medicaid policy bulletin - michigan use standard commercial batteries and battery sizes o be...

Bulletin

Michigan Department of Community Health

Bulletin Number: MSA 09-03 Distribution: Hearing Aid Dealers, Audiologists/Hearing Centers, Outpatient Hospitals, Practitioners Medicaid Health Plans Issued: January 1, 2009 Subject: Volume Purchase Contract for Hearing Aids Effective: February 1, 2009 Programs Affected: Medicaid, Children’s Special Health Care Services (CSHCS) The Michigan Department of Community Health (MDCH) has elected to participate in a volume purchase contract arrangement for hearing aids, and has joined with Minnesota Medicaid and Wisconsin Medicaid in their current contract. Effective for dates of service on or after February 1, 2009, covered hearing aids for both children and adults are indicated on the attached list of participating vendors/models. Prior authorization will not be required for initial analog or digital/programmable hearing aids if all other hearing aid requirements are met and restrictions, i.e., frequency of replacement, are not exceeded. Providers must purchase hearing aids directly from the manufacturers/vendors that contract with MDCH. Hearing aid dealers and licensed audiologists affiliated with a hearing center must bill and will be reimbursed the contract price for the hearing aid. The policy and the amount paid for dispensing fees will not change for non-contracted hearing aids. The terms of the hearing aid contract are as follows: • Hearing aids must:

o Be new, current production models o Be complete instruments, including all necessary equipment to make it fully functional and fit properly o Use standard commercial batteries and battery sizes o Be accompanied by a live performance graph and invoice at the contracted price o Have a minimum 24-month manufacturer warranty covering parts and labor, not including ear piece, cord,

and batteries o Have a 12-month loss and damage warranty

• No extra charge may be made for:

o Specialty molded ear piece/ear molds o Casing color choice o Hypo-allergenic or soft canal casing o Packaging, postage, insurance, or handling while the aid is under any original or repair warranty

MSA 09-03 of 2

Other information regarding the contract: • Hearing aids that do not prove satisfactory to a user are to be returned to the manufacturer within 90 days

from the date the hearing aid is provided to the beneficiary at no cost to MDCH or the hearing aid dealer or licensed audiologist affiliated with a hearing center.

• The contract price for a hearing aid cannot be further reduced or altered. • Manufacturers will not process hearing aid orders unless all applicable authorization requirements are met. Medicaid covers the most cost-effective alternative that meets the beneficiary’s medical need. If a beneficiary requires a hearing aid not included on the attached list, prior authorization is required along with documentation stating why none of the contracted hearing aids will suffice for the specific beneficiary. Payment for a contracted hearing aid includes all repairs and modifications for a two-year period and loss and/or damaged replacements for a one-year period. Repairs required after the new hearing aid repair warranty has expired will be reimbursed based on the contracted rate and will have a new warranty period specified per the contract. When a contracted hearing aid requires a repair, MDCH will not reimburse the hearing aid dealer/audiologist for hearing aid fitting/checking services. Manufacturers will not charge for packing, shipping, invoicing, postage, insurance, or handling while the hearing aid is under warranty and as long as the manufacturer is participating under the terms of the Contract. The Manufacturer will also be responsible for all shipping costs on non-warranty equipment repairs. With the exception of modifications and adjustments required within the manufacturer’s warranty period, the dispensing fee will now cover all services and products listed in section 1.7 of the Hearing Aid Dealers Policy for a period of 90 days. No prior authorization is required for repairs to hearing aids purchased under the contract. The processing fee of $19.20 may be added to the repair cost for hearing aids that are not covered under warranty. When billing for new contracted hearing aids or repair of contracted hearing aids, please include the correct model name and model number in the comments section of the claim form. The repair charge must not exceed the contracted price. As a reminder, licensed hearing aid dealers and licensed audiologists affiliated with hearing centers may dispense hearing aids. Medicaid health plans have the option of participating in the contract, but are not required to do so. Manual Maintenance Retain this bulletin until the information has been incorporated into the Michigan Medicaid Provider Manual. Questions Any questions regarding this bulletin should be directed to Provider Inquiry, Department of Community Health, P.O. Box 30731, Lansing, Michigan 48909-8231, or e-mail at [email protected]. When you submit an e-mail, be sure to include your name, affiliation, and phone number so you may be contacted if necessary. Providers may phone toll-free 1-800-292-2550. Approved Paul Reinhart, Director Medical Services Administration

mailto:[email protected]

February 2009 MDCH Hearing Aid Contract Vendors, Models, Prices, Codes Page 1 of 22

V5030 - Body-Worn Hearing Aid Air; applicable modifiers - LT (Left Side), RT (Right Side)Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyOticon P11P 001-990-010 $275.00 $75.00 6 months

P11P, cord 001-990-010 $283.00P11P, Y-cord 001-990-010 $290.00P11P, single air conduction receiver 001-990-010 $300.00

Rexton Fusion PP + 5636282 $168.00 $80.00 12 months

V5040 - Body-Worn Hearing Aid Bone; applicable modifiers - LT (Left Side), RT (Right Side)Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyOticon P11P 001-990-010 $275.00 $75.00 6 months

P11P, cord 001-990-010 $283.00P11P, Y-cord 001-990-010 $290.00P11P, single bone conduction receiver 001-990-010 $350.00

Rexton Fusion PP + 5636282 $275.00 $80.00 12 months

V5050 - Hearing Aid Monaural In Ear; applicable modifiers - LT (Left Side), RT (Right Side)Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyElectone Analog FS 0202430101ST $109.88 $61.00 6 months

Analog, T-coil FS 0202430503TC0101ST $140.06Analog FS 0202440101ST $140.76Analog, T-coil FS 0202440503TC0101ST $171.36Analog FS 0202490101ST $140.85Analog, T-coil FS 0202490503TC0101ST $171.50Analog AGC, Trimpot FS 0202450101ST $139.95Analog AGC, Trimpot, T-coil FS 0202450503TC0101ST $171.50Analog HS 0202430101HS $150.88Analog, T-coil HS 0202430503TC0101HS $179.00Analog HS 0202440101HS $172.02Analog, T-coil HS 0202440503TC0101HS $201.96Analog w/AGC-O, Trimpot HS 0202450101HS $171.58Analog w/AGC-O, Trimpot, T-coil HS 0202450503TC0101HS $201.50

V5060 - Behind Ear Hearing Aid; applicable modifiers - LT (Left Side), RT (Right Side)Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyOticon Personic 410 Classic (BTE) 001-992-410 $300.00 $75.00 6 months

Personic 420 Power (BTE) 001-992-420 $300.00Personic 425 Power Plus (BTE) 001-992-425 $300.00380P (BTE) 001-991-380 $300.00 $90.00 12 months

Unitron US80 SuperPower (BTE) US80 $324.00 $75.00 12 months

HCPCS codes, descriptions, two digit modifiers are Copyright American Medical Assocation. All Rights Reserved.The applicable model name and number from the contract must be included on all claim submissions. Attachment I - MSA 09-03


V5120 - Body-Worn Binaur Hearing AidManufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyRexton Fusion PP + 5636282 $203.00 $80.00 12 months

V5130 - In Ear Binaural Hearing AidManufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyElectone Analog FS 0202430101ST $219.76 $61.00 6 months

