Q-Logic Controls Order Form / Price List REVISED: October 2014

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1 / List REVISED: October 2014 Pride Mobility Products Corporation 182 Susquehanna Ave., Exeter, PA Sales: Phone: (866) Fax: (866) Account Number: Provider Name: Contact: Marked For: Phone: Fax: Date: PO#: Ship To Address: City: State: Zip: HCPCS codes should not be considered as legal advice. DME providers are responsible for determining appropriate billing codes when submitting for insurance reimbursment. MASTER DRIVE CONTROLS Part # s listed on this form are "On-Chair" MSRP MASTER DRIVE CONTROLS (CONT D) Part # HCPCS Code KIT o Q-Logic 2 Enhanced $2, Display Kit - Enhanced Display - Flexible Gooseneck - Gooseneck Mounting Bracket CTL o Q-Logic 2 Enhanced $2, Display - Specialty controls interface w/ 3.5 LCD display - Up to 5 profiles to control drive, seat and auxilary functions - Integrated single switch scanner, bluetooth mouse emmulator and IR controls - Bluetooth connectivity for mobile devices - Color matching options avaiable Optional Colored Shrouds: $50.00 DGN PBK1 o Black DGN PBU9 o True Blue DGN PGN5 o Emerald Green DGN POR4 o Sunburst Orange DGN PPK1 o Pearl Pink DGN PPR4 o Sapphire Blue DGN PRD1 o Candy Apple Red DGN PSL1 o Silver DGN PYL3 o Orion Yellow DGN PBU1 o Viper Blue DWR1010D446 o Flexible Gooseneck $ DWR1010D443 o Enhanced Display $20.17 Gooseneck Mounting Bracket INDPART2771 o Stealth Swing-Away $ Display Mount (Stealth: ARM260-QL) Bluetooth Mouse Harnesses DWR1265H033 m Bluetooth Mouse Harness $45.87 No PTO DWR1265H032 o Bluetooth Harness w/ PTO $71.91 DWR1265H065 o Bluetooth Harness for Accu- $ Trac Motors HAR o Bluetooth Harness for Accu- $ Trac Motors, Rival Accessories CTL o Attendant Control $ E Up to 3 profiles to control drive and seat functions - Ability to take over wheelchair control from other drive modules DWR1010D298 o Q-Logic Attendant Control $16.71 Mounting Bracket, TB2 Recline FRMASMB10455 o Attendant Mounting Bracket, $ TB2 Recline (Both parts above are required on TB2 recline systems) DWR1010D298 o Q-Logic Attendant Control $16.71 Mounting Bracket, TB2 Tilt FRMASMB4059 o Attendant Mounting Bracket, $ TB2 Tilt (Both parts above are required on TB2 tilt systems) MEC m Attendant Mounting Bracket, $ TB3 Additional Harness: ELE o Stand Alone Joystick $ E2373 With External Charger Port - Up to 3 drive profiles and 1 seating profile when used alone - Use in conjunction w/ enhanced display for up to 5 profiles and auxillary functions including Bluetooth Mouse 2 and IR 2. Bluetooth Mouse harness and additional switches required for mouse buttons (not included). Revised: October 15, 2014 Page 1 of 5

2 SCIM MODULE Part # PROPORTIONAL SECONDARY CONTROLS Part # HCPCS Code KIT o SCIM - Specialty Control $ Interface Module Kit w/ Mounting Bracket - SCIM Module and mounting bracket with hardware CTL o SCIM - Specialty Control $ Interface Module Kit 1 - Allows use of joystick display for specialty controls - Up to 5 profiles to control drive, seat and auxiliary functions - Excludes sip-n-puff and single switch functions - A switch is required to operate the input device attached to the SCIM module - Accessory bar is required to mount on TB3 MEC o Mounting Bracket for $25.00 SCIM Module MEC o TB3 Accessory Bar $ Only available with Q-logic 2. SECONDARY CONTROLS Part # HCPCS Code KITASMB1697 o Sip & Puff Hardware Kit 1 $1, E2325/E Sip & Puff Module - Bus Cable CTLDC1598 m Switch-It Proportional $ E2373 Joystick (Switch-It: JSC-WOM) overall height, 2.5 H gimbal FRMASMB16336 m Switch-It Proportional $ Joystick to Midline or Bib Mount CTLDC1620 m ASL Compact Joystick $1, E2373 (ASL: ASL132) overall height, 2.5 H gimbal FRMASMB16141 m ASL Compact Joystick $ to Midline or Bib Mount CTLDC1516 m ASL Micro Extremity $3, E2312 Control (MEC) (ASL: MEC) - Robust design makes it highly durable - Fully proportional w/ push down on joystick for mode - Short joystick throw requires limited range of motion - Contact Custom Group for mounting options Sip & Puff System: ACCASMB2080 o Therafin Wisper-Lite Sip & $ E2326 Puff (Therafin: 32658) Miscellaneous (not required): INDPART2646 o Sip & Puff Straws, 10 Pk $20.00 K0108 (Therafin:32698) DWR1111H046 o Sip & Puff Bus Cable $ FRMASMB7322 o Power Recline Accessory $50.57 Bracket 2 1. Requires an enhanced display kit and multiplier harness. 2. Allows cane mounted accessories to be mounted to a TB2 power recline back. ENVIRONMENTAL CONTROLS Part # ACCASMB2380 m Stealth Mushroom $1, E2312 Joystick (Stealth: MJM250Q) - Includes swing-away armrest mount bracket CTLDC1380 m Stealth Rim Control $3, E2327 (Stealth: RC-P) - Three directional proportional headrest control - Tape switch mode change mounted to boom KITASMB1696 o ECU Kit $2, Miscellaneous: - ECU Module - Bus Cable DWR1111H046 o ECU Bus Cable $ Revised: October 15, 2014 Page 2 of 5

