Contract Effective 9/1/17 MDHHS Contract Hearing Aid Definitions BELTONE Page 1 of 4 DESCRIPTION & FEATURES (See below) db RANGE MODEL NUMBER (19 Characters or less) HCPCS CODE(S) EQUIPMENT PUBLISHED LIST PRICE EQUIPMENT PERCENT DISCOUNT OFF LIST PRICE EQUIPMENT TOTAL PRICE FIXED NON - WARRANTY REPAIR PRICE NON - WARRANTY REPAIR PERIOD (MONTHS) WARRANTY REPAIR PERIOD (MONTHS) LEGEND 6 63DRW up to 110 dB HL 203939xx V5257 $979.00 59.244% $399.00 $100.00 12 24 Digital BTE-RIE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability LEGEND 6 64DRW up to 110 dB HL 194210xx V5257 $979.00 59.244% $399.00 $100.00 12 24 Digital BTE-RIE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil LEGEND 6 76DW up to 110 dB HL 193687xx V5257 $979.00 59.244% $399.00 $100.00 12 24 Digital BTE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil LEGEND 6 86DW up to 110 dB HL 193689xx V5257 $979.00 59.244% $399.00 $100.00 12 24 Digital BTE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil LEGEND 6 63DRW up to 110 dB HL 203939xx V5261 $1,958.00 59.244% $798.00 $200.00 12 24 Digital BTE-RIE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability LEGEND 6 64DRW up to 110 dB HL 194210xx V5261 $1,958.00 59.244% $798.00 $200.00 12 24 Digital BTE-RIE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil LEGEND 6 76DW up to 110 dB HL 193687xx V5261 $1,958.00 59.244% $798.00 $200.00 12 24 Digital BTE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil LEGEND 6 86DW up to 110 dB HL 193689xx V5261 $1,958.00 59.244% $798.00 $200.00 12 24 Digital BTE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil BOLD 3 95D 60 to 120 dB HL 188820xx V5257 $899.00 55.617% $399.00 $100.00 12 24 Digital BTE with nine (9) channels, automatic noise reduction, adaptive directionality plus T-coil for patients with severe to profound hearing loss BOLD 3 95D 60 to 120 dB HL 188820xx V5261 $1,798.00 55.617% $798.00 $200.00 12 24 Digital BTE with nine (9) channels, automatic noise reduction, adaptive directionality plus T-coil for patients with severe to profound hearing loss ALLY 3 64DRW 10 to 110 dB HL 196267xx V5257 $789.00 55.767% $349.00 $100.00 12 24 Digital BTE-RIE with eight (8) Channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil ALLY 3 66DW up to 80 dB HL 196271xx V5257 $789.00 55.767% $349.00 $100.00 12 24 Digital BTE with eight (8) Channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil ALLY 3 76DW up to 100 dB HL 196276xx V5257 $789.00 55.767% $349.00 $100.00 12 24 Digital BTE with eight (8) Channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil BEHIND THE EAR TYPES - The total price shall be for a single hearing aid or two hearing aids and appropriate case. List model numbers/name and full range of the instrument has a T-coil or T-coil capability. For digital aids, indicate whether a remote control is required. For conventional aids, indicate whether it is a linear or compression circuit L = Linear, C = Compression.
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Contract Effective 9/1/17 MDHHS Contract Hearing Aid ... · $200.00 12 24 Digital ITE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability
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Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsBELTONE
Page 1 of 4
DESCRIPTION & FEATURES (See below) db RANGEMODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY REPAIR
PRICE
NON - WARRANTY
REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
LEGEND 6 63DRW up to 110 dB HL 203939xx V5257 $979.00 59.244% $399.00 $100.00 12 24Digital BTE-RIE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capabilityLEGEND 6 64DRW up to 110 dB HL 194210xx V5257 $979.00 59.244% $399.00 $100.00 12 24Digital BTE-RIE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil
LEGEND 6 76DW up to 110 dB HL 193687xx V5257 $979.00 59.244% $399.00 $100.00 12 24Digital BTE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil
LEGEND 6 86DW up to 110 dB HL 193689xx V5257 $979.00 59.244% $399.00 $100.00 12 24Digital BTE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil
LEGEND 6 63DRW up to 110 dB HL 203939xx V5261 $1,958.00 59.244% $798.00 $200.00 12 24Digital BTE-RIE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capabilityLEGEND 6 64DRW up to 110 dB HL 194210xx V5261 $1,958.00 59.244% $798.00 $200.00 12 24Digital BTE-RIE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil
LEGEND 6 76DW up to 110 dB HL 193687xx V5261 $1,958.00 59.244% $798.00 $200.00 12 24Digital BTE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil
LEGEND 6 86DW up to 110 dB HL 193689xx V5261 $1,958.00 59.244% $798.00 $200.00 12 24Digital BTE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil
BOLD 3 95D 60 to 120 dB HL 188820xx V5257 $899.00 55.617% $399.00 $100.00 12 24Digital BTE with nine (9) channels, automatic noise reduction, adaptive directionality plus T-coil for patients with severe to profound hearing lossBOLD 3 95D 60 to 120 dB HL 188820xx V5261 $1,798.00 55.617% $798.00 $200.00 12 24Digital BTE with nine (9) channels, automatic noise reduction, adaptive directionality plus T-coil for patients with severe to profound hearing lossALLY 3 64DRW 10 to 110 dB HL 196267xx V5257 $789.00 55.767% $349.00 $100.00 12 24Digital BTE-RIE with eight (8) Channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil
ALLY 3 66DW up to 80 dB HL 196271xx V5257 $789.00 55.767% $349.00 $100.00 12 24Digital BTE with eight (8) Channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil
ALLY 3 76DW up to 100 dB HL 196276xx V5257 $789.00 55.767% $349.00 $100.00 12 24Digital BTE with eight (8) Channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil
BEHIND THE EAR TYPES - The total price shall be for a single hearing aid or two hearing aids and appropriate case. List model numbers/name and full range of the instrument has a T-coil or T-coil capability. For digital aids, indicate whether a remote control is required. For conventional aids, indicate whether it is a linear or compression circuit L = Linear, C = Compression.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsBELTONE
Page 2 of 4
DESCRIPTION & FEATURES (See below) db RANGEMODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY REPAIR
PRICE
NON - WARRANTY
REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
ALLY 3 86DW 20 to 115 dB HL 196282xx V5257 $789.00 55.767% $349.00 $100.00 12 24Digital BTE with eight (8) Channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil
ALLY 3 64DRW 10 to 110 dB HL 196267xx V5261 $1,578.00 55.767% $698.00 $200.00 12 24Digital BTE-RIE with eight (8) Channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil
ALLY 3 66DW up to 80 dB HL 196271xx V5261 $1,578.00 55.767% $698.00 $200.00 12 24Digital BTE with eight (8) Channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil
ALLY 3 76DW up to 100 dB HL 196276xx V5261 $1,578.00 55.767% $698.00 $200.00 12 24Digital BTE with eight (8) Channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil
ALLY 3 86DW 20 to 115 dB HL 196282xx V5261 $1,578.00 55.767% $698.00 $200.00 12 24Digital BTE with eight (8) Channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coilORIGIN 3 64D up to 100 dB HL 191854xx V5257 $649.00 55.470% $289.00 $100.00 12 24Digital BTE with six (6) Channels, automatic feedbackcancellation, directional microphone, auto-phone plus T-coilORIGIN 3 64D up to 100 dB HL 191854xx V5261 $1,298.00 55.470% $578.00 $200.00 12 24Digital BTE with six (6) Channels, automatic feedbackcancellation, directional microphone, auto-phone plus T-coilORIGIN 2 75D 10 to 90 dB HL 178420xx V5257 $519.00 52.023% $249.00 $100.00 12 24Digital BTE with four (4) Channels, automatic feedbackcancellation, directional microphone plus T-coilORIGIN 2 85D 20 to 100 dB HL 178421xx V5257 $519.00 52.023% $249.00 $100.00 12 24Digital BTE with four (4) Channels, automatic feedbackcancellation, directional microphone plus T-coilORIGIN 2 75D 10 to 90 dB HL 178420xx V5261 $1,038.00 52.023% $498.00 $200.00 12 24Digital BTE with four (4) Channels, automatic feedbackcancellation, directional microphone plus T-coilORIGIN 2 85D 20 to 100 dB HL 178421xx V5261 $1,038.00 52.023% $498.00 $200.00 12 24Digital BTE with four (4) Channels, automatic feedbackcancellation, directional microphone plus T-coil
FULL SHELL CONCHA MODELDESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY REPAIR
PRICE
NON - WARRANTY
REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
LEGEND 6 ITE up to 110 dB HL LND6-45-FS V5256 $979.00 59.244% $399.00 $100.00 12 24Digital ITE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil capability
IN THE EAR TYPES – Prices shall be for a single hearing aid or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsBELTONE
Page 3 of 4
FULL SHELL CONCHA MODELDESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY REPAIR
PRICE
NON - WARRANTY
REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
LEGEND 6 ITE up to 110 dB HL LND6-45-FS V5260 $1,958.00 59.244% $798.00 $200.00 12 24Digital ITE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil capabilityALLY 3 ITE 20 to 115 dB HL ALY3-45-FS V5256 $789.00 55.767% $349.00 $100.00 12 24Digital ITE with eight (8) Channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil capabilityALLY 3 ITE 20 to 115 dB HL ALY3-45-FS V5260 $1,578.00 55.767% $698.00 $200.00 12 24Digital ITE with eight (8) Channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil capabilityORIGIN 2 ITE up to 95 dB HL OR2-45-FS V5256 $349.00 28.653% $249.00 $100.00 12 24Digital ITE with four (4) Channels, automatic feedbackcancellation, directional microphone plus T-coil capabilityORIGIN 2 ITE up to 95 dB HL OR2-45-FS V5260 $698.00 28.653% $498.00 $200.00 12 24Digital ITE with four (4) Channels, automatic feedbackcancellation, directional microphone plus T-coil capability
HALF SHELL CONCHA MODELDESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY REPAIR
PRICE
NON - WARRANTY
REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
LEGEND 6 ITE up to 110 dB HL LND6-45-HS V5256 $979.00 59.244% $399.00 $100.00 12 24Digital ITE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil capabilityLEGEND 6 ITE up to 110 dB HL LND6-45-HS V5260 $1,958.00 59.244% $798.00 $200.00 12 24Digital ITE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil capabilityALLY 3 ITE 20 to 115 dB HL ALY3-45-HS V5256 $789.00 55.767% $349.00 $100.00 12 24Digital ITE with eight (8) Channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil capabilityALLY 3 ITE 20 to 115 dB HL ALY3-45-HS V5260 $1,578.00 55.767% $698.00 $200.00 12 24Digital ITE with eight (8) Channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil capabilityORIGIN 2 ITE up to 95 dB HL OR2-45-HS V5256 $349.00 28.653% $249.00 $100.00 12 24Digital ITE with four (4) Channels, automatic feedbackcancellation, directional microphone plus T-coil capabilityORIGIN 2 ITE up to 95 dB HL OR2-45-HS V5260 $698.00 28.653% $498.00 $200.00 12 24Digital ITE with four (4) Channels, automatic feedbackcancellation, directional microphone plus T-coil capability
IN THE EAR TYPES – Prices shall be for a single hearing aid, or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsBELTONE
Page 4 of 4
LOW PROFILE MODELDESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY REPAIR
PRICE
NON - WARRANTY
REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
LEGEND 6 ITE up to 110 dB HL LND6-45-LP V5256 $979.00 59.244% $399.00 $100.00 12 24Digital ITE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil capabilityLEGEND 6 ITE up to 110 dB HL LND6-45-LP V5260 $1,958.00 59.244% $798.00 $200.00 12 24Digital ITE with twelve (12) channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil capabilityALLY 3 ITE 20 to 115 dB HL ALY3-45-LP V5256 $789.00 55.767% $349.00 $100.00 12 24Digital ITE with eight (8) Channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil capabilityALLY 3 ITE 20 to 115 dB HL ALY3-45-LP V5260 $1,578.00 55.767% $698.00 $200.00 12 24Digital ITE with eight (8) Channels, automatic noise reduction, adaptive directionality, wireless capability plus T-coil capabilityORIGIN 2 ITE up to 95 dB HL OR2-45-LP V5256 $349.00 28.653% $249.00 $100.00 12 24Digital ITE with four (4) Channels, automatic feedbackcancellation, directional microphone plus T-coil capabilityORIGIN 2 ITE up to 95 dB HL OR2-45-LP V5260 $698.00 28.653% $498.00 $200.00 12 24Digital ITE with four (4) Channels, automatic feedbackcancellation, directional microphone plus T-coil capability
FEATURES = Digital (full digital signal processing with two or three channels, etc.), List CROS and BiCros on separate price lines.
IN THE EAR TYPES – Prices shall be for a single hearing aid or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsHANSATON (Unitron Hearing)
Page 1 of 2
DESCRIPTION & FEATURES (See below) db RANGEMODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY REPAIR
PRICE
NON - WARRANTY
REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
Flow 1 13 SP BTE up to 85 dB Flow 1 V5257 $400.00 55.000% $180.00 $100.00 12 months 36 monthsDigital Programmable 2 channel/4 band BTE 2 memories, C circuit, T-coil, Directional Mics Feedback Reduction, no remote control
up to 85 dB Flow 1 V5261 $800.00 55.000% $360.00 $100.00 12 months 36 months
Flow 2 675 UP BTE up to 86 dB Flow 2 V5257 $575.00 51.000% $281.75 $100.00 12 months 36 monthsDigital Programmable 4 channel/8 band BTE C Circuit, T-coil, Directional microphone, DAI no remote control
up to 86 dB Flow 2 V5261 $1,150.00 51.000% $563.50 $100.00 12 months 36 months
sound 3-312 up to 86 dB sound3 V5257 $500.00 60.200% $199.00 $100.00 12 months 36 months8 channels/band, 3 RIC, no t-coil, directional mic, remote control compatible, feedback manager
up to 86 dB sound3 V5261 $1,000.00 60.200% $398.00 $100.00 12 months 36 months
Beat 3 13 SP up to 86 dB beat3 V5257 $575.00 56.000% $253.00 $100.00 12 months 36 monthsDigital Programmable 6 channel/6 band BTE 4 memories, C Circuit, auto T-coil, Directional Mics Remote control optional, DAI, Feedback Manager
up to 86 dB beat3 V5261 $1,150.00 56.000% $506.00 $100.00 12 months 36 months
soundSHD 3 S312/13 up to 86 dB soundSHD3 V5257 $550.00 56.000% $242.00 $100.00 12 months 36 monthsDigital Programmable 8 channel/8 band RIC 4 memories, C Circuit, auto T-coil, Directional Mics Remote control optional, Feedback Manager
up to 86 dB soundSHD3 V5261 $1,100.00 56.000% $484.00 $100.00 12 months 36 months
soundSHD 5 S312/13 up to 86 dB soundSHD5 V5257 $850.00 60.000% $340.00 $100.00 12 months 36 monthsDigital Programmable 12 channel/12 band BTE 4 memories, C circuit, auto T-coil, Directional Mics Remote control optional, DAI, Feedback Manager
up to 86 dB soundSHD5 V5261 $1,700.00 60.000% $680.00 $100.00 12 months 36 months
FULL SHELL CONCHA MODEL DESCRIPTION & FEATURES (See below) db RANGEMODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY REPAIR
PRICE
NON - WARRANTY
REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
JamHD 3Digital Programmable Full Concha ITE CBDMIC8 channels/8 bands, C circuit, Feedback Manager CBTCDirectional Microphone - no charge CBPHCOTelecoil - no charge CBVCSwitchless Telecoil - no charge CBPBVolume Control - no chargePush Button - no charge
up to 65 dB JamHD 3 ITE V5256 $550.00 56.000% $242.00 $100.00 12 month 36 monthsup to 65 dB JamHD 3 ITE V5260 $1,100.00 56.000% $484.00 $100.00 12 month 36 months
HALF SHELL CONCHA DESCRIPTION & FEATURES (See below) db RANGEMODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY REPAIR
PRICE
NON - WARRANTY
REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)JamHD 3Digital Programmable Half Shell Concha ITE8 channels/8 bands, C circuit, Feedback ManagerDirectional Microphone - no charge CBDMICTelecoil - no charge CBTCSwitchless Telecoil - no charge CBPHCOVolume Control - no charge CBVCPush Button - no charge CBPB
up to 65 dB JamHD 3 HS V5256 $575.00 56.000% $253.00 $100.00 12 month 36 monthsup to 65 dB JamHD 3 HS V5260 $1,150.00 56.000% $506.00 $100.00 12 month 36 months
BEHIND THE EAR TYPES - The total price shall be for a single hearing aid or two hearing aids and appropriate case. List model numbers/name and full range of the instrument has a T-coil or T-coil capability. For digital aids, indicate whether a remote control is required. For conventional aids, indicate whether it is a linear or compression circuit L = Linear, C = Compression.
