2018 hearing aid contract and vendors

DHS-7274F-ENG 9-18 2018 Hearing aid contract, vendors, models, prices and codes Effective 9/1/18 through 8/31/19 This hearing aid contract is available to Minnesota Health Care Programs (MHCP), state agencies, and members of the state’s Cooperative Purchasing Venture (CPV) program at the same price, terms and conditions. All contracted hearing aids include these warranties: • 12 months for loss and damage • Minimum 24 months for equipment including parts and labor; excludes ear piece, cords, tubing and batteries All vendor’s terms are Net 30. 2018 Minnesota Health Care Programs Hearing Aid Volume Purchase Contract Vendors

Contract Vendors Contract # Delivery After receipt of order

Non-Warranty Repair Price Per single unit

Non-Warranty Repair Period (Months)

Beltone Electronics 2601 Patriot Blvd. Glenview, IL 60026 Vendor #: 0000271144-002 Orders: Beltone Customer Service Phone: 800.621.1275 Fax: 847.832.3667 -or- Courtney LaFerle Email: [email protected] Phone: 847.832.3821 Fax: 847.832.3667

129969 1-5 calendar days $100.00 12

Hansaton USA Division of Sonova 14755 27th Ave North Plymouth, MN 55477 Vendor #: 0000800367 Orders: Janice Marfiz Email: [email protected] Phone: 763.331.3780 888.984.7432 Fax: 763.331.3799

129975 2-4 business days $100.00 12

Oticon, Inc. 580 Howard Ave Somerset, NJ 08873 Vendor #: 0000205171-001 Orders: Customer Service Email: [email protected] Phone: 800.526.3921 Fax: 732.560.0029

129970 5 calendar days $100.00 12

Phonak Division of Sonova 4520 Weaver Parkway Warrenville, IL 60555 Vendor #: 0000211365-001 Orders: [email protected]

129975 7 working days $129.00, except all CROS and FM systems $110.00

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mailto:[email protected]




Phone: 800.777.7333 Fax: 630.393.9858 Contact: Bertha Chavez Email: [email protected] Phone: 630.821.5005

ReSound US 8001 E. Bloomington Freeway Bloomington, MN 55420 Vendor #: 0000271144-001 Orders: Paul Rozendaal Email: [email protected] Phone: 800-248-4327 x8259 Fax: 952-769-8259

129968 7 working days $95.00 12

Rexton Division of Sivantos 3033 Campus Dr. W125 Plymouth, MN 55441 Vendor #: 0000203977-002 Orders: [email protected] Contact: Rich Hillwig Email: [email protected] Phone: 732-529-3651 Fax: 732-562-1431

129973 1-3 calendar days $95.00 12

Signia Division of Sivantos 10 Constitution Ave Piscataway, NJ 08855-1397 Vendor #: 0000203977-001 Orders: [email protected] Phone: 800.766.4500 Fax: 732.562.6683

129972 1-3 calendar days $95.00 12

Starkey Hearing Technologies 6700 Washington Avenue S Eden Prairie, MN 55344 Vendor #: 000197443-001 Orders: Starkey Support Email: [email protected] Phone: 952-941-6401 Fax: 952-828-6904

129974 2-5 calendar days $84.99 12

Unitron Division of Sonova 14755 27th Ave N Plymouth, MN 55447 Vendor #: 0000209807-001 Orders: Customer Service Email: [email protected] Phone: 800-888-8882 Fax: 800-521-5400

129975 2-4 business days $75.00 12

Widex USA, INC 185 Commerce Drive Hauppauge, NY 11788 Vendor #: 0000343865-001 Orders: Customer Service Email: [email protected] Contact: Maria Balcerak Phone: 800-221-0639 option 2 Fax: 631-273-0639

129976 2-5 calendar days $100.00 36









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MHCP Hearing Aid Contract Effective September 1, 2018 – August 31, 2019 Revised 8-31-18

• Include the manufacturer’s model number exactly as it appears on the contract on all claim submissions.

• Warranty repair period for each vendor is listed below. Non-warranty repair period and repair rates are listed on the vendor information page.

• All CROS/BiCROS systems in this contract include a compatible hearing aid. Do not bill a hearing aid separately if it is part of a CROS/BiCROS system.

• Certain individual FM System components cannot be billed together on the same claim due to NCCI. Refer to additional information in the Personal Frequency Modulation (FM) Systems, Assistive Listening Device section.

• Rechargeable hearing aids on this contract include the chargers.

CROS/BiCROS – BTE V5180 – CROS V5220 – BiCROS Starkey Warranty Repair Period: 24 months, except: All Cros/BiCros w/Muse i2400s: 36 months

Model Name Model # CROS Unit Price BiCROS Unit Price

CROS/BiCROS Transmitter w/Muse i2400 Micro RIC 312

CrosMuse i2400 mRIC $778.00 $778.00

CROS/BiCROS Transmitter w/Muse i2400 RIC 312

CrosMuse i2400 RIC $778.00 $778.00

CROS/BiCROS Transmitter w/Muse i2400 BTE 13

CrosMusei2400BTE13 $778.00 $778.00


CrosMusei2400B312 $778.00 $778.00

CROS/BiCROS Transmitter w/Muse i2400 BTE 13 Power Plus

CrosMuse i2400 P+ $778.00 $778.00


CrosMuse i2000 mRIC $758.00 $758.00


CrosMuse i2000 RIC $758.00 $758.00


CrosMusei2000BTE13 $758.00 $758.00


CrosMusei2000B312 $758.00 $758.00

CROS/BiCROS Transmitter w/Muse i2000 P+

CrosMuse i2000 P+ $758.00 $758.00


CrosMuse i1600 mRIC $738.00 $738.00


CrosMuse i1600 RIC $738.00 $738.00

https://mn.gov/dhs/partners-and-providers/policies-procedures/minnesota-health-care-programs/provider/billing/ncci.jsp

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CROS Hearing Aids V5170 – ITE V5180 – BTE

CROS ITE – V5170 Phonak Warranty Repair Period: 24 months

Model Name Model # CROS Unit Price CROS II 312 – Venture ITE Package 30 level 063-0098-01.30 $678.00

ROS/BiCROS Transmitter w/Muse i1600 BTE 13

CrosMusei1600BTE13 $738.00 $738.00


CrosMusei1600B312 $738.00 $738.00

CROS/BiCROS Transmitter w/Muse i1600 BTE 13Power Plus

CrosMuse i1600 P+ $738.00 $738.00

Cros/Muse iQ CROS/BiCROS Transmitter w/Muse Micro RIC 312

iQ i2400 CrosMuseiQi2400mRIC $778.00 $778.00

CROS/BiCROS Transmitter w/Muse RIC 312

iQ i2400 CrosMuseiQi2400RIC $778.00 $778.00

CROS/BiCROS BTE 312

Transmitter w/Muse iQ i2400 CrosMuseiQi2400B312 $778.00 $778.00

CROS/BiCROS Transmitter w/Muse BTE 13

iQ i2400 CrosMuseiQi2400BTE $778.00 $778.00

CROS/BiCROS Transmitter w/Muse BTE 13 Power Plus

iQ i2400 CrosiQi2400P+ $778.00 $778.00

CROS/BiCROS Transmitter w/Muse RIC R

iQ i2400 CrosiQi2400RICR $778.00 $778.00

CROS/BiCROS Transmitter w/Muse Micro RIC 312




CROS/BiCROS BTE 312


CROS/BiCROS Transmitter w/Muse BTE 13



iQ i2000 CrosiQi2000P+ $758.00 $758.00

CROS/BiCROS Transmitter w/Muse iQ i2000 RIC R

CrosiQi2000RICR $758.00 $758.00

CROS/BiCROS Transmitter w/Muse Micro RIC 312




CROS/BiCROS BTE 312


CROS/BiCROS Transmitter w/Muse BTE13



iQ i1600 CrosMuseiQi1600P+ $738.00 $738.00

CROS/BiCROS Transmitter w/Muse RIC R

iQ i1600 CrosMuseiQi1600RICR $738.00 $738.00

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CROS II 13 – Venture ITE Package 30 level 063-0099-01.30 $651.64 CROS II 312 – Venture ITE Package 50 level 063-0098-01.50 $764.00 CROS II 13 – Venture ITE Package 50 level 063-0099-01.50 $784.36 CROS B Custom 13 -30 level Belong Virto 063-0247-01.30 $731.00 CROS B Custom 13 -50 level Belong Virto 063-0247-01.50 $818.00 CROS B Custom 312 -30 level Belong Virto 063-0246-01.30 $731.00 CROS B Custom 13 -50 level Belong Virto 063-0246-01.50 $818.00

CROS BTE – V5180 Phonak Warranty Repair Period: 24 months

Model Name Model # CROS Unit Price CROS II 312 BTE Venture Package 30 level 050-0228-01.30 $678.00 CROS II 13 Venture BTE Package 30 level 050-0229-01.30 $678.00 CROS II 312 Venture BTE Package 50 level 050-0228-01.50 $764.00 CROS II 13 Venture BTE Package 50 level 050-0229-01.50 $764.00 CROS B 312 30 level (excludes all rechargeable BTE/RIC)

050-0274-01.30 $731.00

CROS B 13 30 level (excludes all rechargeable BTE/RIC)

