X 20, Includes Cover

SESJA0370 1 $636.00

Jay Solution With Solid Drop Seat, Sizes 19 X 18 - 20 X 18, Includes Cover

SESJA0375 1 $680.00

Jay Solution, Sizes 18 X 16 - 20 X 18, Includes Cover

SESJA0365 1 $499.00

Jay Xtreme Cushion 14x14 To 18x18 With 2 Covers

SESJA9020 1 $496.00

Jay Zip Cushion Jay Zip, All Sizes SESJA5550 1 $476.00

Large Adult 20x18 Includes Solid Seat, 2 Covers & Hardware

SESJA8010 1 $455.00

Large Sizes SESJA9510 1 $689.00

Narrow Pan 16x16, 16x18, 18x16, 18x18 Includes Cushion, 2 Covers & Hardware

SESJA8020 1 $402.00

Narrow Pan 17x16, 17x18 Includes Solid Seat, 2 Covers & Hardware

SESJA8027 1 $410.00

Narrow Pan 20x16 Includes Solid Seat, 2 Covers & Hardware

SESJA8025 1 $455.00

Narrow Pan 20x18 Includes Cushion, 2 Covers & Hardware

SESJA8030 1 $455.00

Pressure Relief Pad With Air Exchange Cover

SESJA5010 1 $689.00

Pressure Relief Pad With Incontinent Cover

SESJA5005 1 $702.00

Page: 39 of 75




Seating


Qty.

ADP Approved

Amt.

Seat Cushion Jay Medical Single Valve - W X D .gt.21 Inches Jay 3 Air Cushion -Width X Depth Greater Than 21 Inches

SESJA9915 1 $872.00

Single Valve Jay 3 Air Cushion - Single Valve

SESJA9905 1 $704.00

Sizes 18x16 To 10x10 With Air Exchange Cover

SESJA0325 1 $638.00

Sizes 18x16 To 10x10 With Incontinent Cover

SESJA0350 1 $626.00

Soft Combi With Lumbar Support 14x14, 12x12

SESJA3326 1 $177.00

Soft Combi With Lumbar Support 18x20, 16x20

SESJA3317 1 $208.00

Soft Combi With Lumbar Support 20x18 SESJA3316 1 $208.00

Soft Combi With Lumbar Support, Narrow Adult Soft 15.5x16

SESJA3320 1 $212.00

Soft Combi With Lumbar Support, Regular Adult Short 18x16

SESJA3310 1 $212.00

Soft Combi With Lumbar Support, Regular Adult

SESJA3315 1 $212.00

Soft Combi Without Lumbar Support 14x14, 12x12

SESJA3346 1 $179.00

Soft Combi Without Lumbar Support 16x20, 18x20

SESJA3337 1 $179.00

Soft Combi Without Lumbar Support 20x18

SESJA3336 1 $179.00

Soft Combi Without Lumbar Support, Narrow Adult Short 15.5x16

SESJA3340 1 $179.00

Soft Combi Without Lumbar Support, Narrow Adult 15.5x18

SESJA3345 1 $179.00

Soft Combi Without Lumbar Support, Regular Adult Short 18x16

SESJA3330 1 $179.00

Soft Combi Without Lumbar Support, Regular Adult Soft 18x18

SESJA3335 1 $179.00

Standard Sizes With Air Exchange Cover

SESJA0440 1 $558.00

Standard Sizes With Incontinent Cover SESJA0460 1 $550.00

Tlc Contoured Seat Cushion SESKT2010 1 $1,148.00

Triad Standard Sizes SESJA9105 1 $347.00

Xpress Standard Seat Cushion - Specify Short (900020/1) Or Long (900022/3)

SESKT2020 1 $200.00

Page: 40 of 75




Seating


Qty.

ADP Approved

Amt.

Seat Cushion Kid Kart Xpress Contour Adjustable Cushion - Specify Short (900312-28) Or Long (900329-36)

SESKT2030 1 $404.00

Xpress Ledge Seat Cushion - Specify Short (900028/9) Or Long (900030/1)

SESKT2026 1 $370.00

Xpress Wedge Seat Cushion - Specify Short (900024/5) Or Long (900026/7)

SESKT2025 1 $76.00

Kids Up Inc Contoured Seat Cushion - All Sizes SESK20005 1 $312.00

Xps Adaptive Seat Cushion SESK20050 1 $312.00

Lpa Medical Inc.

Contour Seat Cushion With Perineal Abductor

SESO12005 1 $108.00

Pre-Cure Cushion SESO12010 1 $180.00


Contour Seat Cushion SESWM0010 1 $208.00

Cozy Cushion Plus All Sizes SESWM0050 1 $480.00

Cozy Cushion Plus Custom Sizes SESWM0055 1 $640.00

Max Comfort Bariatric Cushion All Sizes SESWM0040 1 $784.00

Max Comfort Cushion All Sizes SESWM0030 1 $624.00

Nylon/Leatherette 2" Foam Cushion SESWM0001 1 $64.00

Nylon/Leatherette 3" Foam Cushion SESWM0005 1 $72.00

Matrx Seating 11-12 Inches Wide To 20-21 Inches Deep

SES1M0065 1 $443.00

23x30 Width To 21x30 Deep SES1M0066 1 $796.00

Fits W/C 19"-22" Width & 16"-21" Depth SES1M0010 1 $602.00

Fits W/C 20" - 24 Width & 20" - 22" Depth

SES1M0040 1 $863.00

Fits W/C 20" Width & 16" - 18" Depth SES1M0035 1 $733.00

Fits W/C 20" Width & 16"-19" Depth SES1M1010 1 $714.00

Kidabra Base Fits W/C 12"-14" Width & 12"-15" Depth

SES1M2005 1 $677.00

Kidabra-V Cushion Fits W/C 11"-14" Width & 12"-15" Depth

SES1M0015 1 $509.00

Matrx Flo-Tech Cushion Fits W/C 16" - 19" Width & 16" - 21" Depth

SES1M0030 1 $639.00

Matrx Posture Seat Matrx Posture Seat, All Sizes

SES1M0060 1 $444.00

Matrx-V Base Fits W/C 16"-20" Width & 16"-19" Depth

SES1M1005 1 $677.00

Matrx-V Cushion Bariatric Sizes, Client Weight Exceeds 300lbs

SES1M0011 1 $742.00

Matrx-V Cushion Fits W/C 14"-18" Width & 15"-21" Depth

SES1M0005 1 $551.00

Page: 41 of 75




Seating


Qty.

ADP Approved

Amt.

Seat Cushion Matrx Seating With Visco Foam Upgrade All Sizes SES1M0070 1 $524.00

Motion Concepts

Trx Onyx Seat 16-19" Width SESZG0005 1 $644.00

Trx Onyx Seat 20-22" Width SESZG0010 1 $695.00

Nighthawk 2" Bi-Medium Density Cumfy Cushion & Base, Up To 18x18

SESNM8110 1 $236.00

2" Standard Foam With Cover SESNM2000 1 $95.00

3" Medium Density Cumfy Cushion & Base, Up To 18x18

SESNM8092 1 $230.00

3" Standard Foam With Cover SESNM2010 1 $55.00

Aero Space Cushion, 16x16x3 SESNM9055 1 $352.00


Aero Space Cushion, 18x18x3,20x16x3 SESNM9065 1 $248.00


Afg Cushion 16x16, 16x18, 18x16, 18x18

SESNM1010 1 $347.00

Afg Cushion 20x16, 20x18 SESNM1020 1 $390.00

Bi-Hard Foam 2" Thru 4" With Cover SESNM0150 1 $117.00

Bi-Med Foam 1" Thru 4" With Cover SESNM0050 1 $261.00

Bi-Sunmate Cushion SESNM6000 1 $307.00

Bi-Sunmate Cushion & Base SESNM8070 1 $455.00

Contouring Arms Cushion & Base SESNM8030 1 $250.00

Contouring Arms Deluxe Cushion & Base

SESNM8020 1 $263.00

Cumfy Plus Cushion & Base SESNM8060 1 $500.00

Cumfy Plus Cushion With Cover SESNM4000 1 $316.00

Gel Suspension Cushion 16x16,18x16,18x18

SESNM9045 1 $298.00

Gel Suspension Cushion 20x16, 20x18 SESNM9050 1 $251.00

Gel-Mate, 18x16, 16x17 SESNM9035 1 $298.00

I.S.C.T-Bone Cushion With Cover SESNM3000 1 $162.00

Med Foam 1" Thru 4" With Cover SESNM0010 1 $256.00

Pocket-Mate, 18x16,16x18 SESNM9040 1 $120.00

Superior Cumfy Cushion & Base SESNM8000 1 $550.00

Superior Cushion With Cover SESNM2050 1 $431.00

Superior Thin Cumfy Cushion & Base SESNM8010 1 $260.00

Superior Thin Cushion With Cover SESNM2060 1 $356.00

Upcharge For Custom Sized Or Oversized Cushions

SESNM0000 1 $49.00

Orthofab Cushion With Contour Add Ons Non Standard Sizes & Options

SESOF1010 1 $384.00

Page: 42 of 75




Seating


Qty.

ADP Approved

Amt.

Seat Cushion Orthofab Cushion With Ischial Elastomer Insert & Contour Add Ons 14-20" Width & 15-20" Depth

SESOF1035 1 $544.00

Cushion With Ischial Elastomer Insert & Contour Add Ons 15-18" Width & 15-20" Depth

SESOF1015 1 $426.00

Cushion With Ischial Elastomer Insert & Contour Add Ons Non Standard Sizes

SESOF1020 1 $480.00

Cushion With Ischial Elastomer Insert & Contour Add Ons Non Standard Sizes & Options

SESOF1040 1 $640.00

Cushion With Visco Foam Insert & Contour Add Ons Non Standard Sizes & Options

SESOF1030 1 $448.00

Iscus Cushions Cushion With Contour Add Ons 15-18" Width & 15-20" Depth

SESOF1005 1 $324.00

Iscus Ii Cushions Cushion With Visco Foam Insert & Contour Add Ons 14-20" Width & 15-20" Depth

SESOF1025 1 $368.00

Otto Bock Advantage Cushion All Sizes SESOB704L 1 $444.00

Cloud Seat Cushion Standard Sizes Smaller Than 16x17

SESOB6015 1 $489.00

Comfort Cushion Standard Sizes SESOB8040 1 $627.00

Custom Sizes SESOB6045 1 $641.00

Custom Sizes SESOB8045 1 $810.00

Procontour Custom (Obss) Seat Finished With Spray Coating,Cover,Sewing Pattern

SESOB7100 1 $1,983.00

Seat-Itemized Cushion (Unfinished) SESOB7105 1 $1,453.00

Sizes 16x18,17x16,17x17,18 X16 SESOB6020 1 $503.00

Sizes 17x18,18x17,18x18,19 X16 SESOB6025 1 $503.00

Sizes 19x18,20x16,20x18 SESOB6030 1 $517.00

Permobil Ergo Seat - All Sizes SES1P0005 1 $407.00


Base Cushion Seat Sewn Cover Waterproof Foam, Includes Labour For Digitizing Or Plastering

SESWB0010 1 $1,711.00

Base Cushion Seat Vacuum Formed Cover, Includes Labour For Digitizing Or Plastering

SESWB0005 1 $1,439.00

Base Cushion Seat With All Modifications, Includes Labour For Digitizing Or Plastering

SESWB0015 1 $2,079.00

Precision-Fit Cushion Upcharge, Extra Seat Depth 20"-24"

SESWB0024 1 $306.00

Precision-Fit Cushion Upcharge, Extra Seat Width 20"-24"

SESWB0022 1 $306.00

Page: 43 of 75




Seating


Qty.

