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Safari Tilt Standard Features: *** Measurements:● 5° to 45° of Adjustable Tilt ● 2-Point Positioning Belt
● Silver Powder Coated Frame ● Heavy-Duty Back Upholstery *** Seat Depth: _____________*
● 7.5 x 2" Front, 11.5 x 2.5" Rear Solid Tire (SFT12/14/16) ● One Piece, Non-Folding/Non-Elevating Footplate
● 6" Front, 11" Rear Solid Tires (SFT18) ● Support Cushion with Solid Seat Insert *** Lower Leg Drop: _________*● Quick Release Rear Wheels (SFT12/14/16) ● Made in the USA
● Wheel Locks *** *if this field is left blank,
*** defaults will be set
Standard Models: Price
Safari SFT12 - 900493 $2,365
Safari SFT14 - 901104 $2,365
Safari SFT16 - 900526 $2,365
Safari SFT18 - 902432 $2,365
Upholstery Colors Price SFT12 SFT14 SFT16 SFT18
Royal Blue $0 903850 903850 903850 903850
Forest Green $0 903857 903857 903857 903857
Cherry Red $0 903855 903855 903855 903855
Sassy Purple $0 903851 903851 903851 903851
Princess Pink $0 903759 903759 903759 903759
Panther Black $0 903854 903854 903854 903854
Chocolate Brown $0 904189 904189 904189 904189
Aqua Blue $0 904753 904753 904753 904753
Apple Green $0 904754 904754 904754 904754
Transit Required Items Price HCPCS SFT12 SFT14 SFT16 SFT18
Transit Option (Manufacturer Installation Required) $200 900494 901141 900527 902435
Headrest Extension $130 E0966 900712 901168 901310 902471
H-Harness with Padded Covers $143 E0960 903988 903988 903988 903988
3-Pt Positioning Belt $49 E0978 904017 904017 904017 904017
Elevating Legrests with Swing-Away Footplates (pair) $270 E0990 900698 901117 901299 902460
Foot Positioners - Select Size Below:
Foot Positioners - Small 7" - 10" (pair) $156 903415 903415 903415 903415
Foot Positioners - Medium 8" - 11" (pair) $156 903416 903416 903416 903416
Foot Positioners - Large 9" - 12" (pair) $156 903417 903417 903417 903417
Transit Options Price HCPCS SFT12 SFT14 SFT16 SFT18
Q'Straint Transit Lap Belt $90 E0978 903095 903095 903095 903095
Sure-Lok Transit Lap Belt $90 E0978 903233 903233 903233 903233
Upper Extremity Support Surface (Foam Tray) Small^ $151 E0950 903669 N/A N/A N/A
Upper Extremity Support Surface (Foam Tray) Medium^ $151 E0950 N/A 903670 903670 N/A
Upper Extremity Support Surface (Foam Tray) Large ̂ $151 E0950 N/A N/A N/A 903671
^ Crash tested Foam Tray with vinyl cover. Flip-Up Armrests required.
Pelvic Positioning Price HCPCS SFT12 SFT14 SFT16 SFT18
3-Pt Positioning Belt $49 E0978 904017 904017 904017 904017
Position Cushion - Medial Thigh Support/Anti Thrust * $347 E2607 903588 903589 903590 903591
Align Cushion - Lateral Pelvis/Lateral Thigh Support * $347 E2607 903592 903593 903594 903595
Incontinence Cushion Liner (Cushion and Solid Seat req) $72 E2619 902324 902324 902324 902324
Solid Seat Insert (Required with Cushion) $119 E0992 904029 904029 904029 904029
* Solid Seat Insert required with any Cushion.
Foot & Leg Positioning Price HCPCS SFT12 SFT14 SFT16 SFT18
Foot Positioners - Small 7" - 10" (pair) ^ $156 903415 903415 903415 903415
Foot Positioners - Medium 8" - 11" (pair) ^ $156 903416 903416 903416 903416
Foot Positioners - Large 9" - 12" (pair) ^ $156 903417 903417 903417 903417
Elevating Legrests w/ Swing-Away Footplates (pair) $270 E0990 900698 901117 901299 902460
Legrest Extension - 3" * ^ $55 N/A 901325 901324 902478
Angle Adj. Footplates - Std Size (pair) ^ $179 K0040 903270 903270 N/A N/A
Angle Adj. Footplates - Adult Size (pair) ^ $179 K0040 N/A N/A 903271 903271
Footplate Securement Strap $30 903584 903584 903584 903584
Medial Thigh Support (Abductor) $162 E0957 900708 901113 901297 902458
Lateral Thigh Support (Adductor) $162 E0956 900709 901145 901298 902459
Calf Panel $61 E0995 904580 904580 904580 904580
* 3" Legrest Extension interferes with caster swivel when seat is in upright position.
