qqqqqqqqq - southwestmedical.com...14” N/C qqqqqqqqq 15” N/C qqqqqqqqq 16” N/C qqqqqqqqq 17”...
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Effective 05/29/2018 Company: ________________________________________________ Account Number: __________________ Date: _________________ q Quote q PO Number: ___________________________________ RTS: _____________________________________________________ Marked For: _______________________________________________ Ship To: __________________________________________________ Address: _________________________________________________ City: ________________________________ State: _____________ Zip: ________________ Phone: _____________________________ Email/Fax: ________________________________________________ Frame Seat Width / Seat Depth Select box corresponding to desired Seat Width and Depth Seat Width 14” 15” 16” 17” 18” 19” 20” 21” 22” Price HCPCS N/C N/C N/C N/C N/C N/C $395 E2201 $495 E2201 $495 E2201 Seat Depth 14” N/C q q q q q q q q q 15” N/C q q q q q q q q q 16” N/C q q q q q q q q q 17” N/C q q q q q q q q q 18” N/C q q q q q q q q q 19” $80 q q q q q q q q q 20” $475 E2203 q q q q q q q q q Transit Option q Transit System K0108 ______________________________________________________________________ $320 Not available with Removable Seat Pan or Heavy Duty Option Heavy Duty Option q 350 lb Weight Capacity __________________________________________________________________ $500 Requires minimum 6” caster height Cross Brace q Standard Cross Braces _____________________________________________________________________ Std q Seating System Cross Braces _______________________________________________________ N/C Allows for easy attachment of seating system mounting hardware. Not available with Seat Sling. q Titanium Cross Braces ____________________________________________________________________ $600 Not available with 21” and 22” Seat Widths Rear Frame Type Catalyst 5 K0005 __________________________________________________________________________ $2075 300 lb weight capacity Phone (800) 981-1540 | Fax (715) 254-0996 [email protected] | www.kimobility.com Titanium Option q Titanium Frame K0108 _________________________________________________________________ $1650 Includes hangers and base frame. Does not include Cross Braces. DCN0011.24 Pricing and specifications subject to change without notice Page 1 of 13 No selection needed with Titanium Frame q Curved ____________________________________________________________________________________________________ Std Select from Standard or Angle Adjustable Back Posts on chart on the next page q Depth Adjustable K0108 _________________________________________________________________ $195 Select from Standard Depth Adjustable or Height Adjustable Depth Adjustable Back Posts in chart on the next page. Provides 2” forward and 2” rearward adjustment with minimum Seat Depth of 14” and maximum Seat Depth of 22”. Available only with T-Arm or Flip Up Armrests. Not available with Back Upholstery. q Reclining __________________________________________________________________________________________ $1095 Select from Reclining Back Post in chart on the next page. Not available with Seating Dynamics Rocker Back, O 2 Holder, Transit Option, Heavy Duty Option, Swing Away Armrests, Flip Back Armrest, Height Adjustable Flip Back T-Arm, Back Upholstery or IV Pole. Wheelchair Drive Ready Chair will ship from Ki Mobility with adaption kit installed for selected Alber system. Order system separately from Alber USA. Select Rear Seat Height (full profile selections only) in drive wheel size on Rear Seat Height chart (page 5). Requires Rear Anti-Tips. Not available with Spinergy wheels. q e-motion Ready __________________________________________________________________________________ N/C q twion Ready _________________________________________________________________________________________ N/C HCPCS codes provided are based on code verification by the PDAC or our interpretation of the code definitions. Proper use of HCPCS codes does not ensure coverage or payment. For coverage information, verify the appropriate payer’s coverage policy. This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows.
Transcript of qqqqqqqqq - southwestmedical.com...14” N/C qqqqqqqqq 15” N/C qqqqqqqqq 16” N/C qqqqqqqqq 17”...
Effective 05/29/2018
Company: ________________________________________________
Account Number: __________________ Date: _________________
q Quote q PO Number: ___________________________________
RTS: _____________________________________________________
Marked For: _______________________________________________
Ship To: __________________________________________________
Address: _________________________________________________
City: ________________________________ State: _____________
Zip: ________________ Phone: _____________________________
Email/Fax: ________________________________________________
Frame
Seat Width / Seat DepthSelect box corresponding to desired Seat Width and Depth
Seat Width
14” 15” 16” 17” 18” 19” 20” 21” 22”
PriceHCPCS
N/C N/C N/C N/C N/C N/C$395E2201
$495E2201
$495E2201
Sea
t D
epth
14” N/C q q q q q q q q q
15” N/C q q q q q q q q q
16” N/C q q q q q q q q q
17” N/C q q q q q q q q q
18” N/C q q q q q q q q q
19” $80 q q q q q q q q q
20” $475E2203 q q q q q q q q q
Transit Option
q Transit System K0108 ______________________________________________________________________ $320Not available with Removable Seat Pan or Heavy Duty Option
Heavy Duty Option
q 350 lb Weight Capacity __________________________________________________________________ $500Requires minimum 6” caster height
Cross Brace
q Standard Cross Braces _____________________________________________________________________ Stdq Seating System Cross Braces _______________________________________________________ N/C
Allows for easy attachment of seating system mounting hardware. Not available with Seat Sling.
