q q q - ki mobility · pdf filethis form must be opened in adobe acrobat. the submit button...

Effective 08/24/2017

Company: ________________________________________________

Account Number: __________________ Date: _________________

q Quote q PO Number: ___________________________________

RTS: _____________________________________________________

Marked For: _______________________________________________

Ship To: __________________________________________________

Address: _________________________________________________

City: ________________________________ State: _____________

Zip: ________________ Phone: _____________________________

Email/Fax: ________________________________________________

HCPCS codes provided are based on code verification by the PDAC or our interpretation of the code definitions.

Proper use of HCPCS codes does not ensure coverage or payment. For coverage information, verify the appropriate payer’s coverage policy.

Frame

Seat Width / Seat Depth

Seat Width

14” 16” 18” 20” 22”

PriceHCPCS

$100 N/C N/C$420

E2201

$495

E2201

Sea

t D

epth 16” N/C q q q q q

18” N/C q q q q q

20”$450

E2203q q q q q

Heavy Duty Option

q 350 lb Weight Capacity __________________________________________________________________ $500Requires minimum 6” caster height

Backrest

Back Post / Height Range / Back Height

BackPost

Price Back Height

Standard N/C q 16.5 q 17.5 q 18.5 q 19.5

Angle Adjustable w/ Push Handle

$185 q 16 q 17 q 18

Select Back Height in row corresponding to desired Back Post

Select box corresponding to desired Seat Width and Depth

Phone (800) 981-1540 | Fax (715) [email protected] | www.kimobility.com

DCN0012.23 Pricing and specifications subject to change without notice of 10

Back Upholstery

q Standard ________________________________________________________________________________________________ Stdq Tension Adjustable E2611 ______________________________________________________________ $245q Omit Back Upholstery ___________________________________________________________________ - $10

Military PatchAttached only if ordered with Tension Adjustable Back Upholstery

q US Military Service Patch ________________________________________________________________ $90q Army q Navy q Marines q Air Force q Coast Guard

q US Purple Heart Patch _____________________________________________________________________ $90q Purple Heart with Military Service Patch Combo ___________________ $145q Army q Navy q Marines q Air Force q Coast Guard

q Catalyst 4 K0004 __________________________________________________________________ $114015” Lowest Front Seat Height250 lb weight capacity

q Catalyst 4 Super Low K0004 ________________________________________ $119013.5” Lowest Front Seat Height250 lb weight capacity

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initiator:[email protected];wfState:distributed;wfType:email;workflowId:7d0a04cb434ced41ba53419107d1442d

Footrest

Hanger Bend

q 60º __________________________________________________________________________________________________________ N/Cq 70º __________________________________________________________________________________________________________ N/Cq Elevating Leg Rests (ELR) E0990 _________________________________________________ $295q Pro Elevating Leg Rests (PRO ELR) E0990 ______________________________ $350q Omit Hangers ______________________________________________________________________________________ N/C

Footplate

q Composite ____________________________________________________________________________________________ N/CNot available with PRO ELR

q Composite Angle Adjustable K0040 ___________________________________________ $185Not available with ELR or 14” Seat Width

q Aluminum Angle Adjustable K0040 _____________________________________________ $185

Heel Loop

q Heel Loops E0951 ______________________________________________________________________________ $30q Adjustable Heel Loops E0951 New! _______________________________________ $50q Omit Heel Loops ________________________________________________________________________________ N/C

Phone (800) 981-1540 | Fax (715) 254-0996

[email protected] | www.kimobility.com

Footrest / Extension / Seat to Footrest Length

Footrest Extension Seat to Footrest Length

Extension TubeHangers(60º, 70º)

Short q 11 q 11.5 q 12 q 12.5 q 13 q 13.5 q 14 q 14.5 q 15

Medium q 13 q 13.5 q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17

Long q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5

Elevating Leg Rests (ELR)

Short q 12 q 13 q 14 q 15 q 16

Long q 13 q 14 q 15 q 16 q 17 q 18

Extended Length ELR

Short q 18 q 19 q 20 q 21 q 22

Long q 18 q 19 q 20 q 21 q 22 q 23 q 24

PRO ELRLow Pivot

Short q 12 - 17.5

Long q 15 - 21

PRO ELRHigh Pivot

Short q 10.5 - 15.5

Long q 13 - 19

Select Seat to Footrest Length in row corresponding to desired Footrest and Extension. Footrest Length of at least 2.5” shorter than Front Seat Height recommended. Extension Tube Hanger measurements are based on 70º Hanger / Front Frame Bend.

