|
|
REVISED: |
OCTOBER, 2011 |
| ||
|
Mid-High |
Advanced Level |
Flagship Level |
| ||
|
Member Out-of-Pocket Cost/Hearing Aid |
| ||||
|
$ -0- / Ear |
$250/Ear |
$500/Ear |
$650/Ear |
| |
|
AHB – Starkey |
| ||||
|
Ignite 30 ITE |
X Series 70 ITE |
X Series 90 ITE |
X Series 110 ITE |
| |
|
Ignite 30 HS/ITC |
X Series 70 HS/ITC |
X Series 90 HS/ITC |
X Series 110 HS/ITC |
| |
|
Ignite 30 CIC |
X Series 70 CIC |
X Series 90 CIC |
X Series 110 CIC |
| |
|
Ignite 30 BTE |
X Series 70 BTE |
X Series 90 BTE |
X Series 110 BTE |
| |
|
Ignite 30 Power BTE |
X Series 70 Power BTE |
X Series 90 Power BTE |
X Series 110 Power BTE |
| |
|
Ignite 30 Power Plus BTE |
X Series 70 Power Plus BTE |
X Series 90 Power Plus BTE |
X Series 110 Power Plus BTE |
| |
|
Ignite 30 Mini BTE |
X Series 70 Mini BTE |
X Series 90 Mini BTE |
X Series 110 Mini BTE |
| |
|
Ignite 30 RIC 13 |
X Series 70 RIC 13 |
X Series 90 RIC 13 |
X Series 110 RIC 13 |
| |
|
|
Wi Series i70 RIC 13 |
Wi Series i90 RIC 13 |
Wi Series i110 RIC 13 |
| |
|
Ignite 30 AP RIC 13 |
X Series 70 AP RIC 13 |
X Series 90 AP RIC 13 |
X Series 110 AP RIC 13 |
| |
|
|
Wi Series i70 AP RIC 13 |
Wi Series i90 AP RIC 13 |
Wi Series i110 AP RIC 13 |
| |
|
Ignite 30 RIC 312 |
X Series 70 RIC 312 |
X Series 90 RIC 312 |
X Series 110 RIC 312 |
| |
|
|
Wi Series i70 RIC 312 |
Wi Series i90 RIC 312 |
Wi Series i110 RIC 312 |
| |
|
Ignite 30 AP RIC 312 |
X Series 70 AP RIC 312 |
X Series 90 AP RIC 312 |
X Series 110 AP RIC 312 |
| |
|
|
Wi Series i70 AP RIC 312 |
Wi Series i90 AP RIC 312 |
Wi Series i110 AP RIC 312 |
| |
|
Ignite 30 RIC 10 |
Xino 70 RIC 10 |
Xino 90 RIC 10 |
Xino 110 RIC 10 |
| |
|
Ignite 30 AP RIC 10 |
Xino 70 AP RIC 10 |
Xino 90 AP RIC 10 |
Xino 110 AP RIC 10 |
| |
|
Destiny 400 CROS/BICROS BTE |
Destiny 800 CROS/BICROS BTE |
Destiny 1200 CROS/BICROS BTE |
Destiny 1600 CROS/BICROS BTE |
| |
|
Destiny 400 CROS/BICROS ITE |
Destiny 800 CROS/BICROS ITE |
Destiny 1200 CROS/BICROS ITE |
Destiny 1600 CROS/BICROS ITE |
| |
|
|
| ||||
|
AHB – MicroTech |
| ||||
|
Avail 20 ITE |
Focus 30 ITE |
Focus 40 ITE |
Focus 50 ITE |
| |
|
Avail 20 HS/ITC |
Focus 30 HS/ITC |
Focus 40 HS/ITC |
Focus 50 HS/ITC |
| |
|
Avail 20 CIC |
Focus 30 CIC |
Focus 40 CIC |
Focus 50 CIC |
| |
|
Avail 20 BTE |
Focus 30 BTE |
Focus 40 BTE |
Focus 50 BTE |
| |
|
Avail 20 Power BTE |
Focus 30 Power BTE |
Focus 40 Power BTE |
Focus 50 Power BTE |
| |
|
Avail 20 Power Plus BTE |
Focus 30 Power Plus BTE |
Focus 40 Power Plus BTE |
Focus 50 Power Plus BTE |
| |
|
Avail 20 Mini BTE |
Focus 30 Mini BTE |
Focus 40 Mini BTE |
Focus 50 Mini BTE |
| |
|
Avail 20 RIC 13 |
Focus 30 RIC 13 |
Focus 40 RIC 13 |
Focus 50 RIC 13 |
| |
|
|
Mobility 30 RIC 13 |
Mobility 40 RIC 13 |
Mobility 50 RIC 13 |
| |
|