050-0275-01.30 $731.00


050-0274-01.50 $818.00


050-0275-01.50 $818.00

CROS ITE – V5170 Rexton Warranty Repair Period: 36 months

Model Name Model # CROS Unit Price Wireless CROS Transmitter + Sterling 80 6c Package CROS+Sterling 80 6c $749.80 Wireless CROS Transmitter + Sterling 60 6c Package CROS+Sterling 60 6c $562.40

CROS BTE – V5180 Rexton Warranty Repair Period: 36 months

Model Name Model # CROS Unit Price Wireless CROS Transmitter + Emerald M 80 8c RIC Pckg CROS+Emerald M80 8c $755.44 Wireless CROS Transmitter + Emerald M 60 8c RIC Pckg CROS+Emerald M60 8c $573.44 Wireless CROS Transmitter + Emerald S 80 8c RIC Pckg CROS+Emerald S80 8c $749.40 Wireless CROS Transmitter + Emerald S 60 8c RIC Pckg CROS+Emerald S60 8c $573.44 Wireless CROS Transmitter + Mosaic M/M NR/P/HP 80 Pckg

CROS+Mosaic 80 8c $755.44

Wireless CROS Transmitter + Mosaic M/M NR/P/HP 60 Pckg

CROS+Mosaic 60 8c $573.44

Wireless CROS transmitter + Stellar Li 80 6c RIC Pckg CROS+Stellar Li806c $749.40 Wireless CROS transmitter + Stellar Li 60 6c RIC Pckg CROS+Stellar Li606c $562.20

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CROS Hearing Aids V5170 – ITE V5180 – BTE

CROS ITE – V5170 Signia Warranty Repair Period: 36 months

Model Name Model # CROS Unit Price Wireless CROS Transmitter + Insio 3px Package CROS+Insio 3px $764.10

CROS BTE – V5180 Signia Warranty Repair Period: 36 months

Model Name Model # CROS Unit Price Wireless CROS Transmitter + Pure Charge & Go 3NX RIC Package

CROS+Pure CG NX3 $757.76

Wireless CROS Transmitter + Pure 312 3NX CROS+Pure 312 3NX $683.76 Wireless CROS Transmitter + Pure 13 3NX RIC Package CROS+Pure 13 3NX $683.76 Wireless CROS Transmitter + Motion 13 3NX BTE Package CROS+Motion 13 3NX $683.76 Wireless CROS Transmitter + Motion 13P 3NX BTE Pckg. CROS+Motion 13P 3NX $683.76

CROS BTE – V5180 Widex Warranty Repair Period: 36 months

Model Name Model # CROS Unit Price Evoke 220 Mini BTE w/o VC & Widex Wireless Cros System E2FM-Cros $814.00 Evoke 220 D2-FS rcvr in ear w/push button & Wireless Cros System

E2-FS-Cros $814.00

Evoke 220 Fashion BTE w/VC, prog button & Wireless Cros System

E2FA-VC-Cros $814.00

Evoke 220 Fashion Power BTE w/VC, prog button & Wireless Cros System

E2FAP-VC-Cros $814.00

Evoke 110 Mini BTE w/o VC & Widex Wireless Cros System E1FM-Cros $724.00

Evoke 110 D2-FS rcvr in ear w/push button & Wireless Cros System

E1FS-Cros $724.00

Evoke 110 Fashion BTE w/VC, prog button & Wireless Cros System

E1FA-VC-Cros $724.00

Evoke 110 Fashion Power BTE w/VC, prog button & Wireless Cros System

E1FAP-VC-Cros $724.00

Unique 330 U2-FS rcvr in ear w/ push button & Wireless Cros System

U3-FS-Cros $760.00

Unique 220 U2-FS receiver in the ear w/push button & Wireless Cros system

U2-FS-Cros $760.00

Unique 110 U1-FS receiver in the ear w/push button & Wireless Cros system

U1-FS-Cros $690.00

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BTE V5257 – Monaural Digital BTE V5261 – Binaural Digital BTE Beltone Warranty Repair Period: 24 months

Model Name Model # Monaural unit price Binaural unit price Ally 2 76DW 196277xx $329.00 $658.00 Ally 2 86DW 196283xx $329.00 $658.00 Ally 3 64DRW 196267xx $349.00 $698.00 Ally 3 66DW 196271xx $349.00 $698.00 Ally 3 76DW 196276xx $349.00 $698.00 Ally 3 86DW 196282xx $349.00 $698.00 BOLD 2 95D 188907xx $329.00 $658.00 BOLD 3 95D 188820xx $399.00 $798.00 BOOST MAX 9 86DW 205574xx $449.00 $898.00 BOOST MAX 9 95DW 205572xx $449.00 $898.00 Legend 9 63 DRW 203937xx $449.00 $898.00 Legend 9 64 DRW 190916xx $449.00 $898.00 Legend 9 76DW 193686xx $449.00 $898.00 Legend 9 86DW 193688xx $449.00 $898.00 Legend 6 63 DRW 203939xx $399.00 $798.00 Legend 6 64 DRW 194210xx $399.00 $798.00 Legend 6 76DW 193687xx $399.00 $798.00 Legend 6 86DW 193689xx $399.00 $798.00 ORIGIN 2 75D 178420xx $249.00 $498.00 ORIGIN 2 85D 178421xx $249.00 $498.00 ORIGIN 3 64D 191854xx $289.00 $578.00 TRUST 6 63DRW 197055xx $399.00 $798.00 TRUST 6 64DRW 197052xx $399.00 $798.00 TRUST 6 66DW 200949xx $399.00 $798.00 TRUST 6 76DW 197038xx $399.00 $798.00 TRUST 6 86DW 197033xx $399.00 $798.00 TRUST 9 63DRW 197054xx $449.00 $898.00 TRUST 9 64DRW 197050xx $449.00 $898.00 TRUST 9 66DW 200948xx $449.00 $898.00 TRUST 9 76DW 197037xx $449.00 $898.00 TRUST 9 86DW 197032xx $449.00 $898.00

Hansaton Warranty Repair Period: 36 months

Model Name Model # Monaural unit price Binaural unit price Flow 1 13 SP BTE Flow1 $180.00 $360.00 Flow 2 675 UP BTE Flow2 $281.75 $563.50 Flow 2 312 SP BTE Flow2 312 $281.75 $563.50 Flow 2 13 SP BTE Flow2 13 $281.75 $563.50 Flow 2 675 UP BTE Flow2 675 $281.75 $563.50 soundSHD 3 S312/13 soundSHD3 $242.00 $484.00 soundSHD 5 S312/13 soundSHD5 $340.00 $680.00 soundHD 3-S312E soundHD3 $199.00 $398.00 AQ jamSHD 3 AQjamSHD3 $374.00 $748.00 AQ jamSHD 5 AQjamSHD5 $439.60 $879.20 AQ sound SHD 5 w/charger AQsoundSHD5 $439.60 $879.20 Beat 3 13 SP Beat3 13 $253.00 $506.00 Beat 3 675 UP Beat3 675 $253.00 $506.00 jamSHD 3 S312/13 jamSHD3 $242.00 $484.00

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Model Name Model # Monaural unit price Binaural unit price jamSHD 5 S312/13 jamSHD5 $340.00 $680.00

BTE V5257 – Monaural Digital BTE V5261 – Binaural Digital BTE

Oticon Warranty Repair Period: 36 months

Model Name Model # Monaural unit price Binaural unit price Dynamo SP4 BTE 001-031-014 $225.00 $450.00 Dynamo SP6 BTE 001-032-014 $299.00 $598.00 Dynamo SP8 BTE 001-033-014 $349.00 $698.00 Dynamo SP10 BTE 001-034-014 $449.00 $898.00 Sumo DM 001-010-035 $399.00 $798.00 Sensei SP BTE 001-062-014 $199.00 $398.00 Sensei Pro SP BTE 001-063-014 $349.00 $698.00 Sensei BTE 312 001-052-015 $199.00 $398.00 Sensei BTE 13 001-052-031 $199.00 $398.00 Sensei RITE 001-052-009 $199.00 $398.00 Sensei Pro BTE 312 001-053-015 $349.00 $698.00 Sensei Pro BTE 13 001-053-031 $349.00 $698.00 Sensei Pro RITE 001-053-009 $349.00 $698.00 Ria2 BTE 001-106-031 $199.00 $398.00 Ria2 miniBTE 001-106-027 $199.00 $398.00 Ria2 Power BTE 001-106-012 $199.00 $398.00 Ria2 RITE 001-106-009 $199.00 $398.00 Ria2 miniRITE 001-106-016 $199.00 $398.00 Ria2 Power Plus BTE 001-106-100 $199.00 $398.00 Ria2 Pro BTE 001-112-031 $225.00 $450.00 Ria2 Pro miniBTE 001-112-027 $225.00 $450.00 Ria2 Pro Power BTE 001-112-012 $225.00 $450.00 Ria2 Pro Power Plus BTE 001-112-100 $225.00 $450.00 Ria2 Pro RITE 001-112-009 $225.00 $450.00 Ria2 Pro miniRITE 001-112-016 $225.00 $450.00 Ria2 Pro designRite 001-112-074 $225.00 $450.00 Nera2 BTE 001-151-027 $250.00 $500.00 Nera2 mini BTE 001-151-009 $250.00 $500.00 Nera2 Power BTE 001-151-012 $250.00 $500.00 Nera2 Pro Power Plus BTE 001-151-031 $349.00 $698.00 Nera2 RITE 001-151-016 $250.00 $500.00 Nera2 mini RITE 001-163-074 $250.00 $500.00 Nera2 Pro BTE 001-163-031 $349.00 $698.00 Nera2 Pro miniBTE 001-163-027 $349.00 $698.00 Nera2 Pro Power BTE 001-151-100 $349.00 $698.00 Nera2 Power Plus BTE 001-163-100 $250.00 $500.00 Nera2 Pro RITE 001-163-009 $349.00 $698.00 Nera2 Pro miniRITE 001-163-016 $349.00 $698.00 Nera2 Pro designRITE 001-163-012 $349.00 $698.00 OPN 3 miniRITE-T 001-410-125 $349.00 $698.00 OPN 3 Plus Power BTE 001-410-100 $349.00 $698.00 OPN 3 miniRITE 001-410-016 $349.00 $698.00 OPN 2 miniRITE-T 001-400-125 $449.00 $898.00 OPN 2 Plus Power BTE 001-400-100 $449.00 $898.00 OPN 2 miniRITE 001-400-016 $449.00 $898.00 Alta2 Pro Power BTE 001-334-012 $449.00 $898.00