Residual Limb Support

q Residual Limb Support E1020

q Left ____________________________ $395 q Right _____________________________ $395

q Omit Left Hanger _____ N/C q Omit Right Hanger ______ N/C

Cover q Smooth q Air Mesh q Smooth q Air Mesh

Pad Size q 5 x 8 q 9 x 14 q 5 x 8 q 9 x 14

q 7 x 10 q 11 x 10 q 7 x 10 q 11 x 10

q 9 x 10 q 11 x 14 q 9 x 10 q 11 x 14


Calf Strap

q Velcro Adjustable K0038 ___________________________________________________________________ $35q Padded Velcro Adjustable K0038 __________________________________________________ $68q Bodypoint Padded AeroMesh K0038 _________________________________________ $102

Phone (800) 981-1540 | Fax (715) 254-0996


Rear Wheel Type

q Assembled 24” Six-Spoke Mag with Treaded Tireand Composite Handrim ______________________________________________________________ - $25

No substitutions available. Do not select Rear Tire Type or Handrim. Measures as Full Tire.

q Spoke ____________________________________________________________________________________________________ $50q Mag ________________________________________________________________________________________________________ N/C

Rear Tire Type

q Full Poly 1 3/8” E2218 _______________________________________________________________________ $30q Street Pneumatic 1 3/8” E2211, E2212 __________________________________________ $80q Pneumatic with Airless Insert 1 3/8” E2211, E2213 __________________ $200

Handrim

Handrim Option

q 3M Micro Grip _____________________________________________________________________________________ $65Not available on Plastic Coated or Projection Handrims

q Low Poly 1” E2218 ______________________________________________________________________________ Std

Full Profile

Rear Seat Height and Wheels

Wheel Size / Tire Profile / Rear Seat HeightSelect Rear Seat Height in row corresponding to desired Wheel Size and Tire Profile

Low Profile

q Aluminum Anodized ___________________________________________________________________________ Stdq Plastic Coated _____________________________________________________________________________________ $95q Projection (8 Vertical Projections) ________________________________________________ $295

Available on 22” and 24” Spoke wheels and 24” Mag wheels with full tires

q Omit Handrim ______________________________________________________________________________________ N/C

Standard Handrims Not available on 20” rear wheel or 22” Mag wheels. Not recommended with Mag wheels.

q Natural Fit LT Regular Grip ____________________________________________________________ $445q Natural Fit Standard Regular Grip _______________________________________________ $445q Natural Fit LT Super Grip _______________________________________________________________ $495q Natural Fit Standard Super Grip __________________________________________________ $495q Natural Fit LT Omit Grip _________________________________________________________________ $345q Natural Fit Standard Omit Grip ____________________________________________________ $345

Natural Fit Handrims

WheelSize

TireProfile

Rear Seat Height

20”Low q 12.51 q 13.5 q 14.5 q 15.5 q 16.5

Full q 131 q 14 q 15 q 16 q 17

22”Low q 13.51 q 14.5 q 15.5 q 16.5 q 17.5

Full q 141 q 15 q 16 q 17 q 18

24”Low q 14.51 q 15.5 q 16.5 q 17.5 q 18.5

Full q 151 q 16 q 17 q 18 q 191 Not available with Flip Back Armrests


Front Seat Height and Casters

Caster Type

q 1” Poly ___________________________________________________________________________________________________ N/Cq 1” Pneumatic _______________________________________________________________________________________ $80

Not available with 4”, 5” and 7” Caster Sizes

q 1.5” Poly _______________________________________________________________________________________________ $50Not available with 7” and 8” Caster Sizes

q 2” Poly ___________________________________________________________________________________________________ $70Not available with 4”, 5”, 7” and 8” Caster Sizes

q 2” Pneumatic w/ Foam Insert ______________________________________________________ $225Not available with 4”, 5”, 6” and 7” Caster Sizes

Caster Size / Front Frame Type / Front Seat Height

Fork Stem

q Standard Fork Stem ___________________________________________________________________________ Stdq 3/4” Longer Fork Stem ____________________________________________________________________ $35q 1 1/2” Longer Fork Stem _________________________________________________________________ $35

Select Front Seat Height in row corresponding to desired caster size.Note: Selections in first three Front Seat Height columns require Catalyst 4 Super Low.