Analog, T-coil FS 0202430503TC0101ST $280.12Analog FS 0202440101ST $281.52Analog, T-coil FS 0202440503TC0101ST $342.72Analog FS 0202490101ST $281.70Analog, T-coil FS 0202490503TC0101ST $343.00Analog AGC, Trimpot FS 0202450101ST $279.90Analog AGC, Trimpot, T-coil FS 0202450503TC0101ST $343.00Analog HS 0202430101HS $301.76Analog, T-coil HS 0202430503TC0101HS $358.00Analog HS 0202440101HS $344.04Analog, T-coil HS 0202440503TC0101HS $403.92Analog w/AGC-O, Trimpot HS 0202450101HS $343.16Analog w/AGC-O, Trimpot, T-coil HS 0202450503TC0101HS $403.00

V5140 - Behind Ear Binaur Hearing AidManufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyOticon Personic 410 Classic (BTE) 001-992-410 $600.00 $75.00 6 months

Personic 420 Power (BTE) 001-992-420 $600.00Personic 425 Power Plus (BTE) 001-992-425 $600.00380P (BTE) 001-991-380 $600.00 $90.00 12 months

Unitron US80 SuperPower (BTE) US80 $648.00 $75.00 12 months

V5180 - Behind Ear CROS Hearing Aid - Requires PRIOR AUTH; applicable modifiers - LT (Left Side), RT (Right Side)Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyOticon Gaia BTE CROS 001-006-010 $450.00 $100.00 12 months

Gaia BTE VC CROS 001-006-020 $450.00Gaia BTE Direct CROS 001-006-013 $450.00Gaia BTE Power CROS 001-006-012 $450.00GoPro BTE CROS 001-012-010 $325.00GoPro BTE VC CROS 001-012-020 $325.00GoPro Power Direct CROS (BTE) 001-012-012 $325.00GoPro Power CROS (BTE) 001-012-012-OMNI $325.00



Ergo BTE CROS 001-003-010 $300.00Ergo Power BTE CROS 001-003-012 $300.00

V5180 - Behind Ear CROS Hearing Aid - Requires PRIOR AUTH; applicable modifiers - LT (Left Side), RT (Right Side)Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyOticon (continued)

380P CROS (BTE) 001-991-380 $375.00 $90.00 12 monthsPersonic 410 Classic CROS (BTE) 001-992-410 $375.00 $75.00 6 monthsPersonic 420 Power CROS (BTE) 001-992-420 $375.00Personic 425 Power Plus CROS (BTE) 001-992-425 $375.00

Unitron Unison 6WiFi CROS (BTE) U6WiFi $447.13 $75.00 12 months

V5220 - Behind Ear BICROS Hearing Aid - Requires PRIOR AUTH; applicable modifiers - LT (Left Side), RT (Right Side)Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyOticon Gaia BTE BICROS 001-006-010 $900.00 $100.00 12 months

Gaia BTE VC BICROS 001-006-020 $900.00Gaia BTE Direct BICROS 001-006-013 $900.00Gaia BTE Power BICROS 001-006-012 $900.00GoPro BTE BICROS 001-012-010 $650.00GoPro VC BTE BICROS 001-012-020 $650.00GoPro Power Direct BICROS (BTE) 001-012-012 $650.00GoPro Power BICROS (BTE) 001-012-012-OMNI $650.00Ergo BTE BICROS 001-003-010 $600.00Ergo BTE Power BICROS 001-003-012 $600.00380P BICROS (BTE) 001-991-380 $750.00 $90.00 12 monthsPersonic 410 Classic BICROS (BTE) 001-992-410 $750.00 $75.00 6 monthsPersonic 420 Power BICROS (BTE) 001-992-420 $750.00Personic 425 Power Plus BICROS (BTE) 001-992-425 $750.00

Unitron Unison 6WiFi BICROS (BTE) U6WiFi $894.26 $75.00 12 months

V5246 - Hearing Aid, Prog, Mon, ITE; applicable modifiers - LT (Left Side), RT (Right Side)Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyOticon Ergo FS 001-003-006 $225.00 $100.00 12 months

Ergo FS, Telecoil 001-003-006 $250.00Ergo HS 001-003-004 $225.00Ergo HS, Telecoil 001-003-004 $250.00Ergo LPF 001-003-005 $225.00Ergo LPF, Telecoil 001-003-005 $250.00

V5247 - Hearing Aid, Prog, Mon, BTE; applicable modifiers - LT (Left Side), RT (Right Side)Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyOticon Sumo XP (BTE) 001-010-030 $399.00 $100.00 12 months



Ergo BTE 001-003-010 $225.00Ergo BTE Power 001-003-012 $225.00

V5252 - Hearing Aid, Prog, Bin, ITEManufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyOticon Ergo FS 001-003-006 $450.00 $100.00 12 months

Ergo FS, Telecoil 001-003-006 $500.00Ergo HS 001-003-004 $450.00Ergo HS, Telecoil 001-003-004 $500.00Ergo LPF 001-003-005 $450.00Ergo LPF, Telecoil 001-003-005 $500.00

V5253 - Hearing Aid, Prog, Bin, BTEManufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyOticon Sumo XP (BTE) 001-010-030 $798.00 $100.00 12 months

Ergo BTE 001-003-010 $450.00Ergo BTE Power 001-003-012 $450.00

V5255 - Hearing Aid, Digit, Mon, ITC; applicable modifiers - LT (Left Side), RT (Right Side)Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyMicro Ear Radius 8 HS Radius 8 HS $379.99 $89.99 6 months

Radius 8, Induction Coil HS Radius 8 HS TC $384.99Radius 8, Induction Coil, Dynamic Dir HS Radius 8 HS TCDSD $389.99Radius 4 HS Radius 4 HS $369.99Radius 4, Induction Coil HS Radius 4 HS TC $374.99Radius 4, Induction Coil, Dynamic Dir HS Radius 4 HS TCDSD $379.99Radius 2 HS Radius 2 HS $304.99Radius 2, Induction Coil HS Radius 2 HS TC $309.99Radius 12 HS Radius 12 HS $389.99Radius 12, Induction Coil HS Radius 12 HS TC $394.99Radius 12, Induction Coil, Dynamic Dir HS Radius 12 HS TCDSD $400.00

V5256 - Hearing Aid, Digit, Mon, ITE; applicable modifiers - LT (Left Side), RT (Right Side)Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyElectone Digital One Channel FS 0202670101ST $160.00 $94.00 6 months

Digital One Channel, T-Coil FS 0202670503TC0101ST $189.20Digital Two Channel, Two Trimpots FS 0202660101ST $200.00Digital Two Channel, Two Trimpots, T-Coil FS 0202660503TC0101ST $233.20Digital Single Channel FS 0202700101ST $200.00Digital Single Channel, T-Coil FS 0202700503TC0101ST $233.20



Digital Two Channel FS 0202AA0101ST $264.00Digital Two Channel, T-Coil FS 0202AA0503TC0101ST $264.60Digital Four Channel FS 0202AB0101ST $304.00Digital Four Channel, T-Coil FS 0202AB0503TC0101ST $332.00

V5256 - Hearing Aid, Digit, Mon, ITE; applicable modifiers - LT (Left Side), RT (Right Side)Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyElectone (continued)

