Phonak HEARING AID o:1 o:3 o:2 Invoice Cost EAP Patient Price Approved Infinio I90 Audeo Sphere "$2,345.00 " Yes Audeo R "$2,251.00 " Yes Virto Titanium "$2,234.00 " No Virto R "$2,316.00 " No Virto 10 NW O "$2,072.00 " No I70 Audeo Sphere "$1,692.00 " Yes Audeo R "$1,604.00 " Yes Virto Titanium "$1,586.00 " No Virto R "$1,668.00 " No Virto 10 NW O "$1,433.00 " Yes I50 Audeo R "$1,156.00 " Yes Virto R "$1,222.00 " No Virto 10 NW O $983.00 No I30 Audeo R $815.00 Yes Virto R $878.00 No Virto 10 NW O $658.00 No CROS I CROS I-R "$1,260.00 " Yes Lumity L90 Audeo R "$1,459.00 " V5257.67-95500557 "$2,243.00 " Yes Audeo RT "$1,459.00 " V5257.65-95500555 "$2,243.00 " Yes Audeo R Life "$1,559.00 " V5257.66-95500556 "$2,422.00 " Yes Audeo 312 "$2,164.00 " Yes Audeo Fit "$1,595.65 " *** "$2,777.00 " No- Request Permission Slim R "$1,545.12 " V5257.182-95500755 "$2,422.00 " Yes Naida PR "$1,459.00 " *** "$2,243.00 " Yes Naida UP "$1,430.18 " *** "$2,243.00 " Yes Naida SP "$2,201.00 " Yes Sky M "$2,243.00 " No- Request Permission Sky SP "$2,243.00 " Requested 8/16/24 Sky PR "$2,243.00 " No- Request Permission Sky UP "$2,243.00 " No- Request Permission L70 Audeo R $839.00 V5257.69-95500559 "$1,598.00 " Yes Audeo RT $839.00 V5257.70-95500563 "$1,598.00 " Yes Audeo R Life $909.00 V5257.68-95500558 "$1,723.00 " Yes Audeo 312 "$1,520.00 " Yes Audeo Fit $951.42 *** "$1,702.00 " No- Request Permission Slim R "$1,703.00 " Yes Naida PR $839.00 *** "$1,598.00 " Yes Naida UP $815.83 Requested 8/11 "$1,557.00 " Yes Naida SP "$1,473.00 " Yes Sky M "$1,557.00 " Yes Sky SP "$1,557.00 " No- Request Permission Sky PR "$1,598.00 " No- Request Permission Sky UP "$1,557.00 " No- Request Permission L50 Audeo R $589.00 V5257.72-95500561 "$1,152.00 " Yes Audeo RT $589.00 V5257.71-95500560 "$1,152.00 " Yes Audeo R Life $679.00 V5257.104-95500645 "$1,312.00 " Yes Audeo 312 "$1,070.00 " Yes Slim R $667.29 *** "$1,292.00 " Yes Naida PR $589.00 *** "$1,152.00 " Yes Naida UP $564.41 *** "$1,108.00 " Yes Naida SP "$1,108.00 " Yes Sky M "$1,108.00 " Yes Sky SP "$1,108.00 " Yes Sky PR $589.00 V5257.215-95500796 "$1,152.00 " Yes Sky UP $564.41 V5257.213-95500794 "$1,108.00 " Yes L30 Audeo R $519.00 V5257.74-95500564 $813.00 Yes Audeo RT $519.00 V5257.73-95500562 $859.00 Yes Audeo R Life $629.00 V5257.64-95500554 "$1,082.00 " Yes Audeo 312 $733.00 No- Request Permission Slim R $614.47 *** "$1,082.00 " No- Request Permission Naida SP $778.00 No- Request Permission Naida PR $519.00 *** $813.00 Yes Naida UP $492.30 *** $813.00 No- Request Permission CROS L R $584.46 v5181.6-95500444 USE CROS TAB Yes Paradise P90 Audeo 312 "$1,345.84 " *** "$2,243.00 " No- Request Permission Audeo 13T "$1,345.84 " *** "$2,243.00 " No- Request Permission Virto 312 "$1,345.15 " V5255.15-95500537 "$2,243.00 " Yes Virto NW312 "$1,292.28 " V5255.19-95500541 "$2,243.00 " Yes Virto NW10 "$1,292.28 " V5255.19-95500541 "$2,243.00 " Yes P70 Audeo 312 $759.50 *** "$1,456.00 " Yes Audeo 13T $759.50 *** "$1,456.00 " No- Request Permission Audeo R $759.50 V5257.206-95500784 "$1,456.00 " Yes Audeo RT $759.50 *** "$1,456.00 " No- Request Permission Naida PR $759.50 V5257.183-95500756 "$1,456.00 " Yes Naida UP $759.50 V5257.205-95500783 "$1,456.00 " Yes Virto 312 $759.50 V5255.14-95500536 "$1,456.00 " Yes Virto NW312 $716.42 V5255.18-95500540 "$1,379.00 " Yes Virto NW10 $716.42 V5254.15-95500533 "$1,379.00 " Yes P50 Audeo 312 $540.30 *** "$1,065.00 " Yes Audeo 13T $540.30 V5257.201-95500778 "$1,065.00 " Yes Audeo R $540.30 V5257.180-95500753 "$1,065.00 " Yes Audeo RT $540.30 *** "$1,065.00 " No- Request Permission Naida PR $540.30 V5257.179-95500752 "$1,065.00 " Yes Naida UP $540.30 V5257.202-95500780 "$1,065.00 " Yes Virto 312 $540.30 V5255.13-95500535 "$1,065.00 " Yes Virto NW312 $494.19 V5255.16-95500538 $983.00 Yes Virto NW10 $494.19 V5254.14-95500532 $983.00 Yes P30 Audeo 312 $471.95 V5257.60-95500526 $520.00 Yes Audeo 13T $471.95 V5257.61-95500527 $538.00 Yes Audeo R $471.95 V5257.62-95500528 $573.00 Yes Audeo RT $471.95 V5257.63-95500529 $551.00 Yes Naida PR $471.95 *** $546.00 Yes Naida UP $471.95 *** $538.00 Yes Virto 312 $471.95 V5255.12-95500534 $520.00 Yes Virto NW312 $418.27 V5255.17-95500539 $520.00 Yes Virto NW10 $418.27 V5254.13-95500531 $520.00 Yes CROS P 13 $588.73 v5181.7-95500445 USE CROS TAB Yes R $584.46 v5181.6-95500444 USE CROS TAB Yes Marvel M90 Naida SP "$1,317.58 " *** "$2,453.00 " No- Request Permission Sky M "$1,320.04 " *** "$2,457.00 " No- Request Permission Sky PR "$1,320.04 " *** "$2,457.00 " No- Request Permission Sky SP "$1,320.04 " *** "$2,457.00 " No- Request Permission Bolero M "$2,457.00 " No- Request Permission M70 Naida SP $744.03 *** "$1,362.00 " Yes Sky M $749.98 *** "$1,439.00 " No- Request Permission Sky PR $749.98 *** "$1,439.00 " No- Request Permission Sky SP $749.98 *** "$1,439.00 " No- Request Permission Bolero M "$1,439.00 " No- Request Permission M50 Naida SP $530.12 *** "$1,047.00 " No- Request Permission Naida Link M $528.02 V5257.193-95500766 "$1,043.00 " Yes Sky M $528.04 V5257.184-95500757 "$1,043.00 " Yes Sky PR $528.04 V5257.188-95500761 "$1,043.00 " Yes Sky SP $528.04 V5257.186-95500759 "$1,043.00 " Yes Sky Link M $528.02 V5257.185-95500758 "$1,043.00 " Yes AB Naida Link UP "$1,207.00 " Yes Bolero