ADP Approved

Amt.

Seat Cushion Precision Rehab Manufacturing

Precision-Fit Cushion, Subtle, Moderate Or Aggressive Positioning. Includes Shape Adjustments, Inner Cover, Outer Cover And Cushion Rigidizer.

SESWB0020 1 $1,079.00


Custom Sizes SESX10020 1 $359.00

Sizes 20"X20" - 24"X24" SESX10115 1 $639.00

Sizes 22" X 16" - 22" X 24" SESX10095 1 $399.00

Sizes 22" X 20" - 24" X 24" SESX10125 1 $496.00

Sizes 22" X 20" - 24" X 24" SESX10135 1 $576.00

Synergy Simplicity Cushion All Sizes SESX10080 1 $119.00

Synergy Solution Cushion Standard Sizes

SESX10015 1 $319.00

Synergy Solution Sg Cushion Sizes 14" X 14" - 20" X 18"

SESX10100 1 $215.00

Synergy Soluton Sg Cushion Sizes 20" X 20" - 24" X 24"

SESX10105 1 $255.00

Synergy Spectrum Air Contoured Cushion Sizes 14" X 12" - 20" X 24"

SESX10130 1 $544.00

Synergy Spectrum Air Cushion Sizes 14" X 12" - 20" X 24"

SESX10120 1 $464.00

Synergy Spectrum Cushion Viscoelastic Insert,Standard Sizes

SESX10025 1 $439.00

Synergy Structure 2 Cushion Sizes 14"X16" - 20"X18"

SESX10110 1 $599.00

Synergy Tru Comfort Cushion Sizes 16" X 14" - 20" X 24"

SESX10090 1 $319.00

Twin Cell Insert,Custom Sizes SESX10040 1 $479.00

Twin Cell Insert,Standard Sizes SESX10035 1 $439.00

Viscoelastic Insert,Custom Sizes SESX10030 1 $479.00

Quickie 2", 3" Or 4" Cushion With Cover SESQU0355 1 $122.00

Contour Seat - Tilt Fx SESQU0400 1 $392.00

Ride Designs Custom Cushions Standard (12-20"), Extra Wide (21-22"), Custom Sizes. Cover And Modifications Included.

SESR40005 1 $1,709.00

Ride Forward Cushion - All Sizes SESR41020 1 $472.00

Roho Airlite Cushion With Built In Cover All Sizes

SESRO9005 1 $450.00

Contour Select Contour Select Cushion Standard Sizes

SESRO9020 1 $719.00

Contour Select Cushion Custom Sizes SESRO9025 1 $769.00

Custom Cushion Custom (Made To Order) Cushion W/Cover

SESRO030L 2 $769.00

Custom Sizes Including Cover SESRO2010 1 $739.00

Page: 44 of 75




Seating


Qty.

ADP Approved

Amt.

Seat Cushion Roho Custom Sizes Including Cover SESRO3010 1 $725.00

Custom Sizes Including Cover SESRO3110 1 $725.00

Custom Sizes With Cover SESRO6015 1 $609.00

Custom Sizes,Dual Valve,Cover SESRO8010 1 $725.00

Dual Valve Hybrid Elite Cushion With Cover Sizes 14x14 ,20x20

SESRO9503 1 $789.00

Dual Valve Hybrid Elite Cushion With Cover, Sizes 22x18, 24x20

SESRO9504 1 $803.00

Enhancer Standard Adult & Paediatric Sizes, Dual Valve, With Cover

SESRO8005 1 $650.00

Harmony Harmony Cushion With Cover-Sizes 14x16, 20x18

SESRO9050 1 $499.00

High-Profile Cushions All Standard Adult & Paediatric Sizes Including Cover

SESRO3005 1 $650.00

Low Or High Profile Cushion Custom Sizes With Cover

SESRO7040 1 $769.00

Low-Profile Cushions All Standard Adult & Pediatric Sizes Including Cover

SESRO3105 1 $650.00

Ltc Cushion, Including Cover SESRO3015 1 $733.00



Mid-Profile Cushions All Standard Adult & Paediatric Sizes Including Cover

SESRO2005 1 $659.00

Mini-Max Cushions Standard Sizes (Does Not Include Cover)

SESRO4005 1 $595.00

Nexus Spirit Cushion With Cover Standard Sizes

SESRO6010 1 $585.00

Quatro Select Cushions Low Or High Profile Cushion With Cover Standard Sizes

SESRO7035 1 $719.00

Single Valve Hybrid Elite Cushion With Cover, Sizes 14x14 , 20x20

SESRO9501 1 $742.00

Single Valve Hybride Elite Cushion With Cover, Sizes 22x18, 24x20

SESRO9502 1 $756.00

Special Applicaton Cushions Adaptor 9x13x1" (Maximum 5)

SESRO1105 5 $209.00

Star Cushion Products Inc.

Custom Cell Height Cushion Standard Sizes

SESTJ0115 1 $644.00

Custom Sizes Over 22" In Two Directions Width And Depth

SESTJ0110 1 $716.00

Custom Sizes Over 22" One Direction Width Or Depth

SESTJ0105 1 $644.00

Galaxy Galaxy Cushion - All Sizes SESTJ3005 1 $520.00

Page: 45 of 75




Seating


Qty.

ADP Approved

Amt.

Seat Cushion Star Cushion Products Inc.

Mid Contour Cushion 3" Cells With Cover

SESTJ0015 1 $496.00

Short Contour Cushion 2" Cells With Cover

SESTJ0010 1 $496.00

Standard Contour Cushion 4" Cells With Cover

SESTJ0005 1 $496.00

Starlock Cushion All Sizes 12x12 Through 22x22

SESTJ2005 1 $532.00

Supracor Bariatric Cushion (Classic) Clb 20-24" SESRR0016 1 $756.00

Bariatric Cushion (Classic) Clb 25-28" SESRR0017 1 $869.00

Bariatric Cushion (Classic) Clb 29-31" SESRR0018 1 $1,040.00

Bariatric Cushion (Classic) Clb 32-35" SESRR0019 1 $1,210.00

Classic Cushion 14x16-20x20 SESRR0010 1 $545.00

Classic Sling Bottom Cushion 14x16-20x20

SESRR0015 1 $567.00

Contoured Cushion 14x16-20x20 SESRR0020 1 $665.00

Contoured Sling Bottom Cushion 14x16-20x20

SESRR0025 1 $658.00

Corbee Cushion 10x10-14x14 SESRR0100 1 $343.00

Corbee Sling 10x10-14x14 SESRR0110 1 $371.00

Paediatric Contoured Cushion, Custom Sizes

SESRR0065 1 $469.00

Paediatric Cushions Contoured Cushion, Standard Sizes

SESRR0060 1 $637.00

Slimline Cushion 16x16-20x18 SESRR0030 1 $441.00

Slimline Sling Bottom Cushion 16x16-20x18

SESRR0035 1 $469.00

Tempur-Pedic Medical Wheelchair Cushions

16"X16" Cushion - 3"Thickness SEST20105 1 $194.00




The Comfort Company

Curve Cushion, Stretch Air Or Fusion Cover, All Sizes

SES7C0050 1 $134.00

Curve Cushion, Stretch Air Or Fusion Cover, Custom Sizes

SES7C0055 1 $245.00

Hyalite Cushion, Condura Knit Or Stretch Air Cover, All Sizes

SES7C0030 1 $400.00

Hyalite Cushion, Condura Knit Or Stretch Air Cover, Custom Sizes

SES7C0035 1 $716.00

Maxx Cushion, Round Or Flat Bottom, Fusion Or Stretch Air Cover, All Sizes

SES7C0020 1 $514.00

Page: 46 of 75




Seating


Qty.

ADP Approved

Amt.

Seat Cushion The Comfort Company

Maxx Cushion, Round Or Flat Bottom, Fusion Or Stretch Air Cover, Custom Sizes

SES7C0025 1 $907.00

Ridge Cushion, Stretch Air Or Fusion Cover, All Sizes

SES7C0040 1 $487.00

Ridge Cushion, Stretch Air Or Fusion Cover, Custom Sizes

SES7C0045 1 $894.00

Toronto Orthopedic Ltd.

Tops Seat Cushion (10" & 12" Width) SESTP0005 1 $246.00

Trulife Deep Comfort Cushion, All Sizes SESCZ0110 1 $372.00

Gelcell Contour Cushion, All Sizes SESCZ0080 1 $332.00

Gelcell Contour Plus, All Sizes SESCZ0090 1 $381.00

Relax Duogel Contour Cushion, All Sizes

SESCZ0040 1 $233.00

Relax Easy Cushion All Sizes SESCZ0070 1 $233.00

Relax Gelcell, All Sizes SESCZ0045 1 $319.00

Relax Trio Cushion, All Sizes SESCZ0035 1 $105.00

Varilite Medical Products

Evolution Bariatric Cushion Standard Or Psv, All Sizes, Includes Cover And Pressure Setting Valve

SESVP0408 1 $714.00

Evolution Cushion Standard Or Psv, All Sizes, Includes Cover And Pressure Setting Valve

SESVP0406 1 $672.00

Evolution Wave Bariatric Cushion Includes, Cover And Positioning Base

SESVP0402 1 $817.00

Evolution Wave, All Sizes, Includes Cover And Positioning Base

SESVP0401 1 $700.00

Meridian Bariatric Cushion, All Sizes, Includes Cover

SESVP0605 1 $756.00

Meridian Cushion, All Sizes, Includes Cover

SESVP0600 1 $630.00

Meridian Wave Bariatric Cushion, All Sizes, Includes Cover

SESVP0615 1 $859.00

Meridian Wave Cushion, All Sizes, Includes Cover

SESVP0610 1 $737.00

Proform Nx Cushion, Single, Dual, All Sizes Includes Cover

SESVP0351 1 $667.00

Reflex Cushion, All Sizes, Includes Cover

SESVP6020 1 $397.00

Solo Cushion, Standard Or Psv, All Sizes, Includes Cover

SESVP0200 1 $485.00

Page: 47 of 75




Seating


Qty.