Single Channel Digital, LC Trimpot HS 0202670101HS $160.00 $94.00 6 monthsSingle Channel Digital, LC Trimpot, T-Coil HS 0202670503TC0101HS $189.20Two Channel Digital, AG-C-I, AGC-O HS 0202660101HS $200.00Two Channel Digital, AG-C-I, AGC-O, T-Coil HS 0202660503TC0101HS $233.20Digital One Channel HS 0202700101HS $200.00Digital One Channel, T-Coil HS 0202700503TC0101HS $233.20Digital Two Channel HS 0202AA0101HS $264.00Digital Two Channel, T-Coil HS 0202AA0503TC0101HS $289.80Digital Four Channel HS 0202AB0101HS $304.00Digital Four Channel, T-Coil HS 0202AB0503TC0101HS $332.00

GN Resound Pixel Power, Directional FS PL50-DP $381.15 $95.00 12 monthsPixel Standard, Directional FS PL50-D $371.25Ziga Power, Directional FS ZG50-DP $312.50Ziga Standard, Directional FS ZG50-D $312.50Ziga Power FS ZG50-P $312.50Ziga Standard FS ZG50 $312.50Plus5 Power, Directional FS RP50-DP $256.70Plus5 Standard, Directional FS RP50-D $246.50Plus5 Power FS RP50-P $246.50Plus5 Standard FS RP50 $234.60Ziga Power, Directional HS ZG40-DP $312.50Ziga Standard, Directional HS ZG40-D $312.50Ziga Power HS ZG40-P $312.50Ziga Standard HS ZG40 $312.50Plus5 Power, Directional HS RP40-DP $256.70Plus5 Standard, Directional HS RP40-D $246.50Plus5 Power HS RP40-P $246.50Plus5 Standard HS RP40 $234.60

Micro Ear Radius 8 FS Radius 8 ITE $369.99 $89.99 6 monthsRadius 8, Induction Coil FS Radius 8 ITE TC $374.99Radius 8, Induction Coil, Dynamic Dir FS Radius 8 ITE TCDSD $379.99Radius 4 FS Radius 4 ITE $359.99Radius 4, Induction Coil FS Radius 4 ITE TC $364.99Radius 4, Induction Coil, Dynamic Dir FS Radius 4 ITE TCDSD $369.99Radius 2 FS Radius 2 ITE $294.99



Radius 2, Induction Coil FS Radius 2 ITE TC $299.99Radius 12 FS Radius 12 ITE $380.00Radius 12, Induction Coil FS Radius 12 ITE TC $385.00Radius 12, Induction Coil, Dynamic Dir FS Radius 12 ITE TCDSD $389.99Radius 8 LPF Radius 8 LPF $374.99

V5256 - Hearing Aid, Digit, Mon, ITE; applicable modifiers - LT (Left Side), RT (Right Side)Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyMicro Ear (continued)

Radius 8, Induction Coil LPF Radius 8 LPF TC $379.99 $89.99 6 monthsRadius 8, Induction Coil, Dynamic Dir LPF Radius 8 LPF TCDSD $384.99Radius 4 LPF Radius 4 LPF $364.99Radius 4, Induction Coil LPF Radius 4 LPF TC $369.99Radius 4, Induction Coil, Dynamic Dir LPF Radius 4 LPF TCDSD $374.99Radius 2 LPF Radius 2 LPF $299.99Radius 2, Induction Coil LPF Radius 2 LPF TC $304.99Radius 12 LPF Radius 12 LPF $384.99Radius 12, Induction Coil LPF Radius 12 LPF TC $389.99Radius 12, Induction Coil, Dynamic Dir LPF Radius 12 LPF TCDSD $394.99

Oticon GO Pro FS 001-012-006 $250.00 $100.00 12 monthsGO Pro FS, Telecoil 001-012-006 $275.00GO Pro FS, Auto Phone/Auto T-Coil 001-012-006 $335.00Gaia FS Power P1/P2 001-006-006-2P $375.00Gaia FS Power P1/P2, Telecoil 001-006-006-2P $400.00Gaia FS Power 001-006-006 $375.00Gaia FS Power, Telecoil 001-006-006 $400.00GO Pro HS 001-012-004 $250.00GO Pro HS, Telecoil 001-012-004 $275.00GO Pro HS, Auto Phone/Auto T-Coil 001-012-004 $335.00GO Pro HS Power 001-012-004-P $250.00GO Pro HS Power, Telecoil 001-012-004-P $275.00GO Pro HS Power, Auto Phone/Auto T-Coil 001-012-004-P $335.00Gaia HS 001-006-004 $375.00Gaia HS, Telecoil 001-006-004 $400.00Gaia HS Directional 001-006-004-D $375.00Gaia HS Directional, Telecoil 001-006-004-D $400.00Gaia HS P1/P2 001-006-004-2P $375.00Gaia HS P1/P2, Telecoil 001-006-004-2P $400.00Gaia HS Power 001-006-004-P $375.00Gaia HS Power, Telecoil 001-006-004-P $400.00Gaia HS Power P1/P2 001-006-004-P2P $375.00Gaia HS Power P1/P2, Telecoil 001-006-004-P2P $400.00GO Pro LPF 00-012-005 $250.00



GO Pro LPF, Telecoil 00-012-005 $275.00GO Pro LPF, Auto Phone/Auto T-Coil 00-012-005 $335.00GO Pro LPF Power 001-012-005-P $250.00GO Pro LPF Power, Telecoil 001-012-005-P $275.00GO Pro LPF Power, Auto Phone/Auto T-Coil 001-012-005-P $335.00Gaia LPF 001-006-005 $375.00

V5256 - Hearing Aid, Digit, Mon, ITE; applicable modifiers - LT (Left Side), RT (Right Side)Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyOticon (continued)

Gaia LPF, Telecoil 001-006-005 $400.00 $100.00 12 monthsGaia LPF Directional 001-006-005-D $375.00Gaia LPF Directional, Telecoil 001-006-005-D $400.00Gaia LPF P1/P2 001-006-005-2P $375.00Gaia LPF P1/P2, Telecoil 001-006-005-2P $400.00Gaia LPF Power P1/P2 001-006-005-P2P $375.00Gaia LPF Power P1/P2, Telecoil 001-006-005-P2P $400.00

Phonak UNA FS Digital 0630284-01 $239.99 $110.00 12 monthsUNA with AZ FS Digital 0630285-01 $240.00UNA P FS Digital 0630286-01 $240.00EXTRA 33 with AZ FS Digital 0630244-01 $324.35EXTRA 33 FS Digital 063-0243-01 $324.35EXTRA 33 POWER FS Digital 063-0245-01 $324.35UNA HS / Canal Digital 0630282-01 $240.00UNA with AZ HS / Canal Digital 0630283-01 $239.97EXTRA 22 with AZ HS / Canal 0630242-01 $324.31EXTRA 22 HS or Canal 063-0241-01 $324.36

