AHB – Starkey - AudioNet America

REVISED: August 2014
Mid-Level
Standard Digital
Mid-High
Level Digital
Advanced Level
Flagship Level
Member Out-of-Pocket Cost/Hearing Aid
$250/Ear
$500/Ear
$650/Ear
3 Series 30 ITE
3 Series 70 ITE
3 Series 90 ITE
3 Series 110 ITE
Ignite 30 ITE
X Series 70 ITE
X Series 90 ITE
X Series 110 ITE
3 Series i30 ITE
3 Series i70 ITE
3 Series i90 ITE
3 Series i110 ITE
Ignite i30 ITE
Wi Series i70 ITE
Wi Series i90 ITE
Wi Series i110 ITE
3 Series 30 HS/ITC
3 Series 70 HS/ITC
3 Series 90 HS/ITC
3 Series 110 HS/ITC
Ignite 30 HS/ITC
X Series 70 HS/ITC
X Series 90 HS/ITC
X Series 110 HS/ITC
3 Series i20 HS/ITC
3 Series i70 HS/ITC
3 Series i90 HS/ITC
3 Series i110 HS/ITC
Ignite i30 HS/ITC
Wi Series i70 HS/ITC
Wi Series i90 HS/ITC
Wi Series i110 HS/ITC
3 Series 30 CIC
3 Series 70 CIC
3 Series 90 CIC
3 Series 110 CIC
Ignite 30 CIC
X Series 70 CIC
X Series 90 CIC
X Series 110 CIC
3 Series i30 CIC
3 Series i70 CIC
3 Series i90 CIC
3 Series i110 CIC
Ignite i30 CIC
Wi Series i70 CIC
Wi Series i90 CIC
Wi Series i110 CIC
3 Series 30 BTE 13
3 Series 70 BTE 13
3 Series 90 BTE 13
3 Series 110 BTE 13
Ignite 30 BTE 13
X Series 70 BTE 13
X Series 90 BTE 13
X Series 110 BTE 13
3 Series 30 mini BTE
312
3 Series 70 mini BTE
312
3 Series 90 mini BTE
312
3 Series 110 mini BTE
312
Ignite 30 mini BTE
X Series 70 mini BTE
X Series 90 mini BTE
X Series 110 mini BTE
3 Series i30 mini BTE
3 Series i70 mini BTE
3 Series i90 mini BTE
3 Series i110 mini BTE
Ignite 30 Power BTE
X Series 70 Power BTE
X Series 90 Power BTE
X Series 110 Power BTE
3 Series 30 Power Plus
BTE 13
3 Series 70 Power Plus
BTE 13
3 Series 90 Power Plus
BTE 13
3 Series 110 Power Plus
BTE 13
Ignite 30 Power Plus
BTE
X Series 70 Power Plus
BTE
X Series 90 Power Plus
BTE
X Series 110 Power Plus
BTE
3 Series i30 Power Plus
BTE 13
3 Series i70 Power Plus
BTE 13
3 Series i70 Power Plus
BTE 13
3 Series i110 Power Plus
BTE 13
Ignite 30 RIC 13
X Series 70 RIC 13
Wi Series i70 RIC 13
X Series 90 RIC 13
Wi Series i90 RIC 13
X Series 110 RIC 13
Halo i70 RIC 13
Halo i90 RIC 13
Halo 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
Ignite i30 AP RIC 13
Wi Series i70 AP RIC 13
Wi Series i90 AP RIC 13
Wi Series i110 AP RIC 13
3 Series 30 RIC 312
3 Series 70 RIC 312
3 Series 90 RIC 312
3 Series 110 RIC 312
Ignite 30 RIC 312
X Series 90 RIC 312
3 Series i90 RIC 312
X Series 110 RIC 312
3 Series i30 RIC 312
X Series 70 RIC 312
3 Series i70 RIC 312
Ignite i30 RIC 312
Wi Series i70 RIC 312
Wi Series i90 RIC 312
Wi Series i110 RIC 312
$ -0- / Ear
AHB – Starkey
Ignite i30 RIC 13
Wi Series i110 RIC 13
3 Series i110 RIC 312
Mid-Level
Standard Digital
Mid-High