Avail 20 mPower RIC 13 |
Focus 30 mPower RIC 13 |
Focus 40 mPower RIC 13 |
Focus 50 mPower RIC 13 |
| |
|
|
Mobility 30 mPower RIC 13 |
Mobility 40 mPower RIC 13 |
Axio 32 mPower RIC 13 |
| |
|
Avail 20 RIC 312 |
Focus 30 RIC 312 |
Focus 40 RIC 312 |
Focus 50 RIC 312 |
| |
|
|
Mobility 30 RIC 312 |
Mobility 40 RIC 312 |
Mobility 50 RIC 312 |
| |
|
Avail 20 mPower RIC 312 |
Focus 30 mPower RIC 312 |
Focus 40 mPower RIC 312 |
Focus 50 AP RIC 312 |
| |
|
|
Mobility 30 mPower RIC 312 |
Mobility 40 mPower RIC 312 |
Axio 32 mPower RIC 312 |
| |
|
Avail 20 Mini RIC |
Focus 30 Mini RIC |
Focus 40 Mini RIC |
Focus 50 Mini RIC |
| |
|
Avail 20 mPower Mini RIC |
Focus 30 mPower Mini RIC |
Focus 40 mPower RIC 10 |
Focus 50 mPower RIC 10 |
| |
|
Radius 4 CROS/BICROS BTE |
Radius 8 CROS/BICROS BTE |
Radius 12 CROS/BICROS BTE |
Radius 16 CROS/BICROS BTE |
| |
|
Radius 4 CROS/BICROS ITE |
Radius 8 CROS/BICROS ITE |
Radius 12 CROS/BICROS ITE |
Radius 16 CROS/BICROS ITE |
| |
|
|
| ||||
|
|
| ||||
|
|
| ||||
|
AHB – Audibel |
| ||||
|
Start 6 ITE |
Anthem XT Silver ITE |
Anthem XT Gold ITE |
Anthem XT Platinum ITE |
| |
|
Start 6 HS/ITC |
Anthem XT Silver HS/ITC |
Anthem XT Gold HS/ITC |
Anthem XT Platinum HS/ITC |
| |
|
Start 6 CIC |
Anthem XT Silver CIC |
Anthem XT Gold CIC |
Anthem XT Platinum CIC |
| |
|
Start 6 BTE |
Anthem XT Silver BTE |
Anthem XT Gold BTE |
Anthem XT Platinum BTE |
| |
|
Start 6 Power BTE |
Anthem XT Silver Power BTE |
Anthem XT Gold Power BTE |
Anthem XT Platinum Power BTE |
| |
|
Start 6 Power Plus BTE |
Anthem XT Silver Power Plus BTE |
Anthem XT Gold Power Plus BTE |
Anthem XT Platinum Plus Power BTE |
| |
|
Start 6 Mini BTE |
Anthem XT Silver Mini BTE |
Anthem XT Gold Mini BTE |
Anthem XT Platinum Mini BTE |
| |
|
Start 6 RIC 13 |
Anthem XT Silver RIC 13 |
Anthem XT Gold RIC 13 |
Anthem XT Platinum RIC 13 |
| |
|
Range Silver RIC 13 |
Range Gold RIC 13 |
Range Platinum RIC 13 |
| ||
|
Start 6 Power Solution RIC 13 |
Anthem XT Silver Power Solution RIC 13 |
Anthem XT Gold Power Solution RIC 13 |
Anthem XT Platinum Power Solution RIC 13 |
| |
|
Range Silver Power Solution RIC 13 |
Range Gold Power Solution RIC 13 |
Range Platinum Power Solution RIC 13 |
| ||
|
Start 6 RIC 312 |
Anthem XT Silver RIC 312 |
Anthem XT Gold RIC 312 |
Anthem XT Platinum RIC 312 |
| |
|
|
Range Silver RIC 312 |
Range Gold RIC 312 |
Range Platinum RIC 312 |
| |
|
Start 6 Power Solution RIC 312 |
Anthem XT Silver Power Solution RIC 312 |
Anthem XT Gold Power Solution RIC 312 |
Anthem XT Platinum Power Solution RIC 312 |
| |
|
|
Range Silver Power Solution RIC 312 |
Range Gold Power Solution RIC 312 |
Range Platinum Power Solution RIC 312 |
| |
|
Start 6 Mini RIC |
Anthem XT Silver Mini RIC |
Anthem XT Gold Mini RIC |
