“F”Series CG Tilt/Recline System - Motion Concepts

1 1 of 7 Prices subject to change without Ensminger Rd., Suite 112, Tonawanda, NY 14150 TOLL FREE TEL: TOLL FREE FAX: F series CG Tilt/Recline SystemUS Price List - Effective August 2017 TRD0387, REV JClient Height:Client Weight (lbs) to to to Top of to to to Heel:Cushion Thickness:BCH IDEAAGFTo ensure System is accurately configured please fill in all required of Order: _____Dealer Name: _____Dealer Account #: _____PO #: _____Tag: _____Purchasing Contact: _____Phone:Fax: _____RTS/Therapist: _____Ship to Address: _____City:_____Zip: _____Client Info: Gender: _____Special Client Conditions: _____REQUIRED MEASUREMENTSREQUIRED INFORMATIONMULTIPLE POWER OPTION - K0861qROVI X3(1)HCPCS Code: K0861 ..$7,395 Select Seat-to-Floor height:(2)q17" q18" q19" q20 qWheelchair Transport Brackets(3) ..$250 MULTIPLE FUNCTION CONTROLLER OPTIONSqR-Net LED Remote Joystick (4) ..STDqR-Net LED Remote Joystick for Lights (4).

2 $500qR-Net Color Remote Joystick with Monojacks(4) ..$600qR-Net Color Remote Joystick with Monojacksfor Lights(4) ..$650qR-Net Omni Display for Speciatly Drive Input(4) ..$950qR-Net Attendant Control(4)HCPCS Code:E2331 ..$950qR-Net Expandable Controller(5)HCPCS Code: E2377 ..$615qR-Net Harness for Expandable Controller(5) ..$595 HCPCS Code: E2313 JOYSTICK MOUNTqFixed ..N/CqSwing-Away HCPCS Code: E1028 ..$235qRetract4 Swing-Away Joystick HCPCS Code: E1028 ..$325qAdjustable, Swing-Away Mount for OmniHCPCS Code: E1028 ..$295 Select Mounting Position:qLeftqRightJOYSTICK HANDLESq T Handle for Joystick Knob HCPCS Code: E2323 ..$115qBall Handle for Joystick Knob HCPCS Code: E2323 ..$115qBodyPoint Joystick Handle 3 U-Shaped ..$120 HCPCS Code: E2323qBodyPoint Joystick Handle 4 U-Shaped ..$120 HCPCS Code: E2323qBodyPoint Joystick Handle, Domed Rubber ..$120 HCPCS Code: E2323 BASE COLOR OPTIONSS elect Color:qRed DeliciousqBlizzard WhiteqOriginal OrangeqParty PinkqMatte BlackqMotion GreenqBright BlueqSolar YellowELECTRONIC OPTIONSqR-Net Output Module (ECM)(4)(6).

3 $995qR-Net Bluetooth Module(4)(6) ..$895 Select Color:qiOS Apple qAndroid/PCqLight Package (Fully integrated LED lighting kit: headlights,taillights and turn signals)(7) ..$1,195 ELECTRONIC PROGRAMMERSqR-Net PC Programmer with Dongle ..$450qDiagnostic Test Tool(DTT) with RNet & VR2 Cables$1,400 NOTES:1. Price of the powerbase includes: Active Ride Control suspension, 8 amp offboard charger, flat free inserts and positioning belt, Weight capacity is 300 Seat to floor height is measured at the front of the seat pan based on a standard seat size. Seat to floor heights may vary +/- .25 dependent on conditions of the power base and on seat depths greater than 18 .3. For unoccupied use Requires an R-Net Controller and Harness - order Required for R-Net Remote Joysticks and Specialty Drive Must order R-Net Color Remote Joystick with these Must select Joystick for Lights feature or Omni for note that the HCPCS codes indicated on this order form are our interpretationof the codes and how we believe our products should be coded.