Level Digital
Advanced Level
Flagship Level
Member Out-of-Pocket Cost/Hearing Aid
$500/Ear
3 Series 90 AP RIC 312
$650/Ear
3 Series 30 AP RIC 312
$250/Ear
3 Series 70 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
3 Series i30 AP RIC 312
3 Series i70 AP RIC 312
3 Series i90 AP RIC 312
3 Series i110 AP RIC 312
Xino i30 micro RIC 312
Xino i70 micro RIC 312
Xino i90 micro RIC 312
Xino i110 micro RIC 312
Xino 30 RIC 10
Xino 90 RIC 10
Xino 90 AP RIC 10
Xino 110 RIC 10
Xino 30 AP RIC 10
Xino 70 RIC 10
Xino 70 AP RIC 10
Xino Classic 30 micro
RIC 312
Xino Classic 70 micro
RIC 312
Xino Classic 90 micro
RIC 312
Xino Classic 110 micro
RIC 312
$ -0- / Ear
3 Series 110 AP RIC 312
Xino 110 AP RIC 10
Xino Tinnitus 30 RIC 10
Xino Tinnitus 90 RIC 10
X Series 70
CROS/BICROS RIC 312
X Series 90
CROS/BICROS RIC 312
X Series 110
CROS/BICROS RIC 312
X Series 70
CROS/BICROS ITE
X Series 90
CROS/BICROS ITE
X Series 110
CROS/BICROS ITE
AHB – Audibel
Start 8 ITE
Audibel A2 Silver ITE
Audibel A2 Gold ITE
Audibel A2 Platinum ITE
Start 6 ITE
Anthem XT Silver ITE
Anthem XT Gold ITE
Anthem XT Platinum ITE
Start Wireless 8 ITE
Audibel A2 Wireless
Silver ITE
Audibel A2 Wireless
Gold ITE
Audibel A2 Wireless
Platinum ITE
Start Wireless 6 ITE
Range Silver ITE
Range Gold ITE
Range Platinum ITE
Start 8 HS/ITC
Audibel A2 Silver HS/ITC
Audibel A2 Gold HS/ITC
Audibel A2 Platinum
HS/ITC
Start 6 HS/ITC
Anthem XT Silver
HS/ITC
Anthem XT Gold HS/ITC
Anthem XT Platinum
HS/ITC
Start Wireless 8 HS/ITC
Audibel A2 Wireless
Silver HS/ITC
Audibel A2 Wireless
Gold HS/ITC
Audibel A2 Wireless
Platinum HS/ITC
Start Wireless 6 HS/ITC
Range Silver HS/ITC
Range Gold HS/ITC
Range Platinum HS/ITC
Start 8 CIC
Audibel A2 Gold CIC
Anthem XT Gold CIC
Audibel A2 Platinum CIC
Start 6 CIC
Audibel A2 Silver CIC
Anthem XT Silver CIC
Start Wireless 8 CIC
Audibel A2 Wireless
Silver CIC
Audibel A2 Wireless
Gold CIC
Audibel A2 Wireless
Platinum CIC
Start Wireless 8 CIC
Range Silver CIC
Range Gold CIC
Range Platinum CIC
Start 8 BTE 13
Audibel A2 Silver BTE
13
Audibel A2 Gold BTE 13
Audibel A2 Platinum BTE
13
Start 6 BTE 13
Anthem XT Silver BTE
13
Anthem XT Gold BTE 13
Anthem XT Platinum BTE
13
Start 8 mini BTE 312
Audibel A2 Silver mini
BTE 312
Audibel A2 Gold mini
BTE 312
Audibel A2 Platinum mini
BTE 312
Start 6 mini BTE
Anthem XT Silver mini
BTE
Anthem XT Gold mini
BTE
Anthem XT Platinum mini
BTE
Anthem XT Platinum CIC
Mid-Level
Standard Digital
Mid-High
Level Digital
Advanced Level
Flagship Level
Member Out-of-Pocket Cost/Hearing Aid
$ -0- / Ear
$250/Ear
$500/Ear
$650/Ear
Start Wireless 8 mini
BTE
Audibel A2 Wireless
Silver mini BTE
Audibel A2 Wireless
Gold mini BTE
