Account Number: Provider Name: Contact Name: Phone #: Fax #: Address: Taken By: Client Height: Client Weight: Synergy Seat

Transcription

1 Quantum Rehab Quantum Q6 Edge HD Group 3 Heavy Duty Order Form 450 lbs. weight capacity ACCOUNT INFO Account Number: Provider Name: Contact Name: Phone #: Fax #: Address: Date: PO#: Marked For: 3 Column Pricing on Quote/Order: o Yes o No Quote #: Ship To: Address: City: State: Zip: Lift Gate Needed: o Yes o No Taken By: SET-TO-SPEC* Please Supply Client Information: Client Height: Client Weight: Mount Hip/Thigh Supports: o Yes o No Mount Lateral Thoracic Supports: o Yes o No Armrest Height from Pan: Rigging Length (whole numbers only): Seat to Floor Height (check one): NOTES: Seating System Seat-To-Floor Heights Contoured Seating HD Contoured Seating Synergy Seat TRU-Balance 3 Seat Seat to floor height are +/- 1/8 with solid tires (add 3/8 for pneumatic tires). Increased widths may increase lowest seat to floor heights. * While every effort will be taken to ensure dimensions will be preset to your specifications prior to shipping variations in options may effect final settings. Revised: October 15, 2014 Page 1 of 11

2 DME providers are responsible for determining appropriate billing codes when submitting for insurance reimbursement. HCPCS codes should not be considered as legal advice. All prices are MSRP. BASE MODEL NON-EXPANDABLE CONTROLS o Q6 Edge HD 3HD-C $7,360 K0851 o Q6 Edge HD 3HD-SS $7,360 K0850 o 75 Amp NE COLORS Metallic Colors: o Candy Apple Red o Viper Blue o Black o Sunburst Orange o Silver o Pearl Pink MOTOR OPTIONS o Hammer II o Emerald Green o Sapphire Blue o Orion Yellow o True Blue BASE MOUNTED FOOT PLATFORM o Base Mounted Foot Platform o 9.45 W x 10 D o Bell Footplate (10.12 W, Tapered to 14 W x D) o No Foot Platform DRIVE WHEELS TRANSIT KIT o 14 Run Flat o 14 Pneumatic o Solid Flat-Free Silver Rim/ BATTERY CHARGER o 8 Amp Off-board Charger o Unoccupied Transit Kit $300 Charcoal Tire o 4 W Flat Free, Knobby, $551 Extended Traction Tires 1 o 4 W Pneumatic, Knobby, $551 Extended Traction Tires 1 Rim Color Options: o Silver ( color option) o Matching o Non-Matching Rim Colors: $50 (Available through SOF - 5 Day Lead Time) o Candy Apple Red o Viper Blue o Black o Sunburst Orange o Pearl Pink 1. Increases overall base width by 1.5 o Emerald Green o Sapphire Blue o Orion Yellow o True Blue o 75 Amp NE+ 6-Key $200 (For up to 2 Actuators Thru Joystick) EXPANDABLE CONTROLS Q-Logic 2 EX Joystick or Enhanced Display must be ordered with a Q-Logic 2 EX Controller and Harness For Expandable Controls Revised: October 15, 2014 Page 2 of 11 o 100 Amp Q-Logic 2 EX $695 Controller o Expandable Controller $350 Harness o Q-Logic 2 EX Joystick $700 m Q-Logic 2 EX Joystick $700 (For Lights) o Stand Alone Joystick w/ $700 External Charger Port m SCIM Module 1 $575 Specialty Control Interface Module Features: - Allows use of joystick display for specialty controls - Up to 5 profiles to control drive, seat and auxiliary functions - Excludes sip-n-puff and single switch functions - A switch is required to operate the input device attached to the SCIM module - Includes Accessory bar o USB Mobile Device Charger 2 $175 Armor Color Options: o Black Soft Touch ( color option) o Matching o Non-Matching Colors: $50 o Candy Apple Red o Viper Blue o Black o Sunburst Orange o Silver o Pearl Pink o Emerald Green o Sapphire Blue o Orion Yellow o True Blue 1. Only available with Q-logic Available with NE, NE+ and Q-Logic 2 EX controllers. Can only charge 1 device at a time. A multiplier harness is required with all Static and Tilt only seating systems. The selection of more than 3 modules required an additional multiplier.