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Model Name Model # Monaural unit price Binaural unit price Alta2 Pro RITE 001-334-009 $449.00 $898.00 Alta2 Pro Power Plus BTE 001-334-100 $449.00 $898.00 Alta2 Pro designRITE 001-334-074 $449.00 $898.00 Alta2 Pro BTE 001-334-031 $449.00 $898.00 Alta2 Pro mini BTE 001-334-027 $449.00 $898.00 Alta2 Pro miniRITE 001-334-016 $449.00 $898.00 Alta2 Power Plus BTE 001-311-100 $399.00 $798.00 Alta2 BTE 001-311-031 $399.00 $798.00 Alta2 mini BTE 001-311-027 $399.00 $798.00 Alta2 miniRITE 001-311-016 $399.00 $798.00 Alta2 Power BTE 001-311-012 $399.00 $798.00 Alta2 RITE 001-311-009 $399.00 $798.00


Phonak Warranty Repair Period: 36 months Model Name Model # Monaural unit price Binaural unit price Sky B50-M 050-0467-01 $385.00 $770.00 Sky B50-SP 050-0471-01 $385.00 $770.00 Sky B50-UP 050-0475-01 $385.00 $770.00 Sky B50-RIC 050-0479-01 $385.00 $770.00 Sky B50-PR Rechargeable 050-0482-01 $450.00 $900.00 Sky V50 SP 050-0335-01 $385.00 $770.00 Sky V50-RIC 050-0343-01 $385.00 $770.00 Sky V50-M 050-0327-01 $385.00 $770.00 Sky V50-P 050-0331-01 $385.00 $770.00 Sky V50-UP 050-0339-01 $385.00 $770.00 Naida B50-UP 050-0402-01 $439.00 $878.00 Naida B50-SP 050-0319-01 $439.00 $878.00 Naida B50-R Rechargeable 050-0429-01 $450.00 $900.00 Naida B-30 UP 050-0399-01 $352.00 $704.00 Naida B30-SP 050-0318-01 $352.00 $704.00 Naida V-50 UP 050-0247-01 $385.00 $770.00 Naida V-50 SP 050-0243-01 $385.00 $770.00 Naida V-50 RIC 050-0266-01 $385.00 $770.00 Naida V-30 RIC 050-0265-01 $299.00 $598.00 Naida V-30 UP 050-0246-01 $299.00 $598.00 Naida V-30 SP 050-0242-01 $299.00 $598.00 Audeo V50-10 050-0094-01 $385.00 $770.00 Audeo V50-312 050-0169-01 $385.00 $770.00 Audeo V50-312T 050-0208-01 $385.00 $770.00 Audeo V50-13 050-0217-01 $385.00 $770.00 Audeo V30-10 050-0093-01 $299.00 $598.00 Audeo V30-312 050-0109-01 $299.00 $598.00 Audeo V30-312T 050-0198-01 $299.00 $598.00 Audeo V30-13 050-0216-01 $299.00 $598.00 Bolero B50 Rechargeable 050-0374-01 $450.00 $899.99 Bolero B50-SP 050-0371-01 $439.00 $878.00 Bolero B50-P 050-0367-01 $439.00 $878.00 Bolero B50-M312 050-0363-01 $439.00 $878.00 Bolero B30-M312 050-0362-01 $352.00 $628.06 Bolero B30-P 050-0366-01 $352.00 $628.06

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Model Name Model # Monaural unit price Binaural unit price Bolero B30-SP 050-0370-01 $352.00 $628.06 Bolero V50-M 050-0282-01 $385.00 $770.00 Bolero V50-P 050-0290-01 $385.00 $770.00 Bolero V50-SP 050-0294-01 $385.00 $770.00 Bolero V30-M 050-0281-01 $299.00 $598.00 Bolero V30-P 050-0289-01 $299.00 $598.00 Bolero V30-SP 050-0293-01 $299.00 $598.00 Audeo B50 Rechargeable 050-0234-01 $450.00 $899.99 Audeo B50 Direct 050-0277-01 $450.00 $899.00 Audeo B50 RIC-10 050-0347-01 $439.00 $878.00 Audeo B50 RIC-312 050-0351-01 $439.00 $878.00 Audeo B50-312T 050-0355-01 $439.00 $878.00 Audeo B50-13 050-0359-01 $439.00 $878.00 Audeo B30-10 050-0346-01 $352.00 $704.00 Audeo B30-312 050-0350-01 $352.00 $704.00 Audeo B30-312T 050-0354-01 $352.00 $704.00 Audeo B30-13 050-0358-01 $352.00 $704.00

BTE V5257 – Monaural Digital BTE V5261 – Binaural Digital BTE Resound Warranty Repair Period: 36 months

Model Name Model # Monaural unit price Binaural unit price Enya 3 Standard BTE EY377-DW $300.00 $600.00 Enya 3 Power BTE EY388-DW $300.00 $600.00 Enya 3 Mini BTE EY367-DW $300.00 $600.00 Enya 3 Standard RIC BTE EY362-DRW $300.00 $600.00 Enya 2 Standard BTE EY277-DW $275.00 $550.00 Enya 2 Power BTE EY288-DW $275.00 $550.00 Enya 2 Mini BTE EY267-DW $275.00 $550.00 Enzo2 5 Super Power BTE EN598-DW $397.00 $794.00 Enzo2 5 High Power BTE EN588-DW $397.00 $794.00 Enzo2 7 Super Power BTE EN798-DW $448.00 $896.00 Enzo2 7 High Power BTE EN788-DW $448.00 $896.00 Enzo 3D High Power BTE ET588-DW $397.00 $794.00 Enzo 3D 5 Super Power BTE ET598-DW $397.00 $794.00 Enzo 3D 7 High Power BTE ET788-DW $448.00 $896.00 Enzo 3D 7 Super Power BTE ET798-DW $448.00 $896.00 LiNX2 5 Mini BTE LS567-DW $397.00 $794.00 LiNX2 5 RIE BTE LS562-DRW $397.00 $794.00 LiNX2 5 Mini RIE BTE LS561-DRW $397.00 $794.00 LiNX2 5 Standard BTE LS577-DW $397.00 $794.00 LiNX2 5 Power BTE LS588-DW $397.00 $794.00 LINX2 7 Standard RIE BTE LS762-DRW $448.00 $896.00 LINX2 7 Mini RIE BTE LS761-DRW $448.00 $896.00 LINX2 7 Power BTE LS788-DW $448.00 $896.00 LINX2 7 Standard BTE LS777-DW $448.00 $896.00 LiNX2 7 Mini BTE LS767-DW $448.00 $896.00 LINX3D 5 RIE BTE LT562-DRW $448.00 $896.00 LINX3D 5 Mini RIE BTE LT561-DRW $397.00 $794.00 LINX3D 5 Mini BTE LT567-DW $397.00 $794.00 LINX3D 5 Standard BTE LT577-DW $397.00 $794.00 LINX3D 5 Power BTE LT588-DW $397.00 $794.00

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LINX3D 7 RIE BTE LT762-DRW $448.00 $896.00 LINX3D 7 Mini RIE BTE LT761-DRW $448.00 $896.00 LINX3D 7 Mini BTE LT767-DW $448.00 $896.00 LINX3D 7 Standard BTE LT777-DW $448.00 $896.00 LINX3D 7 Power BTE LT788-DW $448.00 $896.00 Up 7 Mini BTE UP767-DW $397.00 $794.00 Up Smart 7 Standard BTE UPS777-DLW $448.00 $896.00 Up Smart 7 Power BTE UPS788-DLW $448.00 $896.00 Up Smart 7 Super Power BTE UPS798-DLW $448.00 $896.00 Up Smart 5 Standard BTE UPS577-DLW $397.00 $794.00 Up Smart 5 Power BTE UPS588-DLW $397.00 $794.00 Up Smart 5 Super Power BTE UPS598-DLW $397.00 $794.00