IN THE EAR TYPES – Prices shall be for a single hearing aid or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
IN THE EAR TYPES – Prices shall be for a single hearing aid, or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsHANSATON (Unitron Hearing)
Page 2 of 2
LOW PROFILE DESCRIPTION & FEATURES (See below) db RANGEMODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY REPAIR
PRICE
NON - WARRANTY
REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
JamHD 3Digital Programmable Low Profile8 channels/8 bands, C circuitFeedback ManagerDirectional Microphone - no charge CBDMICTelecoil - no charge CBTCSwitchless Telecoil - no charge CBPHCOVolume Control - no charge CBVCPush Button - no charge CBPB
up to 65 dB JamHD 3 LP V5256 $550.00 56.000% $242.00 $100.00 12 month 36 monthsup to 65 dB JamHD 3 LP V5260 $1,100.00 56.000% $484.00 $100.00 12 month 36 months
IN THE EAR TYPES – Prices shall be for a single hearing aid or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsOTICON
Page 1 of 9
DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)
HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)Opn 3 miniRITE-T - Advanced Digital miniRITE with Telecoil (Receiver-In-Ear style BTE), Made for iPhone®, 312 battery, 48 processing channels, 12 fitting bands, Frequency range up to 8000 Hz, Adaptive directionality system, Binaural wireless technology, advanced Noise Management system, Binaural Synchronization and coordination of features, Tinnitus Support System (integrated sound generator can be enabled as part of a tinnitus management program to provide tinnitus relief), DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control. Telecoil and autophone, FM compatible via telecoil.
0-105 dB 001-410-125 V5257 $1,195.00 70.795% $349.00 $100.00 12 36
Opn 3 miniRITE-T - Binaural, Advanced Digital miniRITE with Telecoil (Receiver-In-Ear style BTE), Made for iPhone®, 312 battery, 48 processing channels, 12 fitting bands, Frequency range up to 8000 Hz, Adaptive directionality system, Binaural wireless technology, advanced Noise Management system, Binaural Synchronization and coordination of features, Tinnitus Support System (integrated sound generator can be enabled as part of a tinnitus management program to provide tinnitus relief), DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control. Telecoil and autophone, FM compatible via telecoil.
0-105 dB 001-410-125 V5261 $2,390.00 70.795% $698.00 $100.00 12 36
Opn 3 Plus Power BTE - Advanced Digital Power BTE, Made for iPhone®, 312 battery, 48 processing channels, 12 fitting bands, Frequency range up to 8000 Hz, Adaptive directionality system, Binaural wireless technology, advanced Noise Management system, Binaural Synchronization and coordination of features, Tinnitus Support System (integrated sound generator can be enabled as part of a tinnitus management program to provide tinnitus relief), DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume Control, Telecoil, FM compatible via telecoil, two-color LED indicator.
25-106 dB 001-410-100 V5257 $1,195.00 70.795% $349.00 $100.00 12 36
Opn 3 Plus Power BTE - Binaural, Advanced Digital Power BTE, Made for iPhone®, 312 battery, 48 processing channels, 12 fitting bands, Frequency range up to 8000 Hz, Adaptive directionality system, Binaural wireless technology, advanced Noise Management system, Binaural Synchronization and coordination of features, Tinnitus Support System (integrated sound generator can be enabled as part of a tinnitus management program to provide tinnitus relief), DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume Control, Telecoil, FM compatible via telecoil, two-color LED indicator.
25-106 dB 001-410-100 V5261 $2,390.00 70.795% $698.00 $100.00 12 36
Opn 3 miniRITE - Advanced Digital miniRITE (Receiver-In-Ear style BTE), Made for iPhone®, 312 battery, Rechargeable battery option, 48 processing channels, 12 fitting bands, Frequency range up to 8000 Hz, Adaptive directionality system, Binaural wireless technology, advanced Noise Management system, Binaural Synchronization and coordination of features, Tinnitus Support System (integrated sound generator can be enabled as part of a tinnitus management program to provide tinnitus relief), DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control.
0-105 dB 001-410-016 V5257 $1,195.00 70.795% $349.00 $100.00 12 36
Opn 3 miniRITE - Binaural, Advanced Digital miniRITE (Receiver-In-Ear style BTE), Made for iPhone®, 312 battery, Rechargeable battery option, 48 processing channels, 12 fitting bands, Frequency range up to 8000 Hz, Adaptive directionality system, Binaural wireless technology, advanced Noise Management system, Binaural Synchronization and coordination of features, Tinnitus Support System (integrated sound generator can be enabled as part of a tinnitus management program to provide tinnitus relief), DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control.
0-105 dB 001-410-016 V5261 $2,390.00 70.795% $698.00 $100.00 12 36
Alta2 Power Plus BTE - Premium Digital Power Plus BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, Speech-Weighted Modulation Noise Management, 10 Fitting bands, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
20-105 dB 001-311-100 V5257 $1,295.00 69.189% $399.00 $100.00 12 36
Alta2 Power Plus BTE - Binaural, Premium Digital Power Plus BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, Speech-Weighted Modulation Noise Management, 10 Fitting bands, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
20-105 dB 001-311-100 V5261 $2,590.00 69.189% $798.00 $100.00 12 36
Alta2 BTE - Premium Digital BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, Speech-Weighted Modulation Noise Management, 10 Fitting bands, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
0-85 dB 001-311-031 V5257 $1,295.00 69.189% $399.00 $100.00 12 36
Alta2 BTE - Binaural, Premium Digital BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, Speech-Weighted Modulation Noise Management, 10 Fitting bands, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
0-85 dB 001-311-031 V5261 $2,590.00 69.189% $798.00 $100.00 12 36
BEHIND THE EAR TYPES - The total price shall be for a single hearing aid or two hearing aids and appropriate case. List model numbers/name and full range of the instrument has a T-coil or T-coil capability. For digital aids, indicate whether a remote control is required. For conventional aids, indicate whether it is a linear or compression circuit L = Linear, C = Compression.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsOTICON
Page 2 of 9
DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)
HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)Alta2 miniBTE - Premium Digital miniBTE, 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, Speech-Weighted Modulation Noise Management, 10 Fitting bands, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control.
0-85 dB 001-311-027 V5257 $1,295.00 69.189% $399.00 $100.00 12 36
Alta2 miniBTE - Binaural, Premium Digital miniBTE, 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, Speech-Weighted Modulation Noise Management, 10 Fitting bands, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control.
0-85 dB 001-311-027 V5261 $2,590.00 69.189% $798.00 $100.00 12 36
Alta2 miniRITE- Premium Digital miniRITE (Receiver-In-Ear style BTE), 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, Speech-Weighted Modulation Noise Management, 10 Fitting bands, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control.
0-105 dB 001-311-016 V5257 $1,295.00 69.189% $399.00 $100.00 12 36
Alta2 miniRITE - Binaural, Premium Digital miniRITE (Receiver-In-Ear style BTE), 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, Speech-Weighted Modulation Noise Management, 10 Fitting bands, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control.
0-105 dB 001-311-016 V5261 $2,590.00 69.189% $798.00 $100.00 12 36
Alta2 Power BTE - Premium Digital Power BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, Speech-Weighted Modulation Noise Management, 10 Fitting bands, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
20-100 dB 001-311-012 V5257 $1,295.00 69.189% $399.00 $100.00 12 36
Alta2 Power BTE - Binaural, Premium Digital Power BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, Speech-Weighted Modulation Noise Management, 10 Fitting bands, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
20-100 dB 001-311-012 V5261 $2,590.00 69.189% $798.00 $100.00 12 36
Alta2 RITE - Premium Digital RITE (Receiver-In-Ear style BTE), 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, Speech-Weighted Modulation Noise Management, 10 Fitting bands, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
0-105 dB 001-311-009 V5257 $1,295.00 69.189% $399.00 $100.00 12 36
Alta2 RITE - Binaural, Premium Digital RITE (Receiver-In-Ear style BTE), 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, Speech-Weighted Modulation Noise Management, 10 Fitting bands, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
0-105 dB 001-311-009 V5261 $2,590.00 69.189% $798.00 $100.00 12 36
Nera2 Power Plus BTE - Advanced Digital Power Plus BTE, 13 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
20-105 dB 001-163-100 V5257 $750.00 66.667% $250.00 $100.00 12 36
Nera2 Power Plus BTE - Binaural, Advanced Digital Power Plus BTE, 13 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
20-105 dB 001-163-100 V5261 $1,500.00 66.667% $500.00 $100.00 12 36
Nera2 miniRITE - Advanced Digital miniRITE (Receiver-In-Ear style BTE), 312 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control.
0-105 dB 001-163-074 V5257 $750.00 66.667% $250.00 $100.00 12 36
Nera2 miniRITE - Binaural, Advanced Digital miniRITE (Receiver-In-Ear style BTE), 312 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control.
0-105 dB 001-163-074 V5261 $1,500.00 66.667% $500.00 $100.00 12 36
Nera2 Pro BTE - Advanced Digital BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
0-85 dB 001-163-031 V5257 $950.00 63.263% $349.00 $100.00 12 36
Nera2 Pro BTE - Binaural, Advanced Digital BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
0-85 dB 001-163-031 V5261 $1,900.00 63.263% $698.00 $100.00 12 36
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsOTICON
Page 3 of 9
DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)
HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)Nera2 Pro miniBTE - Advanced Digital miniBTE, 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control.
0-85 dB 001-163-027 V5257 $950.00 63.263% $349.00 $100.00 12 36
Nera2 Pro miniBTE - Binaural, Advanced Digital miniBTE, 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control.
0-85 dB 001-163-027 V5261 $1,900.00 63.263% $698.00 $100.00 12 36
Nera2 Pro miniRITE - Advanced Digital miniRITE (Receiver-In-Ear style BTE), 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control.
0-105 dB 001-163-016 V5257 $950.00 63.263% $349.00 $100.00 12 36
Nera2 Pro miniRITE - Binaural, Advanced Digital miniRITE (Receiver-In-Ear style BTE), 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control.
0-105 dB 001-163-016 V5261 $1,900.00 63.263% $698.00 $100.00 12 36
Nera2 Pro designRITE - Advanced Digital designRITE (Receiver-In-Ear style BTE), 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control with Streamer accessory only.
0-80 dB 001-163-012 V5257 $950.00 63.263% $349.00 $100.00 12 36
Nera2 Pro designRITE - Binaural, Advanced Digital designRITE (Receiver-In-Ear style BTE), 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control with Streamer accessory only.
0-80 dB 001-163-012 V5261 $1,900.00 63.263% $698.00 $100.00 12 36
Nera2 Pro RITE - Advanced Digital RITE (Receiver-In-Ear style BTE), 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
0-105 dB 001-163-009 V5257 $950.00 63.263% $349.00 $100.00 12 36
Nera2 Pro RITE - Binaural, Advanced Digital RITE (Receiver-In-Ear style BTE), 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
0-105 dB 001-163-009 V5261 $1,900.00 63.263% $698.00 $100.00 12 36
Nera2 Pro Power BTE - Advanced Digital Power BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
20-100 dB 001-151-100 V5257 $950.00 63.263% $349.00 $100.00 12 36
Nera2 Pro Power BTE - Binaural, Advanced Digital Power BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
20-100 dB 001-151-100 V5261 $1,900.00 63.263% $698.00 $100.00 12 36
Nera2 Pro Power Plus BTE - Advanced Digital Power Plus BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
20-105 dB 001-151-031 V5257 $950.00 63.263% $349.00 $100.00 12 36
Nera2 Pro Power Plus BTE - Binaural, Advanced Digital Power Plus BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
20-105 dB 001-151-031 V5261 $1,900.00 63.263% $698.00 $100.00 12 36
Nera2 BTE - Advanced Digital BTE, 13 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
0-85 dB 001-151-027 V5257 $750.00 66.667% $250.00 $100.00 12 36
Nera2 BTE - Binaural, Advanced Digital BTE, 13 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
0-85 dB 001-151-027 V5261 $1,500.00 66.667% $500.00 $100.00 12 36
Nera2 RITE - Advanced Digital RITE (Receiver-In-Ear style BTE), 312 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
0-105 dB 001-151-016 V5257 $750.00 66.667% $250.00 $100.00 12 36
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsOTICON
Page 4 of 9
DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)
HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)Nera2 RITE - Binaural, Advanced Digital RITE (Receiver-In-Ear style BTE), 312 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
0-105 dB 001-151-016 V5261 $1,500.00 66.667% $500.00 $100.00 12 36
Nera2 Power BTE - Advanced Digital Power BTE, 13 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
20-100 dB 001-151-012 V5257 $750.00 66.667% $250.00 $100.00 12 36
Nera2 Power BTE - Binaural, Advanced Digital Power BTE, 13 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
20-100 dB 001-151-012 V5261 $1,500.00 66.667% $500.00 $100.00 12 36
Nera2 miniBTE - Advanced Digital miniBTE, 13 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control.
0-85 dB 001-151-009 V5257 $750.00 66.667% $250.00 $100.00 12 36
Nera2 miniBTE - Binaural, Advanced Digital miniBTE, 13 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control.
0-85 dB 001-151-009 V5261 $1,500.00 66.667% $500.00 $100.00 12 36
Ria2 Pro Power Plus BTE - Essential Digital Power Plus BTE, 13 battery, Binaural Synchronization, Single-Band Adaptive Directionality, Modulation Noise Management, 6 channels, Adaptation Manager, Frequency range up to 8000 Hz, Tinnitus Support System (integrated sound generator can be enabled as part of a tinnitus management program to provide tinnitus relief), DSL v5.0 or NAL-NL1 fitting rationales, Volume control, tcoil and
20-105 dB 001-112-100 V5257 $625.00 64.000% $225.00 $100.00 12 36
Ria2 Pro Power Plus BTE - Binaural, Essential Digital Power Plus BTE, 13 battery, Binaural Synchronization, Single-Band Adaptive Directionality, Modulation Noise Management, 6 channels, Adaptation Manager, Frequency range up to 8000 Hz, Tinnitus Support System (integrated sound generator can be enabled as part of a tinnitus management program to provide tinnitus relief), DSL v5.0 or NAL-NL1 fitting rationales, Volume control, tcoil and autophone, DAI and FM Compatibility.
20-105 dB 001-112-100 V5261 $1,250.00 64.000% $450.00 $100.00 12 36
Ria2 Pro designRITE - Essential Digital designRITE (Receiver-In-Ear style BTE), 312 battery, Binaural Synchronization, Single-Band Adaptive Directionality, Modulation Noise Management, 6 channels, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0 or NAL-NL1 fitting rationales, Volume control with Streamer accessory only.
0-80 dB 001-112-074 V5257 $625.00 64.000% $225.00 $100.00 12 36
Ria2 Pro designRITE - Binaural, Essential Digital designRITE (Receiver-In-Ear style BTE), 312 battery, Binaural Synchronization, Single-Band Adaptive Directionality, Modulation Noise Management, 6 channels, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0 or NAL-NL1 fitting rationales, Volume control with Streamer accessory only.
0-80 dB 001-112-074 V5261 $1,250.00 64.000% $450.00 $100.00 12 36
Ria2 Pro BTE - Essential Digital BTE, 13 battery, Binaural Synchronization, Single-Band Adaptive Directionality, Modulation Noise Management, 6 channels, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0 or NAL-NL1 fitting rationales, Volume control, tcoil and autophone, DAI and FM Compatibility.