3 JOYSTICK HANDLES CONTOURED SEATING JOYSTICK MOUNTING BRACKETS PROGRAMMING 1. Works with Q-Logic 2 EX only. o Carrot Handle o Mushroom Handle $71 E2323 o T-Bar $107 E2323 o Chin Cup $71 E o Extended I-Handle $71 E2323 o Soft Ball Handle $50 E2323 o Medium Ball Handle $50 E2323 o Bodypoint 3 Goal Post $69 E2323 Handle o Bodypoint 4 Goal Post $69 E2323 Handle 1. Use HCPCS Code E2323 when not used in conjunction with a chin control. Comes with a Quick Release, Adjustable-Height Joystick Block o Fixed, Inline 1 o Swing-Away $210 E1028 o Retract4 Swing-Away $250 E1028 Joystick Arm Kit o Multi-Axis, Fixed $100 K0108 o No Joystick Mount 1. Not available with Q-Logic 2 EX Stand Alone Joystick. o Q-Logic EX/NE Programmer $545 o Q-Logic PC Programming $750 Disk w/ Cable 1 Depth-Adjustable High Back: 1 o Black Vinyl, Depth-Adjustable High Back, Limited Recline o 20 W x D o 22 W x D Limited Recline High Back: o Black Vinyl, High Back with Limited Recline o 20 W x 16 D o 20 W x 22 D Limited Recline High Back w/ Solid Seat Pan: o Black Vinyl, High Back with Solid Seat pan, Limited Recline o 20 W x 16 D o 20 W x 20 D o 20 W x 18 D o 20 W x 22 D Pinchless Hinge High Back: o Black Vinyl, High Back w/ Headrest, Pinchless Hinges o 20 W x 24 D o 22 W x 26 D o 20 W x 26 D o 24 W x 16 D o 22 W x 16 D o 24 W x 18 D o 22 W x 18 D o 24 W x 20 D o 22 W x 20 D o 24 W x 22 D o 22 W x 22 D o 24 W x 24 D o 22 W x 24 D o 24 W x 26 D Pinchless Hinge High Back with Solid Seat Pan: o Black Vinyl, High Back w/ Headrest and Solid Seat Pan, Pinchless Hinges o 20 W x 24 D o 22 W x 26 D o 20 W x 26 D o 24 W x 16 D o 22 W x 16 D o 24 W x 18 D o 22 W x 18 D o 24 W x 20 D o 22 W x 20 D o 24 W x 22 D o 22 W x 22 D o 24 W x 24 D o 22 W x 24 D o 24 W x 26 D Heavy Duty High Back: 2 o Black Vinyl, Heavy Duty $450 High Back w/ Headrest, Static Hinges o 26 W x 18 D o 28 W x 18 D o 26 W x 20 D o 28 W x 20 D o 26 W x 22 D o 28 W x 22 D o 26 W x 24 D o 28 W x 24 D o 26 W x 26 D o 28 W x 26 D o 26 W x 28 D o 28 W x 28 D 1. Seat comes automatically with a 60 belt and full length armrests. Any other selection would need to be added as an additional part 2. Seat includes a lumbar cutout, static hinges and a Synergy seat frame Revised: October 15, 2014 Page 3 of 11

4 CONTOURED SEATING (CONT D) Heavy Duty High Back with Solid Seat Pan: 2 o Black Vinyl, Heavy Duty $450 High Back w/ Headrest and Solid Seat Pan, Static Hinges o 26 W x 18 D o 28 W x 18 D o 26 W x 20 D o 28 W x 20 D o 26 W x 22 D o 28 W x 22 D o 26 W x 24 D o 28 W x 24 D o 26 W x 26 D o 28 W x 26 D o 26 W x 28 D o 28 W x 28 D Armrest Type: o Flip up, Height-Adjustable, $85 ea. E0973 Removable 1 o Heavy Duty, Bariatric, Height- Adjustable, Removable 2 o 8-12 H o H o Single Post, Height Adjustable, $85 ea. Removable 3 o Quad Release Lever Armpads: Left: o Full Length Special Order Seat W x D Seat size can not exceed 32 W x 28 D **Contact your inside sales specialist for pricing** Right: o Full Length o Desk Length 4 o Desk Length 4 Style: o Straight o Black, Molded, Bariatric Armpads 2 o Waterfall $100 ea. E Only available w/ high back seating, widths Bariatric armrests are full length and require bariatric armpads. Only available on HD High Back seating. 