Rexton Warranty Repair Period: 36 months

Model Name Model # Monaural unit price Binaural unit price Emerald M 80 8c RIC Emerald M 80 8c $428.78 $857.56 Emerald M 60 8c RIC Emerald M 60 8c $389.70 $779.40 Emerald S 80 8c RIC Emerald S 80 8c $428.78 $857.56 Emerald S 60 8C RIC Emerald S 60 8c $389.70 $779.40 Mosaic M NR 80 6c Mosaic M NR 80 6c $419.76 $839.52 Mosaic M NR 60 6c Mosaic M NR 60 6c $390.25 $780.50 Mosaic M 80 8c Mosaic M 80 8c $428.78 $857.56 Mosaic M 60 8c Mosaic M 60 8c $389.70 $779.40 Mosaic P 80 6c Mosaic P 80 6c $419.76 $839.52 Mosaic P 60 6c Mosaic P 60 6c $390.25 $780.50 Mosaic HP 80 6c Mosaic HP 80 6c $427.20 $854.40 Mosaic HP 60 6c Mosaic HP 60 6c $393.75 $787.50 Stellar Li 80 6c RIC rechargeable Stellar Li 80 6c $428.78 $857.56 Stellar Li 60 6c RIC rechargeable Stellar Li 60 6c $402.69 $805.38

Signia Warranty Repair Period: 36 months

Model Name Model # Monaural unit price Binaural unit price Pure 2 px RIC Pure 2px $339.60 $679.20 Pure 1 px RIC Pure 1px $283.05 $566.10 Pure 312 NX 3 RIC Pure 312 NX 3 $428.61 $857.22 Pure 13 NX 3 RIC Pure 13 NX 3 $428.61 $857.22 Pure Charge & Go NX 3 RIC Rechargeable

Pure CG NX 3 $428.67 $857.34

Motion S 2px Motion S 2px $339.60 $679.20 Motion SA 2px Motion SA 2px $339.60 $679.20 Motion P 2px Motion P 2px $339.60 $679.20 Motion SP 2px Motion SP 2px $339.60 $679.20 Motion S 1px Motion S 1px $283.05 $566.10 Motion SA 1px Motion SA 1px $283.05 $566.10 Motion P 1px Motion P 1px $283.05 $566.10 Motion SP 1px Motion SP 1px $283.05 $566.10 Motion 13 NX 3 Motion 13 NX 3 $428.61 $857.22 Motion 13P NX 3 Motion 13P NX 3 $428.61 $857.22

10


Starkey Warranty Repair Period: 24 months, except: Halo 2 i2400s, Muse i2400s and Muse iQ i2400s: 36 months iQ RIC rechargeables are 24 months

Model Name Model # Monaural unit price Binaural unit price 3 Series 20 mini BTE 312 3 Series 20 mBTE $299.00 $598.00 20 BTE 13 3 Series 20 BTE 13 $299.00 $598.00 20 Power Plus BTE 13 3 Series 20 P+BTE $299.00 $598.00 20 RIC 3 Series 20 RIC $299.00 $598.00 Halo iQ Series Halo iQ 2400 RIC 13 HaloiQ i2400 RIC13 $439.00 $878.00 Halo iQ 2400 RIC 312 HaloiQ i2400 RIC312 $439.00 $878.00 Halo iQ 2000 RIC 13 HaloiQ i2000 RIC13 $419.00 $838.00 Halo iQ 2000 RIC 312 HaloiQ i2000 RIC312 $419.00 $838.00 Halo iQ 1600 RIC 13 HaloiQ i1600 RIC13 $399.00 $798.00 Halo iQ 1600 RIC 312 HaloiQ i1600 RIC312 $399.00 $798.00 Halo Series Halo i110 BTE 13 Halo i110 BTE $429.00 $858.00 Halo i90 BTE 13 Halo i90 BTE $409.00 $818.00 Halo i70 BTE 13 Halo i70 BTE $389.00 $778.00 Halo 2 Halo 2 i2400 RIC 13 Halo 2 i2400 RIC 13 $439.00 $878.00 Halo 2 i2400 RIC 312 Halo 2 i2400 RIC312 $439.00 $878.00 Halo 2 i2000 RIC 13 Halo 2 i2000 RIC 13 $419.00 $838.00 Halo 2 i2000 RIC 312 Halo 2 i2000 RIC312 $419.00 $838.00 Halo 2 i1600 RIC 13 Halo 2 i1600 RIC 13 $399.00 $798.00 Halo 2 i1600 RIC 312 Halo 2 i1600 RIC312 $399.00 $798.00 Muse iQ i Series Muse iQ i2400 mRIC Muse iQi2400 mRIC $439.00 $878.00 Muse iQ i2400 RIC 312 Muse iQi2400 RIC312 $439.00 $878.00 Muse iQ i2400 P+ BTE Muse iQi2400 P+ BTE $439.00 $878.00 Muse iQ i2400 BTE 312 Muse iQi2400 BTE312 $439.00 $878.00 Muse iQ i2400 BTE 13 Muse iQi2400 BTE 13 $439.00 $878.00 Muse iQ i2000 Micro RIC 312 Muse iQi2000 mRIC $419.00 $838.00 Muse iQ i2000 RIC 312 Muse iQi2000 RIC312 $419.00 $838.00 Muse iQ i2000 Power Plus Muse iQi2000 P+ BTE $419.00 $838.00 Muse iQ i2000 BTE 312 Muse iQi2000 BTE312 $419.00 $838.00 Muse iQ i2000 BTE 13 Muse iQi2000 BTE 13 $419.00 $838.00 Muse iQ i1600 Micro RIC 12 Muse iQi1600 mRIC $399.00 $798.00 Muse iQ i1600 RIC 312 Muse iQi1600RIC312 $399.00 $798.00 Muse iQ i1600 Power Plus Muse iQi1600 P+ BTE $399.00 $798.00 Muse iQ i1600 BTE 312 Muse iQi1600 BTE312 $399.00 $798.00 Muse iQ i1600 BTE 13 Muse iQi1600 BTE 13 $399.00 $798.00 Muse i Series Muse i2400 BTE 312 Muse i2400 BTE 312 $439.00 $878.00 Muse i2400 RIC 312 Muse i2400 RIC 312 $439.00 $878.00 Muse i2400 Power Plus Muse i2400 P+ BTE $439.00 $878.00 Muse i2400 BTE 13 Muse i2400 BTE 13 $439.00 $878.00 Muse i2400 Micro RIC 312 Muse i2400 mRIC $439.00 $878.00 Muse i2000 BTE 13 Muse i2000 BTE 13 $419.00 $838.00

11

Model Name Model # Monaural unit price Binaural unit price Muse i2000 Micro RIC 312 Muse i2000 mRIC $419.00 $838.00 Muse i2000 RIC 312 Muse i2000 RIC 312 $419.00 $838.00 Muse i2000 Power Plus Muse i2000 P+ BTE $419.00 $838.00 Muse i2000 BTE 312 Muse i2000 BTE 312 $419.00 $838.00 Muse i1600 Power Plus Muse i1600 P+ BTE $399.00 $798.00 Muse i1600 BTE 312 Muse i1600 BTE312 $399.00 $798.00 Muse i1600 BTE 13 Muse i1600 BTE 13 $399.00 $798.00 Muse i1600 Micro RIC 312 Muse i1600 mRIC $399.00 $798.00 Muse i1200 Micro RIC Muse i1200 mRIC $329.00 $658.00 Muse i1200 BTE 312 Muse i1200 BTE312 $329.00 $658.00 Muse i1200 BTE 13 Muse i1200 BTE 13 $329.00 $658.00 Muse i1200 RIC 312 Muse i1200 RIC 312 $329.00 $658.00 Muse i1200 Power Plus Muse i1200 P+ BTE $329.00 $658.00 Muse i1000 Micro RIC 312 Muse i1000 mRIC $279.00 $558.00 Muse i1000 RIC 312 Muse i1000 RIC 312 $279.00 $558.00 Muse i1000 P+ BTE Muse i1000 P+ BTE $279.00 $558.00 Muse i1000 BTE 312 Muse i1000 BTE312 $279.00 $558.00 Muse i1000 BTE 13 Muse i1000 BTE 13 $279.00 $558.00