3 MIDLINE/BIB MOUNTS HCPCS Code HEAD ARRAYS (CONT D) HCPCS Code FRMASMB8304 o Stealth Gatlin Mount $ E1028 (Stealth: GAT406C) INDPART2153 m Therafin Surelock Midline $ E1028 Mount (Therafin: 32695) FRMASMB4126 m Bodypoint Midline Mount $ E1028 (Bodypoint: PC201) FRMASMB7322 o Power Recline Accessory $50.57 Bracket 1 INDPART2152 o Therafin Softline Bridge and $ K0108 Collar (Therafin: 32685) INDPART2895 m Therafin Semi-Rigid Bridge $ K0108 And Collar (Therafin: 32669) 1. Allows cane mounted accessories to be mounted to a TB2 power recline back. HEAD ARRAYS HCPCS Code CTL m Adult idrive Tri Array $4, E2330 Series, 3-Switch w/ Egg Switch for Mode (Stealth: IDH200-1) - 3 embedded proximity sensors for drive control and an egg switch for mode change CTL m Pediatric idrive Tri Array $4, E2330 Series, 3-Switch w/ Egg Switch for Mode (Stealth: IDH250-1) - 3 embedded proximity sensors for drive control and an egg switch for mode change SWTMCRO1019 m Switch-It 5-Switch Head $4, E2330 Array (Switch-It: HDR-5-L-S) - 5 proximity sensors embedded in long, flat wings for 4 direction drive control and mode/reset CTLDC1158 o ASL 3-Switch Head $4, E2330 Array, Junior with Proximity Switch (ASL: PASL105PGJC) CTLDC1187 o ASL 3-Switch Head $4, E2330 Array, Pediatric with Proximity Switch (ASL: PASL105PGPC) CTLDC1188 o ASL 3-Switch Head $4, E2330 Array, Mini with Proximity Switch (ASL: PASLPGMC) CTLDC1192 o Stealth Ultra 3-Switch $5, E2330 Head Array (ASL: PASL105ST) - Allows increased head and neck support over standard head array CTLDC1159 m Sip & Puff Head Array $4, K0108 Junior with Fiber Optic Reset (ASL: PASL109PG) - Controls one directional axis with left and right pads and the second with the sip & puff - Does not require Q-Logic Sip & Puff module - Fiber Optic Switch mounted to Sip & Puff acts as Reset/Mode switch SWTMCRO1018 m Switch-It 4-Switch Head $4, E2330 Array (Switch-It: HDR-4-S-C-Q) - 3 proximity sensors embedded in short, curved wings for 3 direction drive control - Extra proximity sensor for mode/reset SWTMCRO1032 o Switch-It 3-Switch Head $3, E2330 Array (Switch-It: HDR-4M-S-C-Q) - 3 proximity sensors embedded in short, curved wings for 3 direction drive control - Built-in monojack for mechanical mode switch - One egg switch for mode/reset CTLDC1195 o Stealth Ultra Sip & Puff $5,802 K0108 Head Array with Fiber Optic Reset (ASL: PASL109PGST) SWITCH CONTROLS - Allows increased head and neck support over standard sip & puff head array Revised: October 15, 2014 Page 3 of 5 CTL o 4 Function Push Button $ AAM Module 1 (Curtis: ) MEC o Height Adjustable Mounting $23.66 Bracket, 4-Button Push Button 2 1. Only available with TB3 armrests. 2. Push button mounts directly behind joystick.