3. Height adjustable from in 1/2 increments. Only available on HD High Back seating. 4. Not available w/ Bariatric, Height Adjustable, Removable Armrests.. SYNERGY SEAT Choose Synergy Seat options below along with additional items starting on page 6 Synergy Seating Frame: o Synergy Seating Frame $434 Seat Width: o 20 W o 21 W o 22 W o 23 W o 24 W o 25 W o 26 W o 27 W o 28 W Seat Width Package: o 20 W-24 W o 24 W-28 W Seat Depth: o 16 D o 17 D o 18 D o 19 D o 20 D o 21 D o 22 D o 23 D o 24 D o 25 D o 26 D o 27 D o 28 D Seat Depth Package: o 15 D-20 D 1 o 20 D-24 D o 24 D-28 D Back Cane Height: o 18 H o 19 H o 20 H o 21 H o 22 H o 23 H o 24 H o 25 H Back Type: See TRU-Comfort Back Order Forms for Detailed Pricing and Codes o Heavy Duty Sling Back 2 $150 o Omit Back o TRU-Comfort Back (22 W) $695 E2621 Width: o 20 W Height :o 3 20 H o 22 H o 24 H o 25 H o 28 H Width: o 22 W Height 3 :o 24 H o 28 H Back Cane Options: o Back Canes Armrests: o Height Adjustable Cantilever Armrests 4 o Bariatric, Removable, Height $75 ea. E0973 Adjustable 5 o 8 H-12 H o 10 H-14 H Armpads: o Straight, Full Length o Falcon, Gel, Full Length $80 ea. o Full Lenght Gel Armpad $56.69 ea. Mounting Plate (Required) o Flat, Bariatric 5 1. Not available in conjunction with an Articulating Foot Platform. 2. Back height is the same and the back cane ht chosen. Only available on widths less than 24 wide. N/A with cantilever armrests. 3. Overall back height measurement is measured from the seat pan to the top of the back, +/- 1/2. 4. May interfere with lateral thoracic supports. 5. Bariatric armrests require bariatric armpads. For additional Synergy Seat Options, please see the Synergy Seat Order Form Revised: October 15, 2014 Page 4 of 11

5 TRU-BALANCE 3 SEATING Option # TB3STATIC o TRU-Balance 3 Static Seat $2295 SEATING SPECIFICATIONS Seat Width: TRU-BALANCE 3 SEAT TO FLOOR HEIGHT Please refer to page 1 for seat to floor heights available on each seting system STF175 o 17.5 STF185 o 18.5 STF195 o 19.5 Seat Depth: 20W o 20 W 20D o 20 D 21W o 21 W 21D o 21 D 22W o 22 W 22D o 22 D 23W o 23 W 23D o 23 D 24W o 24 W 24D o 24 D 25W o 25 W 25D o 25 D 26W o 26 W 26D o 26 D 27W o 27 W 27D o 27 D 28W o 28 W 28D o 28 D 29W o 29 W 30W o 30 W 31W o 31 W 32W o 32 W Choose a width and depth package and combine both option # s for the full option # Seat Width Package: Seat Depth Package: 2024W o 20 W-24 W 1620D o 16 D-20 D 2428W o 24 W-28 W 2024D o 20 D-24 D 2832W o 28 W-32 W 2428D o 24 D-28 D TRU-BALANCE 3 BACK OPTIONS Option # Choose back option below, sizes available are in TRU-Balance 3 back specifications section BACK SPECIFICATIONS MSIZE o Sport Back 1 Seat Width to Back Width Measurements: o Matching NMSIZE o Non-Matching 1 Sport Back: o TRU-Comfort 2 $595 E Way Stretch Back 1,2 (20 W or less) o TRU-Comfort 2 $695 E Way Stretch Back 1,2 (22 W or greater) LGWG o Large Lateral Positioning $30 Wedge, pair 1,3 o TRU-Comfort 2 $595 E2620 Air Mesh Back 1,2 (20 W or less) o TRU-Comfort 2 $695 E2621 Air Mesh Back 1,2 (22 W or greater) LGWG o Large Lateral Positioning $30 Wedge, pair 1,3 ABI o Aftermarket Back Interface 1,4 $200 Please Indicate which aftermarket back is being used NOBK o Omit Back (-$100) 1. Not available with back cane option. 