Unitron Warranty Repair Period: 36 months

Model Name Model # Monaural unit price Binaural unit price Tempus Moxi All 700 CRT TMA700 $448.00 $895.99 Tempus Moxi All 600 CRT TMA600 $385.00 $769.99 Tempus Moxi All 500 CRT TMA500 $299.00 $598.00 Tempus Moxi All R 700 CRT w/charger TMAR700 $448.00 $896.00 Tempus Moxi All R 600 CRT w/charger TMAR600 $385.00 $770.00 Tempus Moxi All R 500 CRT w/charger TMAR500 $299.00 $598.00 Tempus Moxi Fit 700 CRT TMF700 $448.00 $896.00 Tempus Moxi Fit 600 CRT TMF600 $385.00 $770.00 Tempus Moxi Fit 500 CRT TMF500 $299.00 $598.00 Tempus Moxi Kiss 700 CRT TMK700 $448.00 $896.00 Tempus Moxi Kiss 600 CRT TMK600 $385.00 $770.00 Tempus Moxi Kiss 500 CRT TMK500 $299.00 $598.00 Tempus Moxi Dura 700 CRT TMD700 $448.00 $896.00 Tempus Moxi Dura 600 CRT TMD600 $385.00 $770.00 Tempus Moxi Dura 500 CRT TMD500 $299.00 $598.00 Tempus Moxi Now 700 CRT TMN700 $448.00 $896.00 Tempus Moxi Now 600 CRT TMN600 $385.00 $770.00 Tempus Moxi Now 500 CRT TMN500 $299.00 $598.00 Tempus Moxi Fit R 700 CRT TMFR700 $448.00 $896.00 Tempus Moxi Fit R 600 CRT TMFR600 $385.00 $769.99 Tempus Moxi Fit R 500 CRT TMFR500 $299.00 $598.00 Tempus Stride M 700 BTE TSM700 $448.00 $896.00 Tempus Stride M 600 BTE TSM600 $385.00 $770.00 Tempus Stride M 500 BTE TSM500 $299.00 $598.00 Tempus Stride M R 700 BTE TSMR700 $448.00 $896.00 Tempus Stride M R 600 BTE TSMR600 $385.00 $769.99 Tempus Stride M R 500 BTE TSMR500 $299.00 $598.00 Tempus P Dura 700 BTE TSPD700 $448.00 $896.00 Tempus P Dura 600 BTE TSPD600 $385.00 $770.00

12

Model Name Model # Monaural unit price Binaural unit price Tempus P Dura 500 BTE TSPD500 $299.00 $598.00 Tempus P 700 BTE TSP700 $448.00 $896.00 Tempus P 600 BTE TSP600 $385.00 $770.00 Tempus P 500 BTE TSP500 $299.00 $598.00 Max 6 SP BTE MAX6SP $430.71 $861.42 Max E SP BTE MAXESP $350.00 $700.00 Max 6 SPm BTE MAX6SPM $430.71 $861.42 Max E SPm BTE MAXESPM $350.00 $700.00 Accessories Custom Earmold for BTE V5264: Acrylic $20.00/unit Silicone $20.00/unit C-Shell $40.00/unit


Widex Warranty Repair Period: 36 months Model Name Model # Monaural unit price Binaural unit price Evoke 220 Fashion BTE E2FA $440.00 $880.00 Evoke 220 E2-FS E2FS $440.00 $880.00 Evoke 220 E2FS2 E2FS2 $440.00 $880.00 Evoke 220 Fashion Mini BTE E2FM $440.00 $880.00 Evoke 220 Fashion Power BTE E2FAP $440.00 $880.00 Evoke 110 Fashion BTE E1FA $350.00 $700.00 Evoke 110 E2-FS rcvr in ear w/push button E1FS $350.00 $700.00 Evoke 110 Fashion Mini BTE E1FM $350.00 $700.00 Evoke 110 Fashion Power BTE E1FAP $350.00 $700.00 Super 220, SP receiver in ear, power BTE S2-VS-SP $400.00 $800.00 Super 220, P receiver in ear, power BTE S2-VS-P $400.00 $800.00 Super 220, SP receiver in ear, power BTE S2-VSD-SP $400.00 $800.00 Super 220, P receiver in ear, power BTE S2-VSD-P $400.00 $800.00 Unique 330 U2-FA Fashion BTE w/VC & push button U3-FA-VC $385.00 $770.00 Unique 330 Fashion Power BTE w/VC & prog button U3-FAP-VC $385.00 $770.00 Unique 330 U2-FA Fashion m-BTE w/conf push button U3-FA-m $385.00 $770.00 Unique 330 U2-FS receiver in ear, w/conf push button U3-FS $385.00 $770.00 Unique 220 U2-FA Fashion BTE w/VC & push button U2-FA-VC $385.00 $770.00 Unique 220 U2-FA Fashion mBTE U2-FA-m $385.00 $770.00 Unique 220 U2-FS receiver in the ear push button U2-FS $385.00 $770.00 Unique 220 Fashion Power BTE w/VC & prog button U2-FAP-VC $350.00 $700.00 Unique 110 U1-FA Fashion BTE w/VC & push button U1-FA-VC $315.00 $630.00 Unique 110 U1-FA Fashion m-BTE U1-FA-m $315.00 $630.00 Unique 110 U1-FS receiver in the ear w/push button U1-FS $315.00 $630.00 Unique 110 Fashion Power BTE w/VC and prog button U1-FAP-VC $315.00 $630.00 Beyond 220 U2-FS B2-FS $385.00 $770.00 Beyond 330-B3-FS B3-FS $440.00 $880.00

13

ITE V5256 – Monaural Digital ITE V5260 – Binaural Digital ITE

Beltone – Full Shell Warranty Repair Period: 24 months

Model Name Model # Monaural unit price Binaural unit price Ally 2 ITE ALY2-45-FS $329.00 $658.00 Ally 3 ITE ALY3-45-FS $349.00 $698.00 Legend 6 ITE LND6-45-FS $399.00 $798.00 Legend 9 ITE LND9-45-FS $449.00 $898.00 Origin 2 ITE OR2-45-FS $249.00 $498.00 Trust 6 ITE TST6-45-FS $399.00 $798.00 Trust 9 ITE TST9-45-FS $449.00 $898.00 Beltone – Half-Shell Warranty Repair Period: 24 months

Model Name Model # Monaural unit price Binaural unit price Origin 2 ITE OR2-45-HS $249.00 $498.00 Legend 6 ITE LND6-45-HS $399.00 $798.00 Legend 9 ITE LND9-45-HS $449.00 $898.00 Ally 2 ITE ALY2-45-HS $329.00 $658.00 Ally 3 ITE ALY3-45-HS $349.00 $698.00 Trust 6 ITE TST6-45-HS $399.00 $798.00 Trust 9 ITE TST9-45-HS $449.00 $898.00

Beltone – Low Profile Warranty Repair Period: 24 months

Model Name Model # Monaural unit price Binaural unit price Ally 2 ITE ALY2-45-LP $329.00 $658.00 Ally 3 ITE ALY3-45-LP $349.00 $698.00 Origin 2 ITE OR2-45-LP $249.00 $498.00 Legend 6 ITE LND6-45-LP $399.00 $798.00 Legend 9 ITE LND9-45-LP $449.00 $898.00 Trust 6 ITE TST6-45-LP $399.00 $798.00 Trust 9 ITE TST9-45-LP $449.00 $898.00

ITE V5256 – Monaural Digital ITE V5260 – Binaural Digital ITE

Hansaton – Full Shell Warranty Repair Period: 36 months

Model Name Model # Monaural unit price Binaural unit price JamSHD 3 JamSHD 3 ITE CBDMIC

JamSHD 3 ITE CBTC JamSHD 3 ITE CBPHCO JamSHD 3 ITE CBVC JamSHD 3 ITE CBPB

$242.00 $484.00

14

Model Name Model # Monaural unit price Binaural unit price JamSHD 5 JamSHD 5 ITE CBDMIC

JamSHD 5 ITE CBTC JamSHD 5 ITE CBPHCO JamSHD 5 ITE CBVC JamSHD 5 ITE CBPB

$340.00 $680.00

Accessories – No charge Directional Microphone Telecoil Switchless Telecoil Volume Control Push Button

Hansaton – Half-Shell Warranty Repair Period: 36 months

Model Name Model # Monaural unit price Binaural unit price JamSHD 3 JamSHD 3 HS CBDMIC

JamSHD 3 HS CBTC JamSHD 3 HS CBPHCO JamSHD 3 HS CBVC JamSHD 3 HS CBPB

$253.00 $506.00

JamSHD 5 JamSHD 5 HS CBDMIC JamSHD 5 HS CBTC JamSHD 5 HS CBPHCO JamSHD 5 HS CBVC JamSHD 5 HS CBPB

$298.00 $596.00

JamSHD 7 JamSHD 7 HS CBDMIC JamSHD 7 HS CBTC JamSHD 7 HS CBPHCO JamSHD 7 HS CBVC JamSHD 7 HS CBPB

$418.00 $836.00

Accessories – No charge Directional Microphone Telecoil Switchless Telecoil Volume Control Push Button

ITE

V5256 - Monaural Digital V5260 – Binaural Digital

Oticon – Full Shell Warranty Repair Period: 36 months

Model Name Model # Monaural unit price Binaural unit price Ria2 Full Shell 001-106-006 $199.00 $398.00 Ria2 Pro Full Shell 001-112-006 $225.00 $450.00 Nera2 Full Shell 001-151-006 $250.00 $500.00 Nera2 Pro Full Shell 001-163-006 $349.00 $698.00 Alta2 Pro Full Shell 001-334-006 $449.00 $898.00 Alta2 Full Shell 001-311-006 $399.00 $798.00 Opn 3 Full Shell 188696-FS $349.00 $698.00 Opn 2 Full Shell 188692-FS $449.00 $898.00