Rexton Calibra2 Pro FS 020289 RX-12 $399.00 $150.00 12 monthsCalibra1 Pro FS 020294 RX-12 $349.00Targa Plus FS 020296 RX-12 $250.00 $125.00Targa Pro FS 020295 RX-12 $199.00Gran-D Arena FS 020250 RX-12 $150.00 $80.00High Power Arena FS 020259 RX-12 $150.00AGC-I Arena FS 020261 RX-12 $133.00AGC-O Arena FS 020262 RX-12 $133.00Linear Arena FS 020260 RX-12 $128.00Calibra2 Pro HS 020289 RX-20 $399.00 $150.00Calibra1 Pro HS 020294 RX-20 $349.00Targa Plus HS 020296 RX-20 $250.00 $125.00Targa Pro HS 020295 RX-20 $199.00Gran-D Arena HS 020250 RX-20 $150.00 $80.00High Power Arena HS 020259 RX-20 $150.00AGC-I Arena HS 020261 RX-20 $133.00



AGC-O Arena HS 020262 RX-20 $133.00Linear Arena HS 020260 RX-20 $128.00

Siemens Phoenix ONE FS Phoenix ONE $259.38 $85.00 24 monthsPhoenix ONE FS, Telecoil Phoenix ONE $295.88Intuis ITE FS Intuis ITE $274.38Intuis ITE FS, Telecoil Intuis ITE $310.88Intuis ITE FS, AutoPhone Intuis ITE $320.63

V5256 - Hearing Aid, Digit, Mon, ITE; applicable modifiers - LT (Left Side), RT (Right Side)Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantySiemens (continued)

Intuis ITE FS, Directional Microphone Intuis ITE $349.98 $85.00 24 monthsCielo 2 ITE FS Cielo 2 $332.78Cielo 2 ITE FS, Telecoil Cielo 2 $369.28Cielo 2 ITE FS, AutoPhone Cielo 2 $379.03Phoenix ONE HS Phoenix ONE $259.38Phoenix ONE HS, Telecoil Phoenix ONE $295.88Intuis HS Intuis HS $274.38Intuis HS, Telecoil Intuis HS $310.88Intuis HS, AutoPhone Intuis HS $320.63Intuis HS, Directional Microphone Intuis HS $349.98Cielo 2 HS Cielo 2 HS $332.78Cielo 2 HS, Telecoil Cielo 2 HS $369.28Cielo 2 HS, AutoPhone Cielo 2 HS $379.03

Starkey Destiny 800 FS Destiny 800 $369.26 $74.98 12 monthsDestiny 400 FS Destiny 400 $333.98Destiny 200 FS Destiny 200 $298.92Genesis DX FS Genesis DX w/ 2k Peak $246.83Genesis Intelli Power FS Genesis Intelli D $261.71Destiny 1200 FS Destiny 1200 $399.08Destiny 800 HS Destiny 800 $368.66Destiny 400 HS Destiny 400 $333.15Destiny 200 HS Destiny 200 $298.86Genesis DX HS Genesis DX w/ 2k Peak $246.97Genesis Intelli Power HS Genesis Intelli D $261.90Destiny 1200 HS Destiny 1200 $398.91Destiny 1200 LPF Destiny 1200 $399.08Destiny 800 LPF Destiny 800 $369.26Destiny 400 LPF Destiny 400 $333.98Destiny 200 LPF Destiny 200 $298.92

Unitron Next E FS VC NEFS $262.70 $75.00 12 monthsNext E FS Power VC NEFSP $262.70Next 4 FS VC N4FS $371.25Next 4 FS Power VC N4FSP $371.25Element 8 FS VC E8FS $375.15



Element 8 FS Power VC E8FSP $375.15Next E HS VC NEHS $262.70Next 4 HS VC N4HS $371.25Element 8 HS VC E8HS $375.15Next E LPF VC NELP $262.70Next 4 LPF VC N4LP $371.25Element 8 LPF VC E8LP $375.15

V5257 - Hearing Aid, Digit, Mon, BTE; applicable modifiers - LT (Left Side), RT (Right Side)Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyElectone Digital Single Channel, T-Coil, DAI (BTE) 8760212 $264.00 $94.00 6 months

Digital Two Channel, T-Coil, Dir Mic, DAI (BTE) 10298378 $301.00Digital Four Channel, T-Coil, Dir Mic, DAI (BTE) 10298382 $352.00Digital One Channel (BTE) 10172480 $132.00Digital One Channel, T-Coil, DAI (BTE) 10299384 $150.00Digital Two Channel, T-Coil, DAI (BTE) 8761293 $210.00Digital Two Channel, T-Coil, DAI (BTE) 8761095 $221.00Digital One Channel, T-Coil, DAI (BTE) 10172487 $170.00Digital One Channel, T-Coil, DAI (BTE) 10172562 $183.60Digital One Channel, T-Coil, DAI (BTE) 10172496 $190.40Digital One Channel, T-Coil, DAI (BTE) 10172882 $204.00Digital One Channel, T-Coil, DAI, Open Fit (BTE) 10149796 $210.00

GN Resound Pixel Power BTE DVI PL80-DVI $396.10 $95.00 12 monthsPixel Standard BTE DVI PL70-DVI $372.30Pixel Standard BTE DV PL70-DV $372.30Pixel Standard BTE DI PL70-DI $372.30Pixel Standard BTE D PL70-D $372.30Pixel Mini BTE DI PL60-DI $372.30Ziga Power BTE DVI ZG80-DVI $372.50Ziga Silhouette BTE DVI ZG71-DVI $337.50Ziga Mini BTE DI ZG60-DI $312.50Plus5 Power BTE DVI RP80-DVI $263.50Plus5 Power BTE VI RP80-VI $248.20Plus5 Standard BTE DVI RP70-DVI $236.30Plus5 Standard BTE DV RP70-DV $236.30Plus5 Standard BTE DI RP70-DI $236.30Plus5 Standard BTE D RP70-D $236.30Plus5 Standard BTE VI RP70-VI $224.40Plus5 Standard BTE V RP70-V $224.40Plus5 Standard BTE I RP70-I $224.40Plus5 Standard BTE RP70 $224.40Plus5 Mini BTE DI RP60-DI $236.30



Plus5 Mini BTE VI RP60-VI $224.40dot by ReSound - dot 10 (BTE) DT1060 $312.75ReSoundAIR (BTE) AIR60 $298.50ReSound Sparx (BTE) SP90-VI $312.75

Micro Ear Radius 12 Power Plus BTE Radius 12PP BTE $389.99 $89.99 6 monthsRadius 8 BTE Radius 8 BTE $379.99Radius 4 BTE Radius 4 BTE $369.99Radius 2 BTE Radius 2 BTE $299.99

V5257 - Hearing Aid, Digit, Mon, BTE; applicable modifiers - LT (Left Side), RT (Right Side)Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyMicro Ear (continued)

Radius 12 BTE Radius 12 BTE $389.99 $89.99 6 monthsRadius 12 Mini BTE Radius 12 Mini BTE $389.99Radius 8 Mini BTE Radius 8 Mini BTE $379.99Radius 4 Mini BTE Radius 4 Mini BTE $369.99Radius 12 RIC (BTE) Radius 12 RIC $389.98Radius 12 RIC, Dynamic Directional (BTE) Radius 12 RIC DSD $389.98Radius 8 RIC (BTE) Radius 8 RIC $379.99Radius 8 RIC, Dynamic Directional (BTE) Radius 8 RIC DSD $379.99