2. with bolster kit and small lateral positioning wedge. 3. Not available on Back heights H w/ limited adjustablilty on 18 H. 4. Overall seat depth may need to be adjusted to accommodate certian backs. Contact your Quantum Specialist for details. Does not include brackets to mount aftermarket back. SOF is required on back width less than 16. Width: o 18 W o 19 W o 20 W o 21 W o 22 W o 24 W o 26 W o 28 W o 30 W o 32 W TRU-BALANCE 3 BACK TYPE Height :o 2 16 H o 17 H o 18 H o 19 H o 20 H o 21 H o 22 H o 23 H o 24 H o 25 H o Static Back o Back Cane Option 1 (-$125) Back Cane Type: o Angle Adjustable o 1 Endo $25 o 2 Endo $25 Back Cane Height: o 16 H o 21 H o 17 H o 24 H o 20 H o 25 H 1. Only available with Omit Back and heavy-duty, removeable armrests. Not available with recline. Back Width Package: o 16 W -20 W o 20 W -24 W o 24 W -28 W o 28 W -32 W TRU-Comfort Back: Please refer to TRU-Comfort Back order form for detailed pricing, sizes, codes and part # s Width: o 18 W o 20 W Height o 2 16 H o 17 H o 18 H o 19 H o 20 H o 21 H o 22 H o 23 H o 24 H o 25 H Width: o 22 W o 24 W o 26 W 2 o 28 W 2 Height :o 3 16 H o 17 H o 18 H o 19 H o 20 H o 21 H o 22 H o 23 H Back Width Package: o 16 W -20 W o 20 W -24 W o 24 W -28 W o 28 W -32 W or 2 of seat width. 2. N/A with back heights H. 3. Odd heights = 4 gap, Even heights = 3 gap. Measurement listed is overall back height. Revised: October 15, 2014 Page 5 of 11

6 ADDITIONAL BACK OPTIONS Option # Color Shroud Option: o Black MSH o Matching NMSH o Non-Matching Color Options: BSBLACK o Black BSEGREEN o Emerald Green BSRED o Candy Apple Red BSYELLOW o Orion Yellow BSVBLUE o Viper Blue BSORANGE o Sunburst Orange BSPINK o Pearl Pink BSSILVER o Silver BSSBLUE o Sapphire Blue BSTBLUE o True Blue Privacy Flap: PFLAP o W $35 PFLAP o W 1 $35 1. Recommended on back width package 24 W-28 W and greater. ARMRESTS Option # o TB3 Armrests 1 (Comes with vertical down posts. +/- up to 2 difference between seat and back width) Choose a height package, and armrest height, then Combine all abbreviated option # s for the full option # Left Armrest: Right Armrest: Height Package: Height Package: ARM812 o 8 H-12 H ARM812 o 8 H-12 H ARM1216 o H ARM1216 o H Set Armrest Height: Set Armrest Height: AH8 o 8 H 2 AH8 o 8 H 2 AH9 o 9 H 2 AH9 o 9 H 2 AH10 o 10 H AH10 o 10 H AH11 o 11 H AH11 o 11 H AH12 o 12 H AH12 o 12 H AH13 o 13 H AH13 o 13 H AH14 o 14 H AH14 o 14 H AH15 o 15 H AH15 o 15 H AH16 o 16 H AH16 o 16 H Left Armpad: Right Armpad: Choose an armpad length and style, then combine the Abbreviated option # s for the full option # Length: Length: FL o Full Length FR o Full Length DL o Desk Length 3 DR o Desk Length 3 Style: Style: S o Straight S o Straight 1. May interfere with swing away laterals. Not available with back cane option. 2. Not available with the width package. 