Seat must be tilted back at least 5 degrees OR Legrests must be elevated to allow caster swivel.
^ Elevating Legrests with Swing-Away Footplates required.
Convaid Safari Tilt - HCPCS E1232Retail Price List / Order Form
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Retail Price List / Order Form Convaid Safari Tilt - HCPCS E1232
Trunk Positioning Price HCPCS SFT12 SFT14 SFT16 SFT18
H-Harness with Padded Covers (3-Pt Positioning Belt Req) $143 E0960 903988 903988 903988 903988
SA Adj Lateral Support (single flap) with Scoli Strap $137 E0956 900705 901112 901306 902467
SA Adj Lateral Support (double flap) with Scoli Strap $137 E0956 900706 901144 901307 902468
Full Torso Support Vest * $263 900707 901217 901308 902469
Reducer Seat Insert (Reduces Seat Width 2" & Seat Depth 1") $353 904211 904110 904110 904110
* Not available with Single or Double Flap Lateral Support.
Head Supports Price HCPCS SFT12 SFT14 SFT16 SFT18
Padded Headwings $244 E0955 900704 901111 901309 902470
Occi Headwings $228 E0955 905270 905271 905271 905273
Headrest Extension $130 E0966 900712 901168 901310 902471
Frame Option Price HCPCS SFT12 SFT14 SFT16 SFT18
Anatomic Back $335 900697 901164 901319 902476
Recline Option $461 E1225 900689 901139 901321 N/A
Height Adjustable Flip-Up Armrests (pair) $228 E0973 900716 901143 901322 902477
Solid Side Panels (N/A w/ Recline Option) $211 904390 904391 904392 904393
Tire Options Price HCPCS SFT12 SFT14 SFT16 SFT18
12.5" Rear Solid Knobby Tire $199 904117 904117 904117 N/A
7.5" x 2" Front, 12.5" Rear Pneumatic Knobby Tire $299 904118 904118 904118 N/A
12.5" x 2" Rear Solid Knobby Tire $200 N/A N/A N/A 903420
Accessories Price HCPCS SFT12 SFT14 SFT16 SFT18
Headrest Cover (Canopy) $228 900714 901116 901313 902475
Extended Headrest Cover - No Windows (Canopy) $250 904732 904733 904734 904735
Extended Headrest Cover - with Windows (Canopy) $295 904748 904749 904750 904751
Upper Extremity Support Surface (Clear Tray) ̂ $111 E0950 903401 903402 903403 903404
Adj. Removeable Hardware (Required for Clear Tray) $227 E1028 904519 904519 904519 904519
Upper Extremity Support Surface (Foam Tray) Small^ $151 E0950 903669 N/A N/A N/A
Upper Extremity Support Surface (Foam Tray) Medium^ $151 E0950 N/A 903670 903670 N/A
Upper Extremity Support Surface (Foam Tray) Large ̂ $151 E0950 N/A N/A N/A 903671
Wheelchair Travel Bag $206 902022 902022 902022 902022
Utility Bag $38 904531 904531 904531 904531
Curb Tipper (elevates front of chair to go up curbs) $56 904063 904063 904063 904063
Attendant Hand Brakes (pair) * $236 904064 904064 904064 904064
Mosquito Net Size 1 (Canopy req) $150 904655 904655 N/A N/A
Mosquito Net Size 2 (Canopy req) $150 N/A N/A 904656 904656
^ Flip-Up Armrests required.
* Available with Knobby Tires only. Not available with Recline Option.
www.convaid.com Effective: 4/9/2018 Rev 2
Prices in USD & subject to change, ex works Torrance, California.
Standard Domestic Shipping Rate: $40 • For expedited shipping rates, please call 1-888-CONVAID2830 California St., Torrance, CA 90503 • 1-888-CONVAID (266-8243), 310-618-0111 • Fax: 310-618-2166
HCPCS codes are provided for your convenience and are NOT to be considered billing or legal advice. Providers are responsible for insuring that appropriate billing
codes are used when submitting claims. Proper use of HCPCS codes does not insure coverage or payment. Contact the appropriate payer for coverage information.
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