M "$1,043.00 " M30 Naida SP $236.53 *** $522.00 No- Request Permission Bolero M $524.00 No- Request Permission HEARING AID:ADD ONS o:1 o:2 Invoice Cost EAP Patient Price Approved ACCESSORIES Partner Mic $425.00 *** $550.00 TV Connector $265.30 *** $300.00 Remote Control $224.00 *** $300.00 Com Pilot II $276.00 *** $350.00 ROGER Roger On 3 "$2,221.00 " Yes Roger Select 3 "$1,876.00 " Yes Roger Touchscreen Mic 3 "$2,940.00 " Yes Roger Select iN "$1,042.30 " *** "$1,876.00 " Roger Select $671.30 *** "$1,208.00 " Roger Select Dock $48.00 Roger On iN "$1,119.30 " v5288.21-95500428 "$2,015.00 " Roger On $713.30 *** "$1,284.00 " Roger On Dock $182.00 Roger Table Mic $972.30 *** "$1,750.00 " Roger Table Mic iN "$1,343.30 " *** "$2,418.00 " Roger Clip On Mic $482.30 *** $868.00 Roger Touchscreen Mic $741.30 *** "$1,334.00 " Yes "Roger Adult (03) Receivers, (X, any #)" $552.30 *** $994.00 "Roger Pediatric (02) Receivers (X, any # - 10-18 &21)" $692.30 *** "$1,246.00 " Neckloop (02) $566.30 v5283.6-9550432 "$1,019.00 " Neckloop (03) $489.30 v5283.7-95500429 $881.00 Roger Focus II 312 $559.30 none "$1,007.00 " Roger Focus II R $636.30 none "$1,145.00 " Yes Roger 20(2) "$1,246.00 " Yes Roger Multimedia Hub $742.00 ACOUSTIC COUPLING cShell $63.00 *** $113.00 Yes cShell Titanium $91.00 *** $164.00 Yes Slim Tip $42.00 *** $76.00 Yes Slim Tip Titanium $53.00 *** $95.00 Yes Acrylic or Silicone earmolds $42.00 *** $75.00 Yes Active Vent Receiver $79.90 V5267.72-95500770 $144.00 Yes HEARING PROTECTION Serenity Choice Music (non-custom) pair $16.25 *** $59.00 Yes Serenity Choice Hunting & Shooting (non-custom) pair $9.00 *** $34.00 Yes Serenity Choice Comfort (non-custom) pair $9.50 *** $34.00 No- Request Permission Serenity Choice Motosport (non-custom) pair $7.00 *** $25.00 No- Request Permission Serenity Choice Work (non-custom) pair $7.00 *** $25.00 No- Request Permission Serenity Choice Sleep (non-custom) pair $7.00 *** $25.00 Yes Serenity Choice+ Music per ear $58.00 V5267.64-95500638 $104.00 Yes Serenity Choice+ Hunting & Shooting per ear $58.00 V5267.66-95500640 $104.00 Yes Serenity Choice+ Comfort per ear $42.00 V5267.65-95500639 $76.00 Yes Serenity Choice+ Motorsport per ear $42.00 V5267.63-95500637 $76.00 Yes Serenity Choice+ Work per ear $42.50 V5267.67-95500641 $77.00 Yes Serenity Choice+ Sleep per ear $26.00 V5267.62-95500636 $47.00 Yes Serenity Choice+ Fly per ear $42.00 V5267.68-95500642 $76.00 Yes Serenity Choice+ Swim per ear $31.50 V5267.61-95500635 $57.00 Yes CHARGERS Charger Ease (Lumity) $52.00 *** $94.00 Yes Charge and Care (Paradise) $105.00 *** $189.00 No- Request Permission Life