ADP Approved

Amt.

Seat Cushion Varilite Medical Products

Stratus Cushion, All Sizes, Includes Cover

SESVP0410 1 $369.00

Zoid Cushion, All Sizes, Includes Cover SESVP0500 1 $555.00

Vicair Academy Adjuster SESV10020 1 $630.00

Academy Junior Adjuster SESV10010 1 $541.00

Academy Positioner Plus SESV10015 1 $700.00

Academy Vector SESV10025 1 $677.00

Liberty Pt SESV10005 1 $467.00

Upcharge For Custom Sizes SESV11005 1 $80.00


Comfort 2" Cushion Custom Sizes SESVC5010 1 $421.00

Custom Base Custom Sizes Up To 19" SESVC5050 1 $601.00

Custom Upcharge Upcharge For Cushions Up To 20" X 19", Inclusive

SESVC4500 1 $227.00

Drop-Seat 18x18, 18x16, 16x16.5, 16x18

SESVC4160 1 $950.00

Drop-Seat 18x18, 18x16, 16x16.5, 16x18

SESVC4180 1 $995.00

Drop-Seat 18x18, 18x16, 16x16.5,16x18

SESVC4120 1 $919.00

Super Vantage Base Custom Sizes Up To 19"

SESVC5060 1 $679.00

Super Vantage Base Standard Sizes SESVC5055 1 $530.00

Super Vantage Custom Sizes Up To 19"

SESVC5030 1 $499.00

Super Vantage Special Edition Custom Sizes Up To 19"

SESVC5040 1 $569.00

Super Vantage Special Edition Standard Sizes

SESVC5035 1 $445.00

Super Vantage Standard Sizes SESVC5025 1 $390.00

Upcharge For Cushions 20" - 24" Width Or Depth Inclusive

SESVC4510 1 $327.00

Upcharge For Drop-Seats 20" - 24" Width Or Depth Inclusive

SESVC4530 1 $342.00

Upcharge For Drop-Seats Up To 20" X 19", Inclusive

SESVC4520 1 $241.00

Vantage Bases Comfort Base Standard Sizes

SESVC5045 1 $468.00

Vantage Comfort 2" Cushion Standard Sizes

SESVC5005 1 $328.00

Very Soft - Deep Leg Troughs Sizes 18x18, 18x16, 16x16.5, 16x18

SESVC4100 1 $678.00

Very Soft Cushions Sizes 18x18, 18x16, 16x16.5, 16x18

SESVC4000 1 $684.00

Page: 48 of 75




Seating


Qty.

ADP Approved

Amt.

Seat Cushion Vision Wheelchair Seating Systems Inc.

Very Soft Drop-Seat 18x18, 18x16, 16x16.5, 16x18

SESVC4030 1 $872.00

Very Soft Vive Cushions Sizes 18x18, 18x16, 16x16.5, 16x18

SESVC4150 1 $727.00

Very Soft Vive Deep Leg Troughs Sizes 18x18, 18x16, 16x16.5, 16x18

SESVC4170 1 $763.00

Page: 49 of 75




Seating

OPTIONS:


Qty.

ADP Approved

Amt.

Arm Support Hardware Approved ADP Manufacturers Only

Non Standard Modular Mounting Hardware Required For Positioning (Maximum 2)

SEAND0025 2 $160.00

Custom Fabricated

Armrest Hardware Swivel Armrest Hardware (Maximum 2)

SEICF301L 2 $70.00

Arm Support Options Approved ADP Manufacturers Only

Add Modular Pressure Relief To Armrest - Specialty Foam/Gel (Maximum 2)

SEAND0030 2 $75.00

Custom Fabricated

Options For Arm Supports Rigid Side Panel For Custom Arm Support (Maximum 2)

SEMCF601L 2 $60.00

Side Panel Pad For Custom Arm Support (Maximum 2)

SEMCF602L 2 $40.00

Arm Support(s) Approved ADP Manufacturers Only

Extra Wide &/Or Extended Length For Modular Arm Supports - Includes Mounting Hardware (Maximum 2)

SEAND0010 2 $105.00

Modular Arm Support - Includes Mounting Hardware (Maximum 2)

SEAND0005 2 $275.00

Modular Hand Support - Flat/Cone - Includes Mounting Hardware (Maximum 2)

SEAND0015 2 $75.00

Custom Fabricated

Complex Arm Support, Multi Component, Includes Hardware (Maximum 2)

SEACF102L 2 $250.00

Fixed Arm Support, One Piece, Includes Hardware (Maximum 2)

SEACF101L 2 $150.00

Full Sling Arm Support, Includes Hardware (Maximum 2)

SEACF104L 2 $300.00

Heavy Duty Solid Padded Armrest Support, Replaces Padded W/C Armpad, Includes Hardware (Maximum 2)

SEACF103L 2 $75.00

Back Cover Custom Fabricated

Back Covers Removable Cover For Flat Back

SEMCF101L 2 $120.00

Removable Cover For Back With Laterals

SEMCF103L 2 $230.00

Removable Cover For Contoured/Custom Contoured Back

SEMCF102L 2 $180.00

Removable Cover For Sculptured Or Molded Back

SEMCF104L 2 $270.00

Page: 50 of 75




Seating

OPTIONS:


Qty.

ADP Approved

Amt.

Back Hardware Approved ADP Manufacturers Only

Complex Specialized Mounting Hardware - Including Hardware For Custom Molded Modular Systems - Authorizer Must Provide Clinical Rationale

SEBND0010 2 $400.00

Custom Fabricated

Simple Back Interface Mounts Back To Wheelchair Frame

SEICF160L 1 $195.00

Back Support Options Approved ADP Manufacturers Only

Additional Pressure Relief - Gel/Air Inserts/Pads Etc. (Maximum 6)

SEBND0020 6 $134.00

Custom Modifications And Sizing - Including Custom Sizes, Additional Postural Support - Lumbar Pad, Foam Pads Etc. (Maximum 6)

SEBND0015 6 $55.00

Custom Fabricated

Back Channeling - Upgrade For Slots For Lateral Adjustments

SEMCF201L 1 $150.00

Back Plaster Molding/Vacuum Form SEUCF003L 1 $160.00

Back Reinforcement - Heavy Duty Upgrade

SEMCF202L 1 $100.00

Options & Modifications For Backs Modify Or Refurbish Existing Custom Fabricated Back, Includes Parts, Hardware & Labour

SEMCF200L 1 $225.00

Foot/Leg Support Hardware Approved ADP Manufacturers Only

Complex Specialized Mounting Hardware - Authorizer Must Provide Clinical Rationale

SEFND0030 2 $100.00

Custom Fabricated

Custom Upcharge For Footrests Mount Footrest To Seating System

SEICF501L 2 $120.00

Foot/Leg Support Options Approved ADP Manufacturers Only

Extra Padding For Specific Pressure Relief - (Maximum 2) - Authorizer Must Provide Clinical Rationale

SEFND0035 2 $50.00

Custom Fabricated

Footrest Padding (Maximum2) SEMCF803L 2 $60.00

Footrest Reinforcement Upcharge - Heavy Duty Upgrade To Reinforce Footrest

SEMCF802L 2 $140.00

Options For Footrests Footrest Discrepancy Upcharge - Accommodates Differences Between Left & Right Leg

SEMCF801L 1 $80.00

Foot/Leg Support(s) Approved ADP Manufacturers Only

1 Piece Foot Board - Includes Mounting Hardware & Padding

SEFND0015 1 $110.00

Amputee Board/Stump Support - Includes Mounting Hardware & Padding

SEFND0005 1 $285.00

Page: 51 of 75




Seating

OPTIONS:


Qty.

ADP Approved

Amt.

Foot/Leg Support(s) Approved ADP Manufacturers Only

Calf Panel - Includes Mounting Hardware & Padding

SEFND0010 2 $50.00

Foot Box - Includes Mounting Hardware & Padding - Foot Box May Be 1 Piece Or 2 Piece (Each Foot)

SEFND0020 2 $240.00

Custom Fabricated

Calf Support, Padded And Removable SEFCF107L 2 $195.00

Complex Foot Rest (One Or Two Piece), Includes Parts, Hardware, And Labour

SEFCF102L 1 $440.00

Footplate Extension, Not Padded (Maximum 2)

SEFCF104L 2 $75.00

Footpocket, Not Padded ( Maximum 2) SEFCF106L 2 $200.00

One Piece Double Footbox, Not Padded

SEFCF103L 1 $297.00

One Piece Fixed Footrest, Not Padded

SEFCF101L 1 $150.00

Headrest/Neckrest Hardware Approved ADP Manufacturers Only

Bracket To Mount Headrest To Seating System/Back Support Or Wheelchair

SEHND0020 1 $100.00

Complex Specialized Mounting Hardware - Authorizer Must Provide Clinical Rationale

SEHND0015 1 $300.00

Modular Headrest Options Standard Mounting Hardware Not Included In Base Device - Removable, Allows Height, Anterior & Posterior Adjustments

SEHND0005 1 $140.00

Non Standard Mounting Hardware Not Included In Base Device - Removable, Allows Multi Axis Adjustments

SEHND0010 1 $160.00

Custom Fabricated

Complex Headrest Hardware, Allows For Removability & Height And Forward Adjustment

SEICF007L 1 $155.00

Headrest Hardware Simple Headrest Hardware, Allows For Removability & Height Adjustment

SEICF006L 1 $70.00

Multi-Axis Headrest Hardware, Allows For Removability And Multi Adjustments

SEICF008L 1 $261.00

Wheelchair Mounting Bracket For Headrest Hardware

SEICF009L 1 $220.00

Headrest/Neckrest Options Custom Fabricated

Complex Extension Pad, Mounted (Maximum 2)

SEMCF006L 2 $300.00

Page: 52 of 75




Seating

OPTIONS:


Qty.

ADP Approved

Amt.