3. Not available on depths over 22 D. ARMRESTS (CONT D) Option # o Heavy-Duty, Removable Armrests $75 ea. E0973 Choose a height package, length and armrest height, then Combine all abbreviated option # s for the full option # Left Armrest: Right Armrest: Height Package: Height Package: ARM812 o 8 H-12 H ARM812 o 8 H-12 H ARM1014 o H ARM1014 o H Set Armrest Height: Set Armrest Height: AH8 o 8 H AH8 o 8 H AH9 o 9 H AH9 o 9 H AH10 o 10 H AH10 o 10 H AH11 o 11 H AH11 o 11 H AH12 o 12 H AH12 o 12 H AH13 o 13 H AH13 o 13 H AH14 o 14 H AH14 o 14 H Left Armpad: Right Armpad: Choose an armpad style and length, then combine the Abbreviated option # s for the full option # Revised: October 15, 2014 Page 6 of 11 Length: Length: FL o Full Length FR o Full Length DL o Desk Length DR o Desk Length Style: Style: S o Straight S o Straight W o Waterfall W o Waterfall TB3314G o Falcon, Gel, Full Length $92.50 ea. o Armpad Mounting Plate, $56.52 ea. Full Length 4 TB3310G o Falcon, Gel, Desk Length $70.00 ea. o Armpad Mounting Plate, $56.20 ea. Desk Length 1 4. Required with removable armrests. HEADRESTS Option # Headrest Pads: o 8 W TRU-Comfort Air Mesh 1 $205 E0955 8TCPPAD o 8 W TRU-Comfort 1 $205 E0955 o 10 TRU-Comfort Air Mesh 1 $205 E TCPPAD o 10 TRU-Comfort 1 $205 E0955 CP250 o Stealth 10 Comfort Plus $142 E0955 CP150 o Stealth 14 Comfort Plus $142 E0955 STL:OTSM250 o Stealth Small Contoured $205 E0955 (9.75 W x 3 H) STL:OTLD150 o Stealth Large Contoured $205 E0955 (11 W x 6 H) o Omit Headrest Headrest Mounts: TCBRKT o TRU-Comfort Removable $210 E1028 Headrest Bracket 2 HMO475P o Stealth Removable $210 E1028 Headrest Bracket TWB485-1 o Stealth s Worlds Best $210 E1028 Removable Headrest Bracket NOHR o No Bracket 1. Measurement is taken from the inside of the headrest. 2. Only available w/ TRU-Comfort headrest pads.

7 LAPBELTS Option # 38BELT o 38 Lap Belt 50BELT o 50 Lap Belt 60BELT o 60 Lap Belt 70BELT o 70 Lap Belt 80BELT o 80 Lap Belt 90BELT o 90 Lap Belt o 60 Padded Push Button, $115 Center Pull o Large 13-19, Hip Padded, $92 Push Button TRU-BALANCE 3 PREMIUM INSTALLED ACCESSORIES Option # Available on TB3 Seating Only TB3PUSH o Push Handles (pair) 1 $175 o Accessory Bar 2 $ Not available with O2 holder, back cane option or vent tray. Required with attendant manual recline. 2. Comes standard with SCIM Module, Trilogy vent tray and oxygen holder. May be added to mount additional accessories to back of unit. Not available with back cane option. ELECTRONICS FOR POWER FOOT RIGGINGS Option # NON-POWERED LEGRESTS Option # All efforts will be made to accommodate legrest length selection but minor changes may need to be made to meet shipping guidelines. Some adjustment may be needed upon receipt of the unit. Not available with standard contoured seating. o Heavy Duty Drop-In Legrests o 70 Degree Rigging Selection: o Matching Legrests, pair o Non-Matching Legrests, pair o Individual Legrests (Left or Right Only) Footplate Selection: o Angle-Adjustable Footplates 1 $150 K0040 Left Legrest: Lower Extensions: o 12 H-14.5 L o L o L Right Legrest: Lower Extensions: o 12 L-14.5 L o L o L o Angle Adjustable Footplate Size o 6 W