Oticon Tego BTE 001-014-010 $399.00 $100.00 12 monthsTego BTE VC 001-014-020 $399.00Tego Power BTE 001-014-012 $399.00Gaia BTE 001-006-010 $375.00Gaia BTE VC 001-006-020 $375.00Gaia BTE Direct 001-006-013 $375.00Gaia BTE Power 001-006-012 $375.00GoPro BTE 001-012-010 $250.00GoPro BTE VC 001-012-020 $250.00GoPro Power Direct (BTE) 001-012-012 $250.00GoPro Power (BTE) 001-012-012-OMNI $250.00

Phonak Extra 211 AZ BTE with EasyPhone 0500581-01 $339.97 $110.00 12 monthsExtra 211 AZ BTE 0500597-01 $339.69Extra 311 AZ BTE with EasyPhone 0500583-01 $339.97Extra 311 AZ BTE 0500598-01 $339.69Extra 411 AZ BTE with EasyPhone 0500585-01 $399.63Extra 411 AZ BTE 0500599-01 $399.25MicroExtra 100 AZ BTE 050-0622-01 $399.13Una M AZ BTE 0500063-01 $249.97Una SP BTE 0500064-01 $249.93Una SP AZ BTE 0500065-01 $249.80Audeo III BTE 050-0270-01 $398.95



Naida III Power BTE UP - Adult 050-0075-01 $399.00Naida III Power BTE UP - Junior 050-0078-01 $399.00Naida III Power BTE SP - Adult 050-0672-01 $399.00Naida III Power BTE SP - Junior 050-0673-01 $399.00

Rexton Calibra2 Pro HP D (BTE) 10301688BGE $399.00 $150.00 12 months10301689GRY10301690MCH10301692BRN

V5257 - Hearing Aid, Digit, Mon, BTE; applicable modifiers - LT (Left Side), RT (Right Side)Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyRexton (continued)

Calibra2 Pro P D (BTE) 10295534BGE $399.00 $150.00 12 months10295535GRY10299269BRN10295536MCH10298616TRAN

Calibra2 Pro Free D (BTE) 10293721BGE $399.0010293722GRY10293723BRN10293724MCH

Calibra1 Pro P D (BTE) 10295537BGE $349.0010295538GRY10295539MCH10299268BRN

10298618TRANCalibra1 Pro Free D (BTE) 10293725BGE $349.00

10293726GRY10293727BRN10293728MCH

Targa Plus Free D (BTE) 10173647BGE $250.00 $125.0010173648GRY10299266BRN

Targa Plus HP D (BTE) 10297928BGE $250.0010297929GRY10298693BRN

Targa Plus P D (BTE) 10294092BGE $250.0010294093GRY10299262BRN

Targa Pro P D (BTE) 10294094BGE $199.0010294095GRY10299263BRN



Targa Pro Free D (BTE) 10173644BGE $204.0010173645GRY10299265BRN

Arena1 HP+ (BTE) 10173293BGE $150.00 $80.0010173294BRN10173295GRY

Arena1 P+ (BTE) 10172103BGE $150.0010172104BRN10172105GRY

V5257 - Hearing Aid, Digit, Mon, BTE; applicable modifiers - LT (Left Side), RT (Right Side)Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyRexton (continued

Arena1 HP (BTE) 10173255BGE $149.00 $80.00 12 months10173256BRN10173257GRY

Arena1 P (BTE) 10172100BGE $138.0010172101BRN10172102GRY

Siemens Phoenix 113 BTE Phoenix 113 $248.75 $85.00 24 monthsPhoenix 213 BTE Phoenix 213 $248.75Phoenix 313 BTE Phoenix 313 $248.75Intuis S BTE Intuis S $316.25Intuis Dir BTE Intuis Dir $316.25Intuis SP BTE Intuis SP $338.13Intuis LIFE BTE Intuis LIFE $333.75Cielo 2-S BTE Cielo 2-S $375.70Cielo 2 BTE Cielo 2 $375.70Cielo 2-P BTE Cielo 2-P $393.55Cielo 2-SP BTE Cielo 2-SP $393.55Cielo 2 Life BTE Cielo 2 Life $375.70Explorer 500 BTE Explorer 500 $399.60

Starkey Destiny 800 BTE Destiny 800 $369.26 $74.98 12 monthsDestiny 400 BTE Destiny 400 $334.96Destiny 200 BTE Destiny 200 $299.50Destiny 200 Power BTE Destiny 200 Power $299.50Davinci PxP BTE Davinci PxP $374.90Destiny 1200 RIC BTE Destiny 1200 RIC $398.91Destiny 1200 BTE Destiny 1200 BTE $399.08

Unitron Next E BTE VC NEBTE $262.70 $75.00 12 monthsNext E BTE HP VC NEHPBTE $299.70



Next E BTE Moda II NEBTEModa II $299.70Next 4 BTE VC N4BTE $371.25Next 4 BTE Power VC N4BTEP $376.05Next 4 BTE HP VC N4BTEHP $376.05Next 4 BTE Moda II N4BTEModa II $376.05Next 4 BTE Moxi N4BTEMoxi $376.20Element 8 BTE VC E8BTE $375.15Element 8 Power BTE VC E8BTEP $375.73Element 8 Moda BTE E8BTEModa $375.73

V5259 - Hearing Aid, Digit, Bin, ITCManufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyMicro Ear Radius 8 HS Radius 8 HS $759.98 $89.99 6 months

Radius 8, Induction Coil HS Radius 8 HS TC $769.98Radius 8, Induction Coil, Dynamic Dir HS Radius 8 HS TCDSD $779.98Radius 4 HS Radius 4 HS $739.98Radius 4, Induction Coil HS Radius 4 HS TC $749.98Radius 4, Induction Coil, Dynamic Dir HS Radius 4 HS TCDSD $759.98Radius 2 HS Radius 2 HS $609.98Radius 2, Induction Coil HS Radius 2 HS TC $619.98Radius 12 HS Radius 12 HS $779.98Radius 12, Induction Coil HS Radius 12 HS TC $789.98Radius 12, Induction Coil, Dynamic Dir HS Radius 12 HS TCDSD $800.00

V5260 - Hearing Aid, Digit, Bin, ITEManufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyElectone Digital One Channel FS 0202670101ST $320.00 $94.00 6 months

Digital One Channel, T-Coil FS 0202670503TC0101ST $378.40Digital Two Channel, Two Trimpots FS 0202660101ST $400.00Digital Two Channel, Two Trimpots, T-Coil FS 0202660503TC0101ST $466.40Digital Single Channel FS 0202700101ST $400.00Digital Single Channel, T-Coil FS 0202700503TC0101ST $466.40Digital Two Channel FS 0202AA0101ST $528.00Digital Two Channel, T-Coil FS 0202AA0503TC0101ST $529.20Digital Four Channel FS 0202AB0101ST $608.00Digital Four Channel, T-Coil FS 0202AB0503TC0101ST $664.00Single Channel Digital, LC Trimpot HS 0202670101HS $320.00Single Channel Digital, LC Trimpot, T-Coil HS 0202670503TC0101HS $378.40Two Channel Digital, AG-C-I, AGC-O HS 0202660101HS $400.00Two Channel Digital, AG-C-I, AGC-O, T-Coil HS 0202660503TC0101HS $466.40