15

Oticon – Half Shell Warranty Repair Period: 36 months

Model Name Model # Monaural unit price Binaural unit price Ria2 Half Shell 001-106-004 $199.00 $398.00 Ria2 Pro Half Shell 001-112-004 $225.00 $450.00 Nera2 Half Shell 001-163-004 $250.00 $500.00 Nera2 Pro Half Shell 001-151-004 $349.00 $698.00 Alta2 Pro Half Shell 001-334-004 $449.00 $898.00 Alta2 Half Shell 001-311-004 $399.00 $798.00 Opn 3 Half Shell 188696-HS $349.00 $698.00 Opn 2 Half Shell 188692-HS $449.00 $898.00

ITE V5256 - Monaural Digital V5260 – Binaural Digital

Phonak – Full Shell Warranty Repair Period: 36 months Model Name Model # Monaural unit price Binaural unit price Virto V30 - 13 063-0158-01 $299.00 $598.00 Virto V50 - 13 063-0154-01 $385.00 $770.00 Virto B50 - 13 063-0238-01 $439.00 $878.00 Virto B30 - 13 063-0239-01 $352.00 $704.00

Phonak – Half Shell Warranty Repair Period: 36 months

Phonak – Low Profile Warranty Repair Period: 36 months

Model Name Model # Monaural unit price Binaural unit price Virto V30 - 312 063-0157-01 $299.00 $598.00 Virto V50 - 312 063-0153-01 $385.00 $770.00 Virto B50 - 312 063-0234-01 $439.00 $878.00 Virto B30 - 312 063-0235-01 $352.00 $704.00

Model Name Model # Monaural unit price Binaural unit price Virto V50 – Low Profile MC 063-0152-01 $385.00 $770.00 Virto B50 – Low Profile MC 063-0218-01 $439.00 $878.00 Virto B30 –10 Low Profile MC 063-0219-01 $352.00 $704.00 Virto V30 – Low Profile MC 063-0177-01 $299.00 $598.00

16

ITE

V5256 - Monaural Digital V5260 – Binaural Digital

ReSound – Full Shell Warranty Repair Period: 36 months

Model Name Model # Monaural unit price Binaural unit price Enya 3 Ultra Power Full Shell EY3ITE UP FS $300.00 $600.00 Enya 3 High Power Full Shell EY3ITE HP FS $300.00 $600.00 Enya 3 Medium Power Full Shell EY3ITE MP FS $300.00 $600.00 Enya 3 Directional Ultra Power Full Shell EY3ITE-D UP FS $300.00 $600.00 Enya 3 Directional High Power Full Shell EY3ITE-D HP FS $300.00 $600.00 Enya 3 Directional Medium Power Full Shell EY3ITE-D MP FS $300.00 $600.00 Enya 3 Wireless Ultra Power Full Shell EY3ITE-W UP FS $300.00 $600.00 Enya 3 Wireless High Power Full Shell EY3ITE-W HP FS $300.00 $600.00 Enya 3 Wireless Medium Power Full Shell EY3ITE-W MP FS $300.00 $600.00 Enya 3 Directional Wireless Ultra Power FS EY3ITE-DW UP FS $300.00 $600.00 Enya 3 Directional Wireless High Power FS EY3ITE-DW HP FS $300.00 $600.00 Enya 3 Directional Wireless Med Power FS EY3ITE-DW MP FS $300.00 $600.00 LiNX 3D 5 Ultra Power Full Shell LT5ITE-UP FS $397.00 $794.00 LiNX 3D 5 High Power Full Shell LT5ITE-HP FS $397.00 $794.00 LiNX 3D 5 Medium Power Full Shell LT5ITE-MP FS $397.00 $794.00 LiNX 3D 5 Directional Ultra Power Full Shell LT5ITE-D-UP FS $397.00 $794.00 LiNX 3D 5 Directional High Power Full Shell LT5ITE-D-HP FS $397.00 $794.00 LiNX 3D 5 Directional Medium Power FS LT5ITE-D-MP FS $397.00 $794.00 LiNX 3D 5 Wireless Ultra Power Full Shell LT5ITE-W-UP FS $397.00 $794.00 LiNX 3D 5 Wireless High Power Full Shell LT5ITE-W-HP FS $397.00 $794.00 LiNX 3D 5 Wireless Medium Power FS LT5ITE-W-MP FS $397.00 $794.00 LiNX 3D 5 Directional Wireless Ultra Power FS LT5ITE-DW-UP FS $397.00 $794.00 LiNX 3D 5 Directional Wireless High Power FS LT5ITE-DW-HP FS $397.00 $794.00 LiNX 3D 5 Directional Wireless Med Power FS LT5ITE-DW-MP FS $397.00 $794.00 LiNX 3D 7 Ultra Power Full Shell L7ITE-UP FS $448.00 $896.00 LiNX 3D 7 High Power Full Shell L7ITE-HP FS $448.00 $896.00 LiNX 3D 7 Medium Power Full Shell L7ITE-MP FS $448.00 $896.00 LiNX 3D 7 Directional Ultra Power Full Shell L7ITE-D-UP FS $448.00 $896.00 LiNX 3D 7 Directional High Power Full Shell L7ITE-D-HP FS $448.00 $896.00 LiNX 3D 7 Directional Med Power Full Shell L7ITE-D-MP FS $448.00 $896.00 LiNX 3D 7 Wireless Ultra Power Full Shell L7ITE-W-UP FS $448.00 $896.00 LiNX 3D 7 Wireless High Power Full Shell L7ITE-W-HP FS $448.00 $896.00 LiNX 3D 7 Wireless Medium Power FS L7ITE-W-MP FS $448.00 $896.00 LiNX 3D 7 Directional Wireless Ultra Power FS L7ITE-DW-UP FS $448.00 $896.00 LiNX 3D 7 Directional Wireless High Power FS L7ITE-DW-HP FS $448.00 $896.00 LiNX 3D 7 Directional Wireless Med Power FS L7ITE-DW-MP FS $448.00 $896.00 LiNX2 5 Ultra Power FS LS5ITE UP FS $397.00 $794.00 LiNX2 5 High Power FS LS5ITE HP FS $397.00 $794.00 LiNX2 5 Medium Power FS LS5ITE MP FS $397.00 $794.00 LiNX2 5 Directional Ultra Power FS LS5ITE-D UP FS $397.00 $794.00 LiNX2 5 Directional High Power FS LS5ITE-D HP FS $397.00 $794.00 LiNX2 5 Wireless Ultra Power FS LS5ITE-W UP FS $397.00 $794.00 LiNX2 5 Wireless High Power FS LS5ITE-W HP FS $397.00 $794.00 LiNX2 5 Wireless Medium Power FS LS5ITE-W MP FS $397.00 $794.00 LiNX2 5 Directional Medium Power FS LS5ITE-D MP FS $397.00 $794.00 LiNX2 5 Directional Wireless Ultra Power FS LS5ITE-DW UP FS $397.00 $794.00 LiNX2 5 Directional Wireless High Power FS LS5ITE-DW HP FS $397.00 $794.00 LiNX2 5 Directional Wireless Med Power FS LS5ITE-DW MP FS $397.00 $794.00 LiNX2 7 Ultra Power Full Shell LS7ITE UP FS $448.00 $896.00

17

Model Name Model # Monaural unit price Binaural unit price LiNX2 7 High Power Full Shell LS7ITE HP FS $448.00 $896.00 LiNX2 7 Medium Power Full Shell LS7ITE MP FS $448.00 $896.00 LiNX2 7 Directional Ultra Power Full Shell LS7ITE-D UP FS $448.00 $896.00 LiNX2 7 Directional High Power Full Shell LS7ITE-D HP FS $448.00 $896.00 LiNX2 7 Directional Medium Power FS LS7ITE-D MP FS $448.00 $896.00 LiNX2 7 Wireless Ultra Power Full Shell LS7ITE-W UP FS $448.00 $896.00 LiNX2 7 Wireless High Power Full Shell LS7ITE-W HP FS $448.00 $896.00 LiNX2 7 Wireless Medium Power Full Shell LS7ITE-W MP FS $448.00 $896.00 LiNX2 7 Directional Wireless Ultra Power FS LS7ITE-DW UP FS $448.00 $896.00 LiNX2 7 Directional Wireless High Power FS LS7ITE-DW HP FS $448.00 $896.00 LiNX2 7 Directional Wireless Med Power FS LS7ITE-DW MP FS $448.00 $896.00

ITE

V5256 - Monaural Digital V5260 – Binaural Digital ReSound – Half-Shell Warranty Repair Period: 36 months