Audibel A2 Wireless
Platinum mini BTE
Start 6 Power BTE
Anthem XT Silver Power
BTE
Anthem XT Gold Power
BTE
Anthem XT Platinum
Power BTE
Start 8 Power Plus BTE
13
Audibel A2 Silver Power
Plus BTE 13
Audibel A2 Gold Power
Plus BTE 13
Audibel A2 Platinum
Power Plus BTE 13
Start 6 Power Plus BTE
Anthem XT Silver Power
Plus BTE
Anthem XT Gold Power
Plus BTE
Anthem XT Platinum
Power Plus BTE
Start Wireless 8 Power
Plus BTE 13
Audibel A2 Wireless
Silver Power Plus BTE
13
Audibel A2 Wireless
Gold Power Plus BTE 13
Audibel A2 Wireless
Platinum Power Plus BTE
13
Start 6 RIC 13
Anthem XT Silver RIC 13
Anthem XT Gold RIC 13
Anthem XT Platinum RIC
13
Start Wireless 6 RIC 13
Range Silver RIC 13
Range Gold RIC 13
Range Platinum RIC 13
Audibel A3i Silver RIC
13
Audibel A3i Gold RIC 13
Audibel A3i 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
Start Wireless 6 Power
Solution RIC 13
Range Silver Power
Solution RIC 13
Range Gold Power
Solution RIC 13
Range Platinum Power
Solution RIC 13
Start 8 RIC 312
Audibel A2 Silver RIC
312
Audibel A2 Gold RIC 312
Audibel A2 Platinum RIC
312
Anthem XT Gold RIC
312
Audibel A2 Wireless
Gold RIC 312
Anthem XT Platinum RIC
312
Start Wireless 8 RIC 312
Anthem XT Silver RIC
312
Audibel A2 Wireless
Silver RIC 312
Start Wireless 6 RIC 312
Range Silver RIC 312
Range Gold RIC 312
Range Platinum RIC 312
Start 6 Power Solution
RIC 312
Audibel A2 Silver Power
Solution RIC 312
Audibel A2 Gold Power
Solution RIC 312
Audibel A2 Platinum
Power Solution 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
Start Wireless 8 Power
Solution RIC 312
Audibel A2 Wireless
Silver Power Solution
RIC 312
Audibel A2 Wireless
Gold Power Solution RIC
312
Audibel A2 Wireless
Platinum Power Solution
RIC 312
Start 8 Wireless micro
RIC 312
Audibel A2 Wireless
Silver micro RIC 312
Audibel A2 Wireless
Gold micro RIC 312
Audibel A2 Wireless
micro RIC 312
Start 6 RIC 10
Anthem XT Silver RIC 10
Anthem XT Gold RIC 10
Anthem XT Platinum RIC
10
Start 6 Power Solution
RIC 10
Anthem XT Silver Power
Solution RIC 10
Anthem XT Gold Power
Solution RIC 10
Anthem XT Platinum
Power Solution RIC 10
Start 6 RIC 312
Audibel A2 Wireless
Platinum RIC 312
Mid-Level
Standard Digital
Mid-High
Level Digital
Advanced Level
Flagship Level
Member Out-of-Pocket Cost/Hearing Aid
$ -0- / Ear
Start 8 Classic micro RIC
312
$250/Ear
Audibel A2 Classic Silver
micro RIC 312
$500/Ear
Audibel A2 Classic Gold
micro RIC 312
$650/Ear
Audibel A2 Classic
Platinum micro RIC 312
Anthem XT Silver
CROS/BICROS RIC 312
Audibel A2 Tinnitus Gold
RIC 10
Anthem XT Gold
CROS/BICROS RIC 312
Anthem XT Platinum
CROS/BICROS RIC 312
Anthem XT Silver
CROS/BICROS ITE
Anthem XT Gold