Anthem XT Platinum Mini RIC |
| |
|
Start 6 Power Solution Mini RIC |
Anthem XT Silver Power Solution Mini RIC |
Anthem XT Gold Power Solution Mini RIC |
Anthem XT Platinum Power Solution Mini RIC |
| |
|
Virtue 4 CROS/BICROS BTE |
Virtue 8 CROS/BICROS BTE |
Virtue 12 CROS/BICROS BTE |
Virtue 16 CROS/BICROS BTE |
| |
|
Virtue 4 CROS/BICROS ITE |
Virtue 8 CROS/BICROS ITE |
Virtue 12 CROS/BICROS ITE |
Virtue 16 CROS/BICROS ITE |
| |
|
|
| ||||
|
|
AHB – NuEar | ||||
|
Intro 3 ITE |
Imagine 2 Prestige ITE |
Imagine 2 Pro ITE |
Imagine 2 Premier ITE |
| |
|
Intro 3 HS/ITC |
Imagine 2 Prestige HS/ITC |
Imagine 2 Pro HS/ITC |
Imagine 2 Premier HS/ITC |
| |
|
Intro 3 CIC |
Imagine 2 Prestige CIC |
Imagine 2 Pro CIC |
Imagine 2 Premier CIC |
| |
|
Intro 3 BTE |
Imagine 2 Prestige BTE |
Imagine 2 Pro BTE |
Imagine 2 Premier BTE |
| |
|
Intro 3 Power BTE |
Imagine 2 Prestige Power BTE |
Imagine 2 Pro Power BTE |
Imagine 2 Premier Power BTE |
| |
|
Intro 3 Power Plus BTE |
Imagine 2 Prestige Power Plus BTE |
Imagine 2 Pro Power Plus BTE |
Imagine 2 Premier Power Plus BTE |
| |
|
Intro 3 Mini BTE |
Imagine 2 Prestige Mini BTE |
Imagine 2 Pro Mini BTE |
Imagine 2 Premier Mini BTE |
| |
|
Intro 3 RIC 13 |
Imagine 2 Prestige RIC 13 |
Imagine 2 Pro RIC 13 |
Imagine 2 Premier RIC 13 |
| |
|
|
Look Prestige RIC 13 |
Look Pro RIC 13 |
Look Premier RIC 13 |
| |
|
Intro 3 Max Power RIC 13 |
Imagine 2 Prestige Max Power RIC 13 |
Imagine 2 Pro Max Power RIC 13 |
Imagine 2 Premier Max Power RIC 13 |
| |
|
|
Look Prestige Max Power RIC 13 |
Look Pro Max Power RIC 13 |
Look Premier Max Power RIC 13 |
| |
|
Intro 3 RIC 312 |
Imagine 2 Prestige RIC 312 |
Imagine 2 Pro RIC 312 |
Imagine 2 Premier RIC 312 |
| |
|
|
Look Prestige RIC 312 |
Look Pro RIC 312 |
Look Premier RIC 312 |
| |
|
Intro 3 Max Power RIC 312 |
Imagine 2 Prestige Max Power RIC 312 |
Imagine 2 Pro Max Power RIC 312 |
Imagine 2 Premier Max Power RIC 312 |
| |
|
|
Look Prestige Max Power RIC 13 |
Look Pro Max Power RIC 13 |
Look Premier Max Power RIC 13 |
| |
|
Intro 3 Mini RIC |
Imagine 2 Prestige Mini RIC |
Imagine 2 Pro Mini RIC |
Imagine 2 Premier Mini RIC |
| |
|
Intro 3 Max Power Mini RIC |
Imagine 2 Prestige Max Power Mini RIC |
Imagine 2 Pro Max Power Mini RIC |
Imagine 2 Premier Max Power Mini RIC |
| |
|
Rhapsody 4 CROS/BICROS BTE |
Rhapsody 8 CROS/BICROS BTE |
Rhapsody 12 CROS/BICROS BTE |
Rhapsody 16 CROS/BICROS BTE |
| |
|
Rhapsody 4 CROS/BICROS ITE |
Rhapsody 8 CROS/BICROS ITE |
Rhapsody 12 CROS/BICROS ITE |
Rhapsody 16 CROS/BICROS ITE |
| |
|
REVISED OCTOBER, 2011 |
TOBER, 2011 | |||
|
Mid-Level
|
Mid-High |
Advanced Level |
Flagship Level |
|
|
Member Out-of-Pocket Cost / Per Hearing Aid |
| |||
|
$ -0- / Ear |
$250 / Ear |
$500 / Ear |
$650 / Ear |