Maximum Seat Dump Reference(Front Seat Height minus Rear Seat Height)

Seat Depth 16” 18” 20”

Maximum Dump 2” 2.5” 2.5”

Caster Size

Front Seat Height

Uses Super Low Front Frame

4” q 13.51 q 14 q 14.5 q 152 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20

5” q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5

6” q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5 q 21

7” q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5 q 21

8” q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5 q 21

Selection for Catalyst 4 Super Low is part of base frame selection on page 1 1 Front Seat Height not available with 4 x 1” Poly Caster2 Super Low Front Frame required when using 4 x 1” Poly Caster

Armrest Please select Arm Pad option

Removable Side Guard

q Height Adjustable T-Arm (8.5” - 13.5”) E0973 ________________________________ $265q Height Adjustable T-Arm Low (7.5” - 11.5”) E0973 _____________________ $265q Height Adjustable Flip Back (9.5” - 13.5”) E0973 __________________________ $275

Not available with Angle Adjustable Back Posts

q Flip Back (10.5”) ____________________________________________________________________________________ N/CNot available with Angle Adjustable Back Posts

q Composite Side Guards K0108 ____________________________________________________ $140Not available with T-Arm or Flip Back Armrests

Accessories

Anti-Tip

q Rear Anti-Tips E0971 _______________________________________________________________________ $140

Positioning Belt

q 1 1/2” Auto Buckle E0978 ________________________________________________________________ $70q 1 1/2” Padded Auto Buckle E0978 _____________________________________________ $155q 2” Airline Buckle E0978 ___________________________________________________________________ $110q Bodypoint Evoflex - Pelvic Stabilizer E0978 _____________________________ $183

Size: q Small (16-24”) q Medium (19-29”) q Large (25-37”)

q Bodypoint Belt Mounting Kit ________________________________________________________ $105Style: q Bracket q Band Clamp 1”

Other Accessories

q Tool Kit ___________________________________________________________________________________________________ $45q Removable Underseat Pouch ________________________________________________________ $50q Ki Mobility Backpack ________________________________________________________________________ $65q Black Neoprene Impact Guards ____________________________________________________ $85q Clear Spoke Guards K0065 ___________________________________________________________ $115

Not available with Mag wheels

q Black Spoke Guards K0065 __________________________________________________________ $115Not available with 20” rear wheel or Mag wheels

q Cane and Crutch Holder _______________________________________________________________ $195q IV Pole _________________________________________________________________________________________________ $265

Straight Back Canes will be used when this option is selected

Frame Color

Matte Finish Gloss Finish

q Army Green __________________________________________________________________________________________ N/Cq Charcoal Gray _____________________________________________________________________________________ N/Cq Emerald Green ____________________________________________________________________________________ N/Cq Iridescent Burgundy __________________________________________________________________________ N/Cq Iridescent Navy ___________________________________________________________________________________ N/Cq Retro Red _____________________________________________________________________________________________ N/Cq Royal Blue ____________________________________________________________________________________________ N/Cq Shadow Black _____________________________________________________________________________________ N/Cq Smooth White _____________________________________________________________________________________ N/C

q Black ______________________________________________________________________________________________________ N/C

q Swing Away (10.5” - 12.5”) E0973 _____________________________________________________ $195Not available with Angle Adjustable Back Posts or Arm Pads

q Omit Armrests _____________________________________________________________________________________ N/C

Arm Pad

Armrests

Armrest continued

Phone (800) 981-1540 | Fax (715) 254-0996



Not available with Swing Away Armrests

Standard Arm Pad __________ N/C q Desk q Full

Waterfall Arm Pad ____________ $25 q Desk q FullAvailable only with Height Adjustable T-Arms

O2 Holder

q O2 Holder E2208 _______________________________________________________________________________ $295 q Right Side q Left Side