CROS/BICROS ITE
Anthem XT Platinum
CROS/BICROS ITE
Start Tinnitus 8 RIC 10
AHB – NuEar
Intro 5 ITE
NuEar SDS Prestige ITE
NuEar SDS Pro ITE
NuEar SDS Premier ITE
Intro 3 ITE
Imagine 2 Prestige ITE
Imagine 2 Pro ITE
Imagine 2 Premier ITE
Intro Wireless 5 ITE
NuEar SDS Wireless
Prestige ITE
NuEar SDS Wireless Pro
ITE
NuEar SDS Wireless
Premier ITE
Intro Wireless 3 ITE
Look Prestige ITE
Look Pro ITE
Look Premier ITE
Intro 5 HS/ITC
NuEar SDS Prestige
HS/ITC
NuEar SDS Pro HS/ITC
NuEar SDS Premier
HS/ITC
Intro 3 HS/ITC
Imagine 2 Prestige
HS/ITC
Imagine 2 Pro HS/ITC
Imagine 2 Premier
HS/ITC
Intro Wireless 5 HS/ITC
NuEar SDS Wireless
Prestige HS/ITC
NuEar SDS Wireless Pro
HS/ITC
NuEar SDS Wireless
Premier HS/ITC
Intro Wireless 3 HS/ITC
Look Premier HS/ITC
Look Pro HS/ITC
Look Premier HS/ITC
Intro 5 CIC
NuEar SDS Prestige CIC
NuEar SDS Pro CIC
NuEar SDS Premier CIC
Intro 3 CIC
Imagine 2 Prestige CIC
Imagine 2 Pro CIC
Imagine 2 Premier CIC
Intro Wireless 5 CIC
NuEar SDS Wireless
Prestige CIC
NuEar SDS Wireless Pro
CIC
NuEar SDS Wireless
Premier CIC
Intro Wireless 3 CIC
Look Prestige CIC
Look Pro CIC
Look Premier CIC
Intro 5 BTE 13
NuEar SDS Prestige
BTE 13
NuEar SDS Pro BTE 13
NuEar SDS Premier BTE
13
Intro 3 BTE 13
Imagine 2 Prestige BTE
13
Imagine 2 Pro BTE 13
Imagine 2 Premier BTE
13
Intro 5 mini BTE 312
NuEar SDS Prestige
mini BTE 312
NuEar SDS Pro mini
BTE 312
NuEar SDS Premier mini
BTE 312
Intro 3 mini BTE
Imagine 2 Prestige mini
BTE
Imagine 2 Pro mini BTE
Imagine 2 Premier mini
BTE
Intro Wireless 5 mini
BTE
NuEar SDS Wireless
Prestige mini BTE
NuEar SDS Wireless Pro
mini BTE
NuEar SDS Wireless
Premier mini BTE
Intro 3 Power BTE
Imagine 2 Prestige
Power BTE
Imagine 2 Pro Power
BTE
Imagine 2 Premier Power
BTE
Intro 5 Power Plus BTE
13
NuEar SDS Prestige
Power Plus BTE 13
NuEar SDS Pro Power
Plus BTE 13
NuEar SDS Premier
Power Plus BTE 13
Mid-Level
Standard Digital
Mid-High
Level Digital
Advanced Level
Flagship Level
Member Out-of-Pocket Cost/Hearing Aid
$ -0- / Ear
$250/Ear
$500/Ear
$650/Ear
Intro 3 Power Plus BTE
Imagine 2 Prestige
Power Plus BTE
Imagine 2 Pro Power
Plus BTE
Imagine 2 Premier Power
Plus BTE
Intro Wireless 5 Power
Plus BTE 13
NuEar SDS Wireless
Prestige Power Plus
BTE 13
NuEar SDS Wireless Pro
Power Plus BTE 13
NuEar SDS Wireless
Premier Power Plus BTE
13
Imagine 2 Pro RIC 13
Imagine 2 Premier RIC
13
Look Pro RIC 13
Look Premier RIC 13
iSDS Prestige RIC 13
iSDS Pro RIC 13
iSDS Premier RIC 13
Imagine 2 Prestige AP
RIC 13
Imagine 2 Pro AP RIC
13
Imagine 2 Premier AP
RIC 13
Look Prestige AP RIC 13
Look Pro AP RIC 13
Look Premier AP RIC 13
NuEar SDS Prestige RIC
312
NuEar SDS Pro RIC 312
NuEar SDS Premier RIC