4 The individualDMERCs will determine if our interpretation is appropriate and whether or not itemscoded will be accepted or denied. Motion Concepts cannot guarantee that use ofthe designated codes will ensure coverage or payment. Contact the insurer to con-firm compliance with coding and coverage CG tilt (50 ) and Power recline (168 ) System (HCPCS code E1006) Part # FTR ..$7,700qF- series CG tilt (50 ) and Power recline (168 ) System withExtended Shear Reduction(HCPCS code E1007) Part # FTRESR ..$8,775 ELEVATING SEAT MODULEE levating Lift Seat Module(1)(2)(3)(Scissor Mechanism)q12" Elevation - up to 250lbs(3)max. Part # ESM12 ..$2,995 NOTES:1. Uses an integrated tilt /Lift mechanism, tilt is 45 and the seat to floor height is not affected by the Elevating Lift Seat. 2. Not available on seat sizes greater than 20" wide by 20" deep, call Customer Service for other For weights greater than 175lbs no tilt while elevated is Customer Service for SEAT SPECIFICATIONS Seat Width - Width adjustable range is 15 -21 q15 q16 q17 q18 q19 q20 q21 Part# SWF15 SWF16 SWF17 SWF18 SWF19 SWF20 SWF21q22.

5 $595 Part# SWF22 Seat Depthq15 q16 q17 q18 q19 q20 q21 Part# SDf15 SD16 SD17 SD18 SD19 SD20 SD21q22 ..$595 Part# SD22 Select depth adjustability range:qFrom 15 to 19 Part# SDA1519qFrom 18 to 21 Part# SDA1821 SEAT CUSHION OPTIONSqMatrx-Libra Seat Cushion* 15 w-20 w(HCPCS Code E2624)$485qMatrx-Libra Seat Cushion* 21 w(HCPCS Code E2624) ..$525qMatrx-Libra Seat Cushion* 22 w(HCPCS Code E2625) ..$595*comes standard with Startex fabric, optional Spacetex fabric available belowqMatrx-PS Seat Cushion 15 w-20 w(HCPCS Code E2605) ..$345qMatrx-PS Seat Cushion 21 w-22 w(HCPCS Code E2606) ..$695qMatrx-Vi Seat Cushion 15 w-20 w(HCPCS Code E2607) ..$425qMatrx-Vi Seat Cushion 21 w-22 w(HCPCS Code E2608) ..$475qMatrx-Flo-Tech Cushion 15 w-22 w(HCPCS Code K0734) .$475q ON-CHAIR Cushion Credit ..($90)FABRIC OPTIONS FOR CUSHIONSqSpacetex Fabric Option for Libra CushionPart # SFLF.

6 N/CqInfection Control Fabric Option for Libra CushionPart # ICFL ..$50 qFusion Fabric Upgrade for Matrx Vi CushionPart # FFV$150qOnyx Fabric Upgrade for Matrx Vi CushionPart # OCUMA$100qStartex Fabric Upgrade for Matrx Vi Cushion qSmooth Side upPart # SFVS ..$50qFabric Side upPart # SFVF ..$50 BACK OPTIONSqStandard Rehab Back and Back cushionPart # SRBF inished height from 20" to 27" ..N/CqAdditional Super Soft/HR Foam(1)Part # SS ..$100qMatrx Fabric UpchargePart # MFU ..$100qPlanar interface plate(2)Select one:qFlatPart # PIPFqRecessedPart # PIPR ..$125qOMIT: Back Cushion Only Part # OBC ..($25)NOTES:1. Additional foam added may impact seat Included with all recline Systems when no back is selected. May also be used as an interface for after market BACK HEIGHTF inished Back heights for Tilt/Recline Systems(1)(2)q20" q21" q22" q23" q24" q25" q26"q27"Part# FBR20 FBR21 FBR22 FBR23 FBR24 FBR25 FBR26 FBR27 NOTES:1.

7 Comes with standard cane 6 gap is recommended for systems with BACK OPTIONS(1)qContour Back 15 -21 wide (HCPCS Code E2613) ..$495 Specify actual back height dimension:q12 q15 q17 q21 qContour Back 22 wide (HCPCS Code E2614) ..$595 Specify actual back height dimension:q15 q17 q21 qHigh Back 16 -22 wide (HCPCS Code E2620) ..$595 Specify actual back height dimension:q16 q18 q20 qMatrx PB Elite Back 15 -20 wide (3 Contour) ..$625(HCPCS Code E2620)Specify actual back height dimension:q10 q12 q14 q16 q18 q20 qMatrx PB Elite HD Back 21 -22 wide (3 Contour) .$795(HCPCS Code E2620 for 21 w E2621 for 22 w)Actual back height dimension:q16 q20 qMatrx PB Elite TR Back 16 -20 wide(3 Contour) ..$650(HCPCS Code E2620)Actual back height dimension:q16 q18 q20 qMatrx PB Elite Deep Back 15 -20 wide (6 contour) .$760(HCPCS Code E2620) Specify actual back height dimension:q12 q16 q18 q20 qMatrx PB Back 16 -20 wide (5 Contour) ..$625(HCPCS Code E2615) Specify actual back height dimension:q12 q16 q20 qMatrx PB Deep Back 16 -20 (7 Contour).