Axle

q Fixed Axle ______________________________________________________________________________________________ Stdq Quick Release Axle ____________________________________________________________________________ $95

Axles

Axle Bracket

q Offset Axle Bracket _____________________________________________________________________________ Stdq Reverse Mount Offset Axle Bracket _____________________________________________ N/C

Not available with Swing Away Armrests

Wheel Locks

Wheel Lock Wheel Lock Options

q Push to Lock ________________________________________________________________________________________ Stdq Push to Lock Flush Mount ______________________________________________________________ N/Cq Pull to Lock __________________________________________________________________________________________ N/Cq Omit Wheel Locks _____________________________________________________________________________ N/C

q Extension Handles E0961 ________________________________________________________________ $67Available only with Push to Lock or Pull to Lock Wheel Locks

q Grade Aids E0974 _____________________________________________________________________________ $150Available only with Push to Lock Wheel Locks and Pneumatic or Pneumatic w/Airless Insert Rear Tire Types

Phone (800) 981-1540 | Fax (715) 254-0996



Catalyst Front Seat Height Matrix

4” Caster 5” Caster 6” Caster 7” Caster 8” Caster

FSHSuper Low

Stem Fork FSHSuper Low




Stem Fork

151 13.51

Std

4”

16 14.5 Std

4”

17 15.5 Std

5”

18 17Std

6”

19 18 Std

6”15.5 14 16.5 15.5 3/4 18 16.5 3/4 18.5 17.5 20 18.5 3/4

162 14.52

3/417.5 16 1 1/2 18.5 17 1 1/2 19 17.5

3/420.5 n/a 1 1/2

16.5 15 16 15Std

5”

17 16

Std

6”

19.5 18 19 17.5

Std

7”

16.52 152

1 1/216.5 15.5 17.5 16.5 19.5 18.5

1 1/219.5 18

17 15.5 17 15.53/4

18 17 20 19 20 18.5

15.5 14.5Std

5”

17.5 16 18 16.5

3/4

18.5 17.5

Std

7”

20.5 19

16 15 17.5 16.51 1/2

18.5 17 19 18 19.5 18.5

3/416.5 15

3/418 17 19 17.5 19.5 18.5 20 19

17 15.5 16.5 15.5

Std

6”

18.5 17.5

1 1/2

20 19 20.5 n/a

17 161 1/2

17 16 19 18 19 18

3/4

21 n/a

17.5 16.5 17.5 16.5 19.5 18.5 19.5 18.5 20.5 191 1/2

17 15.5Std

6”

17.5 16

3/4

18 16.5

Std

7”

20 19 21 n/a

17.5 16 18 16.5 18.5 17 20.5 n/a8” x 2” caster not

available with 6” fork17.5 16.53/4

18.5 17 19 17.5 20 18.5

1 1/218 17 18 17

1 1/2

19.5 18.5 20.5 19

18.5 171 1/2

18.5 17.5 18.5 17.5

3/4

21 n/a

19 17.5 19 18 19 18

18 17Std

7”

18 16.5

Std

7”

19.5 18.5

18.5 17.5 18.5 17 20 19

19 17.53/4

19 17.5 19.5 18

1 1/219.5 18 18.5 17.5

3/4

20 18.5

19.5 18.51 1/2

19 18 20.5 19

20 19 19.5 18.5 21 n/a

19.5 18

1 1/2

6” x 2” caster not available with 5” fork

20 18.5

20.5 19

1 Front Seat Height not available with 4 x 1” Poly Caster 2 Not available with 4 x 1” Poly, 4 x 1.5” Poly or 4 x 1.5” Soft Roll Aluminum

Seat heights with “FSH” heading available with Standard Front Frame. Seat heights with “Super Low” heading available with Super Low Front Frame. Actual seat height may vary depending upon configuration.

