Matrx® CUSHION Price List/Order Form

INVACARE® MATRX® CUSHIONS
US PRICE LIST/ORDER FORM
Effective November 1st, 2015
Date of Order:______________________________________________
Ship to Address: ____________________________________________
Dealer Name: ______________________________________________
__________________________________________________________
Dealer Account #: __________________________________________
City: ______________________________________________________
PO #: ____________________________________________________
State:____________________Zip: ______________________________
Tag: ______________________________________________________
Comments: ________________________________________________
Purchasing Contact: __________________________________________
__________________________________________________________
Phone: ____________________Fax: ____________________________
__________________________________________________________
4 Page
Pediatric Cushions
Invacare® Matrx® Kid*ab*ra Cushion/Extra Outer Cover
2
Invacare® Matrx® Kid*ab*ra®Kid*ab*ra Drop Base/Extra Outer Cover
2
Invacare® Matrx® PS Cushion/Extra Outer Cover
6
4 Page
Standard Cushions
Invacare® Matrx® Vi Cushion/Extra Outer Cover
Invacare® Matrx® Vi Drop Base/Extra Outer Cover
Invacare® Matrx® Vi Cushion Rigidizer
Invacare® Matrx® PS Cushion/Extra Outer Cover
Invacare® Matrx® Libra Cushion/Extra Outer Cover
Invacare® Matrx® Flo-tech Cushion/Extra Outer Cover
3
4
4
7
9
12
4 Page
Bariatric Cushions
Invacare® Matrx® Vi Heavy-Duty Cushion/Extra Outer Cover
Invacare® Matrx® PS Heavy-Duty Cushion/Extra Outer Cover
Invacare® Matrx® Libra Heavy-Duty Cushion/Extra Outer Cover
Invacare® Matrx® Flo-tech Heavy-Duty Cushion/Extra Outer Cover
5
8
10
13
4 Page
Modifications & Accessories
Invacare® Matrx® Libra Fit Kit Components
Invacare® Matrx® Flo-Tech Fit Kit Components
Cushion Modifications
Cushion Accessories
Cushion Hardware
11
14
15
15
NOTE: ITEMS HIGHLIGHTED IN GREEN ARE AVAILABLE THROUGH MOTION CONCEPTS ONLY
1.888.433.6818 FAX: 1.888.433.6834
1 of 15
TRD0365 REV D
INVACARE® MATRX® CUSHIONS – US PRICE LIST/ORDER FORM
MATRX KID*AB*RA CUSHION: Pediatric – Skin Protection & Positioning Cushion
®
NOTE: Actual cushion width is ½" narrower
than stated size and cushion depth is 1"
longer than stated depth due to rear cushion
radius.
n Cushion modifications are available and
can be specified on Page 15
WIDTH*
REAR
DEPTH**
FRONT
n
n
Weight capacity up to 150 lbs
Comes standard with inner cover and Kid*ab*ra
outer covers
Kid*ab*ra
Outer Cover
4 HCPCS Code: E2607
Kid*ab*ra Cushion
MODEL
q KA1212-Vi
q KA1214-Vi
q KA1412-Vi
q KA1414-Vi
FITS WIDTH
11", 12"
11", 12"
13", 14"
13", 14"
FITS DEPTH
12", 13"
14", 15"
12", 13"
14", 15"
MSRP
$425.00
$425.00
$425.00
$425.00
Kid*ab*ra Extra Outer Cushion Cover (Refer to cushion sizes above for proper fit)
MODEL
KC
4 HCPCS Code: E2619
FITS WIDTH
FITS DEPTH
REFER TO CUSHION SIZES ABOVE
SPECIFY:
WIDTH_____
DEPTH_____
MSRP
$95.00
q QTY____
