SUS9 F8675

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Alternative Drive Control Order Form

SUS9 F8675

SUS9 F8675

$4,414.00E2330

Reset Egg Switch Color

Packages IncludeTri- Array Head Support (E0955) 3 Proximity Sensors, non-proportional, egg switch for reset mode change (E2330), and i-Drive Interface* SUS9 Swing-Away required to mount switch to headrest

ES-BLK Black ES-BLU Blue ES-GRN Green ES-RED Red ES-YEL YellowStandard Egg Switch Color is Black.

$4,461.00

Occipital Pad (E0955)SUS9-B-HW Bilateral Swing-Away Hardware (E1028) Pro Series Head Support (E0955) 3 Proximity Sensors, non-proportional, egg switch for reset mode change (E2330), and i-Drive Interface** Figure 8 Bracket required to mount switch to headrest 2 Spot Pads - Choose Size:

910 3" x 2" 900 4.5" x 2"

Additional Proximity SwitchesL RIDHBT501 Proximity Sensor L R $551.00

K0108

K0108

L R

Swing-Aways

F8675 Figure 8 Bracket (K0108)† $267.50SUS9-L-HW Left Side Swing-Away (E1028)** $294.25SUS9-R-HW Right Side Swing-Away (E1028)** $294.25

SUS9-B-HW Bilateral Swing-Away (E1028)** $331.70

** The SUS9 is included and not available for mounting additional switches or pads on the Ultra Pro only (IDHBT300-1)† Figure 8 Bracket required for mounting additional switches and pads on the Ultra Pro or Tri-Array w/ swing away hardware.

Select pad to cover switch No Pad 900 4.5x2" 910 3x2"

IDH502 Beam Sensor‡ $470.00

L R LIDH503 Fiber Optic R $656.00

FO660 FO650 FO690Select Mount for Fiber Optic

i-Drive Pro Series Bluetooth System E2330

Chair Manufacturer

i-Drive Tri-Array Bluetooth System

Chair Model

$79.00

L R L REgg Switch $80.85

ES-RED ES-YELES-GRNES-BLUES-BLKL R

No Pad 900 4.5x2" 910 3x2" 920 6x2" 930 6x1.5"

MC210 Tash Mini Cup Switch L R L R $195.00

$79.00L R $208.65

Additional Mechanical Switches IDHA-BT Bluetooth Dongle Cable

MC220 Embedded MC Switch

L R L R $195.00ML210 Tash Micro-Lite SwitchR L R $294.25SP625 Sip & Puff for Swing-Away L

5/11/2018

104 John Kelly Drive, Burnet, Texas 78611 • tel: 1.800.965.9229 • fax: 1.800.806.1225 • email: info@stealthproducts.com

FO660Swing-Away Mount Pad Mount

FO650

FO690‡ Beam Sensor mounts to the back of the occipital pad.

IDHBT200-1 Tri-Array Head SupportIDHBT250-1 Pediatric Tri-Array Head Support $4,414.00

IDHBT300-1 Pro Series Head Support

IDHBT350-1 Pediatric Pro Series Head SupportPackages Include

$4,461.00

IDHM-CE-I Cervical Extension Inhibit Switch

Reset Egg Switch Mounting

ESRM Finger Egg Switch Mount (K0108) $51.45

SUS9 F8675L R L ROn Swing-Away Hardware‡

KN1ADD Knee Add. Fixed (K0108) $225.75

KN1ADD-TRK Knee Add. Swing-Away w/ Track Mount (K0108)

$246.75

None

ARMS260 Swing-Away Armrest Mount (E1028) $262.50‡ SUS9 Swing-Away or F8675 Figure 8 Must be ordered for this option.

Refer to page 3 for mounting hardware selectionCall Stealth Products for additional support and advanced configurations.

$315.00 $315.00 $157.50Tray Mount

PO#:

P127D138R7

Refer to page 4 to select GAT mid line mounting system for trays.