|
|
Beltone Name |
| |||
|
Access Invisa CIC |
Change Invisa CIC |
Identity Invisa CIC |
Reach Invisa CIC |
|
|
Access Petit Plus |
Change Petit Plus MC |
Identity Petit Plus MC |
Reach Petit Plus MC |
|
|
Access Opera Plus |
Change Opera Plus ITC |
Identity Opera Plus ITC |
Reach Opera Plus ITC |
|
|
Access Opera Plus |
Change Opera Plus ITC |
Identity Opera Plus ITC |
Reach Opera Plus ITC |
|
|
Access Optima HS |
Change Optima HS |
Identity Optima HS |
Reach Optima HS |
|
|
Access Optima HS |
Change Optima HS |
Identity Optima HS |
Reach Optima HS |
|
|
Access Optima LP |
Change Optima LP |
Identity Optima LP |
Reach Optima LP |
|
|
Access Optima LP |
Change Optima LP |
Identity Optima LP |
Reach Optima LP w/Dir Mic |
|
|
Access Optima ITE |
Change Optima ITE |
Identity Optima ITE |
Reach Optima ITE |
|
|
Access Optima ITE |
Change Optima ITE |
Identity Optima ITE |
Reach Optima ITE |
|
|
Access S75D BTE |
Change 62D RIE |
Identity 62D RIE |
Reach 62D RIE |
|
|
Access S85D BTE |
Change 75D BTE |
Identity 62D PB RIE |
Reach 62D PB RIE |
|
|
|
Change 85D BTE |
Identity 63D REI |
Reach 63D RIE |
|
|
|
Force BTE |
Identity 66D BTE |
Reach 66D BTE |
|
|
|
|
Identity 76D BTE |
Reach 76D BTE |
|
|
|
|
Identity 86D BTE |
Reach 86D BTE |
|
|
|
|
|
True 6 63DW RIE |
|
|
|
|
|
True 6 62D RIE |
|
|
|
|
|
True 6 (CIC-15) |
|
|
|
|
|
True 6 Petite (MC-25) |
|
|
|
|
|
True 6 Opera (ITC-35) |
|
|
|
|
|
True 6 Optima (FS-45) |
|
|
|
|
|
REVISED: |
OCTOBER, 2011 | |||
|
|
-Level
|
Mid-High |
Advanced Level |
Flagship Level | |||
|
|
Member Out-of-Pocket Cost/Hearing Aid | ||||||
|
|
$ -0- / Ear |
$250/Ear |
$500/Ear |
$650/Ear | |||
|
HearUSA - Siemens | |||||||
|
Motion 101 ITE |
Motion 301 ITE/Nitro |
Motion 501 ITE |
Motion 701 ITE/Nitro 16 | ||||
|
Motion 101 HS |
Motion 301 HS/Nitro |
Motion 501 HS |
Motion 701 HS/Nitro 16 | ||||
|
Motion 101 ITC |
Motion 301 ITC/Nitro |
Motion 501 ITC |
Motion 701 ITC/Nitro 16 | ||||
|
Motion 101 MIC |
Motion 301 MIC |
Motion 501 MIC |
Motion 701 MIC | ||||
|
Motion 101 CIC |
Motion 301 CIC/Nitro |
Motion 501 CIC |
Motion 701 CIC/Nitro 16 | ||||
|
Motion 101 BTE |
Motion 301S BTE |
Motion 501 S BTE |
Motion 701 S BTE | ||||
|
Motion SX BTE |
Life 301 BTE |
Life 501 BTE |
Life 701 BTE | ||||
|
Motion P BTE |
Pure 301 BTE |
Pure 501 RIC (Pure 501 Active BTE) |
Pure 701 RIC (Pure 701 Active BTE) | ||||
|
Life 101 BTE |
|||||||
|
Pure 101 BTE |
|||||||
|
Intuis BTE DM |
|||||||
|
Intuis CIC |
|||||||
|
Intuis HS |
|||||||
|
Intuis ITC |
|||||||
|
Intuis ITE |
|||||||
|
Intuis Life Siemens |
|||||||
|
Intuis MITC |
|||||||
|
Intuis S BTE DM |
|||||||
|
Intuis SP BTE DM |
|||||||
|
|
|
REVISED: |
OCTOBER, 2011 |
|
295Mid-Level
|
Mid-High |
Advanced Level |
Flagship Level |
|