q Titanium Cross Braces ____________________________________________________________________ $600Not available with 21” and 22” Seat Widths
Rear Frame Type
Catalyst 5 K0005 __________________________________________________________________________ $2075300 lb weight capacity
Phone (800) 981-1540 | Fax (715) [email protected] | www.kimobility.com
Titanium Option
q Titanium Frame K0108 _________________________________________________________________ $1650Includes hangers and base frame. Does not include Cross Braces.
DCN0011.24 Pricing and specifications subject to change without notice Page 1 of 13
No selection needed with Titanium Frame
q Curved ____________________________________________________________________________________________________ StdSelect from Standard or Angle Adjustable Back Posts on chart on the next page
q Depth Adjustable K0108 _________________________________________________________________ $195Select from Standard Depth Adjustable or Height Adjustable Depth Adjustable Back Posts in chart on the next page. Provides 2” forward and 2” rearward adjustment with minimum Seat Depth of 14” and maximum Seat Depth of 22”. Available only with T-Arm or Flip Up Armrests. Not available with Back Upholstery.
q Reclining __________________________________________________________________________________________ $1095Select from Reclining Back Post in chart on the next page. Not available with Seating Dynamics Rocker Back, O2 Holder, Transit Option, Heavy Duty Option, Swing Away Armrests, Flip Back Armrest, Height Adjustable Flip Back T-Arm, Back Upholstery or IV Pole.
Wheelchair Drive ReadyChair will ship from Ki Mobility with adaption kit installed for selected Alber system. Order system separately from Alber USA. Select Rear Seat Height (full profile selections only) in drive wheel size on Rear Seat Height chart (page 5). Requires Rear Anti-Tips. Not available with Spinergy wheels.
q e-motion Ready __________________________________________________________________________________ N/Cq twion Ready _________________________________________________________________________________________ N/C
HCPCS codes provided are based on code verification by the PDAC or our interpretation of the code definitions.
Proper use of HCPCS codes does not ensure coverage or payment. For coverage information, verify the appropriate payer’s coverage policy.
This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows.
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0011.24 Pricing and specifications subject to change without notice Page 2 of 13
Backrest
Back Post / Height Range / Back Height Standard Back PostSelect option below only if a Standard Back Post option is selected on chart at left
q Straight with Push Handle ________________________________________________________________ Stdq Straight without Push Handle ________________________________________________________ N/Cq 8º Bend with Push Handle ______________________________________________________________ $25
Not available with Short Back Height Range
q Straight with Fold Down Push Handle ______________________________________ $125Not available with Heavy Duty option
Depth Adjustable Back Post OptionsOptions below may be selected only if Standard Depth Adjustable or Height Adjustable Depth Adjustable option is selected on chart at left
q Stroller Handle Extensions ______________________________________________________________ $75Not available with Height Adjustable Depth Adjustable Back Posts
q Seating Dynamics Rocker Back K0108 __________________________________ $1995Available only with T-Arms
Push Handle OptionsNot available with Standard Depth Adjustable Back Post, Straight Back Post with Fold Down Push Handle, Reclining Back Post or Heavy Duty Option
q Low Profile Push Handle _________________________________________________________________ $652” shorter than standard push handles
Military Patch
Back UpholsterySelect option below only if Standard or Angle Adjustable Back Post option is selected on chart at left
q Standard ________________________________________________________________________________________________ StdNot available with Short or Medium Back Height Ranges on 20” - 22” Seat Widths
q Tension Adjustable E2611 ______________________________________________________________ $245q Omit Back Upholstery ___________________________________________________________________ - $10
Attached only if ordered with Tension Adjustable Back Upholstery
US Military Service Patch _______________________________________________________________________ $90q Army q Navy q Marines q Air Force q Coast Guard
q US Purple Heart Patch _____________________________________________________________________ $90
Purple Heart with Military Service Patch Combo __________________________ $145q Army q Navy q Marines q Air Force q Coast Guard
Footrest
Hanger / Front Frame Bend
q 60º __________________________________________________________________________________________________________ N/CAvailable only with Extension Tube Hangers. Not available with Titanium Frame.
q 70º __________________________________________________________________________________________________________ N/Cq 80º __________________________________________________________________________________________________________ N/C
Not available with 7” or 8” Casters
q 90º __________________________________________________________________________________________________________ N/CAvailable only with Front Mount Hangers. Not available with Titanium Frame or 7” and 8” Casters.
q Pro Elevating Leg Rests (PRO ELR) E0990 _______________________________ $295q Omit Hangers ___________________________________________________________________________________ - $20
Footplate
q Composite ____________________________________________________________________________________________ N/CNot available with Front Mount Hangers or PRO ELR
q Composite Angle Adjustable K0040 ___________________________________________ $185Not available with Front Mount Hangers or 14” Seat Width
q Aluminum Angle Adjustable K0040 _____________________________________________ $185q One Piece Flip Up Angle Adjustable K0040 ______________________________ $190
Not available with Front Mount Hangers or PRO ELR
Reclining Back Post OptionSelect options below if Reclining Back is selected on chart above. Recline angle range is 0º - 65º.