Mark for: PO#:

Bluetooth Tray-Array Series i-Drive Control System IDTBT100-1 Proximity Sensor Tray Array* $5,460.00

Package IncludesGAT440 Hollow Eclipse Tray (K0108), IDHBT500-1 i-Drive Interface, GAT419 360 degree Tray Mount, 4non-proportional proximity switch mechanisms, withegg switch for reset mode change (E2330)

IDTBTF100-1 Tray Array - 3 Fiber Optic Sensor* $4,568.00Package IncludesGAT440 Hollow Eclipse Tray (K0108)IDHBT500-1 i-Drive Interface, GAT419 360 degree Tray Mount, 3fiber optic proximity switch mechanisms, with eggswitch for reset mode change (E2330)

IDTBTF100-2 Tray Array - 4 Fiber Optic Sensor* $4,883.00Package IncludesGAT440 Hollow Eclipse Tray (K0108)IDHBT500-1 i-Drive Interface GAT419 360 degree Tray Mount, 4fiber optic proximity switch mechanisms, with eggswitch for reset mode change (E2330)

*

$4,703.00

Package IncludesTri-Array Head Support (E0955) w/ Sip & Puff, 3 Proximity Sensors, non-proportional, egg switch for reset mode change (E2330), and i-Drive Interface

IDHBT310-1 Pro Series Head Support w/ Sip & Puff $4,750.00i-Drive Sip & Puff Bluetooth System

SP625-CT Clear Tubing for Sip & Puff $101.65Sip & Puff Series Accessories

SP625-S12 Replacement Straws - Set of 12 $32.10

SP625-F Replacement Sip & Puff Filter $16.05SP625-S Replacement Straw for Sip & Puff $13.38

i-Connect for Manual Bases (12V) i-Connect for Power Bases (24V)

IC12P-1 Proximity 12V w/ Single Mono Plug** $614.00Proximity Sensor**

IC12P-2 Proximity 12V w/ Dual Mono Plug** $1013.00

IC12F-1 Fiber Optic 12V w/ Single Mono Plug** $709.00Fiber Optic Sensor**

ICSNP-2 Sip & Puff w/ Dual Mono Plug‡ $499.00Sip & Puff‡

IC12A-BC 12V Battery & Charger for i-Connect $310.00

i-Connect Power Source (12V)

‡ Does NOT Require a Power Source

** Requires 12V Power Source

IC24P-1 Proximity 24V w/ Single Mono Plug† $614.00Proximity Sensor†

IC24P-2 Proximity 24V w/ Dual Mono Plug† $1,013.00

IC24F-1 Fiber Optic 24V w/ Single Mono Plug† $709.00Fiber Optic Sensor†

ICSNP-2 Sip & Puff w/ Dual Mono Plug‡ $499.00Sip & Puff‡

i-Connect Power Source (24V)

IC24PS-QL Power Source for Q-Logic Electronics $294.00

IC24PS-RN Power Source for R-Net Electronics $294.00

‡ Does NOT Require a Power Source

† Requires 24V Power Source

Package IncludesOccipital Pad SUS9-B-HW Bilateral Swing-Away Hardware (E1028) Pro Series Head Support w/ Sip & Puff, 3 Proximity Sensors, non-proportional, egg switch for reset mode change (E2330), and i-Drive Interface2 Spot Pads - Choose Size:

910 3" x 2" 900 4.5" x 2"

IC12A-W 12V AC Wall Adapter for i-Connect $68.00

Refer to page 3 for mounting hardware selection for head arrays.

IDHBT210-1 Tri-Array Head Support w/ Sip & Puff

Mounting OptionsSM670 Stealth PMPJ Mount for Swing-Away Hardware $262.50

GAT486 Stealth PMPJ Mount for Gatlin $137.50

Environment Control UnitIDHA-ECU3 9-Pin Cable w/ 3 Mono Plugs $131.00 IDHA-ECU4 9-Pin Cable w/ 4 Mono Plugs $142.00

Please select a topper and mounting option when ordering a joystickPrecision Mini Proportional Joystick

TWB480-QCRS Link Style Hrdw $235.40

TWB485-QCR w/ Square Tubing $160.50

TWB480-QFDM Link Hrdw w/ FDM $319.93

TWB480-17mm Link Style Hardware $235.40ATWB485-17mm Link Hardware with Offset Square Tubing $220.50B

TWB480-17FDM Link Style Hardware with Flip Down $319.93C

K0108

Sub-Occipital Pad

SU980 Ultra QCRS Adapter $294.25

600 Ultra 8" x 2.75" Medium Sub-Occipital Pad $53.50

620 Ultra 10.5" x 2.75" Large Sub-Occipital Pad $53.50

Sub-Occipital Pads K0108To attach a sub-occipital pad it is required to include the SU980 and ultra mounting hardware.