312
Intro 3 RIC 13
Intro Wireless 5 RIC 13
Intro 3 AP RIC 13
Intro Wireless 3 AP RIC
13
Intro 5 RIC 312
Imagine 2 Prestige RIC
13
Look Prestige RIC 13
Imagine 2 Pro RIC 312
Imagine 2 Premier RIC
312
NuEar SDS Wireless Pro
RIC 312
NuEar SDS Wireless
Premier RIC 312
Intro Wireless 5 RIC 312
Image 2 Prestige RIC
312
NuEar SDS Wireless
Prestige RIC 312
Intro Wireless 3 RIC 312
Look Prestige RIC 312
Look Pro RIC 312
Look Premier RIC 312
Intro 5 AP RIC 312
NuEar SDS Prestige RIC
312
NuEar SDS Pro AP RIC
312
NuEar SDS Premier AP
RIC 312
Intro 3 AP RIC 312
Imagine 2 Prestige AP
RIC 312
Imagine 2 Pro AP RIC
312
Imagine 2 Premier AP
RIC 312
Intro Wireless 5 AP RIC
312
NuEar SDS Wireless
Prestige AP RIC 312
NuEar SDS Wireless Pro
AP RIC 312
NuEar SDS Wireless
Premier AP RIC 312
Intro Wireless 5 micro
RIC 312
NuEar SDS Wireless
Prestige micro RIC 312
NuEar SDS Wireless Pro
micro RIC 312
NuEar SDS Wireless
Premier micro RIC 312
Imagine 2 Pro RIC 10
Imagine 2 Premier RIC
10
Imagine 2 Pro AP RIC
10
Imagine 2 Premier AP
RIC 10
NuEar SDS Classic Pro
micro RIC 312
NuEar SDS Classic
Premier micro RIC 312
Imagine 2 Prestige
CROS/BICROS RIC 312
NuEar SDS Tinnitus Pro
RIC 10
Imagine 2 Pro
CROS/BICROS RIC 312
Imagine 2 Premier
CROS/BICROS RIC 312
Imagine 2 Prestige
CROS/BICROS ITE
Imagine 2 Pro
CROS/BICROS ITE
Imagine 2 Premier
CROS/BICROS ITE
Intro 3 RIC 312
Intro 3 AP RIC 10
Imagine 2 Prestige RIC
10
Imagine 2 Prestige AP
RIC 10
Intro Classic 5 micro RIC
312
NuEar SDS Classic
Prestige micro RIC 312
Intro 3 RIC 10
Intro Tinnitus 5 RIC 10
Mid-Level
Standard Digital
Mid-High
Level Digital
Advanced Level
Flagship Level
Member Out-of-Pocket Cost / Per Hearing Aid
$ -0- / Ear
$250 / Ear
$500 / Ear
$650 / Ear
Beltone
True 3 Invisa (CIC-15)
Promise 6 Invisa (CIC15)
Promise 17 Invisa (CIC15)
True 3 Petite (MC-25)
Promise 6 Petite (MC-25)
Promise 17 Petite (MC25)
Origin 2 Optima (FS-45)
True 3 Opera (ITC-35)
Promise 6 Opera (ITC35)
Promise 17 Opera (ITC35)
Origin 2 75D –BTE
True 3 Optima (FS-45)
Promise 6 Optima (FS45)
Promise 17 Optima (FS45)
Origin 2 85D -BTE
True 3 66DW –BTE
Promise 6 MIC 10a
Promise 17 MIC 10a
Origin 3 Invisa (CIC-15)
Promise 6 MIC 312
Promise 17 MIC 312
Origin 3 Opera (ITC-35)
Promise 6 MIC UPG 312
Promise 17 UPG 312
Origin 3 Optima (FS-45)
Promise 6 62D –BTE
Promise 17 62D –BTE
Origin 3 65D – BTE
Promise 6 63DW –BTE
Promise 17 63DW -BTE
Origin 3 75D – BTE
Promise 6 64DW – BTE
Promise 17 64DW –BTE
Origin 3 85D –BTE
Promise 6 66DW –BTE
Promise 17 66DW –BTE
Change 62D –(RIE)
Promise 6 78DW –BTE
Promise 17 78DW –BTE
Origin 2 Invisa (CIC-15)
Origin 2 Opera (ITC-35)
Bold 3-BTE
Promise 17 85DW –BTE
Promise 9 Invisa (CIC15)