Member Out-of-Pocket Cost/Hearing Aid | |||
|
$ -0- / Ear |
$250/Ear |
$500/Ear |
$650/Ear |
|
HearUSA - Rexton | |||
|
Day 4+ ITE |
Day 6+ ITE |
Bridge 8+ CIC |
Bridge 12+ CIC |
|
Day 4+ FREE |
Day 6+ FREE |
Bridge 8+ FREE |
Bridge 12+ FREE BTE |
|
Day 4+ OPEN |
Day 6+ OPEN |
Bridge 8+ HS |
Bridge 12+ HS |
|
Day 4+ ITC |
Day 6+ ITC |
Bridge 8+ ITC |
Bridge 12+ ITC |
|
Day 4+ MIC |
Day 6+ MIC |
Bridge 8+ ITE |
Bridge 12+ ITE |
|
Day 4+ CIC |
Day 6+ CIC |
Bridge 8+ OPEN |
Bridge 12+ OPEN BTE |
|
Day 4+ P BTE |
Day 6+ P BTE |
Bridge 8+ P BTE |
Bridge 12+ P BTE |
|
Gem 8+ BTE |
Cobalt 12+ BTE | ||
|
Gem 12+ BTE | |||
|
|
|
REVISED: |
OCTOBER, 2011 |
|
Mid-Level
|
Mid-High |
Advanced Level |
Flagship Level |
|
Member Out-of-Pocket Cost/Hearing Aid | |||
|
$ -0- / Ear |
$250/Ear |
$500/Ear |
$650/Ear |
|
HearUSA - Unitron | |||
|
Lattitude 4 ITE |
Lattitude 8 ITE |
Lattitude 16 ITE |
Passport ITE |
|
Lattitude 4 HS |
Lattitude 8 HS |
Lattitude 16 HS |
Passport HS |
|
Lattitude 4 ITC |
Lattitude 8 ITC |
Lattitude 16 ITC |
Passport ITC |
|
Lattitude 4 MC |
Lattitude 8 MC |
Lattitude 16 MC |
Passport MC |
|
Lattitude 4 CIC |
Lattitude 8 CIC |
Lattitude 16 CIC |
Passport CIC |
|
Lattitude 4 BTE |
Lattitude 8 BTE |
Lattitude 16 BTE |
Passport BTE |
|
Lattitude 4 High Power BTE |
High Power BTE |
High Power BTE |
Passport High Power BTE |
|
Lattitude 4 Moda II |
Power BTE |
Power BTE |
Passport Power BTE |
|
Lattitude 4 Moxi |
Lattitude 8 Moda II |
Moda II |
Moda II |
|
Shine + ITE |
Lattitude 8 Moxi |
Moxi |
Moxi |
|
Shine + HS |
360+ Super Power |
||
|
Shine + ITC |
|||
|
Shine + MC |
|||
|
Shine + CIC |
|||
|
Shine + BTE |
|||
|
Shine + High Power BTE |
|||
|
Shine + Moda II |
|||
|
360 Essential SP |
|||
|
|
|
REVISED: |
OCTOBER, 2011 | ||||
|
Mid-Level
|
Mid-High |
Advanced Level |
Flagship Level | ||||
|
Member Out-of-Pocket Cost/Hearing Aid | |||||||
|
$ -0- / Ear |
$250/Ear |
$500/Ear |
$650/Ear | ||||
|
HearUSA - Oticon | |||||||
|
Ino CIC |
Ino Pro ITE |
Acto HS & HS Power |
Acto Pro LP | ||||
|
Ino MIC |
Ino Pro LP |
Acto ITC & ITC Power |
Acto Pro HS & HS Power | ||||
|
Ino ITC |
Ino Pro HS |
Acto MIC & MIC Power |
Acto Pro ITC & ITC Power | ||||
|
Ino HS |
Ino Pro ITC |
Acto CIC & CIC Power |
Acto Pro MIC & MIC Power | ||||
|
Ino LP |
Ino Pro MC |
Acto BTE |
Acto Pro CIC & CIC Power | ||||
|
Ino BTE |
Ino Pro CIC |
Acto RITE |
Acto Pro BTE | ||||
|
Ino RITE |
Ino Pro BTE |
Acto Power BTE |
Acto Pro RITE | ||||
|
Ino Mini RITE |
Ino Pro RITE |
Acto Mini RITE |
Acto Pro Mini RITE | ||||
|
Ino Power BTE |
Ino Pro Mini RITE |
Chili SP 5 |
Acto Pro Power BTE | ||||
|
Hit CIC |
Ino Pro Power BTE |
Vigo Connect HS |
Chili SP7 | ||||
|
Hit MIC |
Hit Pro ITE |
Vigo Connect ITC |
Dual W | ||||
|
Hit ITC |
Hit Pro LP |