Phone (800) 981-1540 | Fax (715) 254-0996



Axiom G, S and P Cushions

Cushions Under 22” Wide Width

14” 15” 16” 17” 18” 19” 20” 21” 22”

Dep

th

14” q15” q q q16” q q q q q q q17” q q q q q q18” q q q q q q q19” q q q20” q q q q q

q Axiom G E2601 __________________________________________________________________________________ $120q Axiom S E2603 __________________________________________________________________________________ $199q Axiom P E2605 __________________________________________________________________________________ $340

q Axiom G E2602 __________________________________________________________________________________ $199q Axiom S E2604 __________________________________________________________________________________ $299q Axiom P E2606 __________________________________________________________________________________ $440

q Axiom SP - Visco E2607 _________________________________________________________________ $410q Axiom SP - Fluid E2607 __________________________________________________________________ $449

q Axiom SP - Visco E2608 _________________________________________________________________ $499q Axiom SP - Fluid E2608 __________________________________________________________________ $549

Width

14” 15” 16” 17” 18” 19” 20” 21” 22”

Dep

th

14” q q q15” q q q q q16” q q q q q q q q17” q q q q q q q q18” q q q q q q q q q19” q q q q q q q q20” q q q q q q q q

Outer Covers

q Axiom G Extra Outer Cover ____________________________________________________________ $70q Axiom S Extra Outer Cover _____________________________________________________________ $80q Axiom P Extra Outer Cover _____________________________________________________________ $90q Axiom SP Extra Visco Outer Cover ____________________________________________ $100q Axiom SP Extra Fluid Outer Cover _____________________________________________ $100

q Axiom SP Extra Visco Inner Cover _____________________________________________ $100q Axiom SP Extra Fluid Inner Cover _______________________________________________ $100

22” Wide Cushions

Axiom SP Cushions

Cushions Under 22” Wide

22” Wide Cushions

Axiom Accessories

Select size in chart below. Weight capacity: 350 lbs.

Solid Seat Insert ________________________________________________________________________________________ $55

Solid Seat Insert

Inner Covers

Width

14” 15” 16” 17” 18” 19” 20” 21” 22”

Dep

th

14” q15” q q q16” q q q q q q q17” q q q q q q18” q q q q q q q19” q q q20” q q q q qInner Cover Quantity: q 1 q 2

If no selection is made, quantity 1 will be selected

Outer Cover Quantity: q 1 q 2If no selection is made, quantity 1 will be selected

Solid Seat Insert Quantity: q 1 q 2If no selection is made, quantity 1 will be selected

Axiom SP Cushion Quantity: q 1 q 2If no selection is made, quantity 1 will be selected

Axiom G, S or P Cushion Quantity: q 1 q 2If no selection is made, quantity 1 will be selected

Select size in chart at right. Weight capacity: 350 lbs.

Select size in chart at right. Weight capacity: 350 lbs.

Phone (800) 981-1540 | Fax (715) 254-0996



Elite Back HCPCS Code: E2620

STEP 1: Choose Back Size

STEP 2: Choose Back Hardware (Selection Required)

q Easy Set Hardware - PBMH ___________________________________________________________ N/CNot available with Angle Adjustable Locking Flip Up or Tubular Flip Up Armrests, O2 Holder or welded rigidizer bar

q Split Mounting Hardware - SMHU ________________________________________________ N/C

q Matrx Elite Back 14 x 14 - PBE1414 _________________________________________ $625q Matrx Elite Back 14 x 16 - PBE1416 _________________________________________ $625q Matrx Elite Back 14 x 18 - PBE1418 _________________________________________ $625q Matrx Elite Back 15 x 14 - PBE1514 _________________________________________ $625q Matrx Elite Back 15 x 16 - PBE1516 _________________________________________ $625q Matrx Elite Back 15 x 18 - PBE1518 _________________________________________ $625q Matrx Elite Back 16 x 12 - PBE1612 _________________________________________ $625q Matrx Elite Back 16 x 14 - PBE1614 _________________________________________ $625q Matrx Elite Back 16 x 16 - PBE1616 _________________________________________ $625q Matrx Elite Back 16 x 18 - PBE1618 _________________________________________ $625q Matrx Elite Back 16 x 20 - PBE1620 _________________________________________ $625q Matrx Elite Back 17 x 16 - PBE1716 _________________________________________ $625q Matrx Elite Back 17 x 18 - PBE1718 _________________________________________ $625q Matrx Elite Back 17 x 20 - PBE1720 _________________________________________ $625q Matrx Elite Back 18 x 14 - PBE1814 _________________________________________ $625q Matrx Elite Back 18 x 16 - PBE1816 _________________________________________ $625q Matrx Elite Back 18 x 18 - PBE1818 _________________________________________ $625q Matrx Elite Back 18 x 20 - PBE1820 _________________________________________ $625q Matrx Elite Back 19 x 16 - PBE1916 _________________________________________ $625q Matrx Elite Back 19 x 18 - PBE1918 _________________________________________ $625q Matrx Elite Back 20 x 16 - PBE2016 _________________________________________ $625q Matrx Elite Back 20 x 18 - PBE2018 _________________________________________ $625q Matrx Elite Back 20 x 20 - PBE2020 _________________________________________ $625