Gas Spring: q Standard Spring q Heavy Duty Spring
Select Back Height in row corresponding to desired Back Post and Height Range. Depth Adjustable not available with Titanium Frame.
BackPost
Price Height Range
Back Height
Standard N/C
Short q 8.5 q 9.5 q10.5 q 11.5
Medium q 12.5 q 13.5 q 14.5 q 15.5
Tall q 16.5 q 17.5 q 18.5 q 19.5
Angle Adjustable w/ Push Handle
$185
Short q 14 q 15 q 16
Medium q 16 q 17 q 18
Tall q 18 q 19 q 20
Standard Depth Adjustable
N/CShort q 20
Tall q 24
Height Adjustable Depth Adjustable
$75
Short1 q 13 q 14 q 15 q 16 q 17
Medium q 16 q 17 q 18 q 19 q 20
Tall q 20 q 21 q 22 q 23 q 24
Reclining w/ Adjustable Handle1, 2
(Removable)
N/CShort q 22
Tall q 261 Not available with Seating Dynamics Rocker Back2 Not available with O2 Holder, Transit Option, Heavy Duty Option, Swing Away Armrests, Flip Back Armrest, Height Adjustable Flip Back T-Arm, Back Upholstery or IV Pole
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Footrest / Extension / Seat to Footrest LengthSelect Seat to Footrest Length in row corresponding to desired Footrest and Extension. Footrest Length of at least 2.5” shorter than Front Seat Height recommended. Extension Tube Hangers and Fixed Front Frame measurements are based on 70º Hanger / Front Frame Bend.
Footrest Extension Seat to Footrest Length
Extension TubeHangers(60º, 70º, 80º)
Short q 11 q 11.5 q 12 q 12.5 q 13 q 13.5 q 14 q 14.5 q 15
Medium q 13 q 13.5 q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17
Long q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5
FrontMount Hangers 1
Standard Selections Requires 3” Extension for $35
Short(70º, 80º, 90º)
q 5 q 5.5 q 6 q 6.5 q 7 q 10 q 10.5 q 11
q 7.5 q 8 q 8.5 q 9 q 9.5 q 11.5 q 12 q 12.5
Medium(70º, 80º, 90º)
q 5 q 5.5 q 6 q 6.5 q 7 q 7.5 q 8 q 12 q 12.5 q 13
q 8.5 q 9 q 9.5 q 10 q 10.5 q 11 q 11.5 q 13.5 q 14 q 14.5
Long(70º, 80º)
q 5 q 5.5 q 6 q 6.5 q 7 q 7.5 q 8 q 8.5 q 9 q 14 q 14.5 q 15
q 9.5 q 10 q 10.5 q 11 q 11.5 q 12 q 12.5 q 13 q 13.5 q 15.5 q 16 q 16.5
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
FixedFront Frame(70º, 80º)
Short q 11.5 q 12 q 12.5 q 13 q 13.5 q 14 q 14.5 q 15
Medium q 13 q 13.5 q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17
Long q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.51 Available only with Aluminum Angle Adjustable Footplates. Not available with Titanium Frame. See Minimum Front Seat Height chart below.
Minimum Front Seat Height with Front Mount Hangers
Hanger Length Short Medium Long
Hanger Bend 70º 80/90º 70º 80/90º 70º 80º
Minimum Front Seat Height with Standard Selection
13.5” 13.5” 14” 15” 16” 17”
Minimum Front Seat Height with 3” Extension
14.5” 16” 16.5” 18” 18.5” 20”
3” ExtensionAvailable only with Front Mount Hangers. Provided as parts.
q 3” Extension for Front Mount Hanger __________________________________________ $35
Footrest continued
Residual Limb SupportResidual Limb Support E1020
q Left ____________________________ $395 q Right _____________________________ $395
q Omit Left Hanger ___- $10 q Omit Right Hanger _____- $10
Cover q Smooth q Air Mesh q Smooth q Air Mesh
Pad Size q 5 x 8 q 9 x 14 q 5 x 8 q 9 x 14
q 7 x 10 q 11 x 10 q 7 x 10 q 11 x 10
q 9 x 10 q 11 x 14 q 9 x 10 q 11 x 14
Hanger ReleaseIf no selection is made Classic Hanger Release will be used
q Classic ____________________________________________________________________________________________________ Stdq 4-Way - In line _____________________________________________________________________________________ N/C
See reference A below. Not available with PRO ELR.