0-85 dB 001-112-031 V5257 $625.00 64.000% $225.00 $100.00 12 36
Ria2 Pro BTE - Binaural, Essential Digital BTE, 13 battery, Binaural Synchronization, Single-Band Adaptive Directionality, Modulation Noise Management, 6 channels, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0 or NAL-NL1 fitting rationales, Volume control, tcoil and autophone, DAI and FM Compatibility.
0-85 dB 001-112-031 V5261 $1,250.00 64.000% $450.00 $100.00 12 36
Ria2 Pro miniBTE - Essential Digital miniBTE, 312 battery, Binaural Synchronization, Single-Band Adaptive Directionality, Modulation Noise Management, 6 channels, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0 or NAL-NL1 fitting rationales, Volume control.
0-85 dB 001-112-027 V5257 $625.00 64.000% $225.00 $100.00 12 36
Ria2 Pro miniBTE - Binaural, Essential Digital miniBTE, 312 battery, Binaural Synchronization, Single-Band Adaptive Directionality, Modulation Noise Management, 6 channels, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0 or NAL-NL1 fitting rationales, Volume control.
0-85 dB 001-112-027 V5261 $1,250.00 64.000% $450.00 $100.00 12 36
Ria2 Pro miniRITE - Essential Digital miniRITE (Receiver-In-Ear style BTE), 312 battery, Binaural Synchronization, Single-Band Adaptive Directionality, Modulation Noise Management, 6 channels, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0 or NAL-NL1 fitting rationales, Volume control.
0-105 dB 001-112-016 V5257 $625.00 64.000% $225.00 $100.00 12 36
Ria2 Pro miniRITE - Binaural, Essential Digital miniRITE (Receiver-In-Ear style BTE), 312 battery, Binaural Synchronization, Single-Band Adaptive Directionality, Modulation Noise Management, 6 channels, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0 or NAL-NL1 fitting rationales, Volume control.
0-105 dB 001-112-016 V5261 $1,250.00 64.000% $450.00 $100.00 12 36
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsOTICON
Page 5 of 9
DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)
HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)Ria2 Pro Power BTE - Essential Digital Power BTE, 13 battery, Binaural Synchronization, Single-Band Adaptive Directionality, Modulation Noise Management, 6 channels, Adaptation Manager, Frequency range up to 8000 Hz, Tinnitus Support System (integrated sound generator can be enabled as part of a tinnitus management program to provide tinnitus relief), DSL v5.0 or NAL-NL1 fitting rationales, Volume control, tcoil and autophone, DAI and FM Compatibility.
20-100 dB 001-112-012 V5257 $625.00 64.000% $225.00 $100.00 12 36
Ria2 Pro Power BTE - Binaural, Essential Digital Power BTE, 13 battery, Binaural Synchronization, Single-Band Adaptive Directionality, Modulation Noise Management, 6 channels, Adaptation Manager, Frequency range up to 8000 Hz, Tinnitus Support System (integrated sound generator can be enabled as part of a tinnitus management program to provide tinnitus relief), DSL v5.0 or NAL-NL1 fitting rationales, Volume control, tcoil and autophone, DAI and FM Compatibility.
20-100 dB 001-112-012 V5261 $1,250.00 64.000% $450.00 $100.00 12 36
Ria2 Pro RITE - Essential Digital RITE (Receiver-In-Ear style BTE), 312 battery, Binaural Synchronization, Single-Band Adaptive Directionality, Modulation Noise Management, 6 channels, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0 or NAL-NL1 fitting rationales, Volume control, tcoil and autophone, DAI and FM Compatibility.
0-105 dB 001-112-009 V5257 $625.00 64.000% $225.00 $100.00 12 36
Ria2 Pro RITE - Binaural, Essential Digital RITE (Receiver-In-Ear style BTE), 312 battery, Binaural Synchronization, Single-Band Adaptive Directionality, Modulation Noise Management, 6 channels, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0 or NAL-NL1 fitting rationales, Volume control, tcoil and autophone, DAI and FM Compatibility.
0-105 dB 001-112-009 V5261 $1,250.00 64.000% $450.00 $100.00 12 36
Ria2 Power Plus BTE - Entry Digital Plus Power BTE, 13 battery, Binaural Coordination, Single-Band Adaptive Directionality, Noise Management, 4 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
20-105 dB 001-106-100 V5257 $425.00 53.177% $199.00 $100.00 12 36
Ria2 Power Plus BTE - Binaural, Entry Digital Plus Power BTE, 13 battery, Binaural Coordination, Single-Band Adaptive Directionality, Noise Management, 4 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
20-105 dB 001-106-100 V5261 $850.00 53.177% $398.00 $100.00 12 36
Ria2 BTE - Entry Digital BTE, 13 battery, Binaural Coordination, Single-Band Adaptive Directionality, Noise Management, 4 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
0-85 dB 001-106-031 V5257 $425.00 53.177% $199.00 $100.00 12 36
Ria2 BTE - Binaural, Entry Digital BTE, 13 battery, Binaural Coordination, Single-Band Adaptive Directionality, Noise Management, 4 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
0-85 dB 001-106-031 V5261 $850.00 53.177% $398.00 $100.00 12 36
Ria2 miniBTE - Entry Digital mini BTE, 312 battery, Binaural Coordination, Single-Band Adaptive Directionality, Noise Management, 4 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control.
0-85 dB 001-106-027 V5257 $425.00 53.177% $199.00 $100.00 12 36
Ria2 miniBTE - Binaural, Entry Digital mini BTE, 312 battery, Binaural Coordination, Single-Band Adaptive Directionality, Noise Management, 4 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control.
0-85 dB 001-106-027 V5261 $850.00 53.177% $398.00 $100.00 12 36
Ria2 miniRITE - Entry Digital miniRITE (Receiver-In-Ear style BTE), 312 battery, Binaural Coordination, Single-Band Adaptive Directionality, Noise Management, 4 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control.
0-105 dB 001-106-016 V5257 $425.00 53.177% $199.00 $100.00 12 36
Ria2 miniRITE - Binaural, Entry Digital miniRITE (Receiver-In-Ear style BTE), 312 battery, Binaural Coordination, Single-Band Adaptive Directionality, Noise Management, 4 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control.
0-105 dB 001-106-016 V5261 $850.00 53.177% $398.00 $100.00 12 36
Ria2 Power BTE - Entry Digital Power BTE, 13 battery, Binaural Coordination, Single-Band Adaptive Directionality, Noise Management, 4 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
20-100 dB 001-106-012 V5257 $425.00 53.177% $199.00 $100.00 12 36
Ria2 Power BTE - Binaural, Entry Digital Power BTE, 13 battery, Binaural Coordination, Single-Band Adaptive Directionality, Noise Management, 4 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
20-100 dB 001-106-012 V5261 $850.00 53.177% $398.00 $100.00 12 36
Ria2 RITE - Entry Digital RITE (Receiver-In-Ear style BTE), 312 battery, Binaural Coordination, Single-Band Adaptive Directionality, Noise Management, 4 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
0-105 dB 001-106-009 V5257 $425.00 53.177% $199.00 $100.00 12 36
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsOTICON
Page 6 of 9
DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)
HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)Ria2 RITE - Binaural, Entry Digital RITE (Receiver-In-Ear style BTE), 312 battery, Binaural Coordination, Single-Band Adaptive Directionality, Noise Management, 4 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility.
0-105 dB 001-106-009 V5261 $850.00 53.177% $398.00 $100.00 12 36
Sensei Pro SP BTE - Premium Digital Pediatric Super Power BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 10 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility, LED Indicator.
20-110 dB 001-063-014 V5257 $1,100.00 68.273% $349.00 $100.00 12 36
Sensei Pro SP BTE - Binaural, Premium Digital Pediatric Super Power BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 10 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility, LED Indicator.
20-110 dB 001-063-014 V5261 $2,200.00 68.273% $698.00 $100.00 12 36
Sensei SP BTE - Advanced Digital Pediatric Super BTE, 13 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility, LED indicator.
20-110 dB 001-062-014 V5257 $775.00 74.323% $199.00 $100.00 12 36
Sensei SP BTE - Binaural, Advanced Digital Pediatric Super BTE, 13 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility, LED indicator.
20-110 dB 001-062-014 V5261 $1,550.00 74.323% $398.00 $100.00 12 36
Sensei Pro BTE 13 - Premium Digital Pediatric BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 10 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility, LED Indicator.
0-90 dB 001-053-031 V5257 $695.00 49.784% $349.00 $100.00 12 36
Sensei Pro BTE 13 - Binaural, Premium Digital Pediatric BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 10 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility, LED Indicator.
0-90 dB 001-053-031 V5261 $1,390.00 49.784% $698.00 $100.00 12 36
Sensei Pro BTE 312 - Premium Digital Pediatric BTE, 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 10 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility, LED Indicator.
0-75 dB 001-053-015 V5257 $695.00 49.784% $349.00 $100.00 12 36
Sensei Pro BTE 312 - Binaural, Premium Digital Pediatric BTE, 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 10 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility, LED Indicator.
0-75 dB 001-053-015 V5261 $1,390.00 49.784% $698.00 $100.00 12 36
Sensei Pro RITE - Premium Digital Pediatric RITE (Receiver-In-Ear style BTE), 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 10 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility, LED Indicator.
0-100 dB 001-053-009 V5257 $695.00 49.784% $349.00 $100.00 12 36
Sensei Pro RITE - Binaural, Premium Digital Pediatric RITE (Receiver-In-Ear style BTE), 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 10 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility, LED Indicator.
0-100 dB 001-053-009 V5261 $1,390.00 49.784% $698.00 $100.00 12 36
Sensei BTE 13 - Advanced Digital Pediatric BTE, 13 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility, LED indicator.
0-90 dB 001-052-031 V5257 $395.00 49.620% $199.00 $100.00 12 36
Sensei BTE 13 - Binaural, Advanced Digital Pediatric BTE, 13 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility, LED indicator.
0-90 dB 001-052-031 V5261 $790.00 49.620% $398.00 $100.00 12 36
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsOTICON
Page 7 of 9
DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)
HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)Sensei BTE 312 - Advanced Digital Pediatric BTE, 312 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility,LED indicator.
0-75 dB 001-052-015 V5257 $395.00 49.620% $199.00 $100.00 12 36
Sensei BTE 312 - Binaural, Advanced Digital Pediatric BTE, 312 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility,LED indicator.
0-75 dB 001-052-015 V5261 $790.00 49.620% $398.00 $100.00 12 36
Sensei RITE - Advanced Digital Pediatric RITE (Receiver-In-Ear style BTE), 312 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility,LED indicator.
0-100 dB 001-052-009 V5257 $395.00 49.620% $199.00 $100.00 12 36
Sensei RITE - Binaural, Advanced Digital Pediatric RITE (Receiver-In-Ear style BTE), 312 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility,LED indicator.
0-100 dB 001-052-009 V5261 $790.00 49.620% $398.00 $100.00 12 36
Dynamo SP8 BTE – Advanced Digital Super Power BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 6500 Hz, DSL v5.0, NAL-NL2 or NAL-RP fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility
20-110 dB 001-033-014 V5257 $1,295.00 73.050% $349.00 $100.00 12 36
Dynamo SP8 BTE – Binaural Advanced Digital Super Power BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 6500 Hz, DSL v5.0, NAL-NL2 or NAL-RP fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility
20-110 dB 001-033-014 V5261 $2,590.00 73.050% $698.00 $100.00 12 36
Dynamo SP6 BTE – Essential Digital Super Power BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 6 fitting bands, Adaptation Manager, Frequency range up to 6500 Hz, DSL v5.0, NAL-NL2 or NAL-RP fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility
20-110 dB 001-032-014 V5257 $795.00 62.390% $299.00 $100.00 12 36
Dynamo SP6 BTE – Binaural Essential Digital Super Power BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 6 fitting bands, Adaptation Manager, Frequency range up to 6500 Hz, DSL v5.0, NAL-NL2 or NAL-RP fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility
20-110 dB 001-032-014 V5261 $1,590.00 62.390% $598.00 $100.00 12 36
Dynamno SP4 BTE - – Entry Digital Super Power BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 4 fitting bands, Adaptation Manager, Frequency range up to 6500 Hz, DSL v5.0, NAL-NL2 or NAL-RP fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility
20-110 dB 001-031-014 V5257 $595.00 62.185% $225.00 $100.00 12 36
Dynamno SP4 BTE – Binaural Entry Digital Super Power BTE, 13 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 4 fitting bands, Adaptation Manager, Frequency range up to 6500 Hz, DSL v5.0, NAL-NL2 or NAL-RP fitting rationales, Volume control, telecoil and auto telecoil, DAI and FM Compatibility
20-110 dB 001-031-014 V5261 $1,190.00 62.185% $450.00 $100.00 12 36
Sumo DM - Basic Digital Super Power BTE, 675 battery, 8 channels, 8 fitting bands, 3 programs, an Automatic Feedback Manager and Adaptation Manager, and programmable telecoil, bone conduction modification available.
50-115 dB 001-010-035 V5257 $775.00 48.516% $399.00 $100.00 12 36
Sumo DM - Binaural, Basic Digital Super Power BTE, 675 battery, 8 channels, 8 fitting bands, 3 programs, an Automatic Feedback Manager and Adaptation Manager, and programmable telecoil, bone conduction modification available, Options:
50-115 dB 001-010-035 V5261 $1,550.00 48.516% $798.00 $100.00 12 36
FULL SHELL CONCHA MODEL DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)
HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)Alta2 Full Shell - Premium Digital Full Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, Speech-Weighted Modulation Noise Management, 10 Fitting bands, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil.
20-90 dB 001-311-006 V5256 $1,295.00 69.189% $399.00 $100.00 12 36
IN THE EAR TYPES – Prices shall be for a single hearing aid or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsOTICON
Page 8 of 9
FULL SHELL CONCHA MODEL DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)
HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)Alta2 Full Shell - Binaural, Premium Digital Full Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, Speech-Weighted Modulation Noise Management, 10 Fitting bands, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil.
20-90 dB 001-311-006 V5260 $2,590.00 69.189% $798.00 $100.00 12 36
Nera2 Pro Full Shell - Advanced Digital Full Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil.
20-90 dB 001-163-006 V5256 $950.00 63.263% $349.00 $100.00 12 36
Nera2 Pro Full Shell - Binaural, Advanced Digital Full Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil.
20-90 dB 001-163-006 V5260 $1,900.00 63.263% $698.00 $100.00 12 36
Nera2 Full Shell - Advanced Digital Full Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil.
20-90 dB 001-151-006 V5256 $750.00 66.667% $250.00 $100.00 12 36
Nera2 Full Shell - Binaural, Advanced Digital Full Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil.
20-90 dB 001-151-006 V5260 $1,500.00 66.667% $500.00 $100.00 12 36
Ria2 Pro Full Shell - Entry Digital Full Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Coordination, Single-Band Adaptive Directionality, Noise Management, 4 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil.
20-90 dB 001-112-006 V5256 $625.00 64.000% $225.00 $100.00 12 36
Ria2 Pro Full Shell - Binaural, Essential Digital Full Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Synchronization, Single-Band Adaptive Directionality, Modulation Noise Management, 6 channels, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0 or NAL-NL1 fitting rationales, Volume control, tcoil and autophone.
20-90 dB 001-112-006 V5260 $1,250.00 64.000% $450.00 $100.00 12 36
Ria2 Full Shell - Essential Digital Full Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Synchronization, Single-Band Adaptive Directionality, Modulation Noise Management, 6 channels, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0 or NAL-NL1 fitting rationales, Volume control, tcoil and autophone.
20-90 dB 001-106-006 V5256 $425.00 53.177% $199.00 $100.00 12 36
Ria2 Full Shell - Binaural, Entry Digital Full Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Coordination, Single-Band Adaptive Directionality, Noise Management, 4 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil.