Quick Ship On Demand

q Matrx Elite Back 12 x 10 - PBE1210 _________________________________________ $625q Matrx Elite Back 12 x 12 - PBE1212 _________________________________________ $625q Matrx Elite Back 12 x 14 - PBE1214 _________________________________________ $625q Matrx Elite Back 12 x 16 - PBE1216 _________________________________________ $625q Matrx Elite Back 12 x 18 - PBE1218 _________________________________________ $625q Matrx Elite Back 13 x 10 - PBE1310 _________________________________________ $625q Matrx Elite Back 13 x 12 - PBE1312 _________________________________________ $625q Matrx Elite Back 13 x 14 - PBE1314 _________________________________________ $625q Matrx Elite Back 13 x 16 - PBE1316 _________________________________________ $625q Matrx Elite Back 13 x 18 - PBE1318 _________________________________________ $625q Matrx Elite Back 14 x 10 - PBE1410 _________________________________________ $625q Matrx Elite Back 14 x 12 - PBE1412 _________________________________________ $625q Matrx Elite Back 14 x 20 - PBE1420 _________________________________________ $625q Matrx Elite Back 15 x 10 - PBE1510 _________________________________________ $625q Matrx Elite Back 15 x 12 - PBE1512 _________________________________________ $625q Matrx Elite Back 15 x 20 - PBE1520 _________________________________________ $625q Matrx Elite Back 16 x 10 - PBE1610 _________________________________________ $625q Matrx Elite Back 17 x 10 - PBE1710 _________________________________________ $625q Matrx Elite Back 17 x 12 - PBE1712 _________________________________________ $625q Matrx Elite Back 17 x 14 - PBE1714 _________________________________________ $625q Matrx Elite Back 18 x 10 - PBE1810 _________________________________________ $625q Matrx Elite Back 18 x 12 - PBE1812 _________________________________________ $625q Matrx Elite Back 19 x 10 - PBE1910 _________________________________________ $625q Matrx Elite Back 19 x 12 - PBE1912 _________________________________________ $625q Matrx Elite Back 19 x 20 - PBE1920 _________________________________________ $625q Matrx Elite Back 20 x 10 - PBE2010 _________________________________________ $625q Matrx Elite Back 20 x 12 - PBE2012 _________________________________________ $625

Back Hardware

Quick Ship products are stocked On Demand products are ordered with an extended lead time

Weight Capacity: 300 lbs.

Phone (800) 981-1540 | Fax (715) 254-0996



Elite Deep Back HCPCS Code: E2620

STEP 1: Choose Back Size

STEP 2: Choose Back Hardware (Selection Required)

q Matrx Elite Deep Back 14 x 16 - EDB1416 _____________________________ $760q Matrx Elite Deep Back 14 x 18 - EDB1418 _____________________________ $760q Matrx Elite Deep Back 15 x 16 - EDB1516 _____________________________ $760q Matrx Elite Deep Back 15 x 18 - EDB1518 _____________________________ $760q Matrx Elite Deep Back 16 x 16 - EDB1616 _____________________________ $760q Matrx Elite Deep Back 16 x 18 - EDB1618 _____________________________ $760q Matrx Elite Deep Back 16 x 20 - EDB1620 _____________________________ $760q Matrx Elite Deep Back 17 x 16 - EDB1716 _____________________________ $760q Matrx Elite Deep Back 17 x 18 - EDB1718 _____________________________ $760q Matrx Elite Deep Back 17 x 20 - EDB1720 _____________________________ $760q Matrx Elite Deep Back 18 x 16 - EDB1816 _____________________________ $760q Matrx Elite Deep Back 18 x 18 - EDB1818 _____________________________ $760q Matrx Elite Deep Back 18 x 20 - EDB1820 _____________________________ $760q Matrx Elite Deep Back 19 x 18 - EDB1918 _____________________________ $760q Matrx Elite Deep Back 19 x 20 - EDB1920 _____________________________ $760q Matrx Elite Deep Back 20 x 16 - EDB2016 _____________________________ $760q Matrx Elite Deep Back 20 x 18 - EDB2018 _____________________________ $760q Matrx Elite Deep Back 20 x 20 - EDB2020 _____________________________ $760