MATRX KID*AB*RA DROP BASE: Pediatric – Skin Protection & Positioning Cushion
®
NOTE: Base can only be ordered with
corresponding Kid*ab*ra Cushion
n Must specify drop hook size: 7/8" or 1"
diameter and 1" or 2" drop
n
n
Weight capacity up to 150 lbs
Includes dropbase and mounting hardware
4 HCPCS Code: E2231
Kid*ab*ra Drop Base Cushion
MODEL
q KB1212-Vi
q KB1214-Vi
q KB1312-Vi
q KB1314-Vi
q KB1412-Vi
q KB1414-Vi
FITS WIDTH
12"
12"
13"
13"
14"
14"
FITS DEPTH
12", 13"
14", 15"
12", 13"
14", 15"
12", 13"
14", 15"
MSRP
$200.00
$200.00
$200.00
$200.00
$200.00
$200.00
DROP HOOKS MOUNTING SPECIFICATIONS:
Diameter:
q 7/8"
q 1"
Front Seat:
q FLUSH q 1"
q 2"
Rear Seat:
q FLUSH q 1"
q 2"
Kid*ab*ra Drop Base Extra Outer Cover (Refer to drop base sizes above for proper fit) 4 HCPCS Code: E2619
MODEL
KBC
SPECIFY:
1.888.433.6818 FAX: 1.888.433.6834
FITS WIDTH
FITS DEPTH
REFER TO CUSHION SIZES ABOVE
WIDTH_____
2 of 15
DEPTH_____
MSRP
$90.00
q QTY____
TRD0365 REV D
INVACARE® MATRX® CUSHIONS – US PRICE LIST/ORDER FORM
MATRX Vi CUSHION: Standard – Skin Protection & Positioning Cushion
®
WIDTH*
REAR
DEPTH**
FRONT
NOTE: Actual cushion width is ½" narrower
than stated size and cushion depth is 1½"
longer than stated depth due to rear cushion
radius.
n Cushion modifications are available and
can be specified on Page 15
n
n
Weight capacity up to 300 lbs
Comes standard with inner cover and outer
covers made of Meshtex material
Meshtex
Outer Cover
n
Startex fabric or smooth fabric side up, Onyx
or Fusion Covers are available as an upcharge
4 HCPCS Code: E2607
Vi Cushion
MODEL
q MA1415-Vi
q MA1417-Vi
q MA1616-Vi
q MA1618-Vi
q MA1620-Vi
q MA1716-Vi
q MA1718-Vi
q MA1720-Vi
q MA1816-Vi
q MA1818-Vi
q MA1820-Vi
q MA2016-Vi
q MA2018-Vi
q MA2020-Vi
FITS WIDTH
13", 14"
13", 14"
15", 16"
15", 16"
15", 16"
16", 17"
16", 17"
16", 17"
17", 18"
17", 18"
17", 18"
19", 20"
19", 20"
19", 20"
FITS DEPTH
15", 16"
17", 18"
16", 17"
18", 19"
20", 21"
16", 17"
18", 19"
20", 21"
16", 17"
18", 19"
20", 21"
16", 17"
18", 19"
20", 21"
MSRP
$425.00
$425.00
$425.00
$425.00
$425.00
$425.00
$425.00
$425.00
$425.00
$425.00
$425.00
$425.00
$425.00
$425.00
4 HCPCS Code: E2608
q MA2218-Vi
q MA2220-Vi
21", 22"
21", 22"
18", 19"
20", 21"
$475.00
$475.00
COVER OPTIONS:
ADD
SPECIFY: q STARTEX-F (Startex Cover - Fabric) q STARTEX-S (Startex Cover-Smooth) $50.00
q OCU-MA (Onyx Cover)
q FSU-MA(Fusion Cover)
$100.00
Vi Extra Outer Cushion Cover (Refer to cushion sizes above for proper fit)
MODEL
C
SPECIFY:
4 HCPCS Code: E2619
FITS WIDTH
FITS DEPTH
REFER TO CUSHION SIZES ABOVE
WIDTH_____
DEPTH_____
MSRP
$100.00
q QTY____
*C2218 &C2220 are $110.00
1.888.433.6818 FAX: 1.888.433.6834
3 of 15
TRD0365 REV D
INVACARE® MATRX® CUSHIONS – US PRICE LIST/ORDER FORM
MATRX Vi DROP BASE: Standard – Skin Protection & Positioning Cushion
®
WIDTH*
REAR
DEPTH**
NOTE: Base can only be ordered with
corresponding Matrx Cushion
n Must specify drop hook size: 7/8" or 1"
diameter and flush 1" or 2" drop
n
n
Weight capacity up to 300 lbs
Includes dropbase and mounting hardware
FRONT
4 HCPCS Code: E2231