20-90 dB 001-106-006 V5260 $850.00 53.177% $398.00 $100.00 12 36
HALF SHELL CONCHA DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)
HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)Alta2 Half Shell - Premium Digital Half Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, Speech-Weighted Modulation Noise Management, 10 Fitting bands, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil.
20-90 dB 001-311-004 V5256 $1,295.00 69.189% $399.00 $100.00 12 36
Alta2 Half Shell - Binaural, Premium Digital Half Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, Speech-Weighted Modulation Noise Management, 10 Fitting bands, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil.
20-90 dB 001-311-004 V5260 $2,590.00 69.189% $798.00 $100.00 12 36
Nera2 Half Shell - Advanced Digital Half Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil.
20-90 dB 001-163-004 V5256 $750.00 66.667% $250.00 $100.00 12 36
Nera2 Half Shell - Binaural, Advanced Digital Half Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Synchronization, Multi-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil.
20-90 dB 001-163-004 V5260 $1,500.00 66.667% $500.00 $100.00 12 36
IN THE EAR TYPES – Prices shall be for a single hearing aid, or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsOTICON
Page 9 of 9
HALF SHELL CONCHA DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)
HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)Nera2 Pro Half Shell - Advanced Digital Half Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil.
20-90 dB 001-151-004 V5256 $950.00 63.263% $349.00 $100.00 12 36
Nera2 Pro Half Shell - Binaural, Advanced Digital Half Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Coordination, Single-band Adaptive Directionality, TriState Noise Management, 8 fitting bands, 16 frequency channels, Adaptation Manager, Frequency range up to 10000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil.
20-90 dB 001-151-004 V5260 $1,900.00 63.263% $698.00 $100.00 12 36
Ria2 Pro Half Shell - Essential Digital Half Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Synchronization, Single-Band Adaptive Directionality, Modulation Noise Management, 6 channels, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0 or NAL-NL1 fitting rationales, Volume control, tcoil and autophone.
20-90 dB 001-112-004 V5256 $425.00 53.177% $199.00 $100.00 12 36
Ria2 Pro Half Shell - Binaural, Essential Digital Half Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Synchronization, Single-Band Adaptive Directionality, Modulation Noise Management, 6 channels, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0 or NAL-NL1 fitting rationales, Volume control, tcoil and autophone.
20-90 dB 001-112-004 V5260 $850.00 53.177% $398.00 $100.00 12 36
Ria2 Half Shell - Entry Digital Half Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Coordination, Single-Band Adaptive Directionality, Noise Management, 4 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil.
20-90 dB 001-106-004 V5256 $625.00 64.000% $225.00 $100.00 12 36
Ria2 Half Shell - Binaural, Entry Digital Half Shell ITE (In-The-Ear), 13 or 312 battery, Binaural Coordination, Single-Band Adaptive Directionality, Noise Management, 4 fitting bands, Adaptation Manager, Frequency range up to 8000 Hz, DSL v5.0, NAL-NL2 or NAL-NL1 fitting rationales, Volume control, telecoil and auto telecoil.
20-90 dB 001-106-004 V5260 $1,250.00 64.000% $450.00 $100.00 12 36
LOW PROFILE DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)
HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST
PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)Get LP - Digital hearing aid with Fixed Directionality, Modulation Noise Management, 4 channels, 4 programs, Adaptation Manager, Frequency range up to 6500 Hz, NAL-NL1, NAL-NL2, DSL v5.0a m[i/o] fitting rationales, Volume control, telecoil
0-85 dB 001-050-005 V5256 $345.00 42.319% $199.00 $100.00 12 36
Get LP - Binaural Digital hearing aid with Fixed Directionality, Modulation Noise Management, 4 channels, 4 programs, Adaptation Manager, Frequency range up to 6500 Hz, NAL-NL1, NAL-NL2, DSL v5.0a m[i/o] fitting rationales, Volume control, telecoil
0-85 dB 001-050-005 V5260 $690.00 42.319% $398.00 $100.00 12 36
FEATURES = Digital (full digital signal processing with two or three channels, etc.), List CROS and BiCros on separate price lines.
IN THE EAR TYPES – Prices shall be for a single hearing aid or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsPHONAK
Page 1 of 9
DESCRIPTION & FEATURES (See below) db RANGEMODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
Bolero B30 - M312 61db Max Gain - 132 Max Output 050-0362-01 V5257 Monaural $649.00 45.763% $352.00 $129.00 12 36V5261 Binaural $1,158.00 45.763% $628.06 $258.00 12 36
Bolero B30 -P 65db Max Gain - 133 Max Output 050-0366-01 V5257 Monaural $649.00 45.763% $352.00 $258.00 12 36V5261 Binaural $1,158.00 45.763% $628.06 $129.00 12 36
Bolero B30 -SP 70db Max Gain - 133 Max Output 050-0370-01 V5257 Monaural $649.00 45.763% $352.00 $129.00 12 36V5261 Binaural $1,158.00 45.763% $628.06 $258.00 12 36
Audeo B30-10 46 Max Gain/ 130 dB Max Output 050-0346-01 V5257 Monaural $649.00 45.763% $352.00 $129.00 12 36 V5261 Binaural $1,298.00 45.763% $704.00 $258.00 12 36
Audeo B30 312 46 dB Max Gain/130 dB Max Output 050-0350-01 V5257 Monaural $649.00 45.763% $352.00 $129.00 12 36
CROS B 312- 30 level (exlcudes Audeo&Bolero B-R) 60 dB Max Gain -122 Output 050-0274-01.30 V5180 Cros $1,398.00 47.581% $731.00 $110.00 12 24Designed for those with Unilateral hearing loss. Transfers the microphone input signal to any model of Phonak Belong Audeo & Bolero
BEHIND THE EAR TYPES - The total price shall be for a single hearing aid or two hearing aids and appropriate case. List model numbers/name and full range of the instrument has a T-coil or T-coil capability. For digital aids, indicate whether a remote control is required. For conventional aids, indicate whether it is a linear or compression circuit L = Linear, C = Compression.
Digital BTE - programmable 8 channels/2 Programs. Includes SoundRecover2 -QuickSync - WhistleBlock - NoiseBlock - Tinnitus Balance- T-Coil/ Roger MyLink- Roger (ComPilot II/Roger X-Datalogging- Cros B/BiCros compatibility- Size 312 Battery. Moderate/Severe hearing loss
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsPHONAK
Page 2 of 9
DESCRIPTION & FEATURES (See below) db RANGEMODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
CROS B 13- 30 level (exlcudes Audeo & Bolero B-R) 63 dB Max Gain -122 Output 050-0275-01.30 V5180 Cros $1,398.00 47.581% $731.00 $110.00 12 24Designed for those with Unilateral hearing loss. Transfers the microphone input signal to any model of Phonak Belong Audeo & Bolero
Bolero V50 - M 63db Max Gain - 133 Max Output 050-0282-01 V5257 Monaural $799.00 51.815% $385.00 $129.00 12 36V5261 Binaural $1,598.00 51.815% $770.00 $258.00 12 36
Bolero V50 - P 65db Max Gain - 133 Max Output 050-0290-01 V5257 Monaural $799.00 51.815% $385.00 $129.00 12 36V5261 Binaural $1,598.00 51.815% $770.00 $258.00 12 36
Bolero V50 - SP 70db Max Gain - 133 Max Output 050-0294-01 V5257 Monaural $799.00 51.815% $385.00 $129.00 12 36V5261 Binaural $1,598.00 51.815% $770.00 $258.00 12 36
Bolero V30 - M 63db Max Gain - 133 Max Output 050-0281-01 V5257 Monaural $629.00 52.464% $299.00 $129.00 12 36V5261 Binaural $1,258.00 52.464% $598.00 $258.00 12 36
Bolero V30 - P 65db Max Gain - 133 Max Output 050-0289-01 V5257 Monaural $629.00 52.464% $299.00 $129.00 12 36V5261 Binaural $1,258.00 52.464% $598.00 $258.00 12 36
Bolero V30 - SP 70db Max Gain - 133 Max Output 050-0293-01 V5257 Monaural $629.00 52.464% $299.00 $129.00 12 36V5261 Binaural $1,258.00 52.464% $598.00 $258.00 12 36
Sky V-50 SP 75db Max Gain - 140 Max Output 050-0335-01 V5257 Monaural $799.00 51.815% $385.00 $129.00 12 36V5261 Binaural $1,598.00 51.815% $770.00 $258.00 12 36
Sky V-50 RIC 65db Max Gain - 133 Max Output 050-0343-01 V5257 Monaural $799.00 51.815% $385.00 $129.00 12 36V5261 Binaural $1,598.00 51.815% $770.00 $258.00 12 36
Digital RIC, AutoSense OS, WhistleBlock, NoiseBlock, Quick Sync, SoundRecover, Tinnitus Balance, auto Acclimatization, UltraZoom Essential, 8 channels, WCP compatible, size 13 battery, Roger compatible, telecoil
Digital BTE, AutoSense OS, WhistleBlock, NoiseBlock, Quick Sync, SoundRecover, Tinnitus Balance, auto Acclimatization, UltraZoom Essential, 8 channels, WCP compatible, size 13 battery, Roger compatible, telecoil
Pediatric Digital Super Power BTE - programmable 12 channels/4 programs. Includes SoundRecover2 - UltraZoom -QuickSync - DuoPhone-Flex Control-WhistleBlock - NoiseBlock - Tinnitus Balance WaterResistant - Datalogging - EasyPhone - FM/DAI - Cros/BiCros compatibility - Wind/Weather Protection - Size 13 Battery. Moderate/Severe hearing loss
Wireless real audio transmission - real ear sound - One touch synchronizaton thru QuickSync. Allows patient to access features in hearing instrument (50 level Hearing instrument included)
Wireless real audio transmission - real ear sound - Water Resistance - One touch synchronizaton thru QuickSync. Allows patient to access features in hearing instrument (50 level Hearing instrument is included)
Wireless real audio transmission - real ear sound - One touch synchronizaton thru QuickSync. Allows patient to access features in hearing instrument (30 level Hearing instrument included)
Digital Super Power BTE - programmable 12 channels/4 programs. Includes SoundRecover - UltraZoom -QuickSync - WhistleBlock - NoiseBlock - Tinnitus Balance WaterResistant - Datalogging - EasyPhone - FM/DAI - Cros/BiCros compatibility - Wind/Weather Protection - Size 13 Battery. Moderate/Severe hearing loss
Digital Super Power BTE - Includes SoundRecover2 -everyday automatic -QuickSync -Sound Relax-Wind Block-Speech in 360-Speech in Loud Noise-Dou Phone-Real Ear Sound-Flex Control- WhistleBlock-Noise Block - Tinnitus Noise Generator -WaterResistant - Datalogging -Cros B compatibility-Roger Ready-Music - Wind/Weather Protection - Size 13 Battery. Moderate/Severe hearing loss
Wireless real audio transmission - real ear sound - Water Resistance - One touch synchronizaton thru QuickSync. Allows patient to access features in hearing instrument (30 level Hearing instrument is included)
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsPHONAK
Page 7 of 9
FULL SHELL CONCHA MODEL DESCRIPTION & FEATURES (See below) db RANGE
CROS B Custom 13- 30 level Belong Virto 063-0247-01.30 V5170 Cros $1,398.00 47.581% $731.00 $110.00 12 24
Designed for those with Unilateral hearing loss. Transfers the microphone input signal to any model of Phonak Belong Virto
63 dB Max Gain -122 Output
Digital ITE AutoSense OS, WhistleBlock, NoiseBlock, Quick Sync, SoundRecover, Tinnitus Balance, auto Acclimatization, UltraZoom Essential, 8 channels, WCP compatible, size 13 battery, Roger compatible, telecoil
70db Max Gain - 130 Max Output
Wireless real audio transmission - real ear sound. One touch synchornization through QuickSync. Allows patient to access features in hearing instrument (50 level Hearing instrument is included)
Designed for those with Unilateral hearing loss. Transfers the microphone input signal to Phonak Virto V hearing aids
70db Max Gain - 130 Max Output
Designed for those with Unilateral hearing loss. Transfers the microphone input signal to Phonak Virto V hearing aids
70db Max Gain - 130 Max Output
Digital Full shell 8 Channels/2 Programs- Includes AutoSense OS- Tinnitus Balance- Sound Recover2- Noise Block- Quick Sync- Whistle Block- Cros B Compatible -WaterResistant - Datalogging - Wind/Weather Protection - Size 312 Battery. Moderate/Severe hearing loss
70db Max Gain - 130 Max Output
Digital ITE, 12 channels/4 programs,AutoSense OS, SNR-Boost, FlexControl, Flex Volume, DuoPhone, Real Ear Sound, WhistleBlock, NoiseBlock, Quick Sync, SoundRecover, Tinnitus Balance, auto Acclimatization, UltraZoom Standard, 12 channels, WCP compatible, size 13 battery, telecoil, Roger compatible
IN THE EAR TYPES – Prices shall be for a single hearing aid or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
Wireless real audio transmission - real ear sound. One touch synchornization through QuickSync. Allows patient to access features in hearing instrument (30 level Hearing instrument is included)
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsPHONAK
Page 8 of 9
HALF SHELL CONCHA DESCRIPTION & FEATURES (See below) db RANGE
Wireless real audio transmission - real ear sound. One touch synchornization through QuickSync. Allows patient to access features in hearing instrument (30 level Hearing instrument is included)
Wireless real audio transmission - real ear sound. One touch synchornization through QuickSync. Allows patient to access features in hearing instrument (50 level Hearing instrument is included)
Digital Half shell 8 Channels/2 Programs- Includes AutoSense OS- Tinnitus Balance- Sound Recover2- Noise Block- Quick Sync- Whistle Block- Cros B Compatible -WaterResistant - Datalogging - Wind/Weather Protection - Size 312 Battery. Moderate/Severe hearing loss
Digital Half Shell,AutoSense OS, WhistleBlock, NoiseBlock, Quick Sync, SoundRecover, Tinnitus Balance, auto Acclimatization, UltraZoom Essential, 8 channels, WCP compatible, size 312 battery, Roger compatible, telecoil
60db Max Gain - 122 Max Output
Digital Half Shell, AutoSense OS, SNR-Boost, FlexControl, Flex Volume, DuoPhone, Real Ear Sound, WhistleBlock, NoiseBlock, Quick Sync, SoundRecover, Tinnitus Balance, auto Acclimatization, UltraZoom Standard, 12 channels, WCP compatible, size 312 battery, telecoil, Roger compatible
60db Max Gain - 122 Max Output
Designed for those with Unilateral hearing loss. Transfers the microphone input signal to Phonak Virto V hearing aids 70db Max Gain - 130 Max Output
IN THE EAR TYPES – Prices shall be for a single hearing aid, or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
Digital ITE - programmable 8 channels/2 programs. Includes SoundRecover - UltraZoom Advanced-WhistleBlock - NoiseBlock - Flex Volume - Zoom Control - UserPreference - Tinnitus Balance- WindBlock WaterResistant - Datalogging- Wind/Weather Protection - Size10 Battery. Mild/Moderate hearing loss
IN THE EAR TYPES – Prices shall be for a single hearing aid or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
60db Max Gain - 122 Max Output
60db Max Gain - 122 Max Output
60db Max Gain - 122 Max Output
60db Max Gain - 122 Max Output
Digital ITE - programmable 16 channels/7 programs. Includes SoundRecover2 -Speech in 360-Sound Relax-Wind Block-Flex Control-Tinnitus Balance Noise Generator- UltraZoom Advanced-WhistleBlock - NoiseBlock -Quick Sync - Zoom Control - UserPreference - Tinnitus Balance- WindBlock WaterResistant - Datalogging- Wind/Weather Protection - Size10 Battery. Mild/Moderate hearing loss
Digital ITE - programmable 12 channels/3 programs. Includes SoundRecover - UltraZoom Advanced-WhistleBlock - NoiseBlock - Flex Volume - Zoom Control - UserPreference - Tinnitus Balance- WindBlock WaterResistant - Datalogging- Wind/Weather Protection - Size10 Battery. Mild/Moderate hearing loss
BEHIND THE EAR TYPES - The total price shall be for a single hearing aid or two hearing aids and appropriate case. List model numbers/name and full range of the instrument has a T-coil or T-coil capability. For digital aids, indicate whether a remote control is required. For conventional aids, indicate whether it is a linear or compression circuit L = Linear, C = Compression.