Model Name Model # Monaural unit price Binaural unit price Enya 3 Ultra Power Half Shell EY3ITE UP HS $300.00 $600.00 Enya 3 High Power Half Shell EY3ITE HP HS $300.00 $600.00 Enya 3 Medium Power Half Shell EY3ITE MP HS $300.00 $600.00 Enya 3 Directional Ultra Power Half Shell EY3ITE-D UP HS $300.00 $600.00 Enya 3 Directional High Power Half Shell EY3ITE-D HP HS $300.00 $600.00 Enya 3 Directional Medium Power Half Shell EY3ITE-D MP HS $300.00 $600.00 Enya 3 Wireless Ultra Power Half Shell EY3ITE-W UP HS $300.00 $600.00 Enya 3 Wireless High Power Half Shell EY3ITE-W HP HS $300.00 $600.00 Enya 3 Wireless Medium Power Half Shell EY3ITE-W MP HS $300.00 $600.00 Enya 3 Directional Wireless Ultra Power HS EY3ITE-DW UP HS $300.00 $600.00 Enya 3 Directional Wireless High Power HS EY3ITE-DW HP HS $300.00 $600.00 Enya 3 Directional Wireless Medium Pwr HS EY3ITE-DW MP HS $300.00 $600.00 LiNX3D 5 Ultra Power Half Shell L5ITE-UP HS $397.00 $794.00 LiNX3D 5 High Power Half Shell L5ITE-HP HS $397.00 $794.00 LiNX3D 5 Medium Power Half Shell L5ITE-MP HS $397.00 $794.00 LiNX3D 5 Directional Ultra Power HS L5ITE-D-UP HS $397.00 $794.00 LiNX3D 5 Directional High Power HS L5ITE-D-HP HS $397.00 $794.00 LiNX3D 5 Directional Medium Power HS L5ITE-D-MP HS $397.00 $794.00 LiNX3D 5 Wireless Ultra Power HS L5ITE-W-UP HS $397.00 $794.00 LiNX3D 5 Wireless High Power HS L5ITE-W-HP HS $397.00 $794.00 LiNX3D 5 Wireless Medium Power HS L5ITE-W-MP HS $397.00 $794.00 LiNX3D 5 Directional Wireless Ultra Power HS L5ITE-DW-UP HS $397.00 $794.00 LiNX3D 5 Directional Wireless High Power HS L5ITE-DW-HP HS $397.00 $794.00 LiNX3D 5 Directional Wireless Med Power HS L5ITE-DW-MP HS $397.00 $794.00 LiNX3D 7 Ultra Power Half Shell L7ITE-UP HS $448.00 $896.00 LiNX3D 7 High Power Half Shell L7ITE -HP HS $448.00 $896.00 LiNX3D 7 Medium Power Half Shell L7ITE-MP HS $448.00 $896.00 LiNX3D 7 Directional Ultra Power HS L7ITE-D-UP HS $448.00 $896.00 LiNX3D 7 Directional High Power HS L7ITE-D-HP HS $448.00 $896.00 LiNX3D 7 Directional Medium Power HS L7ITE-D-MP HS $448.00 $896.00 LiNX3D 7 Wireless Ultra Power HS L7ITE-W-UP HS $448.00 $896.00 LiNX3D 7 Wireless High Power HS L7ITE-W-HP HS $448.00 $896.00 LiNX3D 7 Wireless Medium Power HS L7ITE-W-MP HS $448.00 $896.00 LiNX3D 7 Directional Wireless Ultra Power HS L7ITE-DW-UP HS $448.00 $896.00 LiNX3D 7 Directional Wireless High Power HS L7ITE-DW-HP HS $448.00 $896.00 LiNX3D 7 Directional Wireless Med Power HS L7ITE-DW-MP HS $448.00 $896.00

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Model Name Model # Monaural unit price Binaural unit price LiNX2 5 Ultra Power HS LS5ITE UP HS $397.00 $794.00 LiNX2 5 High Power HS LS5ITE HP HS $397.00 $794.00 LiNX2 5 Medium Power HS LS5ITE MP HS $397.00 $794.00 LiNX2 5 Directional Ultra Power HFS LS5ITE-D UP HS $397.00 $794.00 LiNX2 5 Directional High Power HS LS5ITE-D HP HS $397.00 $794.00 LiNX2 5 Directional Medium Power HS LS5ITE-D MP HS $397.00 $794.00 LiNX2 5 Wireless Ultra Power HS LS5ITE-W UP HS $397.00 $794.00 LiNX2 5 Wireless High Power HS LS5ITE-W HP HS $397.00 $794.00 LiNX2 5 Wireless Medium Power HS LS5ITE-W MP HS $397.00 $794.00 LiNX2 5 Directional Wireless Ultra Power HS LS5ITE-DW UP HS $397.00 $794.00 LiNX2 5 Directional Wireless High Power HS LS5ITE-DW HP HS $397.00 $794.00 LiNX2 5 Directional Wireless Medium Pwr HS LS5ITE-DW MP HS $397.00 $794.00 LiNX2 7 Ultra Power Half Shell LS7ITE UP HS $448.00 $896.00 LiNX2 7 High Power Half Shell LS7ITE HP HS $448.00 $896.00 LiNX2 7 Medium Power Half Shell LS7ITE MP HS $448.00 $896.00 LiNX2 7 Directional Ultra Power Half Shell LS7ITE-D UP HS $448.00 $896.00 LiNX2 7 Directional High Power Half Shell LS7ITE-D HP HS $448.00 $896.00 LiNX2 7 Directional Medium Power Half Shell LS7ITE-D MP HS $448.00 $896.00 LiNX2 7 Wireless Ultra Power Half Shell LS7ITE-W UP HS $448.00 $896.00 LiNX2 7 Wireless High Power Half Shell LS7ITE-W HP HS $448.00 $896.00 LiNX2 7 Wireless Medium Power Half Shell LS7ITE-W MP HS $448.00 $896.00 LiNX2 7 Directional Wireless Ultra Power HS LS7ITE-DW UP HS $448.00 $896.00 LiNX2 7 Directional Wireless High Power HS LS7ITE-DW HP HS $448.00 $896.00 LiNX2 7 Directional Wireless Med Power HS LS7ITE-DW MP HS $448.00 $896.00


Rexton – Full Shell Warranty Repair Period: 36 months

Model Name Model # Monaural unit price Binaural unit price Sterling 80 6c Sterling 80 6c ITE $419.76 $839.52 Sterling 60 6c Sterling 60 6c ITE $390.25 $780.50

Signia –Full Shell Warranty Repair Period: 36 months

Model Name Model # Monaural unit price Binaural unit price Insio 3px Insio 3px ITE $427.05 $854.10 Insio 2px Insio 2px ITE $339.60 $679.20 Insio 1px Insio 1px ITE $283.05 $566.10

Starkey – Full Shell Warranty Repair Period: 24 months, except: Muse i2400s and iQ i2400s: 36 months

Model Name Model # Monaural unit price Binaural unit price 3 Series

3 Series 20 ITE 3 Series 20 ITE $299.00 $598.00 Muse iQ

Muse iQ i2400 ITE Muse iQ i2400 ITE $439.00 $878.00 Muse iQ i2000 ITE Muse iQ i2000 ITE $419.00 $838.00

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Model Name Model # Monaural unit price Binaural unit price Muse iQ i1600 ITE Muse iQ i1600 ITE $399.00 $798.00

Muse Muse i2400 ITE Muse i2400 ITE $439.00 $878.00 Muse i2000 ITE Muse i2000 ITE $419.00 $838.00 Muse i1600 ITE Muse i1600 ITE $399.00 $798.00 Muse i1200 ITE Muse i1200 ITE $329.00 $658.00 Muse i1000 ITE Muse i1000 ITE $279.00 $558.00


Starkey – Half Shell Warranty Repair Period: 24 months, except: Muse i2400s and iQ i2400s: 36 months

Model Name Model # Monaural unit price Binaural unit price 3 Series

3 Series 20 HS 3 Series 20 HS $299.00 $598.00 Muse iQ

Muse iQ i2400 HS Muse iQ i2400 HS $439.00 $878.00 Muse iQ i2000 HS Muse iQ i2000 HS $419.00 $838.00 Muse iQ i1600 HS Muse iQ i1600 HS $399.00 $798.00

Muse Muse i2400 HS Muse i2400 HS $439.00 $878.00 Muse i2000 HS Muse i2000 HS $419.00 $838.00 Muse i1600 HS Muse i1600 HS $399.00 $798.00 Muse i1200 HS Muse i1200 HS $329.00 $658.00 Muse i1000 HS Muse i1000 HS $279.00 $558.00

Unitron – Full Shell Warranty Repair Period: 36 months

Model Name Model # Monaural unit price Binaural unit price Insera Full Shell 700 INSERA700FS $448.00 $896.00 Insera Full Shell 600 INSERA600FS $385.00 $770.00 Insera Full Shell 500 INSERA500FS $299.00 $598.00

Unitron – Half Shell Warranty Repair Period: 36 months

Model Name Model # Monaural unit price Binaural unit price Insera HALF Shell 700 INSERA700HS $448.00 $896.00 Insera HALF Shell 600 INSERA600HS $385.00 $770.00 Insera HALF Shell 500 INSERA500HS $299.00 $598.00

Widex – Full Shell Warranty Repair Period: 36 months Model Name Model # Monaural unit price Binaural unit price Evoke-XP 220 ITE FS E2XPF $440.00 $880.00 Evoke-IM 220 ITE FS E2IMF $440.00 $880.00 Evoke-IP 220 ITE FS E2IPF $440.00 $880.00

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Model Name Model # Monaural unit price Binaural unit price Evoke-IM 110 ITE FS E1XPF $350.00 $700.00 Evoke-IM ITE FS E1IMF $350.00 $700.00 Evoke-IP 110 ITE FS E1IPF $350.00 $700.00 Unique 110 ITE FS U1-XPF $315.00 $630.00 Unique 220 ITE FS U2-XPF $385.00 $770.00

Widex – Half Shell Warranty Repair Period: 36 months Model Name Model # Monaural unit price Binaural unit price Evoke-XP 220 ITE HS E2XPH $440.00 $880.00 Evoke-IM 220 ITE H S E2IMH $440.00 $880.00 Evoke-IP 220 ITE HS E2IPH $440.00 $880.00 Evoke-XP 110 ITE HS E1XPH $350.00 $700.00 Evoke-IM ITE HS E1IMH $350.00 $700.00 Evoke-IP 110 ITE HS E1IPH $350.00 $700.00 Unique 110 ITE HS U1-XPH $315.00 $630.00 Unique 220 ITE HS U2-XPH $385.00 $770.00

Personal Frequency Modulation (FM) Systems, Assistive Listening Devices Authorization required – refer to MHCP Provider Manual for more information

NOTE: When requesting authorization for FM/DM ALD systems V5281 or V5282, list either HCPCS and the appropriate dispensing code on the Authorization Request form. You must also list the individual components on the medical documentation; include the HCPCS, model names, model numbers and unit prices. Do not bill individual ALD/FM components using HCPCS codes V5283 - V5290 on the same claim; they will deny due to NCCI conflicts.

