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
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