Charger (no battery) $94.00 Yes "Charger Case Go (Life, on board battery)" $148.10 *** $267.00 Yes Slim Charger $52.00 *** $94.00 Yes Charger Case Combi BTE $52.99 *** $95.00 Yes Charger Case Combi RIC $85.00 Yes Power Pack $52.30 *** $94.00 Yes USB Cable and Power Supply $15.00 Yes Charger RIC 1 (I-R model) $99.00 No- Request Permission Charger Go RIC 1 (I-R model) $283.00 No- Request Permission Charger Go RIC SPH $283.00 Yes Oticon HEARING AID o:1 o:2 Invoice Cost EAP Patient Price Approved Intent Intent 1 miniRITE R "$2,374.00 " Yes miniBTE R Intent 2 miniRITE R "$1,419.00 " Yes miniBTE R Intent 3 miniRITE R "$1,038.00 " Yes miniBTE R Intent 4 miniRITE R $850.00 No- Request Permission miniBTE R Real Real 1 miniRITE R "$1,235.00 " *** "$2,305.00 " Yes miniRITE T "$1,235.00 " *** "$2,305.00 " Yes miniBTE R "$1,235.00 " *** "$2,179.00 " No- Request Permission miniBTE T "$1,235.00 " *** "$2,179.00 " No- Request Permission Real 2 miniRITE R $710.00 V5257.165-95500735 "$1,368.00 " Yes miniRITE T $710.00 V5257.189-95500762 "$1,368.00 " Yes miniBTE R $710.00 *** "$1,368.00 " Yes miniBTE T $710.00 *** "$1,295.00 " No- Request Permission Real 3 miniRITE R $505.00 V5257.166-95500736 "$1,002.00 " Yes miniRITE T $505.00 V5257.209-95500789 "$1,002.00 " Yes miniBTE R $505.00 V5257.203-95500781 "$1,002.00 " Yes miniBTE T $505.00 V5257.178-95500751 "$1,002.00 " Yes CROS CROS $375.00 *** USE CROS TAB Yes CROS PX CROS PX $375.00 v5181.11-95500487 USE CROS TAB Yes Jet PX Jet PX miniBTE R miniBTE T miniRITE R miniRITE T More More 1 miniRITE R "$1,200.00 " *** "$2,120.00 " No- Request Permission miniRITE T "$1,200.00 " v5257.15-95500446 "$2,243.00 " Yes More 2 miniRITE R $690.00 V5257.192-95500765 "$1,332.00 " Yes miniRITE T $690.00 v5257.16-95500447 "$1,332.00 " Yes miniBTE R $690.00 v5257.47-95500503 "$1,332.00 " Yes miniBTE T $690.00 v5257.46-95500502 "$1,332.00 " Yes More 3 miniRITE R $495.00 V5257.167-95500737 $984.00 Yes miniRITE T $495.00 v5257.17-95500448 $984.00 Yes miniBTE R $495.00 v5257.45-95500501 $984.00 Yes miniBTE T $495.00 v5257.44-95500500 $984.00 Yes CROS CROS $375.00 *** USE CROS TAB Yes CROS PX CROS PX $375.00 v5181.11-95500487 USE CROS TAB Yes Own Own 1 IIC "$1,200.00 " V5254.30-95500634 "$2,143.00 " Yes CIC "$1,200.00 " V5254.29-95500632 "$2,143.00 " Yes ITC "$1,200.00 " V5255.30-95500630 "$2,143.00 " Yes ITE HS "$1,200.00 " V5256.30-95500631 "$2,143.00 " Yes ITE FS "$1,200.00 " V5256.31-95500633 "$2,143.00 " Yes Own 2 IIC $690.00 V5254.28-95500628 "$1,332.00 " Yes CIC $690.00 V5254.27-95500626 "$1,332.00 " Yes ITC $690.00 V5255.29-95500625 "$1,332.00 " Yes ITE HS $690.00 V5256.29-95500629 "$1,332.00 " Yes ITE FS $690.00 V5256.28-95500627 "$1,332.00 " Yes Own 3 IIC $495.00 V5254.26-95500623 $984.00 Yes CIC $495.00 V5254.25-95500622 $984.00 Yes ITC $495.00 V5255.28-95500620 $984.00 Yes ITE HS $495.00 V5256.27-95500624 $984.00 Yes ITE FS $495.00 V5256.26-95500621 $984.00 Yes Own 4 IIC $430.00 V5254.23-95500615 $868.00 Yes CIC $430.00 V5254.24-95500618 $868.00 Yes ITC $430.00 V5255.27-95500617 $868.00 Yes ITE HS $430.00 V5256.24-95500616 $868.00 Yes ITE FS $430.00 Yes Own 5 IIC $250.00 V5254.22-95500614 $546.00 Yes CIC $250.00 V5254.21-95500610 $546.00 Yes ITC $250.00 V5255.26-95500611 $546.00 Yes ITE HS $250.00 V5256.23-95500613 $546.00 Yes ITE FS $250.00 V5256.22-95500612 $546.00 Yes Own SI 1 IIC $250.00 V5254.22-95500614 $546.00 Yes CIC $250.00 V5254.21-95500610 $546.00 Yes Own SI 2 IIC $250.00 V5256.23-95500613 $546.00 Yes CIC $250.00 V5256.22-95500612 $546.00 Yes Own SI 3 IIC $250.00 V5254.22-95500614 $546.00 Yes CIC $250.00 V5254.21-95500610 $546.00 Yes Own SI 4 IIC $250.00 V5256.23-95500613 $546.00 Yes CIC $250.00 V5256.22-95500612 $546.00 Yes Play Play PX 1 miniRITE R $690.00 V5257.51-95500517 "$1,332.00 " Yes miniRITE T $690.00 V5257.49-95500515 "$1,332.00 " Yes miniBTE R $690.00 V5257.52-95500518 "$1,332.00 " Yes miniBTE T $690.00 V5257.48-95500514 "$1,332.00 " Yes Play PX 2 miniRITE R $325.00 V5257.53-95500519 $680.00 Yes miniRITE T $325.00 V5257.50-95500516 $680.00 Yes miniBTE R $325.00 v5257.39 - 95500495 $680.00 Yes miniBTE T $325.00 v5257.38 - 95500494 $680.00 Yes Opn Play 1 BTE PP $495.00 V5257.173-95500743 $984.00 Yes Opn Play 2 BTE PP $295.00 V5257.169-95500739 $627.00 Yes Xceed Xceed 1 BTE SP "$1,100.00 " *** "$1,952.00 " No- Request Permission BTE UP "$1,100.00 " *** "$1,952.00 " No- Request Permission Xceed 2 BTE SP $600.00 *** "$1,110.00 " No- Request Permission BTE UP $600.00 *** "$1,110.00 " No- Request Permission Xceed 3 BTE SP $430.00 *** $824.00 No- Request Permission BTE UP $430.00 *** $868.00 Yes HEARING AID:ADD ONS Invoice Cost EAP Patient Price ACCESSORIES Streamer Pro $157.50 *** $284.00 ConnectLine TV Adapter 3.0 $127.50 *** $230.00 ConnectLine Phone Adapter $82.50 *** $149.00 Connect Clip $165.00 *** $297.00 Remote Control 3.0 $120.00 *** $216.00 EduMic $580.00 *** $626.00 ACOUSTIC COUPLING Power Mold w Receiver $96.00 *** $173.00 MicroShell Mold $96.00 *** $173.00 Slim Tip $43.00 *** $77.00 CHARGERS Power Pack Desktop Charger 1.0 miniRITE $200.00 *** $360.00 Desktop Charger 1.0 miniBTE $120.00 V5267.60-95500488 $360.00 Intent/Sirius Desktop Charger miniRITE $360.00 Smart Charger miniRITE $216.00 Smart Charger miniBTE $216.00 Replacement