Promise 9 Petite (MC-25)
Promise 9 Opera (ITC35)
Promise 9 Optima (FS45)
Promise 9 MIC 10a
Promise 9 MIC 312
Promise 9 MIC UPG 312
Promise 9 62D –BTE
Promise 9 63DW –BTE
Promise 9 64DW –BTE
Promise 9 66DW -BTE
Promise 9 78DW –BTE
Promise 9 85DW –BTE
Mid-High
Level Digital
Mid-Level
Standard Digital
Advanced Level
Flagship Level
Member Out-of-Pocket Cost/Hearing Aid
$ -0- / Ear
$250/Ear
$500/Ear
$650/Ear
Elcipse 301 XCL
Motion 5 mi SX, M, P
Life 3 mi
Ace 5 mi
Insio 3 mi
Aquaris 5 mi
Motion 3 mi
Life 5 mi
Aquaris 3 mi
Pure 501 Carat XCL
Nitro 301
Pure 5 mi
Pure 3 mi
Insio 5 mi (Customs)
HearUSA – Siemens
Sirion
Orion
Pure XCL 101
Pure 30 Carat XCL
Member Out-of-Pocket Cost/Hearing Aid
$ -0- / Ear
$250/Ear
$500/Ear
$650/Ear
HearUSA – Hansaton
Linnea
Lumeo
Veneto
Member Out-of-Pocket Cost/Hearing Aid
$ -0- / Ear
$500/Ear
$650/Ear
Day 6+
Accord 2c 12
Cobalt 12+
Onyx Eco
Strata 2c 12
Bridge 12+
Charismo 2c 12
Gem 12+
$250/Ear
HearUSA – Rexton
Day 4+
Bridge 8+
Onyx 8+
Gem 8+
Mid-Level
Standard Digital
Mid-High
Level Digital
Advanced Level
Flagship Level
Member Out-of-Pocket Cost/Hearing Aid
$ -0- / Ear
$250/Ear
$500/Ear
$650/Ear
HearUSA – Unitron
Quantum2 E
Moxi2 10 RIC
Moxi2 Kiss E
Moxi2 Kiss 10
Moxie2 E
Quantum2 10
Tandem 4
Moxi E SP
Moxi E SPm
360 e Super Power
Member Out-of-Pocket Cost/Hearing Aid
$500/Ear
$650/Ear
Ino Pro HS & HS Power
Nera CIC & CIC Power
Nera Pro CIC & CIC
Power
Ino MIC
Ino Pro ITC & ITC Power
Nera Canal & Canal
Power
Nera Pro Canal & Canal
Power
Ino ITC
Ino Pro MIC & MIC
Power
Nera Half Shell & Half
Shell Power
Nera Pro Half Shell &
Half Shell Power
Ino HS
Ino Pro CIC & CIC
Power
Nera Full Shell & Full
Shell Power
Nera Pro Full Shell &
Full Shell Power
Ino LP
Ino Pro BTE
Nera BTE
Nera Pro BTE
Ino BTE
Ino Pro mini BTE
Nera Mini BTE
Nera Pro Mini BTE
Ino miniBTE
Ino Pro RITE
Nera RITE
Nera Pro RITE
Ino RITE
Ino Pro mini RITE
Nera miniRite
Nera Pro miniRite
Ino miniRITE
Ino Pro Power BTE
Nera Power BTE
Nera Pro Power BTE
Acto HS & HS Power
Agil CIC & CIC Power
Acto ITC & ITC Power
Agil MIC & MIC Power
Acto MIC & MIC Power
Agil Canal & Canal
Power
Acto CIC & CIC Power
Agil Half Shell & Half
Shell Power
Acto BTE
Agil Low Profile
Acto mini BTE
Agil BTE
$ -0- / Ear
$250/Ear
HearUSA – Oticon
Ino CIC
Ino Power BTE
Mid-Level
Standard Digital
Mid-High
Level Digital
Advanced Level
Flagship Level
Member Out-of-Pocket Cost/Hearing Aid
$ -0- / Ear
$250/Ear
$500/Ear
$650/Ear
Acto mini RITE
Agil minRite
Chili SP 5
Agil Power BTE
Intiga 6
Chili SP7
Sumo DM
Intiga 8
Intiga 8 IIC
HearUSA - Bernafon
Inizia 3
Chronos 5
Chronos 7
Chronos 9
BTE
Nano/CompactPower/
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
