Model:
HB03-NB
HCPCS Code:
E2617

Bio ST Custom Solid Deep Contour Back Insert, 15" to 20" in width and height. A foam module is attached to an interface plate which is secured to the wheelchair. The deep contour foam module consists of a Medium Foam Package (1" Soft Sunmate on½" Medium Sunmate), a ¼" of HDPE (High Density Polyethylene) and a zippered Black Neoprene (Rubatex) cover. The interface plate is made of ½" HDPE and secured by depth and angle adjustable steel mounting hardware (standard duty 4ea. L-Brackets w/4 holes, 4ea. J-Hooks w/1 countersunk hole & 4ea. horseshoe clamps for 1" tubing). (Contour represents a 2" difference in foam from lateral edges of back to the center of back)

MSRP:
$2,539.14
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Firm Package: ½” Soft Sunmate on 1” Medium Sunmate Medium Package: 1” Soft Sunmate on 1/2” Medium Sunmate Soft Package: ½” Soft Sunmate on ½” Confor on 1/2” Soft Sunmate Siliconize Foam on Back Build your Own Foam Combination for Back (Must Add Foam Choices) Custom Foam and Materials to Back Oversize Height (one unit every 2” over 20”) Oversize Width (one unit every 2” over 20”) for Back Shape Customization: Curved (rounded) top of back for Back Shape Customization: Bi-Angular Back (Adjustable), w/two brackets Shape Customization: ‘I’ cut out (lateral trunk support) for Back Shape Customization: Height, Depth & Angle Adjustable Lumbar Support for Back Shape Customization: Scapular cut outs for Back Shape Customization: ‘T’ cut out (lateral trunk and/or hip supports) for Back Custom Shape for Back Customization (via foam) of Back: Full width back with foam over canes for Back Customization (via foam) of Back Contour: deep lateral contour, full height for Back Customization (via foam) of Back Contour: internal lumbar roll for Back Customization (via foam) of Back Contour: mild lateral contour, full height for Back Customization (via foam) of Back Contour: mild lateral contour at pelvic area (Up to 30% of back height) for Back Customization (via foam) of Back Contour: deep lateral contour at pelvic area (Up to 30% of back height) for Back Customization (via foam) of Back Contour: reduce foam for scapular relief for Back Custom Back Contour for Back Removable/Washable Cover Additional Removable/Washable Cover
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