8 $645(HCPCS Code E2615)Specify actual back height dimension:q12 q16 q20 qMatrx PB Heavy Duty Back (5 Contour) ..$835(For Systems 20 -22 wide and over 300lbs)(HCPCS Code E2615 for 20 w E2616 for 22 w)Specify actual back height dimension:q16 q20 qMatrx PB Heavy Duty Deep Back (7 Contour) ..$935(For Systems 20 -22 wide and over 300lbs)(HCPCS Code E2615 for 20 w E2616 for 22 w)Specify actual back pan dimensions:q16 q20 q ON-CHAIR Matrx Back Credit Part # OCBC ..($125)qSuper Soft Foam for Elite Back Upgrade Part # EBSS ..$100qFusion Fabric Upgrade High Back Part # FFUHB ..$100qOnyx Fabric Upgrade for High Back Part # OCUHB ..$ 2 of 7 Prices subject to change without Ensminger Rd., Suite 112, Tonawanda, NY 14150 TOLL FREE TEL: TOLL FREE FAX: Dealer Name: _____Dealer Account Number: _____PO #: _____Tag: _____ F series CG Tilt/Recline System RFQ = Request For Quotation- Please call customer service at 1-888-433-6818and/or fax 1-888-433-6834 TRD0387, REV JNOTE:Systems Include Seat Pan, Back Pan, Standard Armrests and FrontRigging.

9 They are designed for use with a 2"-3" 3 of 7 Prices subject to change without ELAN HEADREST PADS (HCPCS code E0955)SELECT ONE:Matrx Elan Standard Pad ..$260 Part # q6" PadESP6 q10" PadESP10 q14" Pad ESP14 Matrx Elan Standard Pad with Infection Control ..$260 Part #q6" PadESP6-ICq10" PadESP10-ICq14" PadESP14-ICMatrx Elan Occipital Pad ..$260 Part #q9" Pad EOP9q12" Pad EOP12 Matrx Elan Occipital Pad with Infection Control ..$260 Part #q9" Pad EOP9-ICq12" Pad EOP12-ICMatrx Elan 4-Point Pad 11"W x 10"H" ..$360 Part #qStandard CoverE4 POINT qInfection ControlE4 POINT-ICMOTION Concepts HEADREST PADSqMotion Concepts StandardPart # MCSH ..$315qMotion Concepts Auto Style(1) Part # MCOH ..$390 STEALTH HEADRESTSS tealth All Positioning - ..$265qLargePart # SAPLqX-LargePart # SAPXLS tealth Nino Comfort Plus 6" qPart # STSHN ..$265 Stealth Comfort Plus ..$265 q8"Part # STSHXS q10"Part # STSHS q14" Part # STSHLqStealth s World s Best Removable Mounting(HCPCS code E1028) Part # WBHU.

10 $245 HEADREST MOUNTING HARDWARESELECT ONE:qFixed Mounting(non-removable)(1)(2) Part # FM .. N/CqElan Headrest Hardware- Multi-Axis Removable(HCPCS code E1028) Part # MEHW ..$235qMotion Concepts Multi-Axis Removable Mounting(HCPCS code E1028)Part # MAHU ..$225qOMIT:Headrest Part # OHR ..N/C NOTES:1. Fixed Mounting hardware is not available on Matrx PB Unless selecting a Removable hdwr option, this Headrest will come standard w/ Fixed Straight Mounting Hardware (non-removable). LAP BELTS AND CHEST STRAPqPadded Lap Belt 2 point(1) Part # PLB2(HCPCS code E0978)$180qPadded Lap Belt 4 point(1) Part # PLB4(HCPCS code E0978)$230qPush Button Style Seat Belt ..STDS elect:q48" Part # BELT48q60" Part # BELT60q71"Part # BELT71 NOTE:1. 67" length only qReclining Adjustable Height q( "-13")q(13"-16") ..STDPart # RC1 RC2qAdd: OutBack Arm Option(1)(each)Specify: Select:RightqPart # OARL eftq Part # OAL.