x 11 D o 6 W x 11 D o 8 W x 11 D o 8 W x 11 D Accessories: BUMP o Wheel Bumpers, pair $25 1. Includes Heel Loops. ADJUSTABLE CENTER MOUNT FOOT PLATFORM Option # THRUJOY o Single Actuator Through $1175 E2310 Joystick (AFP Only) MTHRUJOY o Through Q-Logic 2 EX $2375 E2311 Controller MTHRUTOG o Q-Logic 2 EX Through 4-way $2375 Toggle TOGL Mount TOGR TOGL TOGR Mount o Q-Logic 2 EX Through 4-way $2375 Button Toggle Mount Mount o Through Q-Logic 2 EX $2375 E2311 Controller and Single Function with 4-Button Actuator (Mounts to same side as controller) 1 1. Includes AAM and 4-button actuator modual. Only available with TB3 armrests. All efforts will be made to accommodate legrest length selection but minor changes may need to be made to meet shipping guidelines. Some adjustment may be needed upon receipt of the unit. Not available with standard contoured seating. o Adjustable Center Mount Foot $250 Platform (Includes 10 W x 11 D Split Footplates) Extensions: CM1016 o L CM1319 o L Set Legrest Length: LL10 o 10 H LL13 o 13 H LL16 o 16 H LL105 o 10.5 H LL135 o 13.5 H LL165 o 16.5 H LL11 o 11 H LL14 o 14 H LL17 o 17 H LL115 o 11.5 H LL145 o 14.5 H LL175 o 17.5 H LL12 o 12 H LL15 o 15 H LL18 o 18.5 H LL125 o 12.5 H LL15.5 o 15.5 H LL1 o 19 H Calf Supports: o Calf Pads (pair) o Small (6 H x 6 W) $150 o Large (8 H x 8 W, tapered to 6 W) $150 o Calf Pad Covers (pair) (1/2 Soft Visco Foam) o Air Mesh $120 o Reversed Dartex $120 Revised: October 15, 2014 Page 7 of 11

8 ADJUSTABLE CENTER MOUNT FOOT PLATFORM (CONT D) Option # CENTER MOUNT POWER ARTICULATING FOOT PLATFORM (CONT D) Option # o Calf Panel (ea.) o Small (8 H x 18 W) $150 o Large (8 H x 24 W) 1 $200 o Calf Panel Covers (1/2 Soft Visco Foam) o Air Mesh $120 o Reversed Dartex $120 Optional Modular Footplate Extension Components/Kits: 2 o 4 Width Extension Kit $50 o 2 Bell Shaped, Length $50 Extension Kit Calf Supports: o Calf Pads (pair) o Small (6 H x 6 W) o Large (8 H x 8 W, tapered to 6 W) o Calf Pad Covers (pair) (1/2 Soft Visco Foam) o Air Mesh $120 o Reversed Dartex $120 o Calf Panel (ea.) o Small (8 H x 18 W) $150 o Large (8 H x 24 W) 1 $200 o Calf Panel Covers (1/2 Soft Visco Foam) o Air Mesh $120 o Reversed Dartex $120 Optional Modular Footplate Extension Components/Kits: 2 o 4 Width Extension Kit $50 o 4 Width Extension with 2 Bell $75 Shaped, Length Extension Kit o 2 Bell Shaped, Length $50 Extension Kit o 6-Piece Extension Stock Kit $95 (Includes all above pieces) Additional Optional Accessories: o Wheel Bumpers, pair $25 o Footplate Connector $49 o Footplate Cover, Reversed $120 Dartex 3 (1/2 Soft Visco Foam) o 4 Width Extension with 2 Bell $75 Shaped, Length Extension Kit o 6-Piece Extension Stock Kit $95 (Includes all above pieces) 1. Only available on 20 W or greater. 2. Assembly required. May require seating configuration adjustments to avoid front caster interference. 