q Matrx Elite Deep Back 14 x 12 - EDB1412 _____________________________ $760q Matrx Elite Deep Back 14 x 20 - EDB1420 _____________________________ $760q Matrx Elite Deep Back 15 x 10 - EDB1510 _____________________________ $760q Matrx Elite Deep Back 15 x 12 - EDB1512 _____________________________ $760q Matrx Elite Deep Back 15 x 20 - EDB1520 _____________________________ $760q Matrx Elite Deep Back 16 x 10 - EDB1610 _____________________________ $760q Matrx Elite Deep Back 16 x 12 - EDB1612 _____________________________ $760q Matrx Elite Deep Back 17 x 10 - EDB1710 _____________________________ $760q Matrx Elite Deep Back 17 x 12 - EDB1712 _____________________________ $760q Matrx Elite Deep Back 18 x 10 - EDB1810 _____________________________ $760q Matrx Elite Deep Back 18 x 12 - EDB1812 _____________________________ $760q Matrx Elite Deep Back 19 x 10 - EDB1910 _____________________________ $760q Matrx Elite Deep Back 19 x 12 - EDB1912 _____________________________ $760q Matrx Elite Deep Back 19 x 16 - EDB1916 _____________________________ $760q Matrx Elite Deep Back 20 x 10 - EDB2010 _____________________________ $760q Matrx Elite Deep Back 20 x 12 - EDB2012 _____________________________ $760

Back Hardware


q Easy Set Hardware - PBMH ___________________________________________________________ N/CNot available with Angle Adjustable Locking Flip Up or Tubular Flip Up Armrests, O2 Holder or welded rigidizer bar

q Split Mounting Hardware - SMHU ________________________________________________ N/C


Phone (800) 981-1540 | Fax (715) 254-0996



MX2 Back HCPCS Code: E2615

The MX2 Back is On Demand only. On Demand products are ordered with an extended lead time.

q Matrx MX2 Back w/ Fixed Hardware 14 x 06 - IMX21406-CFH _____ $795




















MX2 Back with Fixed Hardware MX2 Back with Quick Release Hardware

q Matrx MX2 Back w/ QR Hardware 14 x 06 - IMX21406-QRH ________ $820




















Hardware included Hardware included


Phone (800) 981-1540 | Fax (715) 254-0996



Matrx Elan Headrest HCPCS Code: Hardware E0128 / Pad E0955

q Elan Hardware - MEHW _______________________________________________________________________ $220

q Elan Mini Hardware - MEMH _______________________________________________________________ $220

q Elan Standard Pad 6” W x 3.5” H w/ Std Cover - ESP6 __________________ $235

q Elan Standard Pad 10” W x 5” H w/ Std Cover - ESP10 _________________ $235

q Elan Standard Pad 14” W x 5” H w/ Std Cover - ESP14 _________________ $235


q Elan Standard Pad 6” W x 3.5” H w/ Infection Control Cover - ESP6-IC _______ $235

q Elan Standard Pad 10” W x 5” H w/ Infection Control Cover - ESP10-IC ______ $235

q Elan Standard Pad 14” W x 5” H w/ Infection Control Cover - ESP14-IC ______ $235

q Elan Occipital Pad 9” W x 7” H w/ Std Cover - EOP9 __________________________________ $235

q Elan Occipital Pad 9” W x 7” H w/ Infection Control Cover - EOP9-IC __________ $235

q Elan Occiptal Pad 12” W x 8” H w/ Std Cover - EOP12 _______________________________ $235

q Elan Occipital Pad 12” W x 8” H w/ Infection Control Cover - EOP12-IC ______ $235

q Elan 4 Point Pad 11” W x 10” H w/ Std Cover - E4POINT ___________________________ $325

q Elan 4 Point Pad 11” W x 10” H w/ Infection Control Cover - E4POINT-IC ____ $325