q 4-Way - Out _________________________________________________________________________________________ N/CSee reference B below
A B
DCN0011.24 Pricing and specifications subject to change without notice Page 3 of 13
Front Seat Height and Casters
Caster Type
q .75” Rollerblade __________________________________________________________________________________ N/CNot available with 5”, 6”, 7” and 8” Caster Sizes
q .75” Lighted Rollerblade __________________________________________________________________ $70Not available with 5”, 6”, 7” and 8” Caster Sizes
q 1” Poly ___________________________________________________________________________________________________ N/Cq 1” Poly Aluminum _____________________________________________________________________________ $110
Not available with 6”, 7” and 8” Caster Sizes
q 1” Pneumatic _______________________________________________________________________________________ $80Not available with 4”, 5” and 7” Caster Sizes
q 1.5” Poly _______________________________________________________________________________________________ $50Not available with 7” and 8” Caster Sizes
q 1.5” Soft Roll Aluminum _________________________________________________________________ $175Not 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 Options
Fork Stem
q Best Fit ___________________________________________________________________________________________________ StdKi Mobility will pick optimal Fork Stem based on Caster Size and Front Seat Height
q Standard Fork Stem __________________________________________________________________________ N/Cq 3/4” Longer Fork Stem ____________________________________________________________________ N/Cq 1 1/2” Longer Fork Stem _________________________________________________________________ N/C
q Frog Legs Ultra-Sport Fork - Black ____________________________________________ $425Available only with 4”, 5” or 6” casters. Not available with Caster Pin Locks, Heavy Duty Option, 2” Poly caster or 2” Pneumatic w/ Foam Insert caster.
End User Weight Required: ____________ lbsq Frog Legs PHASE 2 Carbon Fork ______________________________________________ $425
Lightweight shock absorbing fork. Available only with 4”, 5” or 6” casters. Not available with Caster Pin Locks, Heavy Duty Option, 2” Poly caster or 2” Pneumatic w/ Foam Insert caster.
q Caster Pin Locks K0073 _________________________________________________________________ $195Not available with Performance Caster Housing, 1 1/2” Longer Fork Stem or Frog Legs Fork
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Caster Housing
q Standard _______________________________________________________________________________________________ N/Cq Performance ________________________________________________________________________________________ $35
Maximum Seat Dump Reference(Front Seat Height minus Rear Seat Height)
Seat Depth 14” 15” 16” 17” 18” 19” 20”Maximum Dump Standard Caster Housing 1.5” 2” 2” 2” 2.5” 2.5” 2.5”Maximum Dump Performance Caster Housing 3” 3” 3” 3.5” 3.5” 4” 4”
Depending on configuration, chairs with Fixed Front Frame Type may achieve up to an additional .75”
Select Front Seat Height in row corresponding to desired caster size.Note: Selections in first three Front Seat Height columns use Super Low Front Frame. Super Low Front Frame not available with Titanium Frame or Fixed Front Frame.
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 211 Front Seat Height not available with 4 x 1” Poly Caster2 Super Low Front Frame required when using 4 x 1” Poly Caster
Footrest continued
Heel Loop
q Heel Loops E0951 ______________________________________________________________________________ $30Not available with One Piece Flip Up Angle Adjustable Footplate
q Adjustable Heel Loops E0951 New! _______________________________________ $50Not available with One Piece Flip Up Angle Adjustable Footplate
q Omit Heel Loops ________________________________________________________________________________ N/C
Calf Strap
q Velcro Adjustable K0038 ___________________________________________________________________ $35q Padded Velcro Adjustable K0038 __________________________________________________ $68q Bodypoint Padded AeroMesh K0038 _________________________________________ $102
DCN0011.24 Pricing and specifications subject to change without notice Page 4 of 13
Wheel Locks
Wheel Lock
q Push to Lock ________________________________________________________________________________________ Stdq Push to Lock Flush Mount ______________________________________________________________ N/Cq Pull to Lock __________________________________________________________________________________________ N/Cq Low Profile Scissor Lock _________________________________________________________________ $45
Not available with Low Poly, Full Poly or Sentinel Solid tires
q Short Thro Scissor Lock ________________________________________________________________ $110q Omit Wheel Locks _____________________________________________________________________________ N/C
Wheel Lock Options
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 with Airless Insert Rear Tire Types
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0011.24 Pricing and specifications subject to change without notice Page 5 of 13
Rear Wheel Type
q 24” Spoke ____________________________________________________________________________________________ N/Cq Spoke (20”, 22”, 25” or 26”) _________________________________________________________ $180q Mag ________________________________________________________________________________________________________ N/C
Not available in 25” or 26” rear wheels
q Superlight Spoke _____________________________________________________________________________ $265Available only in 24” and 25” rear wheels. Not available with Heavy Duty Option.