3. Not available with modular footplate extension components/kits. CENTER MOUNT POWER ARTICULATING FOOT PLATFORM Option # Additional Optional Accessories: o Footplate Connector $49 o Wheel Bumpers, pair $25 o Footplate Cover, Reversed $120 Dartex 3 (1/2 Soft Visco Foam) All efforts will be made to accommodate legrest length selection but minor changes may need to be made to meet shipping guidelines. Some adjustment may be needed upon receipt of the unit. Not available with standard contoured seating. 1. Only available on 20 W or greater. 2. Assembly required. May require seating configuration adjustments to avoid front caster interference. 3. Not available with modular footplate extension components/kits. o Center Mount Power Articulating $2895 K0108 Foot Platform (Includes 10 W x 11 D Split Footplates) Extensions: o L o L Set Legrest Length: LL10 o 10 H LL135 o 13.5 H LL165 o 16.5 H LL105 o 10.5 H LL14 o 14 H LL17 o 17 H LL11 o 11 H LL145 o 14.5 H LL175 o 17.5 H LL115 o 11.5 H LL15 o 15 H LL18 o 18 H LL12 o 12 H LL155 o 15.5 H LL185 o 18.5 H LL125 o 12.5 H LL16 o 16 H LL19 o 19 H LL13 o 13 H Revised: October 15, 2014 Page 8 of 11

9 SYNERGY CUSHIONS o Matching Seat Size o Non-Matching Seat Size Please refer to Synergy Cushion order forms for detailed pricing, sizes, codes and part # s Simplicity Cushion: General Use o 20 x x 24 $98 E2601 o 22 x x 24 $98 E2602 Solution Cushion: Skin Protection & Positioning o 20 x x 24 $430 E2607 o 22 x x 24 $430 E2608 Solution 1 Cushion: Skin Protection o 20 x x 24 $430 E2603 o 22 x x 24 $430 E2604 Spectrum Gel Cushion: Positioning o 20 x x 24 $530 E2605 o 22 x x 24 $530 E2606 Spectrum Visco Cushion: Skin Protection & Positioning o 20 x x 24 $530 E2607 o 22 x x 24 $530 E2608 Spectrum Air Cushion: Adjustable Skin Protection o 20 x x 24 $480 E2622 o 22 x x 24 $550 E2623 Air Tube: Side Side Spectrum Air Contour Cushion: Adjustable Skin Protection & Positioning o 20 x x 24 $499 E2624 o 22 x x 24 $549 E2625 Air Tube: Side Side TRU-Comfort 2 4-Way Stretch: Skin Protection: o 20 x x 24 $380 E2603 o 22 x x 24 $480 E2604 TRU-Comfort 2 Air Mesh: Skin Protection: o 20 x x 24 $380 E2603 o 22 x x 24 $480 E2604 TRU-Comfort Accessory: o Sport Seat Cushion Cover 1 $100 o 20 W x 20 D CONTOURED SEATING/SYNERGY ACCESSORIES Option # o Rear Basket 1 $103 o Cane/Crutch Holder 1 $98 E2207 o Cup Holder $17 2 Side: o Saddle Bag $28 o Flag Holder $17 o Oxygen Holder o Contoured Seating 1 $103 E2208 o Synergy Seat $150 E2208 o Walker Holder $92 o Quantum Back Pack 3 $60 o Tablet Holder 4 $315 o Deluxe Cell Phone/Media $140 Holder 4 o Transfer Bar, Pair 4 $175 (Quick Release) 1. Includes mounting hardware. 2. No charge on Synergy seating 3. Backpack may interfere w/ other rear accessories. Not available w/ contoured seating. 4. Only available with Synergy seating. TRU-BALANCE 3 COMPLIMENTARY ACCESSORIES Option # Choose two complimentary items in this section. Each additional item will be $25 MSRP. Available on TB3 Seating Only CUP o Cup Holder 1 PIH o Personal Item Hook 2 RKIT o Reflector Kit CELL o Cell Phone/Media Holder 1 BPH o Backpack Holder, Pair 2 1. Available as an additional cover option for both TRU-Comfort seat cushion styles. Only available in sizes listed. 1. Not available w/ 2-post, flip back armrests or back cane option. 2. Not available with back cane option. Revised: October 15, 2014 Page 9 of 11