Head Positioning & Headrest HardwareMounting Hardware

E1028

A B

Stealth Ultra Mounting Hardware

i2i Sub-Occipital Pads

i2i ModificationsGel Modification $200.00 Adjustable Arms $21.40

Chin Prompt $80.25 Trachea Chin Prompt $107.00

Hardware Parts & ReplacementsFDM350 HMO Series Flip Down Mount $157.50

K0108

TWB-LINK 3" (Long) Link w/ Set Screw $52.50

Low Profile i2i for Sub-Occipital Pad $347.75

C

GAT441-PMP 4" x 6.5" Center Tray w/ PMPJ Mount $393.75

GAT441-PMP-L 4" x 6.5" Left Tray w/ PMPJ Mount $393.75

GAT441-PMP-R 4" x 6.5" Right Tray w/ PMPJ Mount $393.75

Replacement Items

$79.00

$1,316.00IDHA-BT

IDHBT500

$1,316.00

$1,316.00

IDHBT500-1

IDHBT500-17MM

Dongle Cable - Bluetooth

i-Drive Bluetooth Interface

i-Drive Bluetooth Interface, 1" Ball

i-Drive Bluetooth Interface, 17mm Ball

Select mounting option below

IDPMPBT-1-CA Castle topper

Bluetooth Precision Mini Proportional Joystick $3,964.00

IDPMPBT-1-CO Cone topper IDPMPBT-1-FT Tip topper

I2I455 Small I2I555 Med I2I655 Lrg I2I55 XL

Peripheral Mounts

$603.75 ea.3/4" Gatlin 8 Position Armrest Mount for Quantum or Quickie

GAT400Q

$603.75 ea.3/4" Gatlin 8 Position Armrest Mount for Invacare

GAT400I

$603.75 ea.5/8" Gatlin 8 Position Armrest Mount for Permobil

GAT400P

GAT405Q

GAT405I

3/4" Gatlin 3 Position Armrest Mount $603.75 ea. for Quantum or Quickie3/4" Gatlin 3 Position Armrest Mount $603.75 ea. for Invacare5/8" Gatlin 3 Position Armrest Mount $603.75 ea. for Permobil

GAT405P

Gatlin Midline Mount 8 Position 3 Position

$131.25 ea.GAT425I

$131.25 ea.GAT426I

$131.25 ea.GAT427I

$131.25 ea.GAT455S

$131.25 ea.GAT480R

$204.75 ea.GAT428I

$204.75 ea.GAT429I

$231.00 ea.GAT495I

$231.00 ea.GAT496I

$131.25 ea.GAT483

$131.25 ea.GAT491

Invacare Electronic Mounts Quantum Electronic Mounts$131.25 ea.GAT452Q

$183.75 ea.GAT453Q

$131.25 ea.GAT456Q

$183.75 ea.GAT457Q

$131.25 ea.GAT473Q

$183.75 ea.GAT495QL

Permobil Electronic Mounts$131.25 ea.GAT435-RN

$204.75 ea.GAT458P

$204.75 ea.GAT459P

$131.25 ea.GAT472P

$131.25 ea.GAT473P

Gatlin Trays/Accessories

ARMS260 Swing-Away Hardware

Mounts for Peripheral Mounts

$131.25 ea.

$131.25 ea.

$131.25 ea.

$131.25 ea.

$131.25 ea.

$78.75 ea.

ARM250-S

ARM250-P

ARM250-PC

ARM250-I

ARM250-3/4"FM

ARM240-T

Invacare Mark IV Joystick Mount

Invacare Mark V Joystick Mount

Invacare Mark VI MPJ Mount

SPJ, DPJ, Mk IV-VI Mount (w/ 360°)

Invacare 1812 Joystick Mount

Invacare Mark VI MPJ Mount (w/ 360°)

Invacare Mark VI PSF Mount (w/ 360°)

Invacare Display Mount (w/ 360°)

Invacare Mk VI Display Mount (w/ 360°)

ASL MEC Joystick Mount

Mini ASL Joystick Mount

Curtis Stand Alone Joystick Mount

Stand Alone Joystick Mount (w/ 360°)

Q-Logic Joystick Mount

Q-Logic Joystick Mount (w/ 360°)

Quantum HMC-Compact Joystick Mount

Q-Logic Display Swivel Mount (w/ 360°)

Permobil R-Net Joystick Mount

Permobil Omni Light Mount (w/ 360°)

Compact HMC-RN Mount (w/ 360°)

Permobil Omni Light Mount

Permobil Compact HMC-RN Mount

GAT440M-L

GAT440M-R

$498.75 ea.