Vi Drop Base
MODEL
q MB1415-Vi
q MB1417-Vi
q MB1516-Vi
q MB1518-Vi
q MB1616-Vi
q MB1618-Vi
q MB1716-Vi
q MB1718-Vi
q MB1816-Vi
q MB1818-Vi
q MB1916-Vi
q MB1918-Vi
q MB2016-Vi
q MB2018-Vi
FITS WIDTH
14"
14"
15"
15"
16"
16"
17"
17"
18"
18"
19"
19"
20"
20"
FITS DEPTH
15", 16"
17", 18"
16", 17"
18", 19"
16", 17"
18", 19"
16", 17"
18", 19"
16", 17"
18", 19"
16", 17"
18", 19"
16", 17"
18", 19"
MSRP
$200.00
$200.00
$200.00
$200.00
$200.00
$200.00
$200.00
$200.00
$200.00
$200.00
$200.00
$200.00
$200.00
$200.00
DROP HOOKS MOUNTING SPECIFICATIONS:
Diameter:
q 7/8"
q 1"
Front Seat:
q FLUSH q 1"
q 2"
Rear Seat:
q FLUSH q 1"
q 2"
Vi Drop Base Extra Outer Cover (Refer to drop base sizes above for proper fit)
MODEL
BC
4 HCPCS Code: E2619
FITS WIDTH
FITS DEPTH
REFER TO DROP BASE SIZES ABOVE
SPECIFY:
WIDTH_____
DEPTH_____
MSRP
$90.00*
q QTY____
MATRX Vi CUSHION RIGIDIZER
®
NOTE: Lightweight plastic seat insert fits
between seat rails for level support and
eliminates hammock effect of seat upholstery.
n
Recommended for chairs with sling seat
upholstery.
4 HCPCS Code: E0992
Vi Cushion Rigidizer
MODEL
q CR14S
q CR16S
q CR16M
q CR16L
q CR18S
q CR18M
q CR18L
q CR20S
q CR20M
q CR20L
q CR22M
q CR22L
1.888.433.6818 FAX: 1.888.433.6834
FITS WIDTH
12"-14"
15", 16"
15", 16"
15", 16"
17", 18"
17", 18"
17", 18"
19", 20"
19", 20"
19", 20"
21", 22"
21", 22"
4 of 15
FITS DEPTH
12"-17"
15", 16"
17", 18"
19", 20"
15", 16"
17", 18"
19", 20"
15", 16"
17", 18"
19",20"
17", 18"
19", 20"
MSRP
$75.00
$75.00
$75.00
$75.00
$75.00
$75.00
$75.00
$75.00
$75.00
$75.00
$95.00
$95.00
TRD0365 REV D
INVACARE® MATRX® CUSHIONS – US PRICE LIST/ORDER FORM
MATRX Vi HEAVY-DUTY CUSHION: Bariatric – Skin Protection & Positioning Cushion
®
WIDTH*
REAR
DEPTH**
NOTE: Actual cushion width is as stated and
cushion depth is 1½" longer than stated depth
due to rear cushion radius.
n Cushion modifications are available and can
be specified on Page 15
n
n
Weight capacity up to 600 lbs
Comes standard with inner cover and outer
covers made of mesh material
FRONT
Meshtex
Outer Cover
4 HCPCS Code: E2608
Vi Heavy-Duty Cushion (Additional one week lead time)*
MODEL
MAWWDD-Vi
SPECIFY:
FITS WIDTH
FITS DEPTH
REFERENCE CHART BELOW
WIDTH_____
DEPTH_____
MSRP
$625.00
q QTY____
D E P T H (DD)
W I D T H (WW)
18" 19" 20" 21" 22" 23" 24" 25" 26" 27" 28" 29" 30"
18"
19"
20"
21"
22"
23"
24"
25"
26"
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
Vi Heavy-Duty Extra Outer Cover (Additional one week lead time)*
MODEL
CWWDD-Vi
SPECIFY:
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
4 HCPCS Code: E2619
FITS WIDTH
FITS DEPTH
REFERENCE CHART ABOVE
WIDTH_____
DEPTH_____
MSRP
$150.00
q QTY____
* Made to order and non-refundable
1.888.433.6818 FAX: 1.888.433.6834
5 of 15
TRD0365 REV D
INVACARE® MATRX® CUSHIONS – US PRICE LIST/ORDER FORM
MATRX PS CUSHION: Pediatric Positioning Cushion
®
WIDTH*
REAR
DEPTH**
FRONT
NOTE: Actual cushion width is ½" narrower
than stated size and cushion depth is 1"
longer than stated depth due to rear cushion
radius.