Contract Effective 9/1/2017 MDHHS Contract Hearing Aid DefinitionsRESOUND
Page 2 of 24
DESCRIPTION & FEATURES (See below) db RANGEMODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
LiNX2 5 RIE BTEDigital, wireless RIE. Dual microphones. Size 13 battery. Push button. Made for iPhone technology. 4 receiver options: Low Power, Medium Power, High Power, Ultra Power (Encased). Surround Sound by ReSound, 9-warp compression bands, Environmental Classifier, Sound Shaper frequency compression, Low frequency bass boost. Noise Tracker II noise reduction, WindGuard, Expansion. Directional Mix Processor. Directionality: SoftSwitching, Adaptive DIrectionality. Fixed Directionality. DFS Ultra II feedback management, Music Mode, Auto DFS. Synchronized push button, Synchronized volume control, Smart Start, PhoneNow, Comfort Phone. iSolate nanotech moisture protection. 6-gain handles, 4 fully flexible programs, Synchronized Acceptance Manager, Onboard Analyzer II. Wide Dynamic Range Compression, Semi-linear, Linear amplification strategies. Tinnitus Sound Generator. In-situ audiometry. Wireless: 2.4 GHz wireless technology. Made for iPhone. Ear-to-ear communication. Wireless fitting with Airlink. Compatible with Unite wireless accessories: Remote Control 2, TV Streamer 2, Phone Clip+, Mini Microphone Apps: ReSound Control app. ReSound Smart app. ReSound Relief app. MONAURAL (V5257) Mild, Moderate, Severe, Profound LS562-DRW V5257 $1,075.00 63.070% $397.00 $95.00 12 24
IN THE EAR TYPES – Prices shall be for a single hearing aid or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
Contract Effective 9/1/2017 MDHHS Contract Hearing Aid DefinitionsRESOUND
Page 11 of 24
FULL SHELL CONCHA MODEL DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
Vea 2 Full ShellDigital full-shell ITE, Size 13 battery. 6-band WARP sound processing, Dual Stabilizer II DFS with Whistle Control Feedback Manager, Fixed Directionality, Noise Tracker II noise reduction, push button, volume control, up to 3 programs including Telecoil, DAI compatible. Power-saving chip technology. iSolate nanotech moisture protection.MONAURAL (V5256) Mild, Moderate, Severe VE250 V5256 $495.00 50.000% $247.50 $95.00 12 24
Contract Effective 9/1/2017 MDHHS Contract Hearing Aid DefinitionsRESOUND
Page 15 of 24
FULL SHELL CONCHA MODEL DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)Enya 3 Medium Power Full ShellDigital full shell. Single microphone. Size 13 battery. Push button, Volume Control. ReSound Range II Chip, 8-Warp compression bands. DFS Ultra II, Auto DFSNoiseTracker II, WindGuard Tinnitus Sound Generator MONAURAL (V5256) Mild, Moderate, Severe EY3ITE MP FS V5256 $580.00 48.276% $300.00 $95.00 12 24
Enya 3 Wireless Ultra Power Full ShellDigital full shell. Single microphone. Size 13 battery. Push button, Volume Control. ReSound Range II Chip, 8-Warp compression bands. DFS Ultra II, Auto DFSNoiseTracker II, WindGuard Tinnitus Sound Generator Wireless: 2.4 GHz wireless technology. Wireless fitting with Airlink. Compatible with Unite wireless accessories: Remote Control 2, TV Streamer 2, Phone Clip+, Micro Microphone, Multi Microphone. Apps: ReSound Control app. ReSound Relief app. MONAURAL (V5256) Moderate, Severe, Profound EY3ITE-W UP FS V5256 $580.00 48.276% $300.00 $95.00 12 24
Contract Effective 9/1/2017 MDHHS Contract Hearing Aid DefinitionsRESOUND
Page 16 of 24
FULL SHELL CONCHA MODEL DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
Enya 3 Wireless High Power Full ShellDigital full shell. Single microphone. Size 13 battery. Push button, Volume Control. ReSound Range II Chip, 8-Warp compression bands. DFS Ultra II, Auto DFSNoiseTracker II, WindGuard Tinnitus Sound Generator Wireless: 2.4 GHz wireless technology. Wireless fitting with Airlink. Compatible with Unite wireless accessories: Remote Control 2, TV Streamer 2, Phone Clip+, Micro Microphone, Multi Microphone. Apps: ReSound Control app. ReSound Relief app. MONAURAL (V5256) Moderate, Severe, Profound EY3ITE-W HP FS V5256 $580.00 48.276% $300.00 $95.00 12 24
BINAURAL (V5260) Moderate, Severe, Profound EY3ITE-W HP FS V5260 $1,160.00 48.276% $600.00 $190.00 12 24Enya 3 Wireless Medium Power Full Shelligital full shell. Single microphone. Size 13 battery. Push button, Volume Control. ReSound Range II Chip, 8-Warp compression bands. DFS Ultra II, Auto DFSNoiseTracker II, WindGuard Tinnitus Sound Generator Wireless: 2.4 GHz wireless technology. Wireless fitting with Airlink. Compatible with Unite wireless accessories: Remote Control 2, TV Streamer 2, Phone Clip+, Micro Microphone, Multi Microphone. Apps: ReSound Control app. ReSound Relief app. MONAURAL (V5256) Mild, Moderate, Severe EY3ITE-W MP FS V5256 $580.00 48.276% $300.00 $95.00 12 24
BINAURAL (V5260) Mild, Moderate, Severe EY3ITE-W MP FS V5260 $1,160.00 48.276% $600.00 $190.00 12 24Enya 3 Directional Wireless Ultra Power Full ShellDigital full shell. Dual microphone. Size 13 battery. Push button, Volume Control. ReSound Range II Chip, 8-Warp compression bands. DFS Ultra II, Auto DFSNoiseTracker II, WindGuard Directional Options: Softswitching, Adaptive Directionality.Tinnitus Sound Generator Wireless: 2.4 GHz wireless technology. Wireless fitting with Airlink. Compatible with Unite wireless accessories: Remote Control 2, TV Streamer 2, Phone Clip+, Micro Microphone, Multi Microphone. Apps: ReSound Control app. ReSound Relief app. MONAURAL (V5256) Moderate, Severe, Profound EY3ITE-DW UP FS V5256 $580.00 48.276% $300.00 $95.00 12 24
IN THE EAR TYPES – Prices shall be for a single hearing aid, or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
Contract Effective 9/1/2017 MDHHS Contract Hearing Aid DefinitionsRESOUND
Page 18 of 24
HALF SHELL CONCHA DESCRIPTION & FEATURES (See below) db RANGE MANUFACTURER HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
Vea 3 Directional Power Half ShellPower, Digital Half Shell ITE with Dual Microphones. Size 13 battery. 7-band WARP sound processing, Dual Stabilizer II DFS with Whistle Control Feedback Manager, Adaptive Directionality with Integrated Wind Noise Management, Soft Switching, Fixed Directionality, Noise Tracker II noise reduction, push button, volume control, up to 4 programs including Telecoil, DAI compatible. Low battery drain warning. Power-saving chip technology. iSolate nanotech moisture protection.MONAURAL (V5256) Moderate, Severe, Profound ReSound V5256 $555.00 50.000% $277.50 $95.00 12 24
BINAURAL (V5260) Moderate, Severe, Profound ReSound V5260 $1,110.00 50.000% $555.00 $190.00 12 24Vea 2 Half ShellDigital Half Shell ITE, Size 13 battery. 6-band WARP sound processing, Dual Stabilizer II DFS with Whistle Control Feedback Manager, Fixed Directionality, Noise Tracker II noise reduction, push button, volume control, up to 3 programs including Telecoil, DAI compatible. Power-saving chip technology. iSolate nanotech moisture protection.MONAURAL (V5256)
Wireless CROS Transmitter + Emerald M RIC PackageIdeal for patients with unaidable hearing loss in one ear: TruCore CROS and BiCROS solutions are based on wireless communication with its industry benchmark for low battery consumption. A CROS RIC transmitter is worn behind the unaidable ear and the sound it receives is sent wirelessly to the TruCore hearing aid on the other side, thus allowing the wearer to hear sounds from both sides.
Wireless CROS Transmitter + Emerald M RIC PackageIdeal for patients with unaidable hearing loss in one ear: TruCore CROS and BiCROS solutions are based on wireless communication with its industry benchmark for low battery consumption. A CROS RIC transmitter is worn behind the unaidable ear and the sound it receives is sent wirelessly to the TruCore hearing aid on the other side, thus allowing the wearer to hear sounds from both sides.
Wireless CROS Transmitter + Stellar Li RIC PackageIdeal for patients with unaidable hearing loss in one ear: TruCore CROS and BiCROS solutions are based on wireless communication with its industry benchmark for low battery consumption. A CROS RIC transmitter is worn behind the unaidable ear and the sound it receives is sent wirelessly to the TruCore hearing aid on the other side, thus allowing the wearer to hear sounds from both sides.
BEHIND THE EAR TYPES - The total price shall be for a single hearing aid or two hearing aids and appropriate case. List model numbers/name and full range of the instrument has a T-coil or T-coil capability. For digital aids, indicate whether a remote control is required. For conventional aids, indicate whether it is a linear or compression circuit L = Linear, C = Compression.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsREXTON
Page 2 of 2
DESCRIPTION & FEATURES (See below) db RANGEMODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
Wireless CROS Transmitter + Stellar Li RIC PackageIdeal for patients with unaidable hearing loss in one ear: TruCore CROS and BiCROS solutions are based on wireless communication with its industry benchmark for low battery consumption. A CROS RIC transmitter is worn behind the unaidable ear and the sound it receives is sent wirelessly to the TruCore hearing aid on the other side, thus allowing the wearer to hear sounds from both sides.
Wireless CROS Transmitter + Emerald S RIC PackageIdeal for patients with unaidable hearing loss in one ear: TruCore CROS and BiCROS solutions are based on wireless communication with its industry benchmark for low battery consumption. A CROS RIC transmitter is worn behind the unaidable ear and the sound it receives is sent wirelessly to the TruCore hearing aid on the other side, thus allowing the wearer to hear sounds from both sides.
Wireless CROS Transmitter + Emerald S RIC PackageIdeal for patients with unaidable hearing loss in one ear: TruCore CROS and BiCROS solutions are based on wireless communication with its industry benchmark for low battery consumption. A CROS RIC transmitter is worn behind the unaidable ear and the sound it receives is sent wirelessly to the TruCore hearing aid on the other side, thus allowing the wearer to hear sounds from both sides.
Wireless CROS Transmitter + Mosaic M/M NR/P/HP BTE PackageIdeal for patients with unaidable hearing loss in one ear: TruCore CROS and BiCROS solutions are based on wireless communication with its industry benchmark for low battery consumption. A CROS RIC transmitter is worn behind the unaidable ear and the sound it receives is sent wirelessly to the TruCore hearing aid on the other side, thus allowing the wearer to hear sounds from both sides.
Wireless CROS Transmitter + Mosaic M/M NR/P/HP BTE PackageIdeal for patients with unaidable hearing loss in one ear: TruCore CROS and BiCROS solutions are based on wireless communication with its industry benchmark for low battery consumption. A CROS RIC transmitter is worn behind the unaidable ear and the sound it receives is sent wirelessly to the TruCore hearing aid on the other side, thus allowing the wearer to hear sounds from both sides.
FEATURES = Digital (full digital signal processing with two or three channels, etc.), List CROS and BiCros on separate price lines.
FULL SHELL CONCHA MODEL DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
Wireless CROS Transmitter + Sterling 60 6c PackageIdeal for patients with unaidable hearing loss in one ear: TruCore CROS and BiCROS solutions are based on wireless communication with its industry benchmark for low battery consumption. A CROS RIC transmitter is worn behind the unaidable ear and the sound it receives is sent wirelessly to the TruCore hearing aid on the other side, thus allowing the wearer to hear sounds from both sides.
IN THE EAR TYPES – Prices shall be for a single hearing aid or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsSIGNIA
Page 1 of 3
DESCRIPTION & FEATURES (See below) db RANGEMODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
Cellion 2px (Receiver in Canal)Fully Digital 16-Channel, Auto-adaptive 16-channel Directional, 4 memory, frequency comp, e2e wireless 3.0, tinnitus therapy, wireless programming, Rechargeable Li-Ion batteryPush Button
Pure 1px (Receiver in Canal)Fully Digital 16-Channel, Auto-adaptive 16-channel Directional, 4 memory, frequency comp, e2e wireless 3.0, wireless programmingRocker Switch
BEHIND THE EAR TYPES - The total price shall be for a single hearing aid or two hearing aids and appropriate case. List model numbers/name and full range of the instrument has a T-coil or T-coil capability. For digital aids, indicate whether a remote control is required. For conventional aids, indicate whether it is a linear or compression circuit L = Linear, C = Compression.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsSIGNIA
Page 2 of 3
DESCRIPTION & FEATURES (See below) db RANGEMODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
Wireless CROS Transmitter + Carat 3px RIC PackageIdeal for patients with unaidable hearing loss in one ear: primax CROS and BiCROS solutions are based on e2e wireless 3.0 with its industry benchmark for low battery consumption. A CROS Pure transmitter is worn behind the unaidable ear and the sound it receives is sent wirelessly to the primax hearing aid on the other side, thus allowing the wearer to hear sounds from both sides.
Wireless CROS Transmitter + Cellion 3px RIC PackageIdeal for patients with unaidable hearing loss in one ear: primax CROS and BiCROS solutions are based on e2e wireless 3.0 with its industry benchmark for low battery consumption. A CROS Pure transmitter is worn behind the unaidable ear and the sound it receives is sent wirelessly to the primax hearing aid on the other side, thus allowing the wearer to hear sounds from both sides.
Wireless CROS Transmitter + Pure 3px RIC PackageIdeal for patients with unaidable hearing loss in one ear: primax CROS and BiCROS solutions are based on e2e wireless 3.0 with its industry benchmark for low battery consumption. A CROS Pure transmitter is worn behind the unaidable ear and the sound it receives is sent wirelessly to the primax hearing aid on the other side, thus allowing the wearer to hear sounds from both sides.
Wireless CROS Transmitter + Motion SX/SA/P/SP 3px BTE PackageIdeal for patients with unaidable hearing loss in one ear: primax CROS and BiCROS solutions are based on e2e wireless 3.0 with its industry benchmark for low battery consumption. A CROS Pure transmitter is worn behind the unaidable ear and the sound it receives is sent wirelessly to the primax hearing aid on the other side, thus allowing the wearer to hear sounds from both sides.
FEATURES = Digital (full digital signal processing with two or three channels, etc.), List CROS and BiCros on separate price lines.
FULL SHELL CONCHA MODEL DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
Wireless CROS Transmitter + Insio 3px PackageIdeal for patients with unaidable hearing loss in one ear: primax CROS and BiCROS solutions are based on e2e wireless 3.0 with its industry benchmark for low battery consumption. A CROS Pure transmitter is worn behind the unaidable ear and the sound it receives is sent wirelessly to the primax hearing aid on the other side, thus allowing the wearer to hear sounds from both sides.
FEATURES = Digital (full digital signal processing with two or three channels, etc.), List CROS and BiCros on separate price lines.
IN THE EAR TYPES – Prices shall be for a single hearing aid or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsSIGNIA
Page 3 of 3
HALF SHELL CONCHA DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
Wireless CROS Transmitter + Insio 3px PackageIdeal for patients with unaidable hearing loss in one ear: primax CROS and BiCROS solutions are based on e2e wireless 3.0 with its industry benchmark for low battery consumption. A CROS Pure transmitter is worn behind the unaidable ear and the sound it receives is sent wirelessly to the primax hearing aid on the other side, thus allowing the wearer to hear sounds from both sides.
FEATURES = Digital (full digital signal processing with two or three channels, etc.)