10 TRU-BALANCE 3 PREMIUM ACCESSORIES Option # Available on TB3 Seating Only Premium accessories will be shipped with the unit, not installed Multiple accessories can be mounted along the various tracks, some interference may occur CGUAR o Clothing Guard, Pair $175 GBOX o Glove Box $100 H2O o Hydration System 1 $175 OXYGEN o Oxygen Holder 1 $150 E2208 OXYGEN o Oxygen Holder $150 E2208 (For use w/ back cane option) o Transfer Bar, Pair $175 (Quick Release) LATERALS (CONT D) o Stealth Pelvic/Thigh Guides Side: Bracket: o Flip Down $225 ea. E1028 o Removable $250 ea. E1028 o Flip Down w/ Full Surface $225 ea. E1028 Contact Feature o Removable w/ 1 Offset $325 ea. E1028 Adapter: o 2 Height Adapter Plate 2 $25 ea. K0108 o 2 1/4 Height Adapter $25 ea. K0108 Plate 3 Pads: o Short Pad, 4 x 4 $50 ea. E0956 o Medium Pad, 4 x 8 $50 ea. E0956 o Long Pad, 4 x 12 $50 ea. E0956 Lateral Installation: o Install o Do Not Install QRTB o Transfer Bar, Pair $175 (Bolt-On) BATTERIES o ipad Holder $ Not available with back cane option. o Group 24, 70 Amp, Gel $352 ea. E2363 (Universal) o Group 24, 70 Amp, Gel $352 ea. E2363 (MK) o No Batteries Installation: o Batteries Installed o Do Not Install The following items can be chosen in the Positioning Components screen in iquantum Please refer to the Positioning Components order form for additional details, sizes and pricing LATERALS o Stealth Thoracic Laterals 1 Bracket: o Swing-Away, Rail Mounts $450 pr. E1028 Pads: o Curved Pad, 3 x 5 $200 pr. E0956 o Curved Pad, 4 x 6 $200 pr. E0956 Lateral Installation: o Install o Do Not Install 1. Swing-away laterals may interfere with TB3 armrests. Not available with back cane option. 2. Height adapter is needed w/ Tru Comfort seat cushions. Not available/necessary with the flip Down bracket. 3. Only available w/ the flip down bracket ADDITIONAL FOOT RIGGING ACCESSORIES o Therafin Flip-down Knee $172 E1028 Abductor Bracket Pads: o Small (3.5 x 3.25 x 4 ) $135 E0957 o Small, Gel (3.5 x 3.25 x 4 ) $145 E0957 o Medium (4 x 3.25 x 6 ) $135 E0957 o Large (4.5 x 2.75 x 6 ) $135 E o POSAlinc Knee Adductor for $512 K0108 Swing-Away Legrests (pair) 13555A/13520 o POSAlinc Rail Mounted Knee $574 K0108 Adductors (pair) o One Piece Calf Panels o Calf Panel, 22 W(Fits W) $135 o Calf Panel, 26 W(Fits W) $145 o Calf Panel, 30 W(Fits W) $155 SPFB-SLS SPFB-SLL o Stealth Foot Boxes (pair) $475 K0108 m Small m Medium o Large o Stealth Padded Shoe $166 K0108 Holders (pair) o Small o Medium Revised: October 15, 2014 Page 10 of 11 SPFS-XL o X-Large o Ankle Huggers $156 K0108 o Medium o Large

11 ADDITIONAL ARMREST ACCESSORIES o Otto Bock Arm Channels (ea.) 1 $104 E2209 Side: o Small (4.75 x 8 ) o Medium (4.75 x 11.5 ) o Large (4.75 x 14 ) o One Piece (4.75 x 18 ) o Otto Bock Hand Pads (ea.) 2 $52 Side: Size: o Medium o Large o Stealth Elbow Support Side: o Bracket-Left $170 ea. E1028 o Bracket-Right $170 ea. E1028 Pad Size: o 3 W x 3 H $50 ea. K0108 o 4 W x 4 H $50 ea. K A 2 narrower back width is recommended to avoid interference w/ the back cushion. 2. Not available on same side as controller