Vigo Connect MITC |
Vigo Pro Connect LP | ||||
|
Hit HS |
Hit Pro HS |
Vigo Connect CIC |
Vigo Pro Connect HS | ||||
|
Hit LP |
Hit Pro ITC |
Vigo Connect BTE |
Vigo Pro Connect ITC | ||||
|
Hit BTE |
Hit Pro MC |
Vigo Connect RITE |
Vigo Pro Connect MITC | ||||
|
Hit BTE 13 |
Hit Pro CIC |
Vigo Connect Power BTE |
Vigo Pro Connect CIC | ||||
|
Hit RITE |
Hit Pro BTE |
Vigo Connect Power RITE |
Vigo Pro Connect BTE | ||||
|
Hit Power BTE |
Hit Pro BTE 13 |
Sumo DM |
Vigo Pro Connect RITE | ||||
|
Go Pro ITE |
Hit Pro RITE |
Dual M5 |
Vigo Pro Connect Power RITE | ||||
|
Go Pro LP |
Hit Pro Power BTE |
Vigo Pro Connect Power BTE | |||||
|
Go Pro HS |
Dual m7 | ||||||
|
Go Pro ITC |
|||||||
|
Go Pro MC |
|||||||
|
Go Pro CIC |
|||||||
|
Go Pro BTE |
|||||||
|
HearUSA - Bernafon | |||||||
|
Inizia 3 |
Chronos 5 |
Chronos 7 |
Chronos 9 | ||||
|
BTE (Nano/Compact Power/Compact Power Plus) |
BTE (Nano/Micro/Compact Power/ Compact Power X) |
BTE (Nano/Micro/Compact Power/ Compact Power X) |
BTE (Nano/Micro/Compact Power/ Compact Power X) | ||||
|
ITCD/ITC |
ITED/ITCP/ITCD/ITCPD |
ITED/ITCP/ITCD/ITCPD |
ITED/ITCP/ITCD/ITCPD | ||||
|
CIC |
CIC/CICP |
CIC/CICP |
CIC/CICP | ||||
|
|
|||||||
|
HearUSA - Phonak | |||||||
|
Milo Plus SP |
Cassia Micro M |
Solana Micro M |
Ambra Micro M | ||||
|
Milo Plus UP |
Cassia Micro P |
Solana Micro P |
Ambra Micro P | ||||
|
Milo Plus Micro |
Cassia SP |
Solana SP |
Ambra SP | ||||
|
Milo Plus CIC/MC |
Cassia Petite |
Solana Petite |
Ambra Petite | ||||
|
Milo Plus ITC/HS dAZ |
Cassia 10 Petite |
Solana 10 Petite |
Ambra 10 Petite | ||||
|
Milo Plus FS dAZ |
Cassia 312 Petite |
Solana 312 Petite |
Ambra 312 Petite | ||||
|
Milo PlusFS Power dAZ |
Cassisa 312 UZ Petite |
Solana 312 UZ Petite |
Ambra 312 UZ Petite | ||||
|
OK! Plus SP |
Cassia 312 |
Solana 312 |
Ambra 312 | ||||
|
OK! Plus UP |
Cassia 312 UZ |
Solana 312 UZ |
Ambra 312 UZ | ||||
|
OK! Plus M |
Cassia 13 UZ |
Solana 13 UZ |
Ambra 13 UZ | ||||
|
Certéna Art M |
Versata Art Micro |
Exelia Art M | |||||
|
Certéna Art P |
Versata Art Micro Petite |
Exelia Art P | |||||
|
Certéna Art SP |
Versata Art CIC/MC Petite |
Exelia Art SP | |||||
|
Certéna Art Micro |
Versata Art CIC/MC P Petite |
Exelia Art Micro | |||||
|
Certéna Art Micro Petite |
Versata Art ITC/HS Petite |
Exelia Art Micro Petite | |||||
|
Certéna Art CIC/MC Petite |
Versata Art ITC/HS VZ Petite |
Exélia Art CIC/MC Petite | |||||
|
Certéna Art CIC/MC P Petite |
Versata Art ITC/HS VZ P Petite |
Exelia Art CIC/MC P Petite | |||||
|
Certéna Art ITC/HS Petite |
Versata Art ITC/HS |
Exelia Art ITC/HS Petite | |||||
|
Certéna Art ITC/HS dAZ Petite |
Versata Art ITC/HS VZ |
Exelia Art ITC/HS | |||||
|
Certéna Art ITC/HS P dAZ Petite |
Versata Art ITC/HS VZ P |