LOW PROFILE DESCRIPTION & FEATURES (See below) db RANGEMODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
Wireless CROS Transmitter + Insio 3px PackageIdeal for patients with unaidable hearing loss in one ear: primax CROS and BiCROS solutions are based on e2e wireless 3.0 with its industry benchmark for low battery consumption. A CROS Pure transmitter is worn behind the unaidable ear and the sound it receives is sent wirelessly to the primax hearing aid on the other side, thus allowing the wearer to hear sounds from both sides.
IN THE EAR TYPES – Prices shall be for a single hearing aid or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
IN THE EAR TYPES – Prices shall be for a single hearing aid, or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsSTARKEY
Page 1 of 7
DESCRIPTION & FEATURES (See below) db RANGEMODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
Muse i1600 Micro RIC 312: 16 channels/bands, Wireless, Multiflex tinnitus, Music enhancement, Directional Mics, Ear to ear phone streaming, ATR, T-Coil, Feedback cancellation, MM, Manual user controls, Wireless accessories optional, Size 312 battery
BEHIND THE EAR TYPES - The total price shall be for a single hearing aid or two hearing aids and appropriate case. List model numbers/name and full range of the instrument has a T-coil or T-coil capability. For digital aids, indicate whether a remote control is required. For conventional aids, indicate whether it is a linear or compression circuit L = Linear, C = Compression.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsSTARKEY
Page 2 of 7
DESCRIPTION & FEATURES (See below) db RANGEMODEL NUMBER (19 Characters or
Z Series i70 RIC 312: 8 channels/8 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 312 battery
86 dB+ Z Series i70 RIC V5257 $1,998.00 80.030% $399.00 $84.99 12 Months 24 Months
Z Series i70 RIC 312: 8 channels/8 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 312 battery
86 dB+ Z Series i70 RIC V5261 $3,996.00 80.030% $798.00 $169.98 12 Months 24 Months
Z Series i70 micro RIC 312: 8 channels/8 bands, wireless, manual user controls, ATR, Feedback eliminator, directional mics, MM, remote control optional, tinnitus masker, size 312 battery
86 dB+ Z Series i70 mRIC V5257 $1,998.00 80.030% $399.00 $84.99 12 Months 24 Months
Z Series i70 micro RIC 312: 8 channels/8 bands, wireless, manual user controls, ATR, Feedback eliminator, directional mics, MM, remote control optional, tinnitus masker, size 312 battery
86 dB+ Z Series i70 mRIC V5261 $3,996.00 80.030% $798.00 $169.98 12 Months 24 Months
Z Series i70 BTE 13: 8 channels/8 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 13 battery
86 dB+ Z Series i70 BTE V5257 $1,998.00 80.030% $399.00 $84.99 12 Months 24 Months
Z Series i70 BTE 13: 8 channels/8 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 13 battery
86 dB+ Z Series i70 BTE V5261 $3,996.00 80.030% $798.00 $169.98 12 Months 24 Months
Z Series i70 PowerPlus BTE 13: 8 channels/8 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 13 battery
86 dB+ Z Series i70 P+BTE V5257 $1,998.00 80.030% $399.00 $84.99 12 Months 24 Months
Z Series i70 PowerPlus BTE 13: 8 channels/8 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 13 battery
86 dB+ Z Series i70 P+BTE V5261 $3,996.00 80.030% $798.00 $169.98 12 Months 24 Months
Z Series i70 mini BTE 312: 8 channels/8 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 312 battery
86 dB+ Z Series i70 mBTE V5257 $1,998.00 80.030% $399.00 $84.99 12 Months 24 Months
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsSTARKEY
Page 4 of 7
DESCRIPTION & FEATURES (See below) db RANGEMODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
Z Series i70 mini BTE 312: 8 channels/8 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 312 battery
86 dB+ Z Series i70 mBTE V5261 $3,996.00 80.030% $798.00 $169.98 12 Months 24 Months
Z Series i30 RIC 312: 6 channels/6 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 312 battery
86 dB+ Z Series i30 RIC V5257 $1,198.00 69.199% $369.00 $84.99 12 Months 24 Months
Z Series i30 RIC 312: 6 channels/6 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 312 battery
86 dB+ Z Series i30 RIC V5261 $2,396.00 69.199% $738.00 $169.98 12 Months 24 Months
Z Series i30 micro RIC 312: 6 channels 6 bands, wireless, manual user controls, ATR, Feedback eliminator, directional mics, MM, remote control optional, tinnitus masker, size 312 battery
86 dB+ Z Series i30 mRIC V5257 $1,198.00 69.199% $369.00 $84.99 12 Months 24 Months
Z Series i30 micro RIC 312: 6 channels 6 bands, wireless, manual user controls, ATR, Feedback eliminator, directional mics, MM, remote control optional, tinnitus masker, size 312 battery
86 dB+ Z Series i30 mRIC V5261 $2,396.00 69.199% $738.00 $169.98 12 Months 24 Months
Z Series i30 BTE 13: 6 channels/6 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 13 battery
86 dB+ Z Series i30 BTE 13 V5257 $1,198.00 69.199% $369.00 $84.99 12 Months 24 Months
Z Series i30 BTE 13: 6 channels/6 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 13 battery
86 dB+ Z Series i30 BTE 13 V5261 $2,396.00 69.199% $738.00 $169.98 12 Months 24 Months
Z Series i30 BTE PowerPlus 13: 6 channels/6 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 13 battery
86 dB+ Z Series i30 P+BTE V5257 $1,198.00 69.199% $369.00 $84.99 12 Months 24 Months
Z Series i30 BTE PowerPlus 13: 6 channels/6 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 13 battery
86 dB+ Z Series i30 P+BTE V5261 $2,396.00 69.199% $738.00 $169.98 12 Months 24 Months
Z Series i30 mini BTE 312: 6 channels/6 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 312 battery
86 dB+ Z Series i30 mBTE V5257 $1,198.00 69.199% $369.00 $84.99 12 Months 24 Months
Z Series i30 mini BTE 312: 6 channels/6 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 312 battery
86 dB+ Z Series i30 mBTE V5261 $2,396.00 69.199% $738.00 $169.98 12 Months 24 Months
Z Series i20 RIC 312: 4 channels/4 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 312 battery
86 dB+ Z Series i20 RIC V5257 $998.00 65.030% $349.00 $84.99 12 Months 24 Months
Z Series i20 RIC 312: 4 channels/4 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 312 battery
86 dB+ Z Series i20 RIC V5261 $1,996.00 65.030% $698.00 $169.98 12 Months 24 Months
Z Series i20 micro RIC 312: 4 channels 4 bands, wireless, manual user controls, ATR, Feedback eliminator, directional mics, MM, remote control optional, tinnitus masker, size 312 battery
86 dB+ Z Series i20 mRIC V5257 $998.00 65.030% $349.00 $84.99 12 Months 24 Months
Z Series i20 micro RIC 312: 4 channels 4 bands, wireless, manual user controls, ATR, Feedback eliminator, directional mics, MM, remote control optional, tinnitus masker, size 312 battery
86 dB+ Z Series i20 mRIC V5261 $1,996.00 65.030% $698.00 $169.98 12 Months 24 Months
Z Series i20 BTE 13: 4 channels/4 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 13 battery
86 dB+ Z Series i20 BTE 13 V5257 $998.00 65.030% $349.00 $84.99 12 Months 24 Months
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsSTARKEY
Page 5 of 7
DESCRIPTION & FEATURES (See below) db RANGEMODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
Z Series i20 BTE 13: 4 channels/4 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 13 battery
86 dB+ Z Series i20 BTE 13 V5261 $1,996.00 65.030% $698.00 $169.98 12 Months 24 Months
Z Series i20 PowerPlus BTE 13: 4 channels/4 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 13 battery
86 dB+ Z Series i20 P+BTE V5257 $998.00 65.030% $349.00 $84.99 12 Months 24 Months
Z Series i20 PowerPlus BTE 13: 4 channels/4 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 13 battery
86 dB+ Z Series i20 P+BTE V5261 $1,996.00 65.030% $698.00 $169.98 12 Months 24 Months
Z Series i20 mini BTE 312: 4 channels/4 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 312 battery
86 dB+ Z Series i20 mBTE V5257 $998.00 65.030% $349.00 $84.99 12 Months 24 Months
Z Series i20 mini BTE 312: 4 channels/4 bands, wireless, manual user controls, ATR, Telecoil, Feedback eliminator, directional mics, MM, remote control optional, size 312 battery
86 dB+ Z Series i20 mBTE V5261 $1,996.00 65.030% $698.00 $169.98 12 Months 24 Months
3 Series 70 RIC 312: 8 channels/8 bands, configured with manual user controls, ATR, Feedback eliminator, directional mics, MM, size 312 battery
FULL SHELL CONCHA MODEL DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
Z Series i30 ITE: 6 channels/6 bands, wireless, directional mics, MM, ATR, manual user controls 86 dB+ Z Series i30 ITE V5256 $1,198.00 70.033% $359.00 $84.99 12 months 24 Months
Z Series i30 ITE: 6 channels/6 bands, wireless, directional mics, MM, ATR, manual user controls 86 dB+ Z Series i30 ITE V5260 $2,396.00 70.033% $718.00 $169.98 12 months 24 Months
Z Series i20 ITE: 4 channels/4 bands, wireless, directional mics, MM, ATR, manual user controls 86 dB+ Z Series i20 ITE V5256 $998.00 66.032% $339.00 $84.99 12 months 24 Months
Z Series i20 ITE: 4 channels/4 bands, wireless, directional mics, MM, ATR, manual user controls 86 dB+ Z Series i20 ITE V5260 $1,996.00 66.032% $678.00 $169.98 12 months 24 Months
3 Series 70 ITE: 8 channels/8 bands, directional mics, self learning, ATR, t-coil, MM, remote control optional 86 dB+ 3 Series 70 ITE V5256 $1,698.00 77.091% $389.00 $84.99 12 months 24 Months
3 Series 70 ITE: 8 channels/8 bands, directional mics, self learning, ATR, t-coil, MM, remote control optional 86 dB+ 3 Series 70 ITE V5260 $3,396.00 77.091% $778.00 $169.98 12 months 24 Months
3 Series 30 ITE: 6 channels/6 bands, MM, directional mics, ATR 86 dB+ 3 Series 30 ITE V5256 $998.00 67.034% $329.00 $84.99 12 months 24 Months
3 Series 30 ITE: 6 channels/6 bands, MM, directional mics, ATR 86 dB+ 3 Series 30 ITE V5260 $1,996.00 67.034% $658.00 $169.98 12 months 24 Months
3 Series 20 ITE: 4 channels/4 bands, MM, directional mics, ATR 86 dB+ 3 Series 20 ITE V5256 $798.00 62.531% $299.00 $84.99 12 months 24 Months
3 Series 20 ITE: 4 channels/4 bands, MM, directional mics, ATR 86 dB+ 3 Series 20 ITE V5260 $1,596.00 62.531% $598.00 $169.98 12 months 24 Months
FEATURES = Digital (full digital signal processing with two or three channels, etc.), List CROS and BiCros on separate price lines.
IN THE EAR TYPES – Prices shall be for a single hearing aid or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsSTARKEY
Page 7 of 7
HALF SHELL CONCHA DESCRIPTION & FEATURES (See below) db RANGE
MODEL NUMBER (19 Characters or
less)HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT DISCOUNT OFF LIST
PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)
Z Series i30 HS: 6 channels/6 bands, wireless, directional mics, MM, ATR, manual user controls 86 dB+ Z Series i30 HS V5256 $1,198.00 70.033% $359.00 $84.99 12 month 24 Months
Z Series i30 HS: 6 channels/6 bands, wireless, directional mics, MM, ATR, manual user controls 86 dB+ Z Series i30 HS V5260 $2,396.00 70.033% $718.00 $169.98 12 month 24 Months
Z Series i20 HS: 4 channels/4 bands, wireless, directional mics, MM, ATR, manual user controls 86 dB+ Z Series i20 HS V5256 $998.00 66.032% $339.00 $84.99 12 month 24 Months
Z Series i20 HS: 4 channels/4 bands, wireless, directional mics, MM, ATR, manual user controls 86 dB+ Z Series i20 HS V5260 $1,996.00 66.032% $678.00 $169.98 12 month 24 Months
3 Series 70 HS: 8 channels/8 bands directional mics, self learning, ATR, t-coil, MM, remote control optional 86 dB+ 3 Series 70 HS V5256 $1,698.00 77.091% $389.00 $84.99 12 month 24 Months
3 Series 70 HS: 8 channels/8 bands directional mics, self learning, ATR, t-coil, MM, remote control optional 86 dB+ 3 Series 70 HS V5260 $3,396.00 77.091% $778.00 $169.98 12 month 24 Months
3 Series 30 HS: 6 channels/6 bands MM, directional mics, ATR, MM 86 dB+ 3 Series 30 HS V5256 $998.00 67.034% $329.00 $84.99 12 month 24 Months
3 Series 30 HS: 6 channels/6 bands MM, directional mics, ATR, MM 86 dB+ 3 Series 30 HS V5260 $1,996.00 67.034% $658.00 $169.98 12 month 24 Months
3 Series 20 HS: 4 channels/4 bands, MM, directional mics, ATR 86 dB+ 3 Series 20 HS V5256 $798.00 62.531% $299.00 $84.99 12 month 24 Months
3 Series 20 HS: 4 channels/4 bands, MM, directional mics, ATR 86 dB+ 3 Series 20 HS V5260 $1,596.00 62.531% $598.00 $169.98 12 month 24 Months
IN THE EAR TYPES – Prices shall be for a single hearing aid, or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsUNITRON
Page 1 of 3
DESCRIPTION & FEATURES (See below) db RANGE MODEL NUMBER (19 Characters or less) HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT
DISCOUNT OFF LIST PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)Tempus Moxi Fit 600 CRT up to 62 TMF600 V5257 $799.00 51.815% $385.00 $75.00 12 MONTH 36 month312 battery, Sound Nav (3 environments), Speech Enhancement, Noise Reduction, Multiband Adapative directionality, Pinna Effect, AntiShock 2, Wind control, Feedback Manager, Natural Sound Balance, Log It All, Patient Ratings, Data logging, Flex:trial, Flex:upgrade, Rechargeable, DuoLink, T-Coil, Easy-T, Binaural Phone, Autmatic Adaption Manager, myMusic, Frequestion compression, Tinnitus masker, IntelliVent, Streaming programs, Manual programs, NAL-NL2/NL1 and DSLv5, 10 fitting channels
up to 62 TMF600 V5261 $1,598.00 51.815% $770.00 $75.00 12 MONTH 36 month
Tempus Moxi Fit 500 CRT up to 62 TMF500 V5257 $549.00 45.537% $299.00 $75.00 12 MONTH 36 month312 battery, AutoMic, Speech Enhancement, Noise Reduction, Multiband Adapative directionality, Pinna Effect, AntiShock 2, Wind control, Feedback Manager, Natural Sound Balance, Log It All, Patient Ratings, Data logging, Flex:trial, Flex:upgrade, Rechargeable, DuoLink, T-Coil, Easy-T, Autmatic Adaption Manager, myMusic, Frequestion compression, Tinnitus masker, IntelliVent, Streaming programs, Manual programs, NAL-NL2/NL1 and DSLv5, 6 fitting channels
up to 62 TMF500 V5261 $1,098.00 45.537% $598.00 $75.00 12 MONTH 36 month