Headrest/Neckrest Options Custom Fabricated

Options For Headrest/Neckrest Removable Headrest/Neckrest Cover, Any Fabric, Use For Flat/Contoured Headrest & Neckrest

SEMCF001L 2 $120.00

Removable Cover For Complex Headrests, Use For Complex Headrest & Headrest/Neckrest Combinations

SEMCF002L 2 $180.00

Simple Extension Pad, Mounted (Maximum 2)

SEMCF005L 2 $200.00

Lateral Support Hardware Custom Fabricated

Hinged Swingaway Lateral Hardware, Height& Width Adjustable (Maximum 2)

SEICF202L 2 $200.00

Lateral Support Hardware Fixed Lateral Hardware, Non-Adjustable (Maximum 2)

SEICF201L 2 $60.00

Removable Lateral Hardware, Height & Width Adjustable (Maximum 2)

SEICF203L 2 $100.00

Lateral Support Options Custom Fabricated

Options For Lateral Supports Extra Padding (Maximum 2)

SEMCF651L 2 $60.00

Lateral Support(s) Approved ADP Manufacturers Only

Complex Shape Lateral Supports, Each - Includes Padding & Mounting Hardware (Maximum 4)

SELND0015 4 $192.50

Modular Lateral Support Options Fixed Lateral Supports, Each - Includes Padding & Mounting Hardware (Maximum 4)

SELND0005 4 $120.00

Shoulder Wings, Each - Includes Padding & Mounting Hardware (Maximum 2)

SELND0020 2 $55.00

Swingaway Lateral Supports, Each - Includes Padding & Mounting Hardware (Maximum 4)

SELND0010 4 $180.00

Custom Fabricated

Complex Shaped Thoracolumbar Supports, Non Adjustable, Includes Cover (Maximum 2)

SELCF102L 2 $175.00

Shoulder Wings, Non Adjustable, Includes Cover

SELCF103L 2 $95.00

Thoracolumbar Supports, Rigid & Non Adjustable, Includes Cover (Maximum 2)

SELCF101L 2 $80.00

Pommel Hardware Custom Fabricated

Hardware For Flip-Down Pommel SEICF403L 1 $300.00

Hardware For Removable Pommel SEICF402L 1 $175.00

Pommel Hardware Hardware For Fixed Pommel

SEICF401L 1 $85.00

Page: 53 of 75




Seating

OPTIONS:


Qty.

ADP Approved

Amt.

Pommel/Adductors Approved ADP Manufacturers Only

Pommel, Flip Down, All Components Including Hardware

SESND1043 1 $300.00

Custom Fabricated

Fixed Padded Adductor Includes Cover (Maximum 2)

SEMCF702L 2 $120.00

Pommels & Adductors Custom Pommel Without Hardware

SEMCF701L 1 $160.00

Removable Padded Adductor Includes Cover (Maximum 2)

SEMCF703L 2 $190.00

Positioning Belts Approved ADP Manufacturers Only

Any 2 Point Strap For Positioning Only - Any Closure - Includes Padding & Mounting Hardware -Chest, Hip, Thigh, Calf, Ankle, Foot (Maximum 6)

SERND0030 6 $65.00

Any 4 Point Strap For Positioning Only - Any Closure - Includes Padding & Mounting Hardware - Pelvic "Y" Strap, "H" Leg Strap (Maximum 2)

SERND0020 2 $150.00

Chest Harness For Positioning Only - Any Closure - Includes Padding & Mounting Hardware

SERND0001 1 $140.00

Non Standard Chest Or Shoulder Harness Required For Positioning Support Only - Authorizer Must Provide Clinical Rationale To Support Request

SERND0035 1 $460.00

Shoulder Straps For Positioning Only - Any Closure - Includes Padding & Mounting Hardware (Maximum 2)

SERND0010 2 $60.00

Custom Fabricated

Custom Chest Support, Includes Attachments

SERCF103L 1 $150.00

Custom Positioning Belt, Includes Attachments. Specify Upper &/Or Lower Extremity &/Or Chest (Maximum 12)

SERCF105L 12 $55.00

Custom Shoulder Harness, Includes Padding & Attachments

SERCF104L 1 $210.00

Pelvic "Y" Belt Or Groin Strap, Includes Attachments

SERCF101L 1 $60.00

Positioning Belts Options Custom Fabricated

Complex Control Pads (Maximum 4) SEMCF503L 4 $165.00

Options For Belts Positioning Support Pads (Maximum 12)

SEMCF501L 12 $55.00

Positioning Control Pads (Maximum 12) SEMCF502L 12 $55.00

Page: 54 of 75




Seating

OPTIONS:


Qty.

ADP Approved

Amt.

SE - Custom Modifications Approved ADP Manufacturers Only

Custom Modifications To An Adp Listed Modular Seating Device & No Adp Code With Assigned Funding Is Available - Authorizer Must Provide Clinical Rationale To Support Request - Vendor Must Provide Breakdown Of Cost Of Parts & Labour (Not To Exceed $40.00/Hour)

SEMND2005 1

Seating Clinic Use Only Custom Modifications Required To Adp Listed Wheelchair To Facilitate Installation Of Custom Fabricated Positioning Devices (Seating). Authorizer Must Provide Clinical Rational To Support Request. Clinic Must Provide A Breakdown Of The Cost Of Parts And Labour (Not To Exceed $40.00/Hour).

SEMCF990L 1

Transfer Existing Adp Approved Modular Seating System Into New Or Modified Adp Approved Wheelchair - Labour Only, When No Parts Required

SEMND1005 1 $80.00

Custom Fabricated

Transfer Existing Adp Approved Custom Seating System Into A New Or Modified Adp Approved Wheelchair. Labour Only, No Parts Required.

SEUCF200L 1 $80.00

Seat Cushion Cover(s) Approved ADP Manufacturers Only

Extra Cover Bariatric Sizes SESND1060 1 $155.00

Extra Cover Non Standard Sizes SESND1055 2 $115.00

Extra Cover Standard Sizes SESND1050 2 $75.00

Custom Fabricated

Removable Cover For Sculptured Or Molded Seat, For Incontinence (Maximum 2)

SEMCF107L 2 $250.00

Removable Cover For Wedged Or Contoured Seat, For Incontinence (Maximum 2)

SEMCF106L 2 $180.00

Seat Covers Removable Cover For Flat Seat, For Incontinence (Maximum 2)

SEMCF105L 2 $125.00

Seat Hardware Approved ADP Manufacturers Only

Complex Specialized Mounting Hardware - Including Hardware For Custom Molded Modular Systems - Authorizer Must Provide Clinical Rationale To Support Request

SESND1010 1 $300.00

Custom Fabricated

Complex Interface Mounts Seat & Back To Wheelchair Frame

SEICF170L 1 $350.00

Page: 55 of 75




Seating

OPTIONS:


Qty.

ADP Approved

Amt.

Seat Hardware Custom Fabricated

Hardware To Mount Positioning Device Into Paediatric Stroller

SEICF190L 1 $100.00

Hardware To Mount Seat & Back Into Dynamic Tilt Wheelchair

SEICF180L 1 $570.00

Seat & Back Hardware Strap Interface (2) Mounts Seat To Wheelchair

SEICF140L 2 $100.00

Seat Rigidizer - Flat Rigid Insert SEICF192L 1 $60.00

Securing Hardware That Mounts Hardware To Mobility Device (Maximum 8)

SEICF191L 8 $25.00

Simple Seat Interface Mounts Seat To Wheelchair Frame

SEICF150L 2 $195.00

Seat Options Approved ADP Manufacturers Only

Additional Pressure Relief - Specialty Foam, Air, Gel

SESND1045 1 $415.00

Custom Modifications And Sizing - Including Custom Sizes, Static Adductors & Pommels, Wedges & Anti-Thrust Devices, Leg Length Discrepancy Allowance (Maximum 6).

SESND1040 6 $80.00

Drop Base And Hooks (4) SESND1020 1 $250.00

Roho Bolster SESND1035 1 $180.00

Solid Seat Insert SESND1015 1 $80.00

Subasis Bar, Complete, Including Hardware

SESND1041 1 $200.00

Custom Fabricated

2" Convolute Foam Cut To Size (Maximum 2)

SEMCF403L 2 $40.00

2" Polyfoam Cut To Size (Maximum 2)

SEMCF406L 2 $30.00


SEMCF404L 2 $45.00

3" Polyfoam Cut To Size (Maximum 2)

SEMCF407L 2 $35.00


SEMCF405L 2 $50.00

Add Waterproof Skin On Complex Indirect Molded Seat

SEMCF210L 2 $100.00

Additional Foam Viscoelastic Foam Or Pudgee 1" Thick/1 Square Foot (Maximum 2)

SEMCF401L 2 $60.00

Complex Pelvic Stabilizers, Each (Maximum 2)

SEMCF206L 2 $225.00

Page: 56 of 75




Seating

OPTIONS:


Qty.

ADP Approved

Amt.

Seat Options Custom Fabricated

Contoured Cushion With Troughing Secured In Front Of A Roho Cushion, Not Including Roho Cushion, Includes Cover

SEMCF209L 1 $380.00

Heavy Duty Upgrade To Reinforce Seat SEMCF207L 1 $75.00

Modify Or Refurbish Existing Custom Fabricated Seat, Includes Parts, Hardware & Labour

SEMCF212L 1 $225.00

Options & Modifications For Seats Upgrade To Provide Extra Pressure Relief, Gel/Foam/Air/Liquid Etc. (Maximum 2)

SEMCF203L 2 $150.00

Pelvic Stabilizer (Maximum 2) SEMCF204L 2 $214.00

Polymer Supplement Pad (Maximum 2)

SEMCF402L 2 $150.00

Seat Plaster Molding/Vacuum Form SEUCF005L 1 $160.00

Simple Cushion Secured In Front Of A Roho Cushion, Not Including Roho Cushion, Includes Cover

SEMCF208L 1 $200.00

Single Complex Pelvic Stabilizer For Seat Or Back

SEMCF205L 1 $300.00

Tray Approved ADP Manufacturers Only

Full Tray For Positioning Support Only - Standard Adult & Paediatric Sizes, Includes Mounting Hardware

SETND0005 1 $190.00

Full Tray Non Standard Size For Positioning Support Only - Adult & Paediatric Sizes, Includes Mounting Hardware

SETND0010 1 $325.00

Half Tray For Positioning Support Only - Non Standard Adult & Paediatric Sizes, Includes Mounting Hardware

SETND0020 2 $315.00

Half Tray For Positioning Support Only - Standard Adult & Paediatric Sizes, Includes Mounting Hardware

SETND0015 2 $235.00

Custom Fabricated

Customized Lexan Tray, Includes Mounting Hardware

SETCF103L 1 $420.00

Kydex Tray, Includes Mounting Hardware

SETCF104L 1 $360.00

Plastic Tray, Includes Mounting Hardware

SETCF101L 1 $350.00

Wood/Arborite Tray, Includes Mounting Hardware

SETCF102L 1 $255.00

Page: 57 of 75




Seating

OPTIONS:


Qty.

ADP Approved

Amt.