n Cushion modifications are available and
can be specified on Page 15 (cover will be
non-reversible)
n
n
Weight capacity up to 150 lbs
Comes standard with inner cover and reversible
Startex® outer covers
Startex
Outer Cover
n
No charge outer cover options: Kid*ab*ra,
Pink Lollipop or Blizzard Blue (all non-reversible)
Kid*ab*ra Pink Lollipop Blue Blizzard
Outer Cover Outer Cover Outer Cover
4 HCPCS Code: E2605
PS Cushion
MODEL
q PS1010
q PS1012
q PS1014
q PS1212
q PS1214
q PS1216
q PS1412
q PS1414
q PS1416
FITS WIDTH
9", 10"
9", 10"
9", 10"
11", 12"
11", 12"
11", 12"
13", 14"
13", 14"
13", 14"
FITS DEPTH
10", 11"
12", 13"
14", 15"
12", 13"
14", 15"
16", 17"
12", 13"
14", 15"
16", 17"
MSRP
$345.00
$345.00
$345.00
$345.00
$345.00
$345.00
$345.00
$345.00
$345.00
COVER OPTIONS:
SPECIFY: q PS (Startex) q PS-K (Kid*abra) q PS-P (Pink Lollipop) q PS-B (Blizzard Blue)
4 HCPCS Code: E2619
PS Extra Outer Cover (Refer to cushion sizes above for proper fit)
MODEL
PSC
SPECIFY:
FITS WIDTH
FITS DEPTH
REFER TO CUSHION SIZES ABOVE
WIDTH_____
DEPTH_____
MSRP
$85.00*
q QTY____
COVER OPTIONS:
SPECIFY:
q PSC (Startex)
q PSC-K (Kid*abra)
q PSC-P (Pink Lollipop) q PSC-B (Blizzard Blue)
1.888.433.6818 FAX: 1.888.433.6834
6 of 15
TRD0365 REV D
INVACARE® MATRX® CUSHIONS – US PRICE LIST/ORDER FORM
MATRX PS CUSHION: Standard – Positioning Cushion
®
WIDTH*
REAR
DEPTH**
FRONT
NOTE: Actual cushion width is ½" narrower
than stated size and cushion depth is 1"
longer than stated depth due to rear cushion
radius.
n Cushion modifications are available and
can be specified on Page 15 (cover will be
non-reversible)
n
n
Weight capacity up to 300 lbs
Comes standard with inner cover and reversible
Startex® outer cover
Startex
Outer Cover
4 HCPCS Code: E2605
PS Cushion
MODEL
q PS1616
q PS1618
q PS1620
q PS1816
q PS1818
q PS1820
q PS2016
q PS2018
q PS2020
FITS WIDTH
15", 16"
15", 16"
15", 16"
17", 18"
17", 18"
17", 18"
19", 20"
19", 20"
19", 20"
FITS DEPTH
16", 17"
18", 19"
20", 21"
16", 17"
18", 19"
20", 21"
16", 17"
18", 19"
20", 21"
4 HCPCS Code: E2619
PS Extra Outer Cover (Refer to cushion sizes above for proper fit)
MODEL
PSC
SPECIFY:
1.888.433.6818 FAX: 1.888.433.6834
MSRP
$345.00
$345.00
$345.00
$345.00
$345.00
$345.00
$345.00
$345.00
$345.00
FITS WIDTH
FITS DEPTH
REFER TO CUSHION SIZES ABOVE
WIDTH_____
7 of 15
DEPTH_____
MSRP
$85.00*
q QTY____
TRD0365 REV D
INVACARE® MATRX® CUSHIONS – US PRICE LIST/ORDER FORM
MATRX PS HEAVY-DUTY CUSHION: Bariatric – Positioning Cushion
®
NOTE: Actual cushion width is as stated and
cushion depth is 1" longer than stated depth
due to rear cushion radius.