Tempus Moxi Kiss 600 CRT up to 62 TMK600 V5257 $799.00 51.815% $385.00 $75.00 12 MONTH 36 month312 battery, Sound Nav (3 environments), Speech Enhancement, Noise Reduction, Multiband Adapative directionality, Pinna Effect, AntiShock 2, Wind control, Feedback Manager, Natural Sound Balance, Log It All, Patient Ratings, Data logging, Flex:trial, Flex:upgrade, DuoLink, Easy-T, Binaural Phone, Autmatic Adaption Manager, myMusic, Frequestion compression, Tinnitus masker, IntelliVent, Streaming programs, Manual programs, NAL-NL2/NL1 and DSLv5, 10 fitting channels
up to 62 TMK600 V5261 $1,598.00 51.815% $770.00 $75.00 12 MONTH 36 month
Tempus Moxi Kiss 500 CRT up to 62 TMK500 V5257 $549.00 45.537% $299.00 $75.00 12 MONTH 36 month312 battery, AutoMic, Speech Enhancement, Noise Reduction, Multiband Adapative directionality, Pinna Effect, AntiShock 2, Wind control, Feedback Manager, Natural Sound Balance, Log It All, Patient Ratings, Data logging, Flex:trial, Flex:upgrade, DuoLink, Easy-T, Autmatic Adaption Manager, myMusic, Frequestion compression, Tinnitus masker, IntelliVent, Streaming programs, Manual programs, NAL-NL2/NL1 and DSLv5, 6 fitting channels
up to 62 TMK500 V5261 $1,098.00 45.537% $598.00 $75.00 12 MONTH 36 month
Tempus Moxi Dura 600 CRT up to 66 TMD600 V5257 $799.00 51.815% $385.00 $75.00 12 MONTH 36 month13 battery, Sound Nav (3 environments), Speech Enhancement, Noise Reduction, Multiband Adapative directionality, Pinna Effect, AntiShock 2, Wind control, Feedback Manager, Natural Sound Balance, Log It All, Patient Ratings, Data logging, Flex:trial, Flex:upgrade, DuoLink, T-Coil, Easy-T, Easy-DAI, Binaural Phone, Autmatic Adaption Manager, myMusic, Frequestion compression, Tinnitus masker, IntelliVent, Streaming programs, Manual programs, NAL-NL2/NL1 and DSLv5, 10 fitting channels
up to 66 TMD600 V5261 $1,598.00 51.815% $770.00 $75.00 12 MONTH 36 month
Tempus Moxi Dura 500 CRT up to 66 TMD500 V5257 $549.00 45.537% $299.00 $75.00 12 MONTH 36 month13 battery, AutoMic, Speech Enhancement, Noise Reduction, Multiband Adapative directionality, Pinna Effect, AntiShock 2, Wind control, Feedback Manager, Natural Sound Balance, Log It All, Patient Ratings, Data logging, Flex:trial, Flex:upgrade, DuoLink, T-Coil, Easy-T, Easy-DAI, Autmatic Adaption Manager, myMusic, Frequestion compression, Tinnitus masker, IntelliVent, Streaming programs, Manual programs, NAL-NL2/NL1 and DSLv5, 6 fitting channels
up to 66 TMD500 V5261 $1,098.00 45.537% $598.00 $75.00 12 MONTH 36 month
Tempus Moxi Now 600 CRT up to 57 TMN600 V5257 $799.00 51.815% $385.00 $75.00 12 MONTH 36 month10A battery, Sound Nav (3 environments), Speech Enhancement, Noise Reduction, Multiband Adapative directionality, Pinna Effect, AntiShock 2, Wind control, Feedback Manager, Natural Sound Balance, Log It All, Patient Ratings, Data logging, Flex:trial, Flex:upgrade, DuoLink, Easy-T, Binaural Phone, Autmatic Adaption Manager, myMusic, Frequestion compression, Tinnitus masker, IntelliVent, Streaming programs, Manual programs, NAL-NL2/NL1 and DSLv5, 10 fitting channels
up to 57 TMN600 V5261 $1,598.00 51.815% $770.00 $75.00 12 MONTH 36 month
Tempus Moxi Now 500 CRT up to 57 TMN500 V5257 $549.00 45.537% $299.00 $75.00 12 MONTH 36 month10A battery, AutoMic, Speech Enhancement, Noise Reduction, Multiband Adapative directionality, Pinna Effect, AntiShock 2, Wind control, Feedback Manager, Natural Sound Balance, Log It All, Patient Ratings, Data logging, Flex:trial, Flex:upgrade, DuoLink, Easy-T, Autmatic Adaption Manager, myMusic, Frequestion compression, Tinnitus masker, IntelliVent, Streaming programs, Manual programs, NAL-NL2/NL1 and DSLv5, 6 fitting channels
up to 57 TMN500 V5261 $1,098.00 45.537% $598.00 $75.00 12 MONTH 36 month
BEHIND THE EAR TYPES - The total price shall be for a single hearing aid or two hearing aids and appropriate case. List model numbers/name and full range of the instrument has a T-coil or T-coil capability. For digital aids, indicate whether a remote control is required. For conventional aids, indicate whether it is a linear or compression circuit L = Linear, C = Compression.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsUNITRON
Page 2 of 3
DESCRIPTION & FEATURES (See below) db RANGE MODEL NUMBER (19 Characters or less) HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT
DISCOUNT OFF LIST PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)Tempus Moxi Fit R 500 CRT up to 62 TMFR500 V5257 $624.00 45.537% $339.85 $75.00 12 MONTH 36 month312 battery, AutoMic, Speech Enhancement, Noise Reduction, Multiband Adapative directionality, Pinna Effect, AntiShock 2, Wind control, Feedback Manager, Natural Sound Balance, Log It All, Patient Ratings, Data logging, Flex:trial, Flex:upgrade, Rechargeable, DuoLink, T-Coil, Easy-T, Autmatic Adaption Manager, myMusic, Frequestion compression, Tinnitus masker, IntelliVent, Streaming programs, Manual programs, NAL-NL2/NL1 and DSLv5, 6 fitting channels
up to 62 TMFR500 V5261 $1,248.00 45.537% $679.70 $75.00 12 MONTH 36 month
Tempus Stride M 600 BTE up to 63 TSM600 V5257 $799.00 51.815% $385.00 $75.00 12 MONTH 36 month312 battery, Sound Nav, 3 environments, Speech enhancement, Noise reduction, Multiband Adaptive directionality, Pinna effect, AntiShock 2, Wind control, feedback manager, natural sound balance, log it all, data logging, flex:upgrade, flex:trial, duolink, telecoil and easy-t, binaural phone, automatic adaption manager, binaural myMusic, frequency compression, tinnitus masker, intellivent, streaming programs, manual programs, NAL-NL2/NL and DSLv5, 10 Fitting channels
up to 63 TSM600 V5261 $1,598.00 51.815% $770.00 $75.00 12 MONTH 36 month
Tempus Stride M 500 BTE up to 63 TSM500 V5257 $549.00 45.537% $299.00 $75.00 12 MONTH 36 month312 battery, Sound Nav AutoMic, Speech enhancement, Noise reduction, Multiband Adaptive directionality, Pinna effect, AntiShock 2, Wind control, feedback manager, natural sound balance, log it all, data logging, flex:upgrade, flex:trial, duolink, telecoil and easy-t, binaural phone, automatic adaption manager, binaural myMusic, frequency compression, tinnitus masker, intellivent, streaming programs, manual programs, NAL-NL2/NL and DSLv5, 6 Fitting channels
up to 63 TSM500 V5261 $1,098.00 45.537% $598.00 $75.00 12 MONTH 36 month
Tempus P Dura 600 BTE up to 63 TPD600 V5257 $799.00 51.815% $385.00 $75.00 12 MONTH 36 month13 battery, Sound Nav, 3 environments, Speech enhancement, Noise reduction, Multiband Adaptive directionality, Pinna effect, AntiShock 2, Wind control, feedback manager, natural sound balance, log it all, data logging, flex:upgrade, flex:trial, duolink, telecoil and easy-t, easy DAI, binaural phone, automatic adaption manager, binaural myMusic, frequency compression, tinnitus masker, intellivent, streaming programs, manual programs, NAL-NL2/NL and DSLv5, 10 Fitting channels
up to 63 TPD600 V5261 $1,598.00 51.815% $770.00 $75.00 12 MONTH 36 month
Tempus P Dura 500 BTE up to 63 TPD500 V5257 $549.00 45.537% $299.00 $75.00 12 MONTH 36 month13 battery, Sound Nav AutoMic, Speech enhancement, Noise reduction, Multiband Adaptive directionality, Pinna effect, AntiShock 2, Wind control, feedback manager, natural sound balance, log it all, data logging, flex:upgrade, flex:trial, duolink, telecoil and easy-t, binaural phone, automatic adaption manager, binaural myMusic, frequency compression, tinnitus masker, intellivent, streaming programs, manual programs, NAL-NL2/NL and DSLv5, 6 Fitting channels
up to 63 TPD500 V5261 $1,098.00 45.537% $598.00 $75.00 12 MONTH 36 month
Tempus P 600 BTE up to 66 TP600 V5257 $799.00 51.815% $385.00 $75.00 12 MONTH 36 month13 battery, Sound Nav, 3 environments, Speech enhancement, Noise reduction, Multiband Adaptive directionality, Pinna effect, AntiShock 2, Wind control, feedback manager, natural sound balance, log it all, data logging, flex:upgrade, flex:trial, duolink, telecoil and easy-t, binaural phone, automatic adaption manager, binaural myMusic, frequency compression, tinnitus masker, intellivent, streaming programs, manual programs, NAL-NL2/NL and DSLv5, 10 Fitting channels
up to 66 TP600 V5261 $1,598.00 51.815% $770.00 $75.00 12 MONTH 36 month
Tempus P 500 BTE up to 66 TP500 V5257 $549.00 45.537% $299.00 $75.00 12 MONTH 36 month13 battery, Sound Nav AutoMic, Speech enhancement, Noise reduction, Multiband Adaptive directionality, Pinna effect, AntiShock 2, Wind control, feedback manager, natural sound balance, log it all, data logging, flex:upgrade, flex:trial, duolink, telecoil and easy-t, binaural phone, automatic adaption manager, binaural myMusic, frequency compression, tinnitus masker, intellivent, streaming programs, manual programs, NAL-NL2/NL and DSLv5, 6 Fitting channels
up to 66 TP500 V5261 $1,098.00 45.537% $598.00 $75.00 12 MONTH 36 month
Max E SP BTE up to 142 MAXESP V5257 $579.00 39.131% $352.43 $75.00 12 MONTH 36 monthVC, DIR, T-Coil, Easy -T, NR, AS, 4 Prgs, digital, Data-Logging, PAM, 13 Bat, duo-link, 6 bands, 6 channels, SmartFocus SP, Freq Comp, DAI, IP57 Prot Rating, wireless prg, Std Earhook or Slim tube
up to 142 V5261 $1,158.00 39.131% $704.86 $75.00 12 MONTH 36 month
Max E SPm BTE up to 140 MAXESPM V5257 $579.00 39.131% $352.43 $75.00 12 MONTH 36 monthVC, DIR, T-Coil, Easy -T, NR, AS, 4 Prgs, digital, Data-Logging, PAM, 13 Bat, duo-link, 6 bands, 6 channels, SmartFocus SP, Freq Comp, DAI, IP57 Prot Rating, wireless prg, Std Earhook or Slim tube
up to 142 V5261 $1,158.00 39.131% $704.86 $75.00 12 MONTH 36 month
FEATURES = Digital (full digital signal processing with two or three channels, etc.), List CROS and BiCros on separate price lines.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsUNITRON
Page 3 of 3
FULL SHELL CONCHA MODEL DESCRIPTION & FEATURES (See below) db RANGE MODEL NUMBER (19 Characters or less) HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT
DISCOUNT OFF LIST PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)Unitron Stride Full shell 600 up to 130 S600FS V5256 $799.00 51.815% $385.00 $75.00 12 months 36 monthsSound Nav, Sound Conductor, MyMusic, nat snd bal, AAM, Frequency compression, multi-adp dir, NRLD, antishock, tinnitus masker, feedback mngr, opt rem SE+, 3 streaming prog binaural phone, duolink, wireless, 10 bnd, 10 ch, data logging & learning, Log It All, t-coil, easy-t, antishock, IP57, 2 environ ments, digital VC, push-button, wireless
up to 130 S600FS V5260 $1,598.00 51.815% $770.00 $75.00 12 months 36 months
Unitron Stride Full shell 500 up to 130 S500FS V5256 $549.00 45.537% $299.00 $75.00 12 months 36 months4 man prog, Sound Conductor, MyMusic, nat snd bal, AAM, Frequency compression, multi-adp dir, NRLD, antishock, tinnitus masker, feedback mngr, opt rem SE+, 3 streaming prog binaural phone, duolink, wireless, 6 bnd, 6 ch, data logging & learning, Log It All, t-coil, easy-t, antishock, IP57, Auto Mic Sound Nav VC, push-button, wireless
up to 130 S500FS V5260 $1,098.00 45.537% $598.00 $75.00 12 months 36 months
HALF SHELL CONCHA DESCRIPTION & FEATURES (See below) db RANGE MODEL NUMBER (19 Characters or less) HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT
DISCOUNT OFF LIST PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)Unitron Stride Half shell 600 up to 130 S600HS V5256 $799.00 51.815% $385.00 $75.00 12 Months 36 monthsSound Nav, Sound Conductor, MyMusic, nat snd bal, AAM, Frequency compression, multi-adp dir, NRLD, antishock, tinnitus masker, feedback mngr, opt rem SE+, 3 streaming prog binaural phone, duolink, wireless, 10 bnd, 10 ch, data logging & learning, Log It All, t-coil, easy-t, antishock, IP57, 2 environ ments, digital VC, push-button, wireless
up to 130 S600HS V5260 $1,598.00 51.815% $770.00 $75.00 12 Months 36 months
Unitron Stride Half shell 500 up to 130 S500HS V5256 $549.00 45.537% $299.00 $75.00 12 Months 36 months4 man prog, Sound Conductor, MyMusic, nat snd bal, AAM, Frequency compression, multi-adp dir, NRLD, antishock, tinnitus masker, feedback mngr, opt rem SE+, 3 streaming prog binaural phone, duolink, wireless, 6 bnd, 6 ch, data logging & learning, Log It All, t-coil, easy-t, antishock, IP57, Auto Mic Sound Nav VC, push-button, wireless
up to 130 S500HS V5260 $1,098.00 45.537% $598.00 $75.00 12 Months 36 months
LOW PROFILE DESCRIPTION & FEATURES (See below) db RANGE MODEL NUMBER (19 Characters or less) HCPCS CODE(S)
EQUIPMENT PUBLISHED LIST PRICE
EQUIPMENT PERCENT
DISCOUNT OFF LIST PRICE
EQUIPMENT TOTAL PRICE
FIXED NON - WARRANTY
REPAIR PRICE
NON - WARRANTY REPAIR PERIOD
(MONTHS)
WARRANTY REPAIR PERIOD
(MONTHS)Unitron Stride Low Profile 600 up to 130 S600LP 5256 $799.00 51.815% $385.00 $75.00 12 Months 36 monthsSound Nav, Sound Conductor, MyMusic, nat snd bal, AAM, Frequency compression, multi-adp dir, NRLD, antishock, tinnitus masker, feedback mngr, opt rem SE+, 3 streaming prog binaural phone, duolink, wireless, 10 bnd, 10 ch, data logging & learning, Log It All, t-coil, easy-t, antishock, IP57, 2 environ ments, digital VC, push-button, wireless
up to 130 S600LP 5260 $1,598.00 51.815% $770.00 $75.00 12 Months 36 months
Unitron Stride Low Profile 500 up to 130 S500LP 5256 $549.00 45.537% $299.00 $75.00 12 Months 36 months4 man prog, Sound Conductor, MyMusic, nat snd bal, AAM, Frequency compression, multi-adp dir, NRLD, antishock, tinnitus masker, feedback mngr, opt rem SE+, 3 streaming prog binaural phone, duolink, wireless, 6 bnd, 6 ch, data logging & learning, Log It All, t-coil, easy-t, antishock, IP57, Auto Mic Sound Nav VC, push-button, wireless
up to 130 S500LP 5260 $1,098.00 45.537% $598.00 $75.00 12 Months 36 months
IN THE EAR TYPES – Prices shall be for a single hearing aid or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
IN THE EAR TYPES – Prices shall be for a single hearing aid, or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
IN THE EAR TYPES – Prices shall be for a single hearing aid or two hearing aids and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsWIDEX
Page 1 of 4
MODEL NON - NON-WARRANTY WARRANTYBEHIND THE EAR NUMBER PUBLISHED PERCENT (%) WARRANTY REPAIR PERIOD
db (19 Characters HCPC LIST DISCOUNT TOTAL REPAIR PERIOD (MONTHS)DESCRIPTION & FEATURES (See below) RANGE or less) CODE(S) PRICE OFF LIST PRICE PRICE (MONTHS)
Beyond 220 U2-FS receiver in the ear with configurable push button 26-45 dB10 band sensogram, 6 channel processing, U-Platform with direct wireless mobile connectivity, Wireless, 3 Programs and Zen+ and B2-FS 5261 Binaural $2,488.00 69% $770.00 $200.00 12 24