Tray Options Approved ADP Manufacturers Only

Add Modular Elbow Or Hip Blocks To Any Modular Tray - (Maximum 4)

SETND0030 4 $65.00

Add Padding To Any Tray SETND0035 2 $75.00

Custom Fabricated

Elbow Block Padding Including Cover (Maximum 2)

SEMCF306L 2 $60.00

Elbow Blocks (Maximum 2) SEMCF305L 2 $85.00

Large/Full Tray Pad (Maximum 2) SEMCF304L 2 $145.00

Options & Modifications For Trays Clear Tray Cover, Removable

SEMCF301L 1 $80.00

Small Tray Pad (Maximum 2) SEMCF303L 2 $80.00

Page: 58 of 75




Wheelchairs (Manual)

Device Type Manufacturer Device ADP Code Max Allowed Qty.

ADP Approved Amt.

Adult High Performance Rigid Manual WheelchairWheelchair type offers lightweight rigid frame and optimal maneuverability. Suitable for the very active user who requires postural support and altered wheel placement for mobility. ADP price includes frame (sizes up to 18"wide x 18"deep), standard upholstery, swing away detachable footrests, height adjustable armrests, rear anti-tippers, 2 point seat belt any closure, brake extensions, front casters, wheels. See Manual Wheelchair Options Chart for other basic components funded by ADP.

Invacare A-4 WMA4IN015 1 $3,592.00

Crossfire T6/Ti WMA4IN110 1 $3,592.00

Crossfire T7a WMA4IN130 1 $3,592.00

Terminator WMA4IN105 1 $3,592.00

Ki Mobility Tsunami WMA4KI015 1 $3,592.00

Quickie Quickie Gp/Gpv WMA4QU005 1 $3,592.00

Quickie Gt WMA4QU030 1 $3,592.00

Quickie Gti WMA4QU035 1 $3,592.00

Quickie Q7 WMA4QU040 1 $3,592.00

Quickie Ti WMA4QU020 1 $3,592.00

Quickie Xtr WMA4QU010 1 $3,592.00

Rgk Wheelchairs Hi-Lite WMA4RZ005 1 $3,592.00

Rogue Wheels Inc.

Marvel WMA4M0005 1 $3,592.00

Tisport Tilite Aero Z WMA4TZ010 1 $3,592.00

Tilite Yr/Tr,Yra/Tra,Trc,Zra WMA4TZ005 1 $3,592.00

Adult Lightweight Performance Manual WheelchairWheelchair type offers maximum adjustments and options. Suitable for the very active user who requires altered wheel placement for optimal postural support and mobility. ADP price includes frame (sizes up to 18"wide x 18"deep), standard upholstery, swing away detachable footrests, height adjustable armrests, rear anti-tippers, 2 point seat belt any closure, brake extensions, front casters, wheels. See Manual Wheelchair Options Chart for other basic components funded by ADP.

Future Mobility Galaxy Lite WMA3FM010 1 $2,655.00

Northern Lite WMA3FM005 1 $2,655.00

Handicare Legend 2 Exigo/Exigo WMA3M9015 1 $2,655.00

Invacare Compass Xe (Allegro) WMA3IN030 1 $2,655.00

Mvp WMA3IN060 1 $2,655.00

Myon Active WMA3IN065 1 $2,655.00

Prospin X4 WMA3IN035 1 $2,655.00

Xtra WMA3IN005 1 $2,655.00

Ki Mobility Catalyst 5, 5ti WMA3KI010 1 $2,655.00

Catalyst 5vx WMA3KI015 1 $2,655.00


Ez Ride WMA3WM005 1 $2,655.00

Motion Composites

Helio WMA3QM005 1 $2,655.00

Orthofab Prima WMA3OF010 1 $2,655.00

Otto Bock Motus WMA3OB010 1 $2,655.00

Start M5 Comfort WMA3OB005 1 $2,655.00


Litestream Xf WMA3X1010 1 $2,655.00

Product Design Group

Eclipse 600 WMA3MV005 1 $2,655.00

Quickie Quickie 2 WMA3QU005 1 $2,655.00

Quickie 2 Hp WMA3QU010 1 $2,655.00

Quickie 2 Lite WMA3QU020 1 $2,655.00

Quickie Gtx WMA3QU040 1 $2,655.00

Page: 59 of 75






ADP Approved Amt.

Adult Lightweight Performance Manual WheelchairWheelchair type offers maximum adjustments and options. Suitable for the very active user who requires altered wheel placement for optimal postural support and mobility. ADP price includes frame (sizes up to 18"wide x 18"deep), standard upholstery, swing away detachable footrests, height adjustable armrests, rear anti-tippers, 2 point seat belt any closure, brake extensions, front casters, wheels. See Manual Wheelchair Options Chart for other basic components funded by ADP.

Quickie Quickie Lxi WMA3QU405 1 $2,655.00

Quickie M6 WMA3QU420 1 $2,655.00

Quickie Revolution WMA3QU410 1 $2,655.00

Rgk Wheelchairs Maxima WMA3RZ005 1 $2,655.00

Tisport Tilite X, Sx, Tx WMA3TZ005 1 $2,655.00

Adult Lightweight Standard Manual WheelchairWheelchair type most suitable for user who is independently mobile and requires some adjustments to accommodate postural and mobility requirements. ADP price includes frame (sizes up to 18"wide x 18"deep), standard upholstery, swing away detachable footrests, height adjustable armrests, rear anti-tippers, 2 point seat belt any closure, brake extensions, front casters, wheels. See Manual Wheelchair Options Chart for other basic components funded by ADP.

Future Mobility Stellato WMA2FM005 1 $1,680.00

Invacare 9000 Sl WMA2IN030 1 $1,680.00

9000 Topaz WMA2IN055 1 $1,680.00

9000 Xt WMA2IN025 1 $1,680.00

Myon Manual Wheelchair WMA2IN060 1 $1,680.00

Patriot WMA2IN050 1 $1,680.00

Ki Mobility Catalyst 4, 4c WMA2KI010 1 $1,680.00


Nrg+ WMA2WM005 1 $1,680.00

Swift WMA2WM010 1 $1,680.00

Orthofab Ch+ WMA2OF005 1 $1,680.00

Otto Bock Start M2 Effect WMA2OB005 1 $1,680.00


Litestream Xf Ltd WMA2X1010 1 $1,680.00

Stylus 400 WMA2X1005 1 $1,680.00

Quickie Breezy 600 WMA2QU001 1 $1,680.00

Breezy Ultra 4 WMA2QU010 1 $1,680.00

Quickie Lx WMA2QU105 1 $1,680.00

Adult Manual Dynamic Tilt WheelchairWheelchair type offers manual dynamic tilt required by the user who can not maintain an upright posture through the use of seating components alone. ADP price includes dynamic tilt frame (sizes up to 18" wide x 18"deep), standard upholstery, swing away detachable footrests, height adjustable armrests, rear anti-tippers, brake extensions, 2 point seat belt any closure, front casters, wheels. See Manual Wheelchair Options Chart for other basic components funded by ADP.

Advanced Mobility

Ams Itilt2 WMA5AO020 1 $2,446.00

Tilt Recline/ I Tilt WMA5AO015 1 $2,446.00

Broda Cat 587 WMA5B-025 1 $2,446.00

Elite 785 WMA5B-020 1 $2,446.00

Models 80 & 48 WMA5B-005 1 $2,446.00

Models 85 & 35 & 75 WMA5B-010 1 $2,446.00

Future Mobility Orion 500 WMA5FM010 1 $2,446.00

Orion Ii WMA5FM005 1 $2,446.00

Handicare Emineo WMA5M9010 1 $2,446.00

Ibis WMA5M9005 1 $2,446.00

Invacare Concept 45 WMA5IN020 1 $2,446.00

Htr WMA5IN025 1 $2,446.00

Solara 2g WMA5IN035 1 $2,446.00

Solara 3g WMA5IN040 1 $2,446.00

Lpa Medical Inc Comp-Position WMA5LQ010 1 $2,446.00

Page: 60 of 75






ADP Approved Amt.

Adult Manual Dynamic Tilt WheelchairWheelchair type offers manual dynamic tilt required by the user who can not maintain an upright posture through the use of seating components alone. ADP price includes dynamic tilt frame (sizes up to 18" wide x 18"deep), standard upholstery, swing away detachable footrests, height adjustable armrests, rear anti-tippers, brake extensions, 2 point seat belt any closure, front casters, wheels. See Manual Wheelchair Options Chart for other basic components funded by ADP.

Lpa Medical Inc Dyn-Ergo WMA5LQ020 1 $2,446.00

Evolution WMA5LQ015 1 $2,446.00

Optimum Posturo-Pedic WMA5LQ005 1 $2,446.00


Mlt 700a/B WMA5WM015 1 $2,446.00

Mltr 500 & 600 WMA5WM010 1 $2,446.00

Supertilt WMA5WM005 1 $2,446.00

Orthofab Tango WMA5OF005 1 $2,446.00


Astrotilt WMA5MV015 1 $2,446.00

Bentley WMA5MV005 1 $2,446.00

Fuze T20 WMA5MV025 1 $2,446.00

Fuze T50 WMA5MV020 1 $2,446.00

Stellar WMA5MV010 1 $2,446.00

Quickie Quickie Iris WMA5QU015 1 $2,446.00

Quickie Ts WMA5QU005 1 $2,446.00

Tilt Fx WMA5QU020 1 $2,446.00

Adult Standard Manual WheelchairWheelchair type most suitable for user who is not consistently independently mobile and requires minimal adjustments to accommodate postural and mobility requirements. ADP price includes frame (sizes up to 18"wide x 18"deep), standard upholstery, swing away detachable footrests, height adjustable armrests, rear anti-tippers, 2 point seat belt any closure, brake extensions, front casters, wheels. See Manual Wheelchair Options Chart for other basic components funded by ADP.

Amg Medical Airgo WMA1GM005 1 $1,424.00

Broda 48/Runabout WMA1B-015 1 $1,424.00

Everest & Jennings

Traveler WMA1EJ005 1 $1,424.00

Invacare 900 WMA1IN015 1 $1,424.00

Tracer WMA1IN005 1 $1,424.00

Quickie Easy Care 2000 & 4000 WMA1QU015 1 $1,424.00

Paediatric High Performance Rigid Manual WheelchairWheelchair type offers lightweight rigid frame and optimal maneuverability. Suitable for the very active user who requires postural support and altered wheel placement for mobility. ADP price includes frame (sizes up to 16"wide x 16"deep), standard upholstery, swing away detachable footrests, height adjustable armrests, rear anti-tippers, 2 point seat belt any closure, brake extensions, front casters, wheels. See Manual Wheelchair Options Chart for other basic components funded by ADP.

Invacare Comet WMK4IN020 1 $3,889.00

Crossfire T6a WMK4IN130 1 $3,889.00

Ki Mobility Tsunami WMK4KI005 1 $3,889.00

Quickie Quickie Gp WMK4QU010 1 $3,889.00

Quickie Gt WMK4QU030 1 $3,889.00

Quickie Q7 WMK4QU035 1 $3,889.00

Quickie Ti WMK4QU025 1 $3,889.00

Zippie WMK4QU005 1 $3,889.00

Zippie Zone WMK4QU040 1 $3,889.00

Rgk Wheelchairs Hi-Lite WMK4RZ005 1 $3,889.00

Tisport Tilite Aero Z WMK4TZ010 1 $3,889.00

Tilite Yr/Tr,Yra/Tra,Trc,Zra WMK4TZ005 1 $3,889.00

Page: 61 of 75






ADP Approved Amt.