Mid-Level
Standard Digital
Mid-High
Level Digital
Advanced Level
Flagship Level
Member Out-of-Pocket Cost/Hearing Aid
$ -0- / Ear
$250/Ear
$500/Ear
$650/Ear
HearUSA – Phonak
Milo Plus SP
Audeo Q30 - 10
Virto Q50 - Nano NW O
Audeo S Smart V CERAMIC BLACK
Milo Plus UP
Audeo Q30 - 312
Sky Q50 – M13
Sky Q70 – M13
Milo Plus Micro
Audeo Q30 - 312T
Sky Q50 - RIC
Sky Q70 - RIC
Milo Plus CIC/MC
Naida Q30 – SP
Sky Q50 - SP
Sky Q70 -SP
Milo Plus ITC/HS dAZ
Naida Q30 - UP
Sky Q50 - UP
Sky Q70 - UP
Milo Plus FS dAZ
Naida Q30 - RIC
Audeo Q50 - 10
Audeo Q70 – 10
Milo Plus FS Power dAZ
Bolero Q30 – M13
Audeo Q50 - 312
Audeo Q70 – 312
OK! Plus SP
Bolero Q30 – M312
Audeo Q50 - 312T
Audeo Q70 - 312T
OK! Plus UP
Bolero Q30 - P
Naida Q50 - SP
Naida Q70 – SP
OK! Plus M
Bolero Q30 - SP
Naida Q50 - UP
Naida Q70 – UP
Virto Q30 – 10 NW O
Naida Q50 - RIC
Naida Q70 – RIC
Virto Q30 - 13
Bolero Q50 - M13
Bolero Q70 - M13
Virto Q30 – 312
Bolero Q50 - M312
Bolero Q70 - M312
Virto Q30 – 312 NW
Bolero Q50 - P
Bolero Q70 – P
Audeo S Smart I
Bolero Q50 - SP
Bolero Q70 – SP
Naida S I SP
Virto Q50 - 10 NW O
Virto Q70 - 10 NW O
Naida S I UP
Virto Q50 - 13
Virto Q70 – 13
Dalia M H2O
Virto Q50 - 312
Virto Q70 – 312
Dalia microM
Virto Q50 - 312 NW
Virto Q70 – 312 NW
Dalia microP
Virto Q50 – Nano NW O
Virto Q70 – Nano NW O
Dalia SP
Audeo S YES III
Audeo S YES V
Dalia 10 Petite
Audeo S Mini III
Audeo S Mini V
Dalia 312 UZ Petite
Audeo S Smart III
Audeo S Smart V
Dalia 13 UZ Petite
Naida S III SP
Naida S V SP
Naida S III UP
Naida S V UP
Naida S CRT III
Naida S CRT V
Mid-Level
Standard Digital
Mid-High
Level Digital
Advanced Level
Flagship Level
Member Out-of-Pocket Cost/Hearing Aid
$ -0- / Ear
$250/Ear
$500/Ear
$650/Ear
Nios S H2O III
Solana Micro M
Cassia Micro M
Solana Micro P
Cassia Micro P
Solana SP
Cassia SP
Solana Petite
Cassia Petite
Solana M H2O
Cassia M H2O
Solana 10 Petite
Cassia 10 Petite
Solana 312 Petite
Cassia 312 Petite
Solana 312 UZ Petite
Cassia 312 UZ Petite
Solana 312
Cassia 312
Solana 312 UZ
Cassia 312 UZ
Solana 13 UZ
Cassia 13 UZ
Solana Nano
Cassia Nano
Nios S H2O V
HearUSA – Phonak
Audeo YES V
Audeo Mini V
Audeo Smart V
Naida V UP
Naida V SP
Nios micro V
Mid-Level
Standard Digital
Mid-High
Level Digital
Advanced Level
Flagship Level
Member Out-of-Pocket Cost/Hearing Aid
$250/Ear
$ -0- / Ear
$650/Ear
$500/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
mini
CIC
ME5100 Mirage
REVISED: January 2015
Mid-Level
Standard Digital
Mid-High
Level Digital
Advanced Level
Flagship Level
Member Out-of-Pocket Cost/Hearing Aid
$ -0- / Ear
$250/Ear
$500/Ear
$650/Ear
YourHearing Network - OTICON
GET
Ria BTE
Acto BTE
Chilli SP5