R battery (single) $25.00 V5266.2-95500768 $45.00 Lithium Ion Charger ReSound HEARING AID o:1 Invoice Cost EAP Patient Price Approved Nexia 9 NEXIA 9 NX960S-DRWC (RIE) "$1,281.00 " *** "$2,388.00 " Yes NEXIA 9 NX961-DRW (RIE) "$1,281.00 " *** "$2,388.00 " Yes NEXIA 9 NX962-DRW (RIE) "$1,281.00 " *** "$2,256.00 " No- Request Permission NEXIA 9 NX977-DWC (BTE) "$2,256.00 " No- Request Permission NEXIA 9 NX988-DWC (BTE) "$2,256.00 " No- Request Permission NEXIA 9 NX9CIC-HP "$2,256.00 " No- Request Permission NEXIA 9 NX9CIC-LP "$2,388.00 " Yes NEXIA 9 NXCIC-MP "$2,256.00 " No- Request Permission NEXIA 9 NX9ITC-DW-HP NEXIA 9 NX9ITC-DW-LP NEXIA 9 NX9ITC-DW-MP NEXIA 9 NX9ITC-DW-UP NEXIA 9 NX9ITC-DWC-HP NEXIA 9 NX9ITC-DWC-LP NEXIA 9 NX9ITC-DWC-MP NEXIA 9 NX9ITC-DWC-UP NEXIA 9 NX9ITE-DWC-HP NEXIA 9 NX9ITE-DWC-MP NEXIA 9 NX9ITE-DWC-UP 7 NEXIA 7 NX760S-DRWC (RIE) $758.00 *** "$1,454.00 " Yes NEXIA 7 NX761-DRW (RIE) $758.00 *** "$1,376.00 " yes NEXIA 7 NX762-DRW (RIE) $758.00 *** "$1,376.00 " Requested 9/11/24 NEXIA 7 NX777-DWC (BTE) "$1,454.00 " Yes NEXIA 7 NX788-DWC (BTE) "$1,376.00 " Yes NEXIA 7 NX7CIC-HP "$1,376.00 " No- Request Permission NEXIA 7 NXCIC-LP "$1,454.00 " Yes NEXIA 7 NXCIC-MP "$1,376.00 " No- Request Permission NEXIA 7 NX7ITC-DW-HP NEXIA 7 NX7ITC-DW-LP NEXIA 7 NX7ITC-DW-MP NEXIA 7 NXITC-DW-UP NEXIA 7 NX7ITC-DWC-HP NEXIA 7 NX7ITC-DWC-LP NEXIA 7 NX7ITC-DWC-MP NEXIA 7 NX7ITC-DWC-UP NEXIA 7 NX7ITE-DWC-HP NEXIA 7 NX7ITE-DWC-MP NEXIA 7 NX7ITE-DWC-UP 5 NEXIA 5 NX560S-DRWC (RIE) $521.00 *** "$1,030.00 " Yes NEXIA 5 NX561-DRW (RIE) $521.00 *** $977.00 No- Request Permission NEXIA 5 NX562-DRW (RIE) $521.00 *** $977.00 No- Request Permission NEXIA 5 NX577-DWC (BTE) $977.00 Yes NEXIA 5 NX588-DWC (BTE) "$1,030.00 " Yes NEXIA 5 NX5CIC-HP $977.00 No- Request Permission NEXIA 5 NXCIC-LP "$1,030.00 " Yes NEXIA 5 NX5CIC-MP $977.00 No- Request Permission NEXIA 5 NX5ITC-HP NEXIA 5 NX5ITC-DW-LP NEXIA 5 NX5ITC-DW-MP NEXIA 5 NX5ITC-DW-UP NEXIA 5 NX5ITC-DWC-HP NEXIA 5 NX5ITC-DWC-LP NEXIA 5 NX5ITC-DWC-MP NEXIA 5 NX5ITC-DWC-UP NEXIA 5 NX5ITE-DWC-HP NEXIA 5 NX5ITE-DWC-MP NEXIA 5 NX5ITE-DWC-UP CROS NEXIA CROS-CX160S Enzo 4 ENZO 4 IA EI498-DWHC "$1,103.00 " V5257.161-95500732 "$2,070.00 " Yes 5 "$1,103.00 " V5257.162-95500733 "$2,070.00 " Yes ENZO 5 IA EI598-DWHC 7 $656.00 V5257.160-95500731 "$1,271.00 " Yes ENZO 7 IA EI798-DWHC $656.00 V5257.159-95500730 "$1,271.00 " Yes 9 ENZO 9 IA EI998-DWHC $446.00 V5257.158-95500729 $896.00 Yes $446.00 V5257.158-95500729 $896.00 Yes HEARING AID:ADD ONS Invoice Cost EAP Patient Price Approved ACCESSORIES RS Unite TV2 Streamer $310.00 *** $270.00 Yes RS Unite Phone Clip + $195.00 *** $270.00 Yes Remote Control $175.00 *** $270.00 No- Request Permission RS Unite Multi Microphone $255.00 *** $270.00 Yes VIVIA CROS $175.00 *** $270.00 No- Request Permission ACOUSTIC COUPLING $100.00 *** $180.00 Encased Mold w receiver $45.00 *** $75.00 All other earmolds $55.00 V5267.71-95500769 $99.00 M&RIE receiver CHARGERS $150.00 V5267-95500127 $270.00 Yes Premium Charger $99.00 ? $150.00 Yes Standard Charger $99.00 V5267.69-95500643 $178.00 Yes Custom Charger $79.00 V5267.70-95500644 $142.00 Yes Desktop Charger Starkey HEARING AID o:1 o:2 o:3 Invoice Cost EAP Patient Price Approved Edge AI 24 RIC RT $959.00 *** "$1,813.00 " No- Request Permission mRIC R $959.00 *** "$1,714.00 " No- Request Permission RIC 312 $959.00 *** "$1,714.00 " No- Request Permission ITC R "$1,025.00 " *** "$1,930.00 " Requested 10/24/24 HS R "$1,025.00 " *** "$1,930.00 " No- Request Permission ITE R "$1,025.00 " *** "$1,825.00 " No- Request Permission CIC 312 "$2,304.00 " No- Request Permission 20 RIC RT $643.00 V5257.199-95500776 "$1,248.00 " No- Request Permission mRIC R $643.00 V5257.194-95500767 "$1,248.00 " No- Request Permission RIC 312 $643.00 *** "$1,182.00 " No- Request Permission ITC R $709.00 *** "$1,366.00 " No- Request Permission HS R $709.00 *** "$1,366.00 " No- Request Permission ITE R $709.00 *** "$1,293.00 " No- Request Permission CIC 312 $709.00 *** "$1,366.00 " No- Request Permission 16 RIC RT $469.00 V5257.176-95500747 $938.00 No- Request Permission mRIC R $469.00 V5257.177-95500748 $938.00 No- Request Permission RIC 312 $469.00 *** $938.00 No- Request Permission ITC R $534.00 V5255.33-95500750 "$1,054.00 " No- Request Permission HS R $534.00 V5256.42-95500749 "$1,054.00 " Requested 10/24/24 ITE R $534.00 V5256.41-95500746 "$1,054.00 " No- Request Permission CIC 312 $534.00 *** $999.00 No- Request Permission CROS Transmitter RIC RT $762.00 *** USE CROS TAB No- Request Permission RIC 312 $653.00 *** USE CROS TAB No- Request Permission Signature Series 24 $959.00 *** "$1,813.00 " Yes CIC R NW "$2,304.00 " Yes CIC NW "$1,825.00 " No- Request Permission IIC NW "$2,009.00 " No- Request Permission 20 CIC R NW $643.00 V5257.199-95500776 "$1,248.00 " Yes CIC NW $643.00 V5257.194-95500767 "$1,248.00 " Yes 16 CIC R NW $469.00 V5257.176-95500747 $938.00 Yes CIC NW $469.00 V5257.177-95500748 $938.00 Yes HEARING AID:ADD ONS Invoice Cost EAP Patient Price Approved ACCESSORIES Start Hearing ONE per pair $440.00 V5259.5-95500658 $801.00 Yes 2.4 GHz TV $347.71 *** $375.00 Yes 2.4 GHz Remote $168.95 *** $304.00 No- Request Permission 2.4 GHz Remote Mic + $282.31 *** $508.00 Yes 2.4 GHz Mini Remote