Paediatric Lightweight Performance Manual WheelchairWheelchair type offers maximum adjustments and options. Suitable for the active user who requires altered wheel placement for optimal postural support and mobility. ADP price includes frame (sizes up to 16"wide x 16"deep), standard upholstery, swing away detachable footrests, height adjustable armrests, rear anti-tippers, 2 point seat belt any closure, brake extensions, front casters, wheels. See Manual Wheelchair Options Chart for other basic components funded by ADP.

Invacare Compass Xe (Allegro) WMK3IN020 1 $2,678.00

Mvp Junior WMK3IN030 1 $2,678.00

Myon Jr Manual Wheelchair

WMK3IN040 1 $2,678.00

Prospin X4 WMK3IN035 1 $2,678.00

Otto Bock Motus WMK3OB005 1 $2,678.00

Quickie Quickie 2 WMK3QU010 1 $2,678.00

Quickie 2 Hp WMK3QU015 1 $2,678.00

Quickie 2 Lite WMK3QU020 1 $2,678.00

Quickie Gtx WMK3QU040 1 $2,678.00

Quickie Lxi WMK3QU030 1 $2,678.00

Zippie 2 WMK3QU005 1 $2,678.00

Zippie Gs WMK3QU035 1 $2,678.00

Rgk Wheelchairs Maxima WMK3RZ005 1 $2,678.00

Tisport Tilite X, Sx, Tx WMK3TZ005 1 $2,678.00

Paediatric Lightweight Standard Manual WheelchairWheelchair type most suitable for user who requires some adjustments to accommodate postural and mobility requirements. ADP price includes frame (sizes up to 16"wide x 16"deep), standard upholstery, swing away detachable footrests, height adjustable armrests, rear anti-tippers, 2 point seat belt any closure, brake extensions, front casters, wheels. See Manual Wheelchair Options Chart for other basic components funded by ADP.

Handicare Legend 2 Exigo/Exigo WMK2M9020 1 $1,850.00

Invacare 9000 Jymni WMK2IN010 1 $1,850.00


Litestream Xf WMK2X1010 1 $1,850.00

Quickie Quickie Lx WMK2QU020 1 $1,850.00

Paediatric Manual Dynamic Tilt WheelchairWheelchair type offers manual dynamic tilt required by the user who can not maintain an upright posture through the use of seating components alone. ADP price includes dynamic tilt frame (sizes up to 16" wide x 16"deep), standard upholstery, swing away detachable footrests, height adjustable armrests, rear anti-tippers, brake extensions, 2 point seat belt any closure, front casters, wheels. See Manual Wheelchair Options Chart for other basic components funded by ADP.

Convaid Cuddlebug WMK5CO050 1 $3,251.00

Safari Tilt WMK5CO040 1 $3,251.00

Future Mobility Super Chair For Kids WMK5FM010 1 $3,251.00

Invacare Orbit/Tiger WMK5IN010 1 $3,251.00

Spree 3g WMK5IN030 1 $3,251.00

Spree Gt WMK5IN025 1 $3,251.00

Spree Xt WMK5IN020 1 $3,251.00

Kid Kart Kid Kart Xpress WMK5KT020 1 $3,251.00

Kid-Tlc WMK5KT010 1 $3,251.00

Kids Up Inc Bingo WMK5K2010 1 $3,251.00

F.A.S.T WMK5K2015 1 $3,251.00

Kids Rock WMK5K2005 1 $3,251.00

Otto Bock Kimba Spring & Kimba Spring Plus

WMK5OB010 1 $3,251.00


Astrotilt Jr. WMK5MV015 1 $3,251.00

Fuze T20 WMK5MV025 1 $3,251.00

Fuze T50 WMK5MV020 1 $3,251.00

Page: 62 of 75






ADP Approved Amt.

Paediatric Manual Dynamic Tilt WheelchairWheelchair type offers manual dynamic tilt required by the user who can not maintain an upright posture through the use of seating components alone. ADP price includes dynamic tilt frame (sizes up to 16" wide x 16"deep), standard upholstery, swing away detachable footrests, height adjustable armrests, rear anti-tippers, brake extensions, 2 point seat belt any closure, front casters, wheels. See Manual Wheelchair Options Chart for other basic components funded by ADP.

Quickie Zippie Iris WMK5QU010 1 $3,251.00

Zippie Ts WMK5QU005 1 $3,251.00

Specmat Technologies

Chunc 45 WMK51S005 1 $3,251.00

Paediatric Specific Specialty StrollerADP price includes stroller frame and upholstery, foot support, seat and back supports, headrest, chest and pelvic positioning straps (harness), abductor, and wheels. See Manual Wheelchair Options Chart for additional basic components funded by ADP.

Alvema Series 100/Pix1 WMK6AL005 1 $1,511.00

Convaid Convertible WMK6CO070 1 $1,511.00

Cruiser Cx & Cr WMK6CO005 1 $1,511.00

Ez Rider WMK6CO050 1 $1,511.00

Metro WMK6CO030 1 $1,511.00

Rodeo Tilt WMK6CO060 1 $1,511.00

Scout WMK6CO025 1 $1,511.00

Maclaren Buggy WMK6AM005 1 $1,511.00

Otto Bock Eco-Buggy WMK6OB005 1 $1,511.00

Page: 63 of 75





OPTIONS:


ADP Approved Amt.

Adjustable Tension Back Upholstery over 18" Frame Width

WAME 1 $240.00

Adjustable Tension Back Upholstery up to 18" Frame Width

WAMD 1 $140.00

Amputee Axle Plates (pair) WAMT 1 $113.00

Angle Adjustable Footplates (pair) WAMJ 1 $130.00

Caster Pin Locks (pair) WAMS 1 $171.00

Clothing Guards WAMV 1 $126.00

Elevating Legrests (pair) WAMK 1 $404.00

Grade Aids (pair) WAMR 1 $116.00

Heavy Duty Cross Braces & Upholstery

WAMC 1 $680.00

Heavy Duty Model, Client Weight Exceeds 250 LbsHEAVY DUTY MODEL REQUIRED, CLIENT WEIGHT EXCEEDS 250LBS. Authorizer must document client weight. Selected device must meet weight requirements.

WAMF 1 $730.00


WAMG 1 $992.00


WAMH 1 $1,110.00

Hub-Eez Easy Push Wheel WAMM 1 $716.00

MW - Custom Modifications MWCM 1

One Arm/Lever Drive WAML 1 $1,046.00

Oxygen Tank Holder WAMX 1 $195.00

Plastic Coated Handrims WAMO 1 $134.00

Page: 64 of 75





OPTIONS:


ADP Approved Amt.

Power Add-On DeviceDevice is added onto a manual wheelchair to assist the user meet their long term basic and essential mobility requirements. User must be able to operate the manual wheelchair independently. This code may be used only when it is not anticipated that the user will require the use of a power wheelchair to meet their long term basic and essential mobility requirements. ADP funding assistance is not provided for a power add on device and a power wheelchair.

Dolomite Alber E.Motion WPS1DO005 1 $6,135.00

Magicwheels Magicwheels WPS1WS005 1 $6,135.00

Quickie Quickie Xtender WPS1QU005 1 $6,135.00

Projected Handrims (pair) WAMQ 1 $224.00

Quick Release Axles (pair) WAMU 1 $110.00

Recliner Option WAMI 1 $527.00

Seat Depth Required is Greater Than 18"

WAMB 1 $265.00

Seat Width Required is Greater Than 18"

WAMA 1 $399.00

Spoke Protectors (pair) WAMP 1 $116.00

Standard Manual Wheelchair Frame with Manual Dynamic Tilt *STANDARD MANUAL WHEELCHAIR WITH MANUAL DYNAMIC TILT (WMA5, WMK5). Frame offers ongoing adjustability and facilitates independent mobility. Authorizer must provide clinical rationale to support the request. Selected device must meet clinical requirements.

WANA 1 $1,200.00

Stroller Handles/Paediatric WAMW 1 $147.00

Titanium Frame *TITANIUM FRAME MANUAL WHEELCHAIR, ADP TYPE 3 & TYPE 4. Authorizer must provide clinical rationale to support the request. Selected device must meet clinical requirements.

WAMZ 1 $1,500.00

Uni-Lateral Wheel Lock WAMN 1 $149.00

Ventilator Tray WAMY 1 $425.00

Page: 65 of 75




Wheelchairs (Power)


Qty.

ADP Approved

Amt.

Adult Power Base Type 1Wheelchair type most suitable for use on hard, flat surfaces. Primarily for user who requires minimal adjustments to support independent mobility. ADP price includes seat and back frame (sizes up to 18" wide x 18"deep), standard joystick control, swing away detachable footrests, height adjustable armrests, 2 point seat belt any closure, front casters, wheels. See Power Wheelchair Options Chart for other basic components funded by ADP.

Invacare Nutron Series R51lxp WPA1IN065 1 $5,092.00

Pronto M51 WPA1IN075 1 $5,092.00


Mp1 WPA1WN005 1 $5,092.00


Jazzy 1103 Ultra WPA1X1020 1 $5,092.00

Jazzy Select 14 / Select 14 Plus WPA1X1015 1 $5,092.00

Jazzy Select 6 WPA1X1230 1 $5,092.00

Jet 3 Ultra WPA1X1030 1 $5,092.00

Quickie Quickie V-121 WPA1QU020 1 $5,092.00

Shoprider/Pihsiang

Shoprider P424l WPA1S7015 1 $5,092.00

Shoprider P424m WPA1S7010 1 $5,092.00

Spitfire 888wa WPA1S7005 1 $5,092.00

Adult Power Base Type 2Wheelchair type suitable for use on most surfaces. Primarily for user who requires postural support, modifications to electronics, and other specific options to support independent mobility. ADP price includes seat and back frame (sizes up to 18" wide x 18"deep), standard joystick control, swing away detachable footrests, height adjustable armrests, 2 point seat belt any closure, front casters, and wheels. See Power Wheelchair Options Chart for other basic components funded by ADP.

Invacare 3g Ranger X Storm Series WPA2IN040 1 $6,738.00


Mp2 WPA2WN005 1 $6,738.00


Jazzy 600 WPA2X1220 1 $6,738.00

Quickie Quickie V-521 WPA2QU405 1 $6,738.00

Adult Power Base Type 3Wheelchair type suitable for use on most surfaces. Primarily for the user who requires ongoing changes in postural support, modifications to electronics, and other specific options to support independent mobility. ADP price includes base, 2 point seat belt any closure and standard joystick control. See Power Wheelchair Options Chart for other basic components funded by ADP.

