Jenx Multistander - Prone Quote Order Configurations for representation only Page 1 of 4 Suggested HCPCS code: E0638** Retail Price List and Order Form 2020 Email Address: Phone: Fax: Zip Code: Phone: Knee block width (center to center) min/max 4.75" - 8" 5.75" - 11" * when Multigrip™ Body Support used - 46" 53" - 59" * 6" - 10.25" 28" 4.75" - 10.25" +/- 15 degrees +/- 15 degrees Footplate Angle Range +/- 15 degrees 27.5"/30.5" - Individual Leg Abduction - 5 degree increments 0-30 degrees - 0 - 80 degrees 10 - 90 degrees 4.75" - 10.25" 6" - 10.25" 46" 26" 34" 19.5"/22.5" 10 - 90 degrees 20.5"/23.5" **It is the responsibility of the CRT provider to determine the HCPCS code most appropriate for each circumstance. The HCPCS codes for reference only and are not to be deemed as legal advice. Actual coding and coverage varies by funding entities and the use of HCPCS does not guarantee coverage or payment. 9 mths - 6 yrs Size 1 standard Size 1 ABD 9 mths - 6 yrs 3 yrs - 13 yrs Approximate Age Range Size 2 Branch: Mark for: City: Dealer Contact: State: 28" 25.6" 22.2" 69" 46" 132Lbs 77Lbs 34" 46" 26" Billing Information: Ship To Information: Date: Name: PO Number: Address: 6.75" - 12.5" 6.75" - 12.5" 39" 33" Minimum Height (Footplate to top of upper support) Prone/Supine Maximum Height (Footplate to top of upper support) 22.2" 46" 77Lbs Maximum User Height (Approx.) Maximum User Weight Maximum Height (Footplate to top of head support - Supine) Minimum Height (Footplate to top of head support - Supine) Chest Pad Width (Min/Max) Hip Pad Width (Min/Max) Frame Width Frame Length Angle Range Size 1 Size 2 Standard column and one piece footplate Abduction column and individual footplates Standard column only Email: [email protected]Visit: adaptiveimports.com Phone: (877) 767-9462 Fax: (877) 394-3465 V1. Effective January 1, 2020
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Jenx Multistander - Prone Multistander/Multist… · MUS02-PRN. White metal base with four locking casters and gas strut controlled angle adjustment including safety lock. Retail
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-Individual Leg Abduction - 5 degree increments 0-30 degrees -
0 - 80 degrees10 - 90 degrees
4.75" - 10.25"6" - 10.25"
46"26"34"
19.5"/22.5"10 - 90 degrees
20.5"/23.5"
**It is the responsibility of the CRT provider to determine the HCPCS code most appropriate for each circumstance. The HCPCS codes for reference only and are not to be deemed as legal advice. Actual coding and coverage varies by funding entities and the use of HCPCS does not guarantee coverage or payment.
9 mths - 6 yrsSize 1 standard Size 1 ABD
9 mths - 6 yrs 3 yrs - 13 yrsApproximate Age Range
Size 2
Branch:
Mark for: City:
Dealer Contact: State:
28"25.6"22.2"69"46"
132Lbs77Lbs
34" 46"26"
Billing Information: Ship To Information:
Date: Name:
PO Number: Address:
6.75" - 12.5"6.75" - 12.5"
39"
33"
Minimum Height (Footplate to top of upper support) Prone/SupineMaximum Height (Footplate to top of upper support)
22.2"46"
77Lbs
Maximum User Height (Approx.)Maximum User Weight
Maximum Height (Footplate to top of head support - Supine)Minimum Height (Footplate to top of head support - Supine)
Chest Pad Width (Min/Max)Hip Pad Width (Min/Max)
Frame WidthFrame LengthAngle Range
Size 1 Size 2
Standard column and one piece footplate Abduction column and individual footplates Standard column only