4 SWITCH CONTROLS (CONT D) HCPCS Code SINGLE SWITCHES SWTMCRO1099 o 4-Way Toggle 1 (PME: M26) $ FRMASMB7344 o 4-way Toggle Armrest $45.52 SWTMCRO1100 o 4-Way Button Toggle 1 $ (PME: S12) FRMASMB7345 m 4-way Button Toggle Armrest $45.52 SWTMCRO1077 SWTMCRO1078 SWTMCRO1079 SWTMCRO1080 SWTMCRO1081 o Egg Switches $77.00 o Red (Stealth: ESRED) o Green (Stealth: ESGRN) o Blue (Stealth: ESBLU) o Yellow (Stealth: ESYEL) o Black (Stealth: ESBLK) o Buddy Buttons $59.00 SWTMCRO1008 o Green (Ablenet: 57200) SWTMCRO1098 o Quad Push Button Toggle 1 $ (PME: S24) FRMASMB7346 o Quad Push Button Armrest $40.16 CTLDC1087 m Tash Mini Joystick w/ $ E2599 Push (Ablenet: 50200) - 4 directional switched joystick, push down on joystick shaft for mode change - Tactile and auditory feedback - Includes flexible rubber and hard plastic joystick knobs - Contact custom department for mounting options SWTMCRO1011 o Yellow (Ablenet: 57500) SWTMCRO1012 o Blue (Ablenet: 57600) SWTMCRO1033 o Black (Ablenet: 57000) m Big Buddy Buttons $59.00 SWTMCRO1040 m Raving Red (Ablenet: 56100) SWTMCRO1041 m Yahoo Yellow (Ablenet: 57100) m Micro Lever Switches $79.00 SWTMCRO1017 m Green (Ablenet: 53020) 1. Requires Q-Logic EX with Multiple Actuator Control Module (AAM). 2. SOF required to mount to a TB3 armrest. m Round Switch $69.00 SWTMCRO1064 m Mini Cup Switch w/ Stickers (Ablenet: 58080) m Wobble Switch $ SWTMCRO1027 m Uni-Wob Switch (Switch-It: LLS) o Spec Switches $55.00 SWTMCRO1116 SWTMCRO1115 o Black (Ablenet: 100-SPBK) m Yellow (Ablenet: 100-SPY) Revised: October 15, 2014 Page 4 of 5

5 SINGLE SWITCHES (CONT D) ATTENDANT CONTROLS m Flex Switch $ SWTMCRO1061 m Flex Switch (Ablenet: 58550) CTLDC1096 m Switch-It Remote Stop $ Switch (Switch-It: RSS-QR) - Remotely stop wheelchair up to 100 feet away for safety - Easily plugs in on Quantum ready chairs via barrel connector m Leaf Switch with $ Removable Pad SWTMCRO1050 m Leaf Switch w/ Removable Pad (Ablenet: 58600) CTLDC1527 o ASL Remote Stop Switch $ Q-Logic EX (ASL: ASL504CURTIS) m Plate Membrane Switches $59.00 SWTMCRO1047 m Yellow (Ablenet: 58320) o Micro Light Switch $77.00 POWERTECH VENT POWER MODULE HCPCS Code SWTMCRO1044 o Micro Light Switch (Ablenet: 58500) m Pillow Switch $ ELEASMB m Powertech Vent Power $2, K0108 Module - Powers an LTV style vent from the wheelchair s batteries SWTMCRO1052 m Pillow Switch (Ablenet: 58750) Consists of: SINGLE SWITCH ACCESSORIES CTLDC m Powertech Vent Module $ (Richardson: 06076) HAR m Powertech Vent Harness, $ Volt Output (Richardson: ) HAR m Powertech Vent Harness, $ Volt Input (Richardson: ) INDPART2824 o Single Switch Extension, 6 $27.00 (Ablenet: 43330) DWR1265H064 o 4-Switch to AAM Adapter 1 $65.00 USB CHARGER W/ MOUNTING HARDWARE HARUSHD2101 o 5 to 1 Switch Adapter 2 $ DWR1361H037 o 2 to 1 Switch Adapter 3 $ Allows 4 seperate mechanical switches to be connected to AAM to control seat functions. 2. Connects up to 5 single switches to connect to 1 9-Pin (DB9) connection to act as a multiple switch device. 3. Connects 2 single switches to a stereo jack input to act as a dual switch. ELE m USB Charger w/ Mounting $ Hardware - Charging option for cell phone - iphone/ipad compatible Revised: October 15, 2014 Page 5 of 5