q Spinergy Spox __________________________________________________________________________________ $795Not available in 20” rear wheel
Color: q Black q Red q White q Blue q Yellow
Handrim: q Short Tab q Long TabAvailable only with Aluminum Anodized and Plastic Coated Handrims
q Spinergy LX _______________________________________________________________________________________ $995Not available in 20” rear wheel
Color: q Black q Red q White q Blue q Yellow
q Pink q Green q Orange
Handrim: q Short Tab q Long TabAvailable only with Aluminum Anodized and Plastic Coated Handrims
Axle Plate
Rear Seat Height and Wheels
Wheel Size / Tire Profile / Rear Seat HeightSelect Rear Seat Height in row corresponding to Wheel Size and Tire Profile. 14” Seat Depth not available with 24”, 25” or 26” Rear Wheels. m Requires curved axle plate q Any axle plate can be used (Curved, Standard, Amputee, One Arm Drive)
Wheel Size Tire Profile Rear Seat Height
20”Low m 11.5 q 121 m 12.5 q 131 m 13.5 q 14 m 14.5 q 15 m 15.5 m 16
Full m 12 q 12.51 m 13 q 13.51 m 14 q 14.5 m 15 q 15.5 m 16 m 16.5
22”Low m 12.5 q 131 m 13.5 q 141 m 14.5 q 15 m 15.5 q 16 m 16.5 m 17
Full m 13 q 13.51 m 14 q 14.51 m 15 q 15.5 m 16 q 16.5 m 17 m 17.5
24”Low m 13.5 q 141 m 14.5 q 151 m 15.5 q 16 m 16.5 q 17 m 17.5 m 18
Full m 14 q 14.51 m 15 q 15.51 m 16 q 16.5 m 17 q 17.5 m 18 m 18.5
25” Low m 14 q 14.51 m 15 q 15.51 m 16 q 16.5 m 17 q 17.5 m 18 m 18.5
26”Low m 14.5 q 151 m 15.5 q 161 m 16.5 q 17 m 17.5 q 18 m 18.5 m 19
Full m 15 q 15.51 m 16 q 16.51 m 17 q 17.5 m 18 q 18.5 m 19 m 19.51 Not available with Amputee Axle Plate
q One Arm Drive E0958 ___________________________________________________________________ $1095Available only with 24” Mag wheels. Not available with 14” Rear Seat Height in combination with 24” rear wheel or 4° camber. Standard Handrim will be Aluminum Anodized. Axle not quick release.
Drive Handrim Side: q Left q Right
Drive Handrim Type: q Aluminum ________________________________________________ N/C q Poly Coated __________________________________________ $200
One Arm Drive
No selection needed with One Arm Drive
q Standard ________________________________________________________________________________________________ Stdm Curved __________________________________________________________________________________________________ $85q Amputee _____________________________________________________________________________________________ $175
Not available with Swing Away Armrests or Wheelchair Drive Ready Option. Required with Reclining Backrest.
Rear Tire Type
q Street Pneumatic 1 3/8” E2211, E2212 ___________________________________________ StdNot available on 25” rear wheel
q Full Poly 1 3/8” E2218 _______________________________________________________________________ N/CNot available on Superlight or 25” rear wheel
q Pneumatic with Airless Insert 1 3/8” E2211, E2213 ____________________ $80Not available on Superlight or 25” rear wheel
q Schwalbe HS-127 1 3/8” E2211, E2212 ______________________________________ $125Available only on 24” rear wheel. Not available on Mag wheels.
q Euro Trek Knobby 1 3/8” E2211, E2212 _________________________________________ $95Available only on 24” rear wheel
q Low Poly 1” E2218 _____________________________________________________________________________ N/CNot available on Superlight, 25” or 26” rear wheels
q Sentinel Solid Tire 1” E2218 ____________________________________________________________ $95Not available on Superlight wheels or 20” and 22” Mag wheels
q High Pressure 1” E2211, E2212 ________________________________________________________ $95Not available on Mag wheels
q Schwalbe One 1” E2211, E2212 ____________________________________________________ $125Not available on Mag, 20”, 22” or 26” rear wheels
q Schwalbe Marathon Plus Evolution 1” E2211, E2212 ______________ $125Not available on Mag, 20” or 22” rear wheels
Full Profile Low Profile
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0011.24 Pricing and specifications subject to change without notice Page 6 of 13
Handrim
Handrim Option
q 3M Micro Grip _____________________________________________________________________________________ $65Not available on Plastic Coated or Projection Handrims
q Aluminum Anodized ___________________________________________________________________________ Stdq Superlight Aluminum Anodized _____________________________________________________ $50
Available only on 24” and 25” Superlight and Spinergy wheels. Not available with Heavy Duty Option.