Digital One Channel HS 0202700101HS $400.00Digital One Channel, T-Coil HS 0202700503TC0101HS $466.40Digital Two Channel HS 0202AA0101HS $528.00Digital Two Channel, T-Coil HS 0202AA0503TC0101HS $579.60Digital Four Channel HS 0202AB0101HS $608.00Digital Four Channel, T-Coil HS 0202AB0503TC0101HS $664.00

GN Resound Pixel Power, Directional FS PL50-DP $762.30 $95.00 12 monthsPixel Standard, Directional FS PL50-D $742.50Ziga Power, Directional FS ZG50-DP $625.00Ziga Standard, Directional FS ZG50-D $625.00Ziga Power FS ZG50-P $625.00Ziga Standard FS ZG50 $625.00

V5260 - Hearing Aid, Digit, Bin, ITEManufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyGN Resound (continued)

Plus5 Power, Directional FS RP50-DP $513.40 $95.00 12 monthsPlus5 Standard, Directional FS RP50-D $493.00Plus5 Power FS RP50-P $493.00Plus5 Standard FS RP50 $469.20Ziga Power, Directional HS ZG40-DP $625.00Ziga Standard, Directional HS ZG40-D $625.00Ziga Power HS ZG40-P $625.00Ziga Standard HS ZG40 $625.00Plus5 Power, Directional HS RP40-DP $513.40Plus5 Standard, Directional HS RP40-D $493.00Plus5 Power HS RP40-P $493.00Plus5 Standard HS RP40 $469.20

Micro Ear Radius 8 FS Radius 8 ITE $739.98 $89.99 6 monthsRadius 8, Induction Coil FS Radius 8 ITE TC $749.98Radius 8, Induction Coil, Dynamic Dir FS Radius 8 ITE TCDSD $759.98Radius 4 FS Radius 4 ITE $719.98Radius 4, Induction Coil FS Radius 4 ITE TC $729.98Radius 4, Induction Coil, Dynamic Dir FS Radius 4 ITE TCDSD $739.98Radius 2 FS Radius 2 ITE $589.98Radius 2, Induction Coil FS Radius 2 ITE TC $599.98Radius 12 FS Radius 12 ITE $760.00Radius 12, Induction Coil FS Radius 12 ITE TC $770.00Radius 12, Induction Coil, Dynamic Dir FS Radius 12 ITE TCDSD $779.98Radius 8 LPF Radius 8 LPF $749.98Radius 8, Induction Coil LPF Radius 8 LPF TC $759.98Radius 8, Induction Coil, Dynamic Dir LPF Radius 8 LPF TCDSD $769.98Radius 4 LPF Radius 4 LPF $729.98



Radius 4, Induction Coil LPF Radius 4 LPF TC $739.98Radius 4, Induction Coil, Dynamic Dir LPF Radius 4 LPF TCDSD $749.98Radius 2 LPF Radius 2 LPF $599.98Radius 2, Induction Coil LPF Radius 2 LPF TC $609.98Radius 12 LPF Radius 12 LPF $769.98Radius 12, Induction Coil LPF Radius 12 LPF TC $779.98Radius 12, Induction Coil, Dynamic Dir LPF Radius 12 LPF TCDSD $789.98

Oticon GO Pro FS 001-012-006 $500.00 $100.00 12 monthsGO Pro FS, Telecoil 001-012-006 $550.00GO Pro FS, Auto Phone/Auto T-Coil 001-012-006 $670.00Gaia FS Power P1/P2 001-006-006-2P $750.00Gaia FS Power P1/P2, Telecoil 001-006-006-2P $800.00Gaia FS Power 001-006-006 $750.00

V5260 - Hearing Aid, Digit, Bin, ITEManufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyOticon (continued)

Gaia FS Power, Telecoil 001-006-006 $800.00 $100.00 12 monthsGO Pro HS 001-012-004 $500.00GO Pro HS, Telecoil 001-012-004 $550.00GO Pro HS, Auto Phone/Auto T-Coil 001-012-004 $670.00GO Pro HS Power 001-012-004-P $500.00GO Pro HS Power, Telecoil 001-012-004-P $550.00GO Pro HS Power, Auto Phone/Auto T-Coil 001-012-004-P $670.00Gaia HS 001-006-004 $750.00Gaia HS, Telecoil 001-006-004 $800.00Gaia HS Directional 001-006-004-D $750.00Gaia HS Directional, Telecoil 001-006-004-D $800.00Gaia HS P1/P2 001-006-004-2P $750.00Gaia HS P1/P2, Telecoil 001-006-004-2P $800.00Gaia HS Power 001-006-004-P $750.00Gaia HS Power, Telecoil 001-006-004-P $800.00Gaia HS Power P1/P2 001-006-004-P2P $750.00Gaia HS Power P1/P2, Telecoil 001-006-004-P2P $800.00GO Pro LPF 00-012-005 $500.00GO Pro LPF, Telecoil 00-012-005 $550.00GO Pro LPF, Auto Phone/Auto T-Coil 00-012-005 $670.00GO Pro LPF Power 001-012-005-P $500.00GO Pro LPF Power, Telecoil 001-012-005-P $550.00GO Pro LPF Power, Auto Phone/Auto T-Coil 001-012-005-P $670.00Gaia LPF 001-006-005 $750.00Gaia LPF, Telecoil 001-006-005 $800.00Gaia LPF Directional 001-006-005-D $750.00Gaia LPF Directional, Telecoil 001-006-005-D $800.00



Gaia LPF P1/P2 001-006-005-2P $750.00Gaia LPF P1/P2, Telecoil 001-006-005-2P $800.00Gaia LPF Power P1/P2 001-006-005-P2P $750.00Gaia LPF Power P1/P2, Telecoil 001-006-005-P2P $800.00

Phonak UNA FS Digital 0630284-01 $479.98 $110.00 12 monthsUNA with AZ FS Digital 0630285-01 $480.00UNA P FS Digital 0630286-01 $480.00EXTRA 33 with AZ FS Digital 0630244-01 $648.70EXTRA 33 FS Digital 063-0243-01 $648.70EXTRA 33 POWER FS Digital 063-0245-01 $648.70UNA HS / Canal Digital 0630282-01 $480.00UNA with AZ HS / Canal Digital 0630283-01 $479.94EXTRA 22 with AZ HS / Canal 0630242-01 $648.62EXTRA 22 HS or Canal 063-0241-01 $648.72

V5260 - Hearing Aid, Digit, Bin, ITEManufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyRexton Calibra2 Pro FS 020289 RX-12 $798.00 $150.00 12 months

Calibra1 Pro FS 020294 RX-12 $698.00Targa Plus FS 020296 RX-12 $500.00 $125.00Targa Pro FS 020295 RX-12 $398.00Gran-D Arena FS 020250 RX-12 $300.00 $80.00High Power Arena FS 020259 RX-12 $300.00AGC-I Arena FS 020261 RX-12 $266.00AGC-O Arena FS 020262 RX-12 $266.00Linear Arena FS 020260 RX-12 $256.00Calibra2 Pro HS 020289 RX-20 $798.00 $150.00Calibra1 Pro HS 020294 RX-20 $698.00Targa Plus HS 020296 RX-20 $500.00 $125.00Targa Pro HS 020295 RX-20 $398.00Gran-D Arena HS 020250 RX-20 $300.00 $80.00High Power Arena HS 020259 RX-20 $300.00AGC-I Arena HS 020261 RX-20 $266.00AGC-O Arena HS 020262 RX-20 $266.00Linear Arena HS 020260 RX-20 $256.00