$498.75 ea.

$393.75 ea.GAT441AM

Solid Partial Eclipse Tray w/ Mini Joystick Mount - Left Side (w/ 360°)

Solid Partial Eclipse Tray w/ Mini Joystick Mount - Right Side (w/ 360°)

Solid Mini Tray w/ ASL Joystick Mount (w/ 360°)

$157.50 ea.GAT440

$210.00 ea.GAT440S

$393.75 ea.GAT441

Hollow Partial Exlipse Tray (w/ 360°)

Solid Partial Eclipse Tray (w/ 360°)

Hollow Mini Tray (w/ 360°)

$236.25 ea.GAT441S

$393.75 ea.GAT444-IP

$131.25 ea.GAT-ESM Gatlin Egg Switch Mount

Solid Mini Tray (w/ 360°)

Tablet Mount (w/ 360°)

$262.50 ea.ARMS260

$262.50 ea.ARMS260-I

$262.50 ea.ARMS260-QL

$262.50 ea.ARMS260-P

Swing-Away w/ Egg Switch Mount

Invacare Mk VI Display S/A Mount

Q-Logic Display S/A Mount

Omni Plus Display S/A Mount

$262.50 ea.ARMS260-UNI2

$420.00 ea.ARMS260-TAB

$288.75 ea.ARMS260-MPJ

$288.75 ea.ARMS260-MEC

$341.25 ea.TWBM260-RNETVD

Cellular Device Swing-Away Mount

Small Tablet Swing-Away Mount

Invacare MPJ Swing-Away Mount

ASL MEC Joystick S/A Mount

R-Net Joystick S/A Mount

TWBM480 Link Hardware

$262.50 ea.TWBM480-QL

$262.50 ea.TWBM480-SPJ

Q-Logic Display Mount

Invacare Mk VI SPJ Mount

$472.50 ea.TWBM480-TAB

$262.50 ea.TWBM480-DS

Tablet Mount

Invacare SPJ, DPJ, Mk IV Mount

Height Adjustable Cane Mount for 3/4" Mounts

Height Adjustable Flat Mount w/ Track Nuts for Permobil 5/8"Mounts

Height Adjustable Cane Mount for Permobil 5/8" Mounts

Height Adjustable Cane Mount for Invacare 7/8"Mounts

Height Adjustable Mount w/ Flat Bracket for 3/4" Mounts

Non-Adjustable Track Mount w/ Track Nuts for 3/4" Mounts

Stealth Products, LLC. | www.stealthproducts.com P127D138R7| 5/11/2018

Hybrid Driving Packages

Mark for : PO#

HCPCS codes provided should not be considered as legal advice and do not guarantee reimbursement.

DME providers are responsible for determining appropriate billing codes when submitting for insurance reimbursement. P127D138R7 | 5/11/2018

Add Mo-Vis Power Chin Boom - IDM-PCB-R or - L for an additional

Additional Options for IDA1H Package (Package 1)

i-Drive Control Harness - IDCH-S, -M, or -L

$3570.00

$866.00

MSRP

Add Mo-Vis Power Chin Boom - IDM-PCB-R or - L for an additional

Additional Options for IDA2H Package (Package 2)

i-Drive Control Harness - IDCH-S, -M, or -L

$3570.00

$866.00

MSRP

Add Mo-Vis Power Chin Boom - IDM-PCB-R or - L for an additional

Additional Options for IDA3H Package (Package 3)

i-Drive Control Harness - IDCH-S, -M, or -L

$3570.00

$866.00

MSRP

$7,571.89 IDA2H (Package 2)

The IDA2H Package Includes The following:

$9,054.94 IDA3H (Package 3)