q Plastic Coated _____________________________________________________________________________________ $95q Projection (8 Vertical Projections) ________________________________________________ $295
Available on 22”, 24”, 25” and 26” Spoke wheels & 24” Mag wheels w/full tires
q Spinergy Flex Rim ____________________________________________________________________________ $600Available only on 24” and 25” Spinergy LX wheels
q Omit Handrim ______________________________________________________________________________________ N/C
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 Standard Handrims
Rear Seat Height and Wheels continued
No selection needed with One Arm Drive
Armrest Please select Arm Pad Option
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 T-Arm (9.5”-13.5”) E0973 _______________ $275
Not available with Depth Adjustable Back Posts
q Flip Back (10.5”) ____________________________________________________________________________________ N/CNot available with Seat Depths less than 16” or Angle Adjustable or Depth Adjustable Back Posts
q Angle Adjustable Locking Extendable Flip Up E0973 ____________ $265Available only with Depth Adjustable and Reclining Back Posts
q Swing Away (10.5” - 12.5”) E0973 _____________________________________________________ $195Not available with Angle Adjustable or Depth Adjustable Back Posts or Arm Pads
q Swing Away with Side Guard (10.5” - 12.5”) E0973 _____________________ $285Not available with Angle Adjustable or Depth Adjustable Back Posts or Arm Pads
q Omit Armrests _____________________________________________________________________________________ N/C
Arm Pad
Armrests
Axle
Axles
Axle Position
Rear Wheel Camber: q 0º q 2º q 4º
Center of Gravity: q Rear q Center q Forward
Armrest continued
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
Foam Grip _________________ N/C q Desk q FullAvailable only with Angle Adjustable Locking Extendable Flip Up Armrest
No selection needed with Wheelchair Drive Ready Option and One Arm Drive
q Quick Release ______________________________________________________________________________________ Stdq Quad Quick Release _______________________________________________________________________ $135
Not available with Mag wheels
Removable Side Guard
q Composite Side Guards K0108 ____________________________________________________ $140Not available with T-Arm, Flip Back or Swing Away with Side Guard Armrests
Accessories
Seat Pan
q Removable Aluminum Seat Pan E2231 _____________________________________ $245Not available with Transit System. Pan depth 1/2” shorter than Seat Depth.
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 ___________________________________________________________________ $110
Bodypoint Evoflex - Pelvic Stabilizer E0978 ____________________________________ $183Size: q Small (16-24”) q Medium (19-29”) q Large (25-37”)
Bodypoint Belt Mounting Kit _______________________________________________________________ $105Style: q Bracket q Band Clamp 1”
Other Accessories
q Tool Kit ___________________________________________________________________________________________________ $45q Removable Underseat Pouch ________________________________________________________ $50q Pediatric Ki Mobility Backpack New! _____________________________________ $50q Ki Mobility Backpack ________________________________________________________________________ $65q Luggage Carrier _________________________________________________________________________________ $85
Not available with PRO ELR or Residual Limb Support
q Black Neoprene Impact Guards ____________________________________________________ $85q Clear Spoke Guards K0065 ___________________________________________________________ $115
Not available with Mag wheels
q Black Spoke Guards K0065 __________________________________________________________ $115Not available with 20” or Mag rear wheels
q Cane and Crutch Holder _______________________________________________________________ $195q IV Pole _________________________________________________________________________________________________ $265
Available only with Curved Rear Frame Type and Straight Back Posts
Frame Color
Matte FinishGloss 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/Cq Blue Skies ____________________________________________________________________________________________ N/Cq Bubblegum Pink _________________________________________________________________________________ N/Cq Candy Blue __________________________________________________________________________________________ N/Cq Candy Purple ______________________________________________________________________________________ N/Cq Candy Red ___________________________________________________________________________________________ N/Cq Copper __________________________________________________________________________________________________ N/Cq Fuchsia __________________________________________________________________________________________________ N/Cq Granny Smith ______________________________________________________________________________________ N/Cq Metallic Orange New! _________________________________________________________________ N/Cq Yellow ____________________________________________________________________________________________________ N/C
Graphic Image TransferVisit www.kimobility.com for current graphic image transfer optionsNote selection below
q $595
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
O2 HolderNot available with Depth Adjustable Rear Frame
O2 Holder E2208 ______________________________________________________________________________________ $295 q Right Side q Left Side
Frame Color not available with Titanium Frame Option
DCN0011.24 Pricing and specifications subject to change without notice Page 7 of 13
DCN0011.24 Pricing and specifications subject to change without notice Page 8 of 13
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Catalyst Front Seat Height Matrix
4” Caster 5” Caster 6” Caster 7” Caster 8” Caster
FSHSuper Low
Stem Fork FSHSuper Low
Stem Fork FSHSuper Low
Stem Fork 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.
Axiom G, S and P Cushions
Cushions Under 22” WideWidth
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.
DCN0011.24 Pricing and specifications subject to change without notice Page 9 of 13
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
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
Quick Ship products are stocked
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 DemandOn Demand products are ordered with an extended lead time
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
Weight Capacity: 300 lbs.