Matrx Elite/Mini Laterals HCPCS Code: Swing Away Hardware, Offset Hardware E1028 / Fixed Hardware, Pad E0956

Elite Swing Away Lateral Hardware Only - SAHEB

q Quantity 1 _________________________________________________________________________________ $225

q Quantity 2 _________________________________________________________________________________ $450

q Elite Offset Swing Away Lateral Hardware Only (Left) - OSAH-L ____ $225

q Elite Offset Swing Away Lateral Hardware Only (Right) - OSAH-R __ $225

Pad for Swing Away Lateral Medium 3.75” H x 5.75” L - EPAD-M

q Quantity 1 _________________________________________________________________________________ $110

q Quantity 2 _________________________________________________________________________________ $220

Pad for Swing Away Lateral Large 4.25” H x 6.5” L - EPAD-L

q Quantity 1 _________________________________________________________________________________ $110

q Quantity 2 _________________________________________________________________________________ $220


q Elite Lateral Fixed Standard Pad 5” H x 7.5” L (Left) - PBLS-L _______________ $110

q Elite Lateral Fixed Standard Pad 5” H x 7.5” L (Right) - PBLS-R ____________ $110

q Elite Lateral Fixed Small Pad 3” H x 5.5” L (Left) - PBSS-L ____________________ $110

q Elite Lateral Fixed Small Pad 3” H x 5.5” L (Right) - PBSS-R _________________ $110

q Elite Lateral Fixed Offset Pad 5” H x 7.5” L (Left) - PBOL-L ___________________ $110

q Elite Lateral Fixed Offset Pad 5” H x 7.5” L (Right) - PBOL-R _________________ $110

Mini Swing-Away Lateral Hardware Only - SAHMINI

q Quantity 1 ___________________________________________________________________________________ $225

q Quantity 2 ___________________________________________________________________________________ $450

Pad for Swing Away Lateral X Small 3.25” H x 4.25” L - EPAD-XS

q Quantity 1 ___________________________________________________________________________________ $110

q Quantity 2 ___________________________________________________________________________________ $220

Pad for Swing Away Lateral Small 3.5” H x 5.25” L - EPAD-S

q Quantity 1 ___________________________________________________________________________________ $110

q Quantity 2 ___________________________________________________________________________________ $220


Hardware Options

On Demand

q Easy Set Hardware (Pair) - PBMH ______________________________________________________ $225

q Split Mounting Hardware (Pair) - SMH _______________________________________________ $200

q Heavy Duty Easy Set Hardware (Pair) - HDMH _________________________________ $325

q Extended Range Mounting Hardware (Pair) - ERMH ________________________ $225

q Fixed Space Saver Mounting Hardware (Pair) - FSSH _____________________ $200

q Carbon Fiber Fixed Mount Hardware for MX2 Back - IMX2CFH _____ $245

q Quick Release Hardware for MX2 Back - IMX2QRH ________________________ $270

On Demand products are ordered with an extended lead time

Other Matrx Products

On Demand

q Chest Harness Interface Kit for Elite Back - CHIEB ____________________________ $95

q Chest Harness Interface Kit for Mini Back - HIMINI ____________________________ $85

q Extended Mounting Pins for Mounting to Backs 2” Wider - EMP _____ $60

q Privacy Flap X Small (Fits 12” to 14” Backs) - PFLAP-XS __________________ $40

q Privacy Flap Small (Fits 15” to 16” Backs) - PFLAP-S ________________________ $40

q Privacy Flap Medium (Fits 17” to 18” Backs) - PFLAP-M __________________ $40

q Privacy Flap Large (Fits 19” to 20” Backs) - PFLAP-L ________________________ $40

q Privacy Flap X Large (Fits 21” to 22” Backs) - PFLAP-XL __________________ $40

On Demand products are ordered with an extended lead time

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