WIDTH*
REAR
n
n
DEPTH**
Weight capacity up to 600 lbs
Comes standard with inner cover and
Startex® non-reversible outer covers; specify
fabric or smooth side out option
FRONT
Startex
Outer Cover
4 HCPCS Code: E2606
PS Heavy-Duty Cushion (Additional one week lead time)*
MODEL
PSWWDD
SPECIFY:
FITS WIDTH
FITS DEPTH
REFERENCE CHART BELOW
WIDTH_____
DEPTH_____
q Fabric side up
STARTEX COVER:
MSRP
$695.00
q QTY____
q Smooth side up
D E P T H (DD)
W I D T H (WW)
21" 22" 23" 24" 25" 26" 27" 28" 29" 30" 30"
16"
17"
18"
19"
20"
21"
22"
23"
24"
25"
26"
27"
28"
29"
30"
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
PS Heavy-Duty Extra Outer Cover (Additional one week lead time)*
MODEL
PSCWWDD
SPECIFY:
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
4 HCPCS Code: E2619
FITS WIDTH
FITS DEPTH
REFERENCE CHART BELOW
WIDTH_____
STARTEX COVER:
DEPTH_____
q Fabric side up
MSRP
$125.00
q QTY____
q Smooth side up
* Made to order and non-refundable
1.888.433.6818 FAX: 1.888.433.6834
8 of 15
TRD0365 REV D
INVACARE® MATRX® CUSHIONS – US PRICE LIST/ORDER FORM
MATRX LIBRA CUSHION: Standard – Adjustable Skin Protection and Positioning Cushion
®
NOTE: Actual cushion width is as stated
and cushion depth is 1½" longer than stated
depth due to rear cushion radius.
WIDTH*
REAR
n
n
Weight capacity up to 300 lbs
Comes standard with foam base, fluid sac,
platilon inner liner and Startex outer cover
®
DEPTH**
FRONT
Startex
Outer Cover
n
Spacetex
Infection Control
Outer Cover Outer Cover
Libra Cushion
Startex Outer Cover
Spacetex Outer Cover
Infection Control Outer Cover
Spacetex is a no charge outer cover option;
Infection Control additional $50 (all non-reversible)
MODEL
q LC1412
q LC1414
q LC1416
q LC1516
q LC1518
q LC1520
q LC1616
q LC1618
q LC1620
q LC1622
q LC1716
q LC1718
q LC1720
q LC1722
q LC1816
q LC1818
q LC1820
q LC1822
q LC1916
q LC1918
q LC1920
q LC1922
q LC2016
q LC2018
q LC2020
q LC2022
FITS WIDTH
14"
14"
14"
15"
15"
15"
16"
16"
16"
16"
17"
17"
17"
17"
18"
18"
18"
18"
19"
19"
19"
19"
20"
20"
20"
20"
4 HCPCS Code: E2624
FITS DEPTH
12", 13"
14", 15"
16", 17"
16", 17"
18", 19"
20", 21"
16", 17"
18", 19"
20", 21"
22", 23"
16", 17"
18", 19"
20", 21"
22", 23"
16", 17"
18", 19"
20", 21"
22", 23"
16", 17"
18", 19"
20", 21"
22", 23"
16", 17"
18", 19"
20", 21"
22", 23"
MSRP
$485.00
$485.00
$485.00
$485.00
$485.00
$485.00
$485.00
$485.00
$485.00
$595.00
$485.00
$485.00
$485.00
$595.00
$485.00
$485.00
$485.00
$595.00
$485.00
$485.00
$485.00
$595.00
$485.00
$485.00
$485.00
$595.00
COVER OPTIONS:
SPECIFY: q LC (Startex) q LC-SP (Spacetex) q LC-IC (Infection Control)*
*Additional $50 for Infection Control Cover
Libra Extra Outer Cover (Refer to cushion sizes above for proper fit)
MODEL
LCC
LSC
LIC
SPECIFY:
4 HCPCS Code: E2619
FITS WIDTH
FITS DEPTH
REFER TO CUSHION SIZES ABOVE
REFER TO CUSHION SIZES ABOVE
REFER TO CUSHION SIZES ABOVE
WIDTH_____
DEPTH_____
MSRP
$100.00
$125.00
$150.00
q QTY____
COVER OPTIONS:
SPECIFY: q LCC (Startex) q LSC (Spacetex) q LIC (Infection Control)
1.888.433.6818 FAX: 1.888.433.6834
9 of 15
TRD0365 REV D
INVACARE® MATRX® CUSHIONS – US PRICE LIST/ORDER FORM
MATRX LIBRA HEAVY-DUTY CUSHION: Bariatric – Adjustable Skin Protection and
Positioning Cushion
®
NOTE: Actual cushion width is as stated
and cushion depth is 1½" longer than stated
depth due to rear cushion radius.