GET BTE 13
Ria Canal & Canal
Power
Acto BTE-Power
Intiga 8
GET CIC/MIC Power
Ria CIC & CIC Power
Acto Custom
Nera Pro BTE
GET ITC Power
Ria Full Shell&Full Shell
Power
Acto Mini RITE
Nera Pro Canal & Canal
Power
GET ITC Power
Ria Half Shell& Half
Shell Power
Acto Pro BTE
Nera Pro CIC, & CIC
Power
GET ITE
Ria Mini BTE
Acto Pro BTE-Power
Nera Pro Full Shell & Full
Shell Power
GET Power
Ria miniRite
Acto Pro Custom
Nera Pro Half Shell &
Half Shell Power
Go Pro BTE
Ria Power BTE
Acto Pro Mini Rite
Nera Pro IIC
Go Pro BTE Power
Ria RITE
Acto Pro RITE
Nera Pro Mini BTE
Go Pro BTE Power Omni
Safari 300 BTE
Acto RITE
Nera Pro Mini Rite
Go Pro CIC/MIC
Safari 300 Power BTE
Intiga 6
Nera Pro Power BTE
Go Pro ITC
Safari 300 Super Power
BTE
Nera BTE
Nera Pro Rite
Go Pro ITE
Sensei 13 BTE
Nera Canal & Canal
Power
Safarai 900 Power BTE
Go Pro ITE P Omni
Sensei 312 BTE
Nera CIC & CIC Power
Safari 900 BTE
Ino BTE 13
Sensei RITE
Nera Full Shell & Full
Shell Power
Safari 900 Super Power
BTE
Ino BTeE Power
Nera Half Shell & Hall
Shell Power
Ino CIC Mic Power
Nera Mini BTE
Ino CIC/MIC
Nera mini Rite
Ino ITC
Nera Power BTE
Ino ITC Power
Nera RITE
Ino ITE
Ria Pro BTE
Ria Pro Canal & Canal
Power
Mid-Level
Standard Digital
Mid-High
Level Digital
Advanced Level
Flagship Level
Member Out-of-Pocket Cost/Hearing Aid
$ -0- / Ear
$250/Ear
$500/Ear
$650/Ear
Ria Pro CIC & CIC
Power
Ria Pro Full Shell & Full
Shell Power
Ria Pro Half Shell & Half
Shell Power
Ria Pro IIC
Ria Pro Mini BTE
Ria Pro miniRite
Ria Pro Power BTE
Ria Pro RITE
Safari 600 BTE
Safari 600 Power BTE
Safari 600 Super Power
BTE
Sensei Pro 13 BTE
Sensei Pro 312 BTE
Sensei Pro RITE
Sumo DM
YourHearing Network - PHONAK
Audeo Q30
Audeo Q50
Audeo Q70
Audeo Q30
Audeo S Mini III
Audeo S Smart III
Bolero Q70
Audeo S Mini III
Audeo S Smart I
Bolero Q 50
Cassia
Audeo S Smart I
Audeo S Yes III
Naida S CRT III
Dalia
Audeo S Yes III
Bolero Q30
Nios S H20 III
Nios S H20 V
Bolero Q30
Naida Q30
Virto Q50
Sky Q50
Naida Q30
Naida Q50
Sky Q70
Naida Q50
Naida S I SP
Solana
Naida S I SP
Naida S I UP
Virto Q70
Naida S I UP
Naida S III SP
Virto Q90
Naida S III SP
Mid-Level
Standard Digital
Mid-High
Level Digital
Advanced Level
Flagship Level
Member Out-of-Pocket Cost/Hearing Aid
$ -0- / Ear
$250/Ear
$500/Ear
$650/Ear
Naida S III UP
Naida S III UP
Virto Q30
Virto Q30
YourHearing Network - SONIC
Ion RIC
Charm 40
Bliss 80
Bilss 100
Endura 6
Charm 60
Flip 100
Flip 40
Charm 60 IIC
Ion 200
Charm 60 Standard
Endura 12
Flip 60
Flip 80
YourHearing Network - WIDEX
Bravo
Bravissimo
Clear 330
Flash
Clear 220
Passion 115
Mind 220
Mind 330
VITA SV38 No Volume
Control
Real
Passion 105
Passion 110
Super 220 BTE