Exelia Art FS VZ | |||||
|
Certéna Art ITC/HS |
Versata Art FS P |
Exelia Art FS P | |||||
|
Certéna Art ITC/HS dAZ |
Versata Art FS VZ |
Exelia Art ITC/HS VZ | |||||
|
Certéna Art ITC/HS P dAZ |
Versata Art FS P VZ |
Exelia Art ITC/HS VZ Petite | |||||
|
Certéna Art FS P |
Audéo YES V |
Exelia Art IT/HS VZ P Petite | |||||
|
Certéna Art FS dAZ |
Audéo Mini V |
Exelia Art ITC/HS VZ P | |||||
|
Certéna Art FS P |
Audéo Smart V |
Exélia Art FS P dAZ | |||||
|
Audéo Zip III LEFT |
Audéo Zip V LEFT |
Audéo S YES IX | |||||
|
Audéo Zip III RIGHT |
Audéo Zip V RIGHT |
Audéo S Mini IX | |||||
|
Audéo S YES III |
Naîda V UP |
Audéo S Smart IX | |||||
|
Audéo S Mini III |
Naîda V SP |
Naîda S IX SP | |||||
|
Audéo S Smart III |
Nios Micro V |
Naîda S IX UP | |||||
|
Nios Micro III |
Audéo S Mini V |
Audéo Zip IX LEFT | |||||
|
Naîda III UP dAZ |
Audéo S Yes V |
Audéo Zip IX RIGHT | |||||
|
Naîda III SP dAZ |
Audéo S Smart V |
Audéo Smart IX | |||||
|
Naîda S III SP |
Audéo S Smart V – CERAMIC BLACK |
Naîda IX UP | |||||
|
Naîda S III UP |
Naîda S V SP |
Naîda IX SP | |||||
|
Audéo Yes III |
Naîda S V UP |
Audéo YES IX | |||||
|
Audéo Mini III |
Audéo Mini IX | ||||||
|
Audéo Smart III |
Audéo Smart IX | ||||||
|
|
HearUSA – Hansaton | ||||||
|
|
Cemia |
Lumeo |
Veneto |
Auriga | |||
|
|
|||||||
|
|
|||||||
|
|
|
REVISED: |
OCTOBER, 2011 | ||||
|
Mid-Level
|
Mid-High |
Advanced Level |
Flagship Level | ||||
|
Member Out-of-Pocket Cost/Hearing Aid | |||||||
|
$ -0- / Ear |
$250/Ear |
$500/Ear |
$650/Ear | ||||
|
Miracle-Ear Products | |||||||
|
ME2100 CIC |
CIC |
ME3100 CIC |
CIC |
ME4100 CIC |
CIC |
ME5100 CIC |
CIC |
|
ME2100 C |
Canal |
ME3100 C |
Canal |
ME4100 C |
Canal |
ME5100 C |
Canal |
|
ME2100 HS |
HS |
ME3100 HS |
HS |
ME4100 HS |
HS |
ME5100 HS |
HS |
|
ME2100 I |
ITE |
ME3100 I |
ITE |
ME4100 I |
ITE |
ME5100 I |
ITE |
|
ME2100 OP |
BTE |
ME3100 OP |
BTE |
ME4100 0P |
BTE |
ME5100 OP |
BTE |
|
ME2100 SX |
BTE |
ME3100 SX |
BTE |
ME4100 SX |
BTE |
ME5100 SX |
BTE |
|
ME2000 M |
BTE |
ME3000 M |
BTE |
ME4000 M VC D |
BTE |
ME5000 M D |
BTE |
|
ME2000 M VC |
BTE |
ME3000 M VC |
BTE |
ME4000 M JR |
BTE |
ME5000 M VC D |
BTE |
|
ME2100 P |
BTE |
ME3100 P |
BTE |
ME4100 P D |
BTE |
ME5100 P D |
BTE |
|
ME750 SP |
BTE |
ME3100 SP |
BTE |
ME4100 RIC |
RIC |
ME5100 SP |
BTE |
|
ME2100 RIC |
RIC |
ME3100 RIC |
RIC |
ME4100 XT RIC |
RIC |
ME5100 RIC |
RIC |
|
|
|
ME3100 XT RIC |
RIC |
|
|
ME5100 XT RIC |
RIC |
|
|
|
ME3100xP CIC |
CIC |
|
|
ME5100xP CIC |
CIC |
|
|
|
ME3100xP C |
Canal |
|
|
ME5100xP C |
Canal |
|
|
|
ME3100xP HS |
HS |
|
|
ME5100xP HS |
HS |
|
|
|
ME3100xP I |
ITE |
|
|
ME5100xP I |
ITE |
|
|
|
|
|
|
|
ME5100 Mirage |
mini CIC |
|
|
|
REVISED: |
OCTOBER, 2011 | |
|
Mid-Level
|
Mid-High |