DCN0011.24 Pricing and specifications subject to change without notice Page 10 of 13
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0011.24 Pricing and specifications subject to change without notice Page 11 of 13
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Elite Deep Back HCPCS Code: E2620
STEP 1: Choose Back Size
STEP 2: Choose Back Hardware (Selection Required)
Quick Ship products are stocked
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
Quick Ship On DemandOn Demand products are ordered with an extended lead time
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
Weight Capacity: 300 lbs.
DCN0011.24 Pricing and specifications subject to change without notice Page 12 of 13
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
MX2 Back HCPCS Code: E2615
The MX2 Back is On Demand only. On Demand products are ordered with an extended lead time.
Hardware included
q Matrx MX2 Back w/ Fixed Hardware 14 x 06 - IMX21406-CFH _____ $795
q Matrx MX2 Back w/ Fixed Hardware 14 x 09 - IMX21409-CFH _____ $835
q Matrx MX2 Back w/ Fixed Hardware 14 x 12 - IMX21412-CFH _____ $875
q Matrx MX2 Back w/ Fixed Hardware 14 x 16 - IMX21416-CFH _____ $915
q Matrx MX2 Back w/ Fixed Hardware 15 x 06 - IMX21506-CFH _____ $795
q Matrx MX2 Back w/ Fixed Hardware 15 x 09 - IMX21509-CFH _____ $835
q Matrx MX2 Back w/ Fixed Hardware 15 x 12 - IMX21512-CFH _____ $875
q Matrx MX2 Back w/ Fixed Hardware 15 x 16 - IMX21516-CFH _____ $915
q Matrx MX2 Back w/ Fixed Hardware 16 x 06 - IMX21606-CFH _____ $795
q Matrx MX2 Back w/ Fixed Hardware 16 x 09 - IMX21609-CFH _____ $835
q Matrx MX2 Back w/ Fixed Hardware 16 x 12 - IMX21612-CFH _____ $875
q Matrx MX2 Back w/ Fixed Hardware 16 x 16 - IMX21616-CFH _____ $915
q Matrx MX2 Back w/ Fixed Hardware 17 x 06 - IMX21706-CFH _____ $795
q Matrx MX2 Back w/ Fixed Hardware 17 x 09 - IMX21709-CFH _____ $835
q Matrx MX2 Back w/ Fixed Hardware 17 x 12 - IMX21712-CFH _____ $875
q Matrx MX2 Back w/ Fixed Hardware 17 x 16 - IMX21716-CFH _____ $915
q Matrx MX2 Back w/ Fixed Hardware 18 x 06 - IMX21806-CFH _____ $795
q Matrx MX2 Back w/ Fixed Hardware 18 x 09 - IMX21809-CFH _____ $835
q Matrx MX2 Back w/ Fixed Hardware 18 x 12 - IMX21812-CFH _____ $875
q Matrx MX2 Back w/ Fixed Hardware 18 x 16 - IMX21816-CFH _____ $915
MX2 Back with Fixed Hardware MX2 Back with Quick Release HardwareHardware included
q Matrx MX2 Back w/ QR Hardware 14 x 06 - IMX21406-QRH ________ $820
q Matrx MX2 Back w/ QR Hardware 14 x 09 - IMX21409-QRH ________ $860
q Matrx MX2 Back w/ QR Hardware 14 x 12 - IMX21412-QRH ________ $900
q Matrx MX2 Back w/ QR Hardware 14 x 16 - IMX21416-QRH ________ $940
q Matrx MX2 Back w/ QR Hardware 15 x 06 - IMX21506-QRH ________ $820
q Matrx MX2 Back w/ QR Hardware 15 x 09 - IMX21509-QRH ________ $860
q Matrx MX2 Back w/ QR Hardware 15 x 12 - IMX21512-QRH ________ $900
q Matrx MX2 Back w/ QR Hardware 15 x 16 - IMX21516-QRH ________ $940
q Matrx MX2 Back w/ QR Hardware 16 x 06 - IMX21606-QRH ________ $820
q Matrx MX2 Back w/ QR Hardware 16 x 09 - IMX21609-QRH ________ $860
q Matrx MX2 Back w/ QR Hardware 16 x 12 - IMX21612-QRH ________ $900
q Matrx MX2 Back w/ QR Hardware 16 x 16 - IMX21616-QRH ________ $940
q Matrx MX2 Back w/ QR Hardware 17 x 06 - IMX21706-QRH ________ $820
q Matrx MX2 Back w/ QR Hardware 17 x 09 - IMX21709-QRH ________ $860
q Matrx MX2 Back w/ QR Hardware 17 x 12 - IMX21712-QRH ________ $900
q Matrx MX2 Back w/ QR Hardware 17 x 16 - IMX21716-QRH ________ $940
q Matrx MX2 Back w/ QR Hardware 18 x 06 - IMX21806-QRH ________ $820
q Matrx MX2 Back w/ QR Hardware 18 x 09 - IMX21809-QRH ________ $860
q Matrx MX2 Back w/ QR Hardware 18 x 12 - IMX21812-QRH ________ $900
q Matrx MX2 Back w/ QR Hardware 18 x 16 - IMX21816-QRH ________ $940
Weight Capacity: 250 lbs.