WIDTH*
REAR
n
n
Weight capacity up to 500 lbs
Comes standard with foam base, fluid sac,
platilon inner liner and Startex outer cover
®
DEPTH**
FRONT
Startex
Outer Cover
n
Spacetex is a no charge outer cover option;
Infection Control additional $50 (all non-reversible)
Spacetex
Infection Control
Outer Cover Outer Cover
4 HCPCS Code: E2624
Libra Heavy-Duty Cushion
MODEL
q LC2118
q LC2120
q LC2122
FITS WIDTH
21"
21"
21"
FITS DEPTH
18", 19"
20", 21"
22", 23"
q
q
q
q
q
q
q
q
q
22"
22"
22"
23"
23"
23"
24"
24"
24"
18", 19"
20", 21"
22", 23"
18", 19"
20", 21"
22", 23"
18", 19"
20", 21"
22", 23"
LC2218
LC2220
LC2222
LC2318
LC2320
LC2322
LC2418
LC2420
LC2422
MSRP
$525.00
$525.00
$595.00
4 HCPCS Code: E2625
$595.00
$595.00
$595.00
$595.00
$595.00
$595.00
$595.00
$595.00
$595.00
COVER OPTIONS:
SPECIFY: q LCC (Startex) q LSC-SP (Spacetex) q LSC-IC (Infection Control)*
*Additional $50 for Infection Control Cover
Libra Heavy-Duty Extra Outer Cover (Refer to cushion sizes above for proper fit)
Startex Outer Cover
MODEL
LCC
LSC
LIC
Spacetex Outer Cover
SPECIFY:
4 HCPCS Code: E2619
FITS WIDTH
FITS DEPTH
REFER TO CUSHION SIZES ABOVE
REFER TO CUSHION SIZES ABOVE
REFER TO CUSHION SIZES ABOVE
WIDTH_____
DEPTH_____
MSRP
$125.00
$150.00
$165.00
q QTY____
COVER OPTIONS:
SPECIFY: q LCC (Startex) q LSC (Spacetex) q LIC (Infection Control)
Infection Control Outer Cover
1.888.433.6818 FAX: 1.888.433.6834
10 of 15
TRD0365 REV D
INVACARE® MATRX® SEATING SERIES – US PRICE LIST
MATRX LIBRA FIT KIT COMPONENTS & OTHER COMPONENTS:
®
Libra Components
MODEL
q LAB
q FTSW
qFTHW
q FTTW-LFRR
q FTTW-RFLR
q LFS
q LLW
q CLCFP-M
q CLCFP-L
q LCPL-WWDD
1.888.433.6818 FAX: 1.888.433.6834
COMPONENT
Libra Abductor
1" Abductor built-up - Top mounted
Anterior Seat Wedges
1" Anterior wedge increases pre-ischial
contour - Underside mounted
Hemi Wedges
1" Anterior thigh support - Underside mounted
Tapered Wedge LFRR
¾" Tapered wedge for users’s Left front
or Right rear - Underside mounted
Tapered Wedge RFLR
¾" Tapered wedge for users’s Right front
or Left rear - Underside mounted
Libra Fluid Supplement
May be used to accommodate mild pelvic
obliquity/additional pressure reduction
Lateral Wedge
1" Lateral wedge increases hip/thigh loading,
- Underside mounted
Complete Libra Cushion Fluid Sac
18" Wde and below
SPECIFY CUSHION SIZE:
WIDTH_____
MSRP
$60.00
$90.00
$50.00
$50.00
$50.00
$50.00
$65.00
$315.00
DEPTH_____
Complete Libra Cushion Fluid Sac
19" Wde and above
SPECIFY CUSHION SIZE:
WIDTH_____
DEPTH_____
Platilon Inner Liner
SPECIFY CUSHION SIZE:
WIDTH_____
$35.00
DEPTH_____
11 of 15
$315.00
TRD0365 REV D
INVACARE® MATRX® CUSHIONS – US PRICE LIST/ORDER FORM
MATRX FLO-TECH CUSHION: Standard – Adjustable, Skin Protection Cushion
®
WIDTH*
n
n
REAR
Weight capacity up to 300 lbs