Future Mobility

Orion Explorer Magellan WPA3FM005 1 $7,101.00

Orion Explorer Viking WPA3FM010 1 $7,101.00

Handicare Alex Power Wheelchair WPA3M9005 1 $7,101.00

Invacare Action Torque Storm WPA3IN015 1 $7,101.00

Arrow Storm Rwd WPA3IN020 1 $7,101.00

Fdx WPA3IN080 1 $7,101.00

Pronto M91 WPA3IN050 1 $7,101.00

Pronto M94 WPA3IN052 1 $7,101.00

Tdx Sp/Sr WPA3IN070 1 $7,101.00

Tdx-Sc WPA3IN075 1 $7,101.00


Mp5 WPA3WM005 1 $7,101.00

Orthofab Oasis WPA3OF110 1 $7,101.00

Permobil C300 WPA31P010 1 $7,101.00

C350 WPA31P030 1 $7,101.00

C400 WPA31P015 1 $7,101.00

C500 WPA31P020 1 $7,101.00

Chairman Hd3 WPA31P025 1 $7,101.00

Street WPA31P005 1 $7,101.00

Page: 66 of 75




Wheelchairs (Power)


Qty.

ADP Approved

Amt.

Adult Power Base Type 3Wheelchair type suitable for use on most surfaces. Primarily for the user who requires ongoing changes in postural support, modifications to electronics, and other specific options to support independent mobility. ADP price includes base, 2 point seat belt any closure and standard joystick control. See Power Wheelchair Options Chart for other basic components funded by ADP.


Jazzy/Quantum 1113 WPA3X1100 1 $7,101.00



Jazzy/Quantum 1402 & 1420 WPA3X1020 1 $7,101.00


Quantum 600 WPA3X1220 1 $7,101.00

Quantum 6000 WPA3X1240 1 $7,101.00

Quantum 6000z WPA3X1245 1 $7,101.00

Quantum 610 WPA3X1225 1 $7,101.00

Quantum 614 WPA3X1255 1 $7,101.00

Quantum R4000 WPA3X1250 1 $7,101.00

Quickie Quickie P-222 WPA3QU240 1 $7,101.00

Quickie Rhythm WPA3QU260 1 $7,101.00

Quickie S-525 WPA3QU220 1 $7,101.00

Quickie S-646 (S-626) WPA3QU230 1 $7,101.00

Quickie X2 WPA3QU290 1 $7,101.00

Quickie Xcel WPA3QU300 1 $7,101.00

Quickie Xperience WPA3QU280 1 $7,101.00

Quickie Xplore WPA3QU270 1 $7,101.00

Paediatric Power Base Type 1Wheelchair type most suitable for use on hard, flat surfaces. Primarily for user who requires minimal adjustments to support independent mobility. ADP price includes seat and back frame (sizes up to 16" wide x 16"deep), standard joystick control, swing away detachable footrests, height adjustable armrests, 2 point seat belt any closure, front casters, wheels. See Power Wheelchair Options Chart for other basic components funded by ADP.

Invacare Nutron Series R51lxp WPK1IN015 1 $5,424.00


Jazzy Select 6 WPK1X1230 1 $5,424.00

Quickie Quickie V-121 WPK1QU025 1 $5,424.00

Paediatric Power Base Type 2Wheelchair type suitable for use on most surfaces. Primarily for user who requires postural support, modifications to electronics, and other specific options to support independent mobility. ADP price includes seat and back frame (sizes up to 16" wide x 16"deep), standard joystick control, swing away detachable footrests, height adjustable armrests, 2 point seat belt any closure, front casters, wheels. See Power Wheelchair Options Chart for other basic components funded by ADP.

Invacare Tiger WPK2IN015 1 $6,385.00

Quickie Quickie V-521 WPK2QU405 1 $6,385.00

Page: 67 of 75




Wheelchairs (Power)


Qty.

ADP Approved

Amt.

Paediatric Power Base Type 3Wheelchair type suitable for use on most surfaces. Primarily for the user who requires ongoing changes in postural support, modifications to electronics, and other specific options to support independent mobility. ADP price includes base, 2 point seat belt any closure, and standard joystick control. See Power Wheelchair Options Chart for other basic components funded by ADP.

Handicare Alex Power Wheelchair WPK3M9005 1 $6,843.00

Invacare Arrow Storm WPK3IN010 1 $6,843.00

Fdx WPK3IN080 1 $6,843.00

Storm Torque WPK3IN015 1 $6,843.00

Tdx Sp/Sr WPK3IN070 1 $6,843.00

Tdx Spree WPK3IN075 1 $6,843.00

Permobil C300 Corpus Junior / K300 WPK31P010 1 $6,843.00

C400 Corpus Junior WPK31P015 1 $6,843.00


Quantum 600 WPK3X1220 1 $6,843.00

Quantum 6000 WPK3X1240 1 $6,843.00

Quantum 6000z WPK3X1245 1 $6,843.00

Quantum 610 WPK3X1225 1 $6,843.00

Quantum 614 WPK3X1255 1 $6,843.00

Quantum R4000 WPK3X1250 1 $6,843.00

Quickie Quickie P-222 WPK3QU020 1 $6,843.00

Quickie Rhythm WPK3QU040 1 $6,843.00

Quickie S-525 WPK3QU010 1 $6,843.00

Quickie Xperience WPK3QU080 1 $6,843.00

Quickie Xplore WPK3QU070 1 $6,843.00

Paediatric Power Base with Manual Dynamic TiltWheelchair type offers manual dynamic tilt required by the user who can not maintain a functional posture through the use of seating components alone. ADP price includes dynamic tilt frame (sizes up to 16" wide x 16"deep), standard joystick control, swing away detachable footrests, height adjustable armrests, 2 point seat belt any closure, front casters, wheels. See Power Wheelchair Options Chart for other basic components funded by ADP.

Invacare Tdx Spree WPK4IN075 1 $6,505.00

Tiger WPK4IN005 1 $6,505.00

Quickie Quickie Z-500 WPK4QU005 1 $6,505.00

Power ScooterDevice is suitable for the user who requires power mobility to meet their long term basic and essential mobility requirements, and does not require specific postural support now or in the future. ADP price includes base, tiller and seat. ADP funding for positioning devices (seating) is not available for scooters. See Power Wheelchair Options Chart when heavy duty models are required.

Activelite Mobility

Easy Travel -3 Wh. WS16A0005 1 $3,041.00

Advanced Vehicle Concepts

Quingo Classic WS15V0005 1 $3,041.00

Fortress 1700fs -3 Wh. WS1FS0015 1 $3,041.00

1700fs -4 Wh. WS1FS0020 1 $3,041.00

2000fs -3 Wh. WS1FS0005 1 $3,041.00

2000fs -4 Wh WS1FS0010 1 $3,041.00

Winner -3 Wh. WS1FS0070 1 $3,041.00

Winner -4 Wh. WS1FS0075 1 $3,041.00

Invacare Auriga - 3 Wh. WS1IN0070 1 $3,041.00

Page: 68 of 75




Wheelchairs (Power)


Qty.

ADP Approved

Amt.


Invacare Auriga - 4 Wh. WS1IN0075 1 $3,041.00

Leo Scooter 4 Wheel WS1IN0085 1 $3,041.00

Meteor - 4 Wh. WS1IN0080 1 $3,041.00


Mp3 -3 Wh. WS1WN0005 1 $3,041.00

Mp4 -4 Wh. WS1WN0010 1 $3,041.00

Nexidea Health Products

Hs320c.T.M.-3 Wh. WS1UI2020 1 $3,041.00

Hs360c.T.M.-4 Wh. WS1UI2000 1 $3,041.00

Hs570c.T.M.-3 Wh. WS1UI2005 1 $3,041.00

Hs580c.T.M.-4 Wh. WS1UI2010 1 $3,041.00

Hs666c.T.M.-3 Wh. WS1UI2015 1 $3,041.00

Hs686c.T.M.-4 Wh. WS1UI2025 1 $3,041.00


Celebrity X - 3 Wh. WS1X10010 1 $3,041.00

Celebrity X - 4 Wh. WS1X10015 1 $3,041.00

Celebrity Xl - 4 Wh. WS1X10017 1 $3,041.00

Gogo Elite Traveller Plus - 3 Wh. WS1X10100 1 $3,041.00

Gogo Elite Traveller Plus - 4 Wh. WS1X10105 1 $3,041.00

Hurricane WS1X10085 1 $3,041.00

Legend Xl WS1X10045 1 $3,041.00

Maxima -3 Wh. WS1X10060 1 $3,041.00

Maxima -4 Wh. WS1X10065 1 $3,041.00

New Legend -3 Wh. WS1X10030 1 $3,041.00

New Legend -4 Wh. WS1X10040 1 $3,041.00

Revo Sc63 - 3 Wh. WS1X10090 1 $3,041.00

Revo Sc64 - 4wh. WS1X10095 1 $3,041.00

Victory 10 - 3 Wh, 3 Wh Twin WS1X10110 1 $3,041.00

Victory 10 - 4 Wh WS1X10115 1 $3,041.00

Shoprider/Pihsiang

Chameleon Gkb - 3 Wh WS1S7005 1 $3,041.00

Chameleon Gkb - 4 Wh WS1S7010 1 $3,041.00

Cobra 778el -3 Wh. WS1S70020 1 $3,041.00

Cobra 778el -4 Wh. WS1S70025 1 $3,041.00

Landcruiser 889-3wh. WS1S70035 1 $3,041.00

Landcruiser 889xls 4wh. WS1S70036 1 $3,041.00

Sovereign 888 -3 Wh. WS1S70030 1 $3,041.00

Sovereign 888 -4 Wh. WS1S70032 1 $3,041.00

Trailblazer 889sel 4wh. WS1S70045 1 $3,041.00

Voyager 778s -3 Wh. WS1S70037 1 $3,041.00

Voyager 888sel -4 Wh. WS1S70040 1 $3,041.00

Page: 69 of 75




Wheelchairs (Power)


Qty.

ADP Approved

Amt.


Yelle & Associates Ltd.

Freedom - 3 Wh. WS1YE0030 1 $3,041.00

Safari/Ltd-3 Wh. WS1YE0020 1 $3,041.00

Solo Ltd-4 Wh. WS1YE0007 1 $3,041.00

Solo/Ltd-3 Wh. WS1YE0005 1 $3,041.00

Solo/Xt550-4 Wh. WS1YE0010 1 $3,041.00

Page: 70 of 75




Wheelchairs (Power)

OPTIONS:


Qty.

ADP Approved

Amt.