Advanced Level |
Flagship Level | |
|
Member Out-of-Pocket Cost/Hearing Aid | ||||
|
$ -0- / Ear |
$250/Ear |
$500/Ear |
$650/Ear | |
|
Sonus - Resound | ||||
|
Essence CIC |
Live 5 CIC |
Live 7 CIC |
Live 9 CIC | |
|
Essence ITC |
Live 5 MC |
Live 7 MC |
Live 9 MC | |
|
Essence HS |
Live 5 ITC |
Live 7 ITC |
Live 9 ITC | |
|
Essence ITE |
Live 5 HS |
Live 7 HS |
Live 9 HS | |
|
Essence BTE |
Live 5 ITE |
Live 7 ITE |
Live 9 ITE | |
|
Essence Open BTE |
Live 5 BTE |
Live 7 BTE |
Live 9 BTE | |
|
Sparx BTE |
Live 5 Open BTE |
Live 7 Open BTE |
Live 9 OPEN BTE | |
|
|
Live 5 RIC BTE |
Live 7 RIC BTE |
Live 9 RIC BTE | |
|
|
Alera 5 CIC |
Alera 7 CIC |
Alera 9 CIC | |
|
|
Alera 5 ITC |
Alera 7 ITC |
Alera 9 ITC | |
|
|
Alera 5 ITE |
Alera 7 ITE |
Alera 9 ITE | |
|
|
Alera 5 BTE |
Alera 7 BTE |
Alera 9 BTE | |
|
|
Alera 5 RIC BTE |
Alera 7 RIC BTE |
Alera 9 RIC BTE | |
|
|
Mid-Level
|
Mid-High |
Advanced Level |
Flagship Level | |
|
|
Member Out-of-Pocket Cost/Hearing Aid | ||||
|
|
$ -0- / Ear |
$250/Ear |
$500/Ear |
$650/Ear | |
|
|
Sonus - Siemens | ||||
|
Motion 101 CIC |
Motion 301 CIC |
Motion 501 CIC |
Motion 701 iMini MINI CIC | ||
|
Motion 101 ITC |
Motion 301 ITC |
Motion 501 ITC |
Motion 701 CIC | ||
|
Motion 101 HS |
Motion 301 HS |
Motion 501 HS |
Motion 701 ITC | ||
|
Motion 101 ITE |
Motion 301 ITE |
Motion 501 ITE |
Motion 701 HS | ||
|
Motion 101 BTE |
Motion 301 BTE |
Motion 501 BTE |
Motion 701 ITE | ||
|
Life 101 BTE |
Life 301 BTE |
Life 501 BTE |
Motion 701 BTE | ||
|
Pure 101 RIC BTE |
Pure 301 RIC BTE |
Pure 501 RIC |
Life 701 BTE | ||
|
|
Nitro 301 CIC |
|
Pure 701 RIC | ||
|
|
Nitro 301 ITC |
|
Nitro 701 CIC | ||
|
|
Nitro 301 HS |
|
Nitro 701 ITC | ||
|
|
Nitro 301 ITE |
|
Nitro 701 HS | ||
|
|
|
|
Nitro 701 ITE | ||
|
|
|
|
| ||
|
|
|
REVISED: |
OCTOBER, 2011 | |
|
Mid-Level
|
Mid-High |
Advanced Level |
Flagship Level | |
|
Member Out-of-Pocket Cost/Hearing Aid | ||||
|
$ -0- / Ear |
$250/Ear |
$500/Ear |
$650/Ear | |
|
Sonus - Phonak | ||||
|
Milo Plus CIC |
Cassia CIC |
Solana CIC |
Ambra CIC | |
|
Milo Plus MC
|
Cassia MC |
Solana MC |
Ambra MC | |
|
Milo Plus ITC |
Cassia ITC |
Solana ITC |
Ambra ITC | |
|
Milo Plus HS |
Cassia HS |
Solana HS |
Ambra HS | |
|
Milo Plus ITE |
Cassia ITE |
Solana ITE |
Ambra ITE | |
|
Milo Plus BTE |
Cassia BTE |
Solana BTE |
Ambra BTE | |
|
Milo Plus Micro Open BTE |
Cassia Micro Open BTE |
Solana Micro Open BTE |
Ambra Micro Open BTE | |
|
|
Audeo S Yes III RIC BTE |
Audeo S Yes V RIC BTE |
Audeo S Yes IX RIC BTE | |
|
|
Audeo S Smart III RIC BTE |
Audeo S Smart V RIC BTE |
Audeo S Smart IX RIC BTE | |
|
|
Audeo S Mini III RIC BTE |
Audeo S Mini V RIC BTE |
Audeo S Mini IX RIC BTE | |
|
|
Naida S III BTE |
Naida S V BTE |
Naida S IX BTE | |