Siemens Phoenix ONE FS Phoenix ONE $518.76 $85.00 24 monthsPhoenix ONE FS, Telecoil Phoenix ONE $591.76Intuis ITE FS Intuis ITE $548.76Intuis ITE FS, Telecoil Intuis ITE $621.76Intuis ITE FS, AutoPhone Intuis ITE $641.26Intuis ITE FS, Directional Microphone Intuis ITE $699.96Cielo 2 ITE FS Cielo 2 $665.56



Cielo 2 ITE FS, Telecoil Cielo 2 $738.56Cielo 2 ITE FS, AutoPhone Cielo 2 $758.06Phoenix ONE HS Phoenix ONE $518.76Phoenix ONE HS, Telecoil Phoenix ONE $591.76Intuis HS Intuis HS $548.76Intuis HS, Telecoil Intuis HS $621.76Intuis HS, AutoPhone Intuis HS $641.26Intuis HS, Directional Microphone Intuis HS $699.96Cielo 2 HS Cielo 2 HS $665.56Cielo 2 HS, Telecoil Cielo 2 HS $738.56Cielo 2 HS, AutoPhone Cielo 2 HS $758.06

Starkey Destiny 800 FS Destiny 800 $738.52 $74.98 12 monthsDestiny 400 FS Destiny 400 $667.96Destiny 200 FS Destiny 200 $597.84Genesis DX FS Genesis DX w/ 2k Peak $493.66

V5260 - Hearing Aid, Digit, Bin, ITEManufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyStarkey (continued)

Genesis Intelli Power FS Genesis Intelli D $523.42 $74.98 12 monthsDestiny 1200 FS Destiny 1200 $798.16Destiny 800 HS Destiny 800 $737.32Destiny 400 HS Destiny 400 $666.30Destiny 200 HS Destiny 200 $597.72Genesis DX HS Genesis DX w/ 2k Peak $493.94Genesis Intelli Power HS Genesis Intelli D $523.80Destiny 1200 HS Destiny 1200 $797.82Destiny 1200 LPF Destiny 1200 $798.16Destiny 800 LPF Destiny 800 $738.52Destiny 400 LPF Destiny 400 $667.96Destiny 200 LPF Destiny 200 $597.84

Unitron Next E FS VC NEFS $525.40 $75.00 12 monthsNext E FS Power VC NEFSP $525.40Next 4 FS VC N4FS $742.50Next 4 FS Power VC N4FSP $742.50Element 8 FS VC E8FS $750.30Element 8 FS Power VC E8FSP $750.30Next E HS VC NEHS $525.40Next 4 HS VC N4HS $742.50Element 8 HS VC E8HS $750.30Next E LPF VC NELP $525.40Next 4 LPF VC N4LP $742.50Element 8 LPF VC E8LP $750.30



V5261 - Hearing Aid, Digit, Bin, BTEManufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyElectone Digital Single Channel, T-Coil, DAI (BTE) 8760212 $528.00 $94.00 6 months

Digital Two Channel, T-Coil, Dir Mic, DAI (BTE) 10298378 $602.00Digital Four Channel, T-Coil, Dir Mic, DAI (BTE) 10298382 $704.00Digital One Channel (BTE) 10172480 $264.00Digital One Channel, T-Coil, DAI (BTE) 10299384 $300.00Digital Two Channel, T-Coil, DAI (BTE) 8761293 $420.00Digital Two Channel, T-Coil, DAI (BTE) 8761095 $442.00Digital One Channel, T-Coil, DAI (BTE) 10172487 $340.00Digital One Channel, T-Coil, DAI (BTE) 10172562 $367.20Digital One Channel, T-Coil, DAI (BTE) 10172496 $380.80Digital One Channel, T-Coil, DAI (BTE) 10172882 $408.00Digital One Channel, T-Coil, DAI, Open Fit (BTE) 10149796 $420.00

V5261 - Hearing Aid, Digit, Bin, BTEManufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyGN Resound Pixel Power BTE DVI PL80-DVI $792.20 $95.00 12 months

Pixel Standard BTE DVI PL70-DVI $744.60Pixel Standard BTE DV PL70-DV $744.60Pixel Standard BTE DI PL70-DI $744.60Pixel Standard BTE D PL70-D $744.60Pixel Mini BTE DI PL60-DI $744.60Ziga Power BTE DVI ZG80-DVI $745.00Ziga Silhouette BTE DVI ZG71-DVI $675.00Ziga Mini BTE DI ZG60-DI $625.00Plus5 Power BTE DVI RP80-DVI $527.00Plus5 Power BTE VI RP80-VI $496.40Plus5 Standard BTE DVI RP70-DVI $472.60Plus5 Standard BTE DV RP70-DV $472.60Plus5 Standard BTE DI RP70-DI $472.60Plus5 Standard BTE D RP70-D $472.60Plus5 Standard BTE VI RP70-VI $448.80Plus5 Standard BTE V RP70-V $448.80Plus5 Standard BTE I RP70-I $448.80Plus5 Standard BTE RP70 $448.80Plus5 Mini BTE DI RP60-DI $472.60Plus5 Mini BTE VI RP60-VI $448.80dot by ReSound - dot 10 (BTE) DT1060 $625.50ReSoundAIR (BTE) AIR60 $597.00



ReSound Sparx (BTE) SP90-VI $625.50Micro Ear Radius 12 Power Plus BTE Radius 12PP BTE $779.98 $89.99 6 months

Radius 8 BTE Radius 8 BTE $759.98Radius 4 BTE Radius 4 BTE $739.98Radius 2 BTE Radius 2 BTE $599.98Radius 12 BTE Radius 12 BTE $779.98Radius 12 Mini BTE Radius 12 Mini BTE $779.98Radius 8 Mini BTE Radius 8 Mini BTE $759.98Radius 4 Mini BTE Radius 4 Mini BTE $739.98Radius 12 RIC (BTE) Radius 12 RIC $779.96Radius 12 RIC, Dynamic Directional (BTE) Radius 12 RIC DSD $779.96Radius 8 RIC (BTE) Radius 8 RIC $759.98Radius 8 RIC, Dynamic Directional (BTE) Radius 8 RIC DSD $759.98

Oticon Tego BTE 001-014-010 $798.00 $100.00 12 monthsTego BTE VC 001-014-020 $798.00Tego Power BTE 001-014-012 $798.00Gaia BTE 001-006-010 $750.00

V5261 - Hearing Aid, Digit, Bin, BTEManufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyOticon (continued)

Gaia BTE VC 001-006-020 $750.00 $100.00 12 monthsGaia BTE Direct 001-006-013 $750.00Gaia BTE Power 001-006-012 $750.00GoPro BTE 001-012-010 $500.00GoPro BTE VC 001-012-020 $500.00GoPro Power Direct (BTE) 001-012-012 $500.00GoPro Power (BTE) 001-012-012-OMNI $500.00