The IDA3H Package Includes The following:

$5,075.44 IDA1H (Package 1)

The IDA1H Package Includes The following:

900 Stealth Ultra Standard Lateral Pad (K0108)

Swing Away Joystick Mount For All Round

IDM-ARLITE-9

IDM-17

ARMS260-AR

mo-Vis All Round Joystick Lite (E2373)

mo-Vis Satellite Twister-Red

900 PAD

CP250 Comfort Plus Medium 10in. Headrest with Back Pad with Ring

CPS9-B-HW Cp 1” s/a Assm Both Sides w/ Qty - 2 9” Rods

TWB485-1S Features 1” Ball, Square Tubing on Vertical Bar

KN1ADD-TRK Adjustable Knee Adductor Package w/ Track Nut

SM660-M Swing away for IDM –Allround-9

IDAH-TBOX Stealth Hybrid Driving Package Tackle Box

TWB-1” BK TWB-1” BK 3 Piece 1” Ball Kit for TWB480/TWB485

KN1ADD3 KN1ADD3 Knee Adductor Pad 3”

ARMS250-3/4”FM Height Adjustable Mount w/Flat Fixed Bracket (K0108)

IDM-30 All Round Chin Ball

SBM300P Interface Plate For Permobil CS3G Back

LPHW403 Lateral Pelvic Universal Tracl Nut

ARMS-TB3 Track Nut TB3 Armrest

ARMS-HW-TNP Track Nut for Permobil CSG3 Armrest

Comfort Plus nino - 6” Headrest Pad with Ring

Swing Away Joystick Mount For All Round

IDM-ARLITE-9

IDM-17

ARMS260-AR

mo-Vis All Round Joystick Lite (E2373)

mo-Vis Satellite Twister-Red

CPN350

TWB485-17MM Package Includes TWB485-17mm Headrest Hardware

TWB-17MMBK TWB-17MMBK 3 Piece 17mmBall Kit for TWB480/TWB485

SUNS9-B-HW SUN 17mm Nino s/a Assm Both Sides w/ Qty-2 6”

KN1ADD-TRK Adjustable Knee Adductor Package w/ Track Nut

SM660-M Swing away for IDM –Allround-9

IDAH-TBOX Stealth Hybrid Driving Package Tackle Box

TWB-1” BK TWB-1” BK 3 Piece 1” Ball Kit for TWB480/TWB485

KN1ADD3 KN1ADD3 Knee Adductor Pad 3”

ARMS250-3/4”FM Height Adjustable Mount w/Flat Fixed Bracket (K0108)

IDM-30 All Round Chin Ball

SBM300P Interface Plate For Permobil CS3G Back

LPHW403 Lateral Pelvic Universal Tracl Nut

ARMS-TB3 Track Nut TB3 Armrest

ARMS-HW-TNP Track Nut for Permobil CSG3 Armrest

IDM-18 mo-Vis Satellite Twister-Black

IDHBT900

IDHBT500 i-Drive Bluetooth Head Control Interface

900 Stealth Ultra Standard Lateral Pad Note: Make with long cable

(K0108)

Comfort Plus Nino - 6” Headrest Pad with Ring

Swing Away Joystick Mount For All Round

IDM-ARLITE-9

IDM-18

ARMS260-AR

mo-Vis All Round Joystick Lite (E2373)

Satellite Twister-Black

CPN350

TWB485-17MM Package Includes TWB485 - 17mm Headrest Hardware

IDHBT300-1 i-Drive Bluetooth Stealth Pro Series 3-Proximity

KN1ADD-TRK Adjustable Knee Adductor Package w/ Track Nut

SM660-M Swing away for IDM –Allround-9

IDAH-TBOX Stealth Hybrid Driving Package Tackle Box

KN1ADD3 KN1ADD3 Knee Adductor Pad 3”

ARMS250-3/4”FM Height Adjustable Mount w/Flat Fixed Bracket (K0108)

IDM-30 All Round Chin Ball

SBM300P Interface Plate For Permobil CS3G Back

LPHW403 Lateral Pelvic Universal Tracl Nut

ARMS-TB3 Track Nut TB3 Armrest

ARMS-HW-TNP Track Nut for Permobil CSG3 Armrest

IDM-17 Satellite Twister –Red