2.4 GHz Bluetooth connectivity allows for direct iPhone audio streaming as well as direct control from smartphones and tablets for both iPhone and select Android phones. 46-65 dB 5257 Monaural $1,244.00 69% $385.00 $100.00 12 24
T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program and66-85 dB86 dB +
Unique 220 U2-FA Fashion BTE with volume control and push button 26-45 dB U2-FA-VC 5261 Binaural $2,288.00 66% $770.00 $200.00 12 2410 band sensogram, 6 channel processing, U-Platform, Wireless, 3 Programs and Zen+ and 5257 Monaural $1,144.00 66% $385.00 $100.00 12 24T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB
and66-85 dB
Unique 220 U2-FA Fashion m-BTE with configurable push button 26-45 dB U2-FA-m 5261 Binaural $2,288.00 66% $770.00 $200.00 12 2410 band sensogram, 6 channel processing, U-Platform, Wireless, 3 Programs and Zen+ and 5257 Monaural $1,144.00 66% $385.00 $100.00 12 24Audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB
and66-85 dB
Unique 220 U2-FS receiver in the ear with configurable push button 26-45 dB10 band sensogram, 6 channel processing, U-Platform, Wireless, 3 Programs and Zen+ and U2-FS 5261 Binaural $2,288.00 66% $770.00 $200.00 12 24T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5257 Monaural $1,144.00 66% $385.00 $100.00 12 24
and66-85 dB86 dB +
Unique 220 U2-FS receiver in the ear with push button & Widex Wireless Cros System 26-45 dB
10 band sensogram, 6 channel processing, U-Platform, Wireless, 3 Programs and Zen+ and U2-FS-Cros V5180 Hearing Aid, Cros, BTE
$1,893.00 60% $759.00 $200.00 12 24
T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB $100.00 12 24and
66-85 dB86 dB +
Unique 110 U1-FA Fashion BTE with volume control and push button 26-45 dB10 band sensogram, 4 channel processing, U-Platform, Wireless, 3 Programs and Zen+ and U1-FA-VC 5261 Binaural $1,678.00 62% $630.00 $200.00 12 12T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5257 Monaural $839.00 62% $315.00 $100.00 12 12
and66-85 dB
Unique 110 U1-FA Fashion m-BTE with configurable push button 26-45 dB10 band sensogram, 4 channel processing, U-Platform, Wireless, 3 Programs and Zen+ and U1-FA-m 5261 Binaural $1,678.00 62% $630.00 $200.00 12 12Audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5257 Monaural $839.00 62% $315.00 $100.00 12 12
and66-85 dB
Unique 110 U1-FS receiver in the ear with configurable push button 26-45 dB10 band sensogram, 4 channel processing, U-Platform, Wireless, 3 Programs and Zen+ and U1-FS 5261 Binaural $1,678.00 62% $630.00 $200.00 12 12T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5257 Monaural $839.00 62% $315.00 $100.00 12 12
and66-85 dB86 dB +
Unique 110 U1-FS receiver in the ear with push button & Widex Wireless Cros System 26-45 dB
10 band sensogram, 4 channel processing, U-Platform, Wireless, 3 Programs and Zen+ and U1-FS-Cros V5180 Hearing Aid, Cros, BTE
$1,588.00 57% $689.00 $200.00 12 12
audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB $100.00 12 12and
66-85 dB86 dB +
and86+ dB
Dream 220 9 BTE with volume control 26-45 dB14 band sensogram, 5 channel processing, C-ISP, Wireless, 3 Programs and Zen+ and D2-9-VC 5261 Binaural $1,748.00 60% $700.00 $200.00 12 24T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5257 Monaural $874.00 60% $350.00 $100.00 12 24
BEHIND THE EAR TYPES - The total price shall be for a single hearing aid and appropriate case. List model numbers/name and full range of the instrument has a T-coil or T-coil capability. For analog, programmable and digital aids, indicate whether a remote control is required. For conventional aids, indicate whether it is a linear or compression circuit L = Linear, C = Compression.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsWIDEX
Page 2 of 4
MODEL NON - NON-WARRANTY WARRANTYBEHIND THE EAR NUMBER PUBLISHED PERCENT (%) WARRANTY REPAIR PERIOD
db (19 Characters HCPC LIST DISCOUNT TOTAL REPAIR PERIOD (MONTHS)DESCRIPTION & FEATURES (See below) RANGE or less) CODE(S) PRICE OFF LIST PRICE PRICE (MONTHS)
Dream 220 9 BTE without volume control 26-45 dB14 band sensogram, 5 channel processing, C-ISP, Wireless, 3 Programs and Zen+ and D2-9 5261 Binaural $1,748.00 60% $700.00 $200.00 12 24T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5257 Monaural $874.00 60% $350.00 $100.00 12 24Dream 220 D2-FS receiver in the ear with push button 26-45 dB14 band sensogram, 5 channel processing, C-ISP, Wireless, 3 Programs and Zen+ and D2-FS 5261 Binaural $1,948.00 64% $700.00 $200.00 12 24T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5257 Monaural $974.00 64% $350.00 $100.00 12 24
and66-85 dB86 dB +
Dream 220 m-CB micro ClearBand BTE 26-45 dB14 band sensogram, 5 channel processing, C-ISP, Wireless, 3 Programs and Zen+ and D2-MR CB 5261 Binaural $1,748.00 60% $700.00 $200.00 12 24audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5257 Monaural $874.00 60% $350.00 $100.00 12 24Dream 220 Fashion BTE with volume control and program button 26-45 dB14 band sensogram, 5 channel processing, C-ISP, Wireless, 3 Programs and Zen+ and D2-FA-VC 5261 Binaural $1,748.00 60% $700.00 $200.00 12 24T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5257 Monaural $874.00 60% $350.00 $100.00 12 24
and66-85 dB
Dream 220 Fashion Power BTE with volume control and program button 46-65 dB14 band sensogram, 5 channel processing, C-ISP, Wireless, 3 Programs and Zen+ and D2-FAP-VC 5261 Binaural $1,748.00 60% $700.00 $200.00 12 24T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 66-85 dB 5257 Monaural $874.00 60% $350.00 $100.00 12 24
and86+ dB
Dream 220 9 BTE with volume control & Widex Wireless Cros System 26-45 dB14 band sensogram, 5 channel processing, C-ISP, Wireless, 3 Programs and Zen+ and D2-9-VC-Cros
T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB V5180 Hearing Aid, Cros, BTE
$1,623.00 55% $724.00 $100.00 12 24
Dream 220 9 BTE without volume control & Widex Wireless Cros System 26-45 dB14 band sensogram, 5 channel processing, C-ISP, Wireless, 3 Programs and Zen+ and D2-9-Cros
T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB V5180 Hearing Aid, Cros, BTE
$1,623.00 55% $724.00 $100.00 12 24
Dream 220 D2-FS receiver in the ear with push button & Widex Wireless Cros System 26-45 dB14 band sensogram, 5 channel processing, C-ISP, Wireless, 3 Programs and Zen+ and D2-FS-Cros
T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB V5180 Hearing Aid, Cros, BTE
$1,723.00 58% $724.00 $100.00 12 24
and66-85 dB86 dB +
Dream 220 m-CB micro ClearBand BTE & Widex Wireless Cros System 26-45 dB14 band sensogram, 5 channel processing, C-ISP, Wireless, 3 Programs and Zen+ and D2-MR CB-Cros
audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB V5180 Hearing Aid, Cros, BTE
$1,623.00 55% $724.00 $100.00 12 24
Dream 220 Fashion BTE with volume control and program button & Widex Wireless Cros System 26-45 dB14 band sensogram, 5 channel processing, C-ISP, Wireless, 3 Programs and Zen+ and D2-FA-VC-Cros
T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB V5180 Hearing Aid, Cros, BTE
$1,623.00 55% $724.00 $100.00 12 24
and66-85 dB
Dream 220 Fashion Power BTE with volume control and program button & Widex Wireless Cros System 46-65 dB14 band sensogram, 5 channel processing, C-ISP, Wireless, 3 Programs and Zen+ and D2-FAP-VC-Cros
T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 66-55 dB V5180 Hearing Aid, Cros, BTE
$1,623.00 55% $724.00 $100.00 12 24
and86+ dB
Dream 110 9 BTE with volume control 26-45 dB14 band sensogram, 3 channel processing, C-ISP, Wireless, 2 Programs and Zen+ and D1-9-VC 5261 Binaural $1,198.00 62% $450.00 $200.00 12 12audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5257 Monaural $599.00 62% $225.00 $100.00 12 12Dream 110 9 BTE without volume control 26-45 dB14 band sensogram, 3 channel processing, C-ISP, Wireless, 2 Programs and Zen+ and D1-9 5261 Binaural $1,198.00 62% $450.00 $200.00 12 12audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5257 Monaural $599.00 62% $225.00 $100.00 12 12
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsWIDEX
Page 3 of 4
MODEL NON - NON-WARRANTY WARRANTYBEHIND THE EAR NUMBER PUBLISHED PERCENT (%) WARRANTY REPAIR PERIOD
db (19 Characters HCPC LIST DISCOUNT TOTAL REPAIR PERIOD (MONTHS)DESCRIPTION & FEATURES (See below) RANGE or less) CODE(S) PRICE OFF LIST PRICE PRICE (MONTHS)
Dream 110 D1-FS receiver in the ear with push button 26-45 dB14 band sensogram, 3 channel processing, C-ISP, Wireless, 2 Programs and Zen+ and D1-FS 5261 Binaural $1,398.00 68% $450.00 $200.00 12 12audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5257 Monaural $699.00 68% $225.00 $100.00 12 12
and66-85 dB86 dB +
Dream 110 m-CB micro ClearBand BTE 26-45 dB14 band sensogram, 3 channel processing, C-ISP, Wireless, 2 Programs and Zen+ and D1-MR CB 5261 Binaural $1,198.00 62% $450.00 $200.00 12 12audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5257 Monaural $599.00 62% $225.00 $100.00 12 12Dream 110 Fashion BTE with volume control and program button 26-45 dB14 band sensogram, 3 channel processing, C-ISP, Wireless, 2 Programs and Zen+ and D1FA-VC 5261 Binaural $1,198.00 62% $450.00 $200.00 12 12audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5257 Monaural $599.00 62% $225.00 $100.00 12 12
and66-85 dB
Dream 110 9 BTE with volume control & Widex Wireless Cros System 26-45 dB14 band sensogram, 3 channel processing, C-ISP, Wireless, 2 Programs and Zen+ and D1-9-VC-Cros
audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB V5180 Hearing Aid, Cros, BTE
$1,348.00 56% $599.00 $100.00 12 12
Dream 110 9 BTE without volume control & Widex Wireless Cros System 26-45 dB14 band sensogram, 3 channel processing, C-ISP, Wireless, 2 Programs and Zen+ and D1-9-Cros
audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB V5180 Hearing Aid, Cros, BTE
$1,348.00 56% $599.00 $100.00 12 12
Dream 110 D1-FS receiver in the ear with push button & Widex Wireless Cros System 26-45 dB14 band sensogram, 3 channel processing, C-ISP, Wireless, 2 Programs and Zen+ and D1-FS-Cros
audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB V5180 Hearing Aid, Cros, BTE
$1,448.00 59% $599.00 $100.00 12 12
and66-85 dB86 dB +
Dream 110 m-CB micro ClearBand BTE & Widex Wireless Cros System 26-45 dB14 band sensogram, 3 channel processing, C-ISP, Wireless, 2 Programs and Zen+ and D1-MR CB-Cros
audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB V5180 Hearing Aid, Cros, BTE
$1,348.00 56% $599.00 $100.00 12 12
Dream 110 Fashion BTE with volume control and program button & Widex Wireless Cros System 26-45 dB14 band sensogram, 3 channel processing, C-ISP, Wireless, 2 Programs and Zen+ and D1FA-VC-Cros
audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB V5180 Hearing Aid, Cros, BTE
$1,348.00 56% $599.00 $100.00 12 12
and66-85 dB
MODEL NON - NON-WARRANTY WARRANTY FULL CONCHA MODEL NUMBER PUBLISHED PERCENT (%) WARRANTY REPAIR PERIOD
IN THE EAR - FULL SHELL db (19 Characters HCPC LIST DISCOUNT TOTAL REPAIR PERIOD (MONTHS)DESCRIPTION & FEATURES (See below) RANGE or less) CODE(S) PRICE OFF LIST PRICE PRICE (MONTHS)
Unique 220 In the Ear-Full Shell 26-45 dB10 band sensogram, 6 channel processing, U-Platform, Wireless, 3 Programs and Zen+ and U2-XPF 5260 Binaural $2,288.00 66% $770.00 $200.00 12 24T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5256 Monaural $1,144.00 66% $385.00 $100.00 12 24Unique 110 In the Ear-Full Shell 26-45 dB10 band sensogram, 4 channel processing, U-Platform, Wireless, 3 Programs and Zen+ and U1-XPF 5260 Binaural $1,678.00 62% $630.00 $200.00 12 12T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5256 Monaural $839.00 62% $315.00 $100.00 12 12Dream 220 In the Ear-Full Shell 26-45 dB14 band sensogram, 5 channel processing, C-ISP, Wireless, 3 Programs and Zen+ and D2-XPF 5260 Binaural $1,748.00 60% $700.00 $200.00 12 24T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5256 Monaural $874.00 60% $350.00 $100.00 12 24Dream 110 In the Ear-Full Shell 26-45 dB14 band sensogram, 3 channel processing, C-ISP, Wireless, 2 Prog and Zen + and D1-XPF 5260 Binaural $1,198.00 62% $450.00 $200.00 12 12adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5256 Monaural $599.00 62% $225.00 $100.00 12 12
IN THE EAR TYPES – Prices shall be for a single hearing aid and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.
Contract Effective 9/1/17 MDHHS Contract Hearing Aid DefinitionsWIDEX
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MODEL NON - NON-WARRANTY WARRANTYHALF SHELL CONCHA MODEL NUMBER PUBLISHED PERCENT (%) WARRANTY REPAIR PERIOD
db (19 Characters HCPC LIST DISCOUNT TOTAL REPAIR PERIOD (MONTHS)DESCRIPTION & FEATURES (See below) RANGE or less) CODE(S) PRICE OFF LIST PRICE* PRICE ** (MONTHS)
Unique 220 In the Ear-Half Shell 26-45 dB10 band sensogram, 6 channel processing, U-Platform, Wireless, 3 Programs and Zen+ and U2-XPH 5260 Binaural $2,288.00 66% $770.00 $200.00 12 24T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5256 Monaural $1,144.00 66% $385.00 $100.00 12 24Unique 110 In the Ear-Half Shell 26-45 dB10 band sensogram, 4 channel processing, U-Platform, Wireless, 3 Programs and Zen+ and U1-XPH 5260 Binaural $1,678.00 62% $630.00 $200.00 12 12T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5256 Monaural $839.00 62% $315.00 $100.00 12 12Dream 220 In the Ear-Half Shell 26-45 dB14 band sensogram, 5 channel processing, C-ISP, Wireless, 3 Programs and Zen+ and D2-XPH 5260 Binaural $1,748.00 60% $700.00 $200.00 12 24T-Coil, audibility extender, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5256 Monaural $874.00 60% $350.00 $100.00 12 24Dream 110 In the Ear-Half Shell 26-45 dB14 band sensogram, 3 channel processing, C-ISP, Wireless, 2 Prog and Zen + and D1-XPH 5260 Binaural $1,198.00 62% $450.00 $200.00 12 12T-Coil, adaptive directional, noise manager, Feedback Canceller, Zen program 46-65 dB 5256 Monaural $599.00 62% $225.00 $100.00 12 12
IN THE EAR TYPES – Prices shall be for a single hearing aid and case. List model number for the full range of instruments. Include all features. Indicate Class D power or Class B power.