Oticon - V5288 Assistive Listening Device, personal FM/DM transmitter Warranty Repair Period: 36 months

Model Name Model # Unit price Amigo T5 001-056-022 $261.75

Oticon - V5285 Assistive Listening Device, personal FM/DM direct audio input receiver Warranty Repair Period: 36 months

Model Name Model # Unit price Amigo R5 001-056-023 $336.75 Amigo R2 001-055-023 $486.75 Amigo R12G2 001-055-023-R12 $486.75

Oticon - V5283 Assistive Listening Device, personal FM/DM neck, loop induction receiver Warranty Repair Period: 36 months

Model Name Model # Unit price Amigo Arc 001-054-023 $449.25

Oticon - V5284 Assistive Listening Device, personal FM/DM, ear level receiver Warranty Repair Period: 36 months

Model Name Model # Unit price Amigo Star 001-055-062 $449.25

https://mn.gov/dhs/partners-and-providers/policies-procedures/minnesota-health-care-programs/provider/billing/ncci.jsp

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Oticon - V5290 Assistive Listening Device, transmitter microphone, any type Warranty Repair Period: 36 months

Model Name Model # Unit price Amigo T30 001-055-052 $486.75

Phonak - V5273 Assistive Listening Device for cochlear implant Repair Warranty Period: 24 months

Model Name Model # Unit price Roger 14 (02) Pediatric Integrated Receiver

052-3222-D02XX $601.90

Roger 14 (03) Adult Integrated Receiver

052-3223-D03XX $481.00

Roger 17 (02) Pediatric Integrated Receiver

052-3235-D02XX $601.90

Roger 17 (03) Adult Receiver 052-3236-D03XX $481.00

Phonak - V5281 Assistive Listening Device, personal FM/DM system, monaural, (1 receiver, transmitter, microphone), any type Repair Warranty Period: Per individual component

Note: The following model numbers contain ‘underscores’:

Model Name Model # Unit price Roger Adult Monaural FM_ADULT_MON Price is total of all components

included in system Roger Pediatric Monaural FM_PED_MON

Phonak - V5282 Assistive Listening Device, personal FM/DM system, binaural (2 receivers, transmitter, microphone), any type Repair Warranty: Per individual component

Note: The following model numbers contain ‘underscores’:

Model Name Model # Unit price Roger Adult Binaural FM_ADULT_BIN Price is total of all components

included in the FM system Roger Pediatric Binaural FM_PED_BIN

Phonak - V5283 Assistive Listening Device, personal FM/DM neck, loop induction receiver Repair Warranty Period: 24 months

Model Name Model # Unit price Roger MyLink (02) Pediatric Receiver 052-0502 $454.35 Roger MyLink (02) Pediatric Receiver (short loop) 052-0501 $454.35 Roger MyLink (03) Adult Receiver (includes charger) 052-0510 $390.00

Phonak -V5284 Assistive Listening Device, personal FM/DM, ear level receiver Repair Warranty Period: 24 months

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Model Name Model # Unit price Roger Focus (02) Receiver 052-3272-D02XX $487.50 Roger X (02) Pediatric Receiver 052-3113-D02P5 $601.90 Roger X (03) Adult Receiver 052-3215-D03P5 $481.00 Roger 10 (03) Adult Integrated Receiver 052-3216-D03XX $481.00 Roger 11 (02) Pediatric Integrated Receiver 052-3183-D02XX $601.90 Roger 11 (03) Adult Integrated Receiver 052-3217-D03XX $481.00 Roger 15 (02) Pediatric Integrated Receiver 052-3116-D02XX $601.90 Roger 15 (03) Adult Integrated Receiver 052-3218-D03XX $481.00 Roger 16 (02) Pediatric Integrated Receiver 052-3189-D02XX $601.90 Roger 16 (03) Adult Integrated Receiver 052-3190-D03XX $481.00 Roger 18 (02) Pediatric Integrated Receiver 052-3281-D02XX $601.90 Roger 18 (03) Adult Integrated Receiver 052-3236-D03XX $481.00 Roger 19 (02) Pediatric Integrated Receiver 052-3291-D02XX $601.90 Roger 19 (03) Adult Integrated Receiver 052-3292-D03XX $481.00 Roger 20 Pediatric Integrated Receiver 052-3317-D02XX $601.90 Roger 21 Pediatric Integrated Receiver 052-3469-D02XX $601.90

Phonak - V5288 Assistive Listening Device, personal FM/DM transmitter Repair Warranty Period: 24 months

Model Name Model # Unit price Roger Easy Pen Transmitter 052-3285-000XX $503.75 Roger Pen Transmitter 052-3191-000XX $536.25 Roger Clip-On Mic-Transmitter 052-3294 $416.00 Roger Select 052-3477-000XX $585.00

Other Hearing Aid Codes Code Description Notes V5050 Monaural ITE These codes always require

authorization

V5060 Monaural BTE V5070 Air Conductive – hearing aid in glasses V5080 Bone Conductive – hearing aid in glasses V5090 Dispensing Fee, unspecified hearing aid

(for FM System or vibrotactile device) V5100 Hearing aid, bilateral, body worn V5110 Dispensing fee, bilateral V5130 Binaural ITE V5140 Binaural BTE V5150 Binaural – hearing aid in glasses V5190 CROS, in glasses V5230 BiCROS, in glasses V5246 Monaural digitally programmable ITE V5252 Binaural digitally programmable ITE V5253 Binaural digitally programmable BTE V5273 Assistive listening device, for use with cochlear implant V5274 Assistive listening device, not otherwise specified V5281 Assistive listening device, personal FM/DM system,

monaural,(1 receiver, transmitter, microphone,) any type V5282 Assistive listening device, personal FM/DM system, binaural, (2

receivers, transmitter, microphone,) any type V5283 Assistive listening device, personal FM/DM neck, loop induction

receiver V5284 Assistive listening device, personal FM/DM, ear level receiver V5285 Assistive listening device, personal FM/DM direct audio input

receiver V5286 Assistive listening device, personal blue tooth FM/DM receiver

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Code Description Notes V5288 Assistive listening device, personal FM/DM transmitter V5290 Assistive listening device, transmitter microphone, any type V5298 Hearing aid, not otherwise classified

Dispensing Fees Code Description Notes V5110 Dispensing Fee, Bilateral If hearing aid requires authorization,

dispensing fee also requires authorization

V5160 Dispensing Fee, Binaural V5200 CROS Dispensing Fee V5240 BiCROS Dispensing Fee V5241 Monaural Dispensing Fee, any type

General Hearing Aid Services Code Description Notes V5011 Hearing aid checks. May not be billed during trial period. Use to bill programming aids. V5014 Repair/modification of a hearing aid. Attachment required with description of

repair service. V5264 Ear mold/insert, not disposable, any type V5266 Batteries for use in hearing device (see manual for coverage) Use for standard hearing aid batteries. V5267 Hearing aid or assistive listening device/supplies/accessories

not otherwise specified Invoice attachment required.Use for rechargeable hearing aid batteries.

V5275 Ear impression, each V5299 Hearing service, miscellaneous Requires a description

Non-Covered Hearing Aids Code Description V5242 Analog, Monaural – CIC V5243 Analog, Monaural – ITC V5244 Digitally Programmable Analog, Monaural – CIC V5245 Digitally Programmable Analog, Monaural – ITC V5248 Analog, Binaural – CIC V5249 Analog, Monaural – ITC V5250 Digitally Programmable Analog, Binaural – CIC V5251 Digitally Programmable Analog, Binaural – ITC V5254 Digital, Monaural – CIC V5255 Digital, Monaural – ITC V5258 Digital, Binaural – ITC V5259 Digital, Binaural – ITC V5262 Disposable, Monaural, any type V5263 Disposable, Binaural, any type V5265 Ear mold/insert, disposable, any type V5268 Assistive Listening Device, telephone amplifier, any type V5269 Assistive listening device, alerting type, any type V5270 Assistive listening device, television amplifier, any type V5271 Assistive listening device, television caption decoder V5272 Assistive listening device, TDD

2018 hearing aid contract and vendors

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