Comes standard with foam base, fluid sac,
platilon inner liner and Startex outer cover
®
DEPTH**
FRONT
Startrex
Outer Cover
4 HCPCS Code: E2622
Flo-tech Cushion
MODEL
q FT1414
q FT1416
q FT1516
q FT1517
q FT1518
q FT1519
q FT1520
q FT1521
q FT1616
q FT1617
q FT1618
q FT1619
q FT1620
q FT1621
q FT1716
q FT1717
q FT1718
q FT1719
q FT1720
q FT1721
q FT1816
q FT1817
q FT1818
q FT1819
q FT1820
q FT1821
q FT1916
q FT1917
q FT1918
q FT1919
q FT1920
q FT1921
q FT2016
q FT2017
q FT2018
FITS WIDTH
14"
14"
15"
15"
15"
15"
15"
15"
16"
16"
16"
16"
16"
16"
17"
17"
17"
17"
17"
17"
18"
18"
18"
18"
18"
18"
19"
19"
19"
19"
19"
19"
20"
20"
20"
FITS DEPTH
14"
16"
16"
17"
18"
19"
20"
21"
16"
17"
18"
19"
20"
21"
16"
17"
18"
19"
20"
21"
16"
17"
18"
19"
20"
21"
16"
17"
18"
19"
20"
21"
16"
17"
18"
Flo-tech Extra Outer Cover (Refer to cushion sizes above for proper fit)
MODEL
FTC
SPECIFY:
1.888.433.6818 FAX: 1.888.433.6834
MSRP
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
$475.00
4 HCPCS Code: E2619
FITS WIDTH
FITS DEPTH
REFER TO CUSHION SIZES ABOVE
WIDTH_____
12 of 15
DEPTH_____
MSRP
$100.00
q QTY____
TRD0365 REV D
INVACARE® MATRX® CUSHIONS – US PRICE LIST/ORDER FORM
MATRX FLO-TECH HEAVY-DUTY CUSHION: Bariatric – Adjustable, Skin Protection Cushion
n Weight capacity up to 500 lbs
®
WIDTH*
n
REAR
Comes standard with foam base, fluid sac,
platilon inner liner and outer cover
DEPTH**
FRONT
Startex
Outer Cover
4 HCPCS Code: E2622
Flo-tech Heavy-Duty Cushion
MODEL
q FT2020
q FT2022
q FT2118
q FT2120
q FT2122
FITS WIDTH
20"
20"
21"
21"
21"
FITS DEPTH
19", 20"
21", 22"
17", 18"
19", 20"
21", 22"
q FT2218
q FT2220
q FT2222
q FT2320
q FT2322
q FT2420
q FT2422
22"
22"
22"
23"
23"
24"
24"
17", 18"
19", 20"
21", 22"
19", 20"
21", 22"
19", 20"
21", 22"
$595.00
$595.00
$595.00
$595.00
$595.00
$595.00
$595.00
4 HCPCS Code: E2619
Flo-tech Heavy-Duty Extra Outer Cover
MODEL
FTC
SPECIFY:
1.888.433.6818 FAX: 1.888.433.6834
MSRP
$545.00
$545.00
$545.00
$545.00
$545.00
4 HCPCS Code: E2623
FITS WIDTH
FITS DEPTH
REFERENCE CHART ABOVE
WIDTH_____
13 of 15
DEPTH_____
MSRP
$125.00
q QTY____
TRD0365 REV D
INVACARE® MATRX® CUSHIONS – US PRICE LIST/ORDER FORM
MATRX FLO-TECH FIT KIT COMPONENTS & OTHER COMPONENTS:
®
Flo-tech Components
MODEL
q FTPO
q FTAD-R
q FTAD-F
q FTAB-S
q FTAB-L
q FTSW
q FTHW
q FTTW-LFRR
q FTTW-RFLR
q FTFS
q FTLW
q FTCFP
q FTPL-WWDD
1.888.433.6818 FAX: 1.888.433.6834
COMPONENT
Pelvic Obliquity
1" Pelvic Obliquity built-up-up - Top mounted
Adductor Rear
1" Posterior adductor support - op mounted
Adductor Front
1" Anterior adductor support - Top mounted
Adbuctor - Small ¾"
¾" Abductor built-up - Top mounted
Adbuctor - Large 2"
2" Abductor built-up - Top mounted
Seat Wedge
1" Anterior wedge increases pre-ischial
contour - Underside mounted