Phonak Extra 211 AZ BTE with EasyPhone 0500581-01 $679.94 $110.00 12 monthsExtra 211 AZ BTE 0500597-01 $679.38Extra 311 AZ BTE with EasyPhone 0500583-01 $679.94Extra 311 AZ BTE 0500598-01 $679.38Extra 411 AZ BTE with EasyPhone 0500585-01 $799.26Extra 411 AZ BTE 0500599-01 $798.50MicroExtra 100 AZ BTE 050-0622-01 $798.26Una M AZ BTE 0500063-01 $499.94Una SP BTE 0500064-01 $499.86Una SP AZ BTE 0500065-01 $499.60Audeo III BTE 050-0270-01 $797.90Naida III Power BTE UP - Adult 050-0075-01 $798.00Naida III Power BTE UP - Junior 050-0078-01 $798.00Naida III Power BTE SP - Adult 050-0672-01 $798.00Naida III Power BTE SP - Junior 050-0673-01 $798.00



Rexton Calibra2 Pro HP D (BTE) 10301688BGE $798.00 $150.00 12 months10301689GRY10301690MCH10301692BRN

Calibra2 Pro P D (BTE) 10295534BGE $798.0010295535GRY10299269BRN10295536MCH10298616TRAN

Calibra2 Pro Free D (BTE) 10293721BGE $798.0010293722GRY10293723BRN10293724MCH

Calibra1 Pro P D (BTE) 10295537BGE $698.0010295538GRY10295539MCH10299268BRN

10298618TRANV5261 - Hearing Aid, Digit, Bin, BTE

Manufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantyRexton (continued)

Calibra1 Pro Free D (BTE) 10293725BGE $698.00 $150.00 12 months10293726GRY10293727BRN10293728MCH

Targa Plus Free D (BTE) 10173647BGE $500.00 $125.0010173648GRY10299266BRN

Targa Plus HP D (BTE) 10297928BGE $500.0010297929GRY10298693BRN

Targa Plus P D (BTE) 10294092BGE $500.0010294093GRY10299262BRN

Targa Pro P D (BTE) 10294094BGE $398.0010294095GRY10299263BRN

Targa Pro Free D (BTE) 10173644BGE $408.0010173645GRY10299265BRN

Arena1 HP+ (BTE) 10173293BGE $300.00 $80.0010173294BRN



10173295GRYArena1 P+ (BTE) 10172103BGE $300.00

10172104BRN10172105GRY

Arena1 HP (BTE) 10173255BGE $298.0010173256BRN10173257GRY

Arena1 P (BTE) 10172100BGE $276.0010172101BRN10172102GRY

Siemens Phoenix 113 BTE Phoenix 113 $497.50 $85.00 24 monthsPhoenix 213 BTE Phoenix 213 $497.50Phoenix 313 BTE Phoenix 313 $497.50Intuis S BTE Intuis S $632.50Intuis Dir BTE Intuis Dir $632.50Intuis SP BTE Intuis SP $676.26Intuis LIFE BTE Intuis LIFE $667.50Cielo 2-S BTE Cielo 2-S $751.40Cielo 2 BTE Cielo 2 $751.40

V5261 - Hearing Aid, Digit, Bin, BTEManufacturer Model Name Model Number Purchase Rate Repair Rate Repair WarrantySiemens (continued)

Cielo 2-P BTE Cielo 2-P $787.10 $85.00 24 monthsCielo 2-SP BTE Cielo 2-SP $787.10Cielo 2 Life BTE Cielo 2 Life $751.40Explorer 500 BTE Explorer 500 $799.20

Starkey Destiny 800 BTE Destiny 800 $738.52 $74.98 12 monthsDestiny 400 BTE Destiny 400 $669.92Destiny 200 BTE Destiny 200 $599.00Destiny 200 Power BTE Destiny 200 Power $599.00Davinci PxP BTE Davinci PxP $749.80Destiny 1200 RIC BTE Destiny 1200 RIC $797.82Destiny 1200 BTE Destiny 1200 BTE $798.16

Unitron Next E BTE VC NEBTE $525.40 $75.00 12 monthsNext E BTE HP VC NEHPBTE $599.40Next E BTE Moda II NEBTEModa II $599.40Next 4 BTE VC N4BTE $742.50Next 4 BTE Power VC N4BTEP $752.10Next 4 BTE HP VC N4BTEHP $752.10Next 4 BTE Moda II N4BTEModa II $752.10Next 4 BTE Moxi N4BTEMoxi $752.40Element 8 BTE VC E8BTE $750.30



Element 8 Power BTE VC E8BTEP $751.46Element 8 Moda BTE E8BTEModa $751.46


Michigan Department of Community HealthHearing Aid Contract Vendors

All contracted hearing aids include a manufacturer's warranty: 12 months on loss and damage and 24 months on parts and labor; as well as a repair warranty of 6, 12, or 24 months.

Contract Vendor Contract Number Terms Delivery Repair

Warranty Vendor No. Contact: Phone Number Fax Number

Electone, Inc. 439601 Net 30 As 6 months 200511656-00 Stephanie Robeldo (407) 831-2555 or (407) 830-46781124 Florida Central Parkway Required [email protected] (800) 432-7483Longwood, FL 32760GN Hearing Care Corp. 439602 Net 30 As 12 months 200561930-00 CJ Nilson (952) 769-8313 or (952) 769-8012DBA GN Resound Required [email protected] (800) 248-43278001 Bloomington FreewayBloomington, MN 55420Micro Ear Technology 439603 Net 30 As 6 months 200502598-00 Mathew Davis (952) 995-8873 or (952) 995-89556425 Flying Cloud Drive Required [email protected] (800) 943-7142Eden Prairie, MN 55344Oticon, Inc. 439604 Net 30 As 12 months 081073007-00 Irene Hnidj (732) 560-1220 or (732) 560-0029 or29 Schoolhouse Road Required [email protected] (800) 526-3921 (800) 453-8618Somerset, NJ 08875Phonak, LLC 439605 Net 30 As 12 months 143459003-00 Debbie Beck (630) 821-5157 or (630) 393-74004520 Weaver Parkway Required [email protected] (800 679-4871Warrenville, IL 60555Rexton, Inc. 439606 Net 30 As 12 months 092407013-00 Dale Nelson (763) 577-5177 or (763) 553-07875010 Cheshire Lane N, Ste. 2 Required [email protected] (800) 876-1141Plymouth, MN 55446 X6177Siemens Hearing Instruments 439607 Net 30 As 24 months 070630006-00 Rick Musselman (763) 258-6675 or (847) 808-129910 Constitution Avenue Required [email protected] (800) 333-9083Piscataway, NJ 08855-1397Starkey Labs 439608 Net 30 As 12 months 035008001-00 Tony Farmer (952) 941-6401 (952) 947-47016700 Washington Avenue S. Required [email protected] X2855 orEden Prairie, MN 55344-3405 (800) 328-8602Unitron Hearing, Inc. 439609 Net 30 As 12 months 126371004-00 Jessie Thielbar (763) 744-3465 or (763) 557-88282300 Berkshire Lane N, Ste. A Required [email protected] (800) 888-8882Plymouth, MN 55441

2/2009 Attachment II - MSA 09-03

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