Adjustable Tension Back Upholstery over 18" Frame Width

WEPE 1 $240.00

Adjustable Tension Back Upholstery up to 18" Frame Width

WEPD 1 $140.00

Angle Adjustable Footplates (pair) WEPJ 1 $117.00

Auto Correction System*SPECIALIZED ELECTRONICS FOR POWER WHEELCHAIRS (WPA3, WPK3) Offers increased driving control through specific auto-correction system; for client with limited trunk and/or upper extremity control. Authorizer must provide clinical rationale to support the request. Selected device must meet clinical requirements.

WEPQ 1 $1,500.00


WEPF 1 $556.00


WEPG 1 $667.00


WEPH 1 $979.00

Manual Elevating Legrests (pair) WEPK 1 $391.00

Manual Recline Option WEPI 1 $749.00

Midline Control WE3D 1 $340.00

Multi-function Control Box Amysystems Multi-Function Control Box Multi-Function Control Box, For Use On Systems With Multiple Functions Including Tilt And Power Legs, Tilt, Recline And Power Legs Etc.

SEC4P5005 1 $2,048.00

Invacare Multi-Function Control Box Multi-Function Control Box For Use On Systems With Multiple Functions. Including Tilt And Power Legs, Tilt, Recline And Power Legs Etc.

SECIN5005 1 $1,841.00

Page: 71 of 75




Wheelchairs (Power)

OPTIONS:


Qty.

ADP Approved

Amt.

Multi-function Control Box Motion Concepts

Trx Helix Multi-Function Control Box (Thmc) Trx Helix Multi-Function Control Box (Thmc) For Use On Systems With Multiple Functions, Including Tilt And Power Legs, Tilt, Recline, Power Legs, Etc. Includes Reduced Drive With Elevate.

SECZG5005 1 $1,820.00

Permobil Multi-Function Control Box Multi-Function Control Box - For Use On Systems With Multiple Functions Including, Tilt And Power Legs, Tilt, Recline And Power Legs, Etc.

SEC1P1005 1 $2,142.00


Multi-Function Control Box Multi-Function Control Box - Advanced Acutator Module (Aam)

SECX15005 1 $596.00

Quickie Multi-Function Control Box Multi-Function Control Box For Use On Systems With Multiple Functions, Including Tilt And Power Legrest, Tilt, Recline, Power Legrests Etc.

SECQU4005 1 $2,786.00

One Piece 90/90 Front Riggings WEPL 1 $213.00

Oxygen Tank Holder WEPX 1 $135.00

PW - Custom Modifications PWCM 1

Power Elevating Footrests Amysystems Power Elevating & Articulating Legrests SEF4P0005 1 $2,609.00

Motion Concepts

Power Elevating At5544 Legrest Package For Invacare And Quickie Bases. Includes Legrests And Actuators.

SEFZG0010 1 $2,567.00

Power Elevating Legrests For Invacare, Quantum, And Quickie Bases. Includes Legrests And Actuators.

SEFZG0005 1 $2,567.00

Permobil Power Elevating Articulating Leg Rests SEF1P0005 1 $2,637.00


Articulating Foot Platform SEFX13010 1 $2,795.00

Power Elevating Articulating Leg Rests SEFX13005 1 $2,543.00

Quickie Power Elevating/Articulating Leg Rests SEFQU0005 1 $2,609.00

Tarsys (Invacare)

Power Elevating Legrests SEFTY0005 1 $2,746.00

Power Recline Only Amysystems Power Recline With Integrated Shear Reduction (Isr)

SEC4P0010 1 $4,289.00

Power Recline With Integrated Shear Reduction (Isr)

SEC4P0045 1 $7,462.00

Page: 72 of 75




Wheelchairs (Power)

OPTIONS:


Qty.

ADP Approved

Amt.

Power Recline Only Invacare 12" 20" Recline Only SECIN1010 1 $9,286.00

21" - 24" Recline Only SECIN1015 1 $10,041.00

Motion Concepts

Power Recline Only With Power Sliding Back (Psb) For Invacare, Quantum, And Quickie Bases.

SECZG0015 1 $8,698.00

Power Recline System With Esr For Invacare, Quickie, And Quantum Bases

SECZG1010 1 $9,534.00

Power Recline System With Extended Shear Reduction (Esr) For Invacare, Quantum, And Quickie Bases.

SECZG0010 1 $8,138.00

Permobil Corpus Power Positioning System With Power Recline Only

SEC1P0010 1 $6,958.00


Tru-Balance 2 Power Recline SECX12055 1 $6,300.00

Power Tilt Only Amysystems Amy Seat Cg Power Tilt SEC4P0005 1 $5,129.00

Amy Seat Ii Cg Power Tilt SEC4P0040 1 $6,062.00

Invacare 21" - 24" Tilt Only SECIN1005 1 $7,003.00

Formula Cg Tilt And Recline 12" - 20" Tilt Only

SECIN1000 1 $6,249.00

Motion Concepts

Trx Low-Pro Bariatric Cg Systems Power Tilt Only For Invacare, Quantum, And Quickie Bases.

SECZG1005 1 $7,462.00

Trx-Cg Systems, Cg, Low Pro, Ultra Low Power Tilt Only For Invacare, Quantum, And Quickie Bases.

SECZG0005 1 $6,067.00

Permobil Corpus Hd Power Positioning System Corpus Hd Power Positioning System With 30 Deg. Power Tilt Only

SEC1P0105 1 $10,635.00

Corpus Power Positioning System Corpus Power Positioning System With 45 Deg. Power Tilt Only

SEC1P0005 1 $6,155.00

Ps Power Positioning System Ps Power Positioning System With 45 Deg. Power Tilt Only

SEC1P0205 1 $5,222.00


Tru-Balance 2 Tru-Balance 2 Power Tilt SECX12050 1 $5,595.00

Tue-Balance Tru-Balance Power Tilt SECX12005 1 $5,320.00

Quickie Power C.G. Tilt For Quickie G-424 & S-525

SECQU1005 1 $5,431.00

Power C.G. Tilt For Quickie P-222se SECQU1015 1 $5,479.00

Power C.G. Tilt For Quickie Rhythm SECQU3005 1 $5,502.00

Power C.G. Tilt For Quickie S-626 SECQU1010 1 $5,431.00

Page: 73 of 75




Wheelchairs (Power)

OPTIONS:


Qty.

ADP Approved

Amt.

Power Tilt and Recline Amysystems Cg Power Tilt & Power Recline With Integrated Shear Reduction (Isr)

SEC4P0015 1 $7,275.00

Cg Power Tilt & Power Recline With Integrated Shear Reduction (Isr)

SEC4P0050 1 $10,728.00

Invacare 16" 20" Tilt And Recline SECIN1020 1 $10,382.00

21" - 24" Tilt And Recline SECIN1025 1 $11,136.00

Motion Concepts

Power Tilt And Power Recline For Invacare, Quickie, And Quantum Bases.

SECZG0018 1 $9,683.00

Power Tilt And Power Recline For Invacare, Quantum, And Quickie Bases.

SECZG2010 1 $8,866.00

Power Tilt And Power Recline With Esr For Invacare, Quantum, And Quickie Bases

SECZG0020 1 $10,210.00

Power Tilt And Power Recline With Esr For Invacare, Quantum, And Quickie Bases.

SECZG2015 1 $9,394.00

Power Tilt And Power Recline With Esr For Invacare, Quickie, And Quantum Bases.

SECZG1015 1 $10,775.00

Power Tilt And Power Recline With Psb For Invacare, Quantum, And Quickie Bases.

SECZG0025 1 $10,770.00

Power Tilt And Power Recline With Psb For Invacare, Quantum, And Quickie Bases.

SECZG2020 1 $9,954.00

Permobil Corpus Power Positioning System With 45 Deg. Power Tilt And Power Recline

SEC1P0015 1 $10,262.00


Tru-Balance 2 Power Tilt And Recline SECX12060 1 $10,500.00

Quickie Smart Seat Tilt & Recline System SECQU2005 1 $10,733.00

Seat Depth Required is Greater Than 18"

WEPB 1 $292.00

Seat Package 1 for Power BasesSEAT PACKAGE 1 FOR POWER BASES (includes frame, sling upholstery, armrests, footrests.)

WEPN 1 $842.00

Seat Package 2 for Power BasesSEAT PACKAGE 2 FOR POWER BASES (includes deluxe seat and back, armrests, footrests.) No positioning devices (seating) allowed with this code.

WEPO 1 $866.00

Page: 74 of 75




Wheelchairs (Power)

OPTIONS:


Qty.

ADP Approved

Amt.

Seat Width Required is Greater Than 18"

WEPA 1 $430.00

Specialty Controls 1 Non Standard Joystick*SPECIALTY CONTROLS 1- SIMPLE NON STANDARD JOYSTICK (includes mounting hardware, upgraded electronics & labour). Authorizer must provide clinical rationale to support the request. Selected device must meet clinical requirements.

WEX1 1 $1,400.00

Specialty Controls 2 Chin/Rim Control*SPECIALTY CONTROLS 2 - COMPLEX NON STANDARD JOYSTICK - (includes upgraded electronics, mounting hardware, display, joystick modifications & labour). For chin/rim control etc. Authorizer must provide clinical rationale to support the request. Selected device must meet clinical requirements.

WEX2 1 $3,000.00

Specialty Controls 3 Simple Touch*SPECIALTY CONTROLS 3 - SIMPLE TOUCH - (includes mounting hardware, upgraded electronics, display, cables, 4 switches & labour). For footplate/headrest/tray switches etc. Authorizer must provide clinical rationale to support the request. Selected device must meet clinical requirements.

WEX3 1 $6,700.00

Specialty Controls 4 Proximity Control*SPECIALTY CONTROLS 4 - PROXIMITY CONTROL - (includes mounting hardware, upgraded electronics, display, cables, 4 switches & labour). Authorizer must provide clinical rationale to support the request. Selected device must meet clinical requirements.

WEX4 1 $7,500.00

Specialty Controls 5 Breath Control*SPECIALTY CONTROLS 5 - BREATH CONTROL - SIP'N'PUFF (includes mounting hardware, upgraded electronics, display, cables & labour). Authorizer must provide clinical rationale to support the request. Selected device must meet clinical requirements.

WEX5 1 $3,000.00

Specialty Controls 6 Scanners*SPECIALTY CONTROLS 6 - SCANNERS (includes mounting hardware, upgraded electronics, display, cables, scanner & labour). Authorizer must provide clinical rationale to support the request. Selected device must meet clinical requirements.

WEX6 1 $5,000.00

Swingaway Mounting Bracket WEPM 1 $294.00

Ventilator Tray WEPY 1 $1,690.00

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mobility devices product catalogue - ministry of health · paediatric specific wheeled walker type...

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