Hemi Wedge
1" Anterior thigh support - Underside mounted
Tapered Wedge LFRR
¾" Tapered wedge for users’s Left front
or Right rear - Underside mounted
Tapered Wedge LFLR
¾" Tapered wedge for users’s Right front
or Left rear - Underside mounted
Fluid Supplement
May be used to accommodate mild pelvic
obliquity/additional pressure reduction
Lateral Wedge
1" Lateral wedge increases hip/thigh loading,
- Underside mounted
MSRP
$60.00
$55.00
$55.00
$50.00
$60.00
$90.00
$50.00
$55.00
$55.00
$50.00
$65.00
Complete Flo-tech Cushion Fluid Sac
SPECIFY CUSHION SIZE:
WIDTH_____
DEPTH_____
Platilon Inner Liner
SPECIFY CUSHION SIZE:
DEPTH_____
14 of 15
$315.00
$35.00
WIDTH_____
TRD0365 REV D
INVACARE® MATRX® CUSHIONS – US PRICE LIST/ORDER FORM
CUSHION MODIFICATIONS:
NOTE: Rear Cushion radius included on all PS, VI & Libra Cushions.
WIDTH*
Notes:
REAR
________________________________________________________________________
________________________________________________________________________
DEPTH**
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
FRONT
________________________________________________________________________
LEFT SIDE
________________________________________________________________________
RIGHT SIDE
Modifications (Additional one week lead time)
SEAT WITDTH REDUCTION
LEG LENGTH
DISCREPENCY
SEAT DEPTH
REDUCTION
MODEL
q SDR
COMPONENT
MSRP
Seat Depth Reduction
$100.00
Less: q 1" q 2"* q 3"* q 4"* Specify_____
*Not available on Libra Cushions
q SWR
Seat Width Reduction
$100.00
Less: q 1" q 2"* q 3"* q 4"* Specify_____
*Not available on Libra Cushions
q LLDR
Leg Length Discrepancy - Right
Less: q 1" q 2" Specify_____
$100.00
q LLDL
Leg Length Discrepancy - Left
Less: q 1" q 2" Specify_____
$100.00
q ECM
Outer Cover Modification
Accommodates LLDL/LLDR/SDR/SWR
$50.00
q MAC
Miscellaneous Modification
$100.00
Please use a diagram above to indicate required
modifications- Requires approval
ACCESSORIES & HARDWARE:
MODEL
q CIC
COMPONENT
MSRP
Extra Inner Cover
$75.00
1" Pelvic Obliquity built-up- Top mounted
Non-Standard Fabric Selection
$75.00
Available for Cushions/bases; excluding Flo-tech & Libra
Pelvic Obliquity Kit
$50.00
Accommodates ½” and ” Obliquities
Base Drop Hooks (pair)
$27.00
Flushmount (0) drop for 7/8” or 1” Diameter
Base Drop Hooks (pair)
$27.00
1” Drop for 7/8” Diameter
Base Drop Hooks (pair)
$27.00
2” Drop for 7/8” Diameter
Base Drop Hooks (pair)
$27.00
1” Drop for 1” Diameter
Base Drop Hooks (pair)
$27.00
1” Drop for 2” Diameter
Dura Clip (pair)
$60.00
Top lock retractable hardware for use with Drop Hooks
FixClip (pair)
$25.00
Top lock hardware for use with Drop Hooks
q NSF
q POK
q BDH0
q BDH1-7/8
q DH2-7/8
q BDH1-1
q DH2-1
q BDC
q BFC
1.888.433.6818 FAX: 1.888.433.6834
15 of 15
TRD0365 REV D