DCN0011.24 Pricing and specifications subject to change without notice Page 13 of 13
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Matrx Elan Headrest HCPCS Code: Hardware E0128 / Pad E0955
Quick Ship products are stocked
q Elan Hardware - MEHW _______________________________________________________________________ $220
q Elan Mini Hardware - MEMH _______________________________________________________________ $220
q Elan Standard Pad 6” W x 3.5” H w/ 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
Quick Ship On DemandOn Demand products are ordered with an extended lead time
q Elan Standard Pad 6” W x 3.5” H w/ Infection Control Cover - ESP6-IC _______ $235
q Elan Standard Pad 10” W x 5” H w/ Infection Control Cover - ESP10-IC ______ $235
q Elan Standard Pad 14” W x 5” H w/ Infection Control Cover - ESP14-IC ______ $235
q Elan Occipital Pad 9” W x 7” H w/ 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
Quick Ship products are stocked
Elite Swing Away Lateral Hardware Only - SAHEB
q Quantity 1 _________________________________________________________________________________ $225
q Quantity 2 _________________________________________________________________________________ $450
q Elite Offset Swing Away Lateral Hardware Only (Left) - OSAH-L ____ $225
q Elite Offset Swing Away Lateral Hardware Only (Right) - OSAH-R __ $225
Pad for Swing Away Lateral Medium 3.75” H x 5.75” L - EPAD-M
q Quantity 1 _________________________________________________________________________________ $110
q Quantity 2 _________________________________________________________________________________ $220
Pad for Swing Away Lateral Large 4.25” H x 6.5” L - EPAD-L
q Quantity 1 _________________________________________________________________________________ $110
q Quantity 2 _________________________________________________________________________________ $220
Quick Ship On DemandOn Demand products are ordered with an extended lead time
q Elite Lateral Fixed Standard Pad 5” H x 7.5” L (Left) - PBLS-L _______________ $110
q Elite Lateral Fixed Standard Pad 5” H x 7.5” L (Right) - PBLS-R ____________ $110
q Elite Lateral Fixed Small Pad 3” H x 5.5” L (Left) - PBSS-L ____________________ $110
q Elite Lateral Fixed Small Pad 3” H x 5.5” L (Right) - PBSS-R _________________ $110
q Elite Lateral Fixed Offset Pad 5” H x 7.5” L (Left) - PBOL-L ___________________ $110
q Elite Lateral Fixed Offset Pad 5” H x 7.5” L (Right) - PBOL-R _________________ $110
Mini Swing-Away Lateral Hardware Only - SAHMINI
q Quantity 1 ___________________________________________________________________________________ $225
q Quantity 2 ___________________________________________________________________________________ $450
Pad for Swing Away Lateral X Small 3.25” H x 4.25” L - EPAD-XS
q Quantity 1 ___________________________________________________________________________________ $110
q Quantity 2 ___________________________________________________________________________________ $220
Pad for Swing Away Lateral Small 3.5” H x 5.25” L - EPAD-S
q Quantity 1 ___________________________________________________________________________________ $110
q Quantity 2 ___________________________________________________________________________________ $220
Hardware Options
On DemandOn Demand products are ordered with an extended lead time
q Easy Set Hardware (Pair) - PBMH ______________________________________________________ $225
q Split Mounting Hardware (Pair) - SMH _______________________________________________ $200
q Heavy Duty Easy Set Hardware (Pair) - HDMH _________________________________ $325
q Extended Range Mounting Hardware (Pair) - ERMH ________________________ $225
q Fixed Space Saver Mounting Hardware (Pair) - FSSH _____________________ $200
q Carbon Fiber Fixed Mount Hardware for MX2 Back - IMX2CFH _____ $245
q Quick Release Hardware for MX2 Back - IMX2QRH ________________________ $270
Other Matrx Products
On DemandOn Demand products are ordered with an extended lead time
q Chest Harness Interface Kit for Elite Back - CHIEB ____________________________ $95
q Chest Harness Interface Kit for Mini Back - HIMINI ____________________________ $85
q Extended Mounting Pins for Mounting to Backs 2” Wider - EMP _____ $60
q Privacy Flap X Small (Fits 12” to 14” Backs) - PFLAP-XS __________________ $40
q Privacy Flap Small (Fits 15” to 16” Backs) - PFLAP-S ________________________ $40
q Privacy Flap Medium (Fits 17” to 18” Backs) - PFLAP-M __________________ $40
q Privacy Flap Large (Fits 19” to 20” Backs) - PFLAP-L ________________________ $40
q Privacy Flap X Large (Fits 21” to 22” Backs) - PFLAP-XL __________________ $40