Microphone $191.84 *** $345.00 Requested 9/20/24 2.4 GHz Table Microphone $434.91 *** $783.00 No- Request Permission HEARING PROTECTION SoundGear Platinum ITE/ per ear $543.00 *** $489.00 No- Request Permission SoundGear Silver ITE/ per ear $434.00 *** $391.00 Yes SoundGear Phantom ITE/ per ear $925.00 *** $798.00 Requested 9/18/24 Phantom Charger $117.00 No- Request Permission Racing Receivers/ per ear $153.00 No- Request Permission Custom Filtered Earplugs per ear $114.00 yes Custom Solid Earplugs/ per ear $61.02 *** $55.00 Yes Custom High Frequency Noise Filters/ per ear $85.00 *** $77.00 No- Request Permission Instant Fit Electronic/ per ear $217.00 *** $195.00 No- Request Permission Newscaster $84.00 No- Request Permission Pilot Headset $69.00 No- Request Permission Anesthesiologist $69.00 No- Request Permission iPod $92.00 No- Request Permission Earpod $92.00 No- Request Permission Floatables Swim Molds $46.00 No- Request Permission ACOUSTIC COUPLING Earmold w/ AP Receiver $163.48 *** $294.00 Yes RIC Earmold $40.31 *** $75.00 BTE Earmold $33.77 *** $75.00 OTC Receiver $74.00 Yes CHARGERS StarLink Charger 2.0 RIC RT $86.11 *** $150.00 Yes StarLink Premium Charger 2.0 RIC RT $107.91 *** $194.00 Yes StarLink Premium Mini Charger RIC RT $194.00 Yes StarLink Charger 2.0 mRIC R $150.00 Yes StarLink Premium Charger 2.0 mRIC R $194.00 Yes StarLink Premium Mini Charger mRIC R $150.00 Yes StarLink Custom Charger 2.0 $150.00 Yes StarLink Custom Premium Charger 2.0 $194.00 Yes Thrive Charger $150.00 Yes Thrive Premium Charger $194.00 Yes Widex HEARING AID o:1 o:3 o:2 Invoice Cost EAP Patient Price Approved Allure 440 BTE R D "$1,200.00 " V5257.124-95500668 "$2,243.00 " Yes RIC R D "$1,200.00 " V5257.114-95500669 "$2,243.00 " Yes ITE R D "$1,200.00 " V5256.35-95500665 "$2,243.00 " Yes 330 BTE R D "$1,200.00 " V5257.124-95500668 "$2,243.00 " Yes RIC R D "$1,200.00 " V5257.114-95500669 "$2,243.00 " Yes ITE R D "$1,200.00 " V5256.35-95500665 "$2,243.00 " Yes 220 BTE R D "$1,154.00 " Yes RIC R D $538.00 V5257.125-95500680 "$1,061.00 " Yes ITE R D $538.00 V5257.128-95500683 "$1,061.00 " Yes HEARING AID:ADD ONS Invoice Cost EAP Patient Price Approved ACCESSORIES Sony CRE C10 $792.00 No- Request Permission Sony CRE E10 "$1,224.00 " No- Request Permission Com-Dex $148.00 *** $266.00 FM+Dex $181.00 *** $326.00 Phone-Dex 2 $247.00 *** $445.00 RC2-Dex $88.00 *** $158.00 TV-Dex $247.00 *** $445.00 TV-Dex Base $115.00 *** $207.00 TV Play $175.00 *** $315.00 Remote Mic $218.00 *** $392.00 Sound Assist $295.00 V5256.37-95500692 $531.00 Yes Sound Connect $90.00 No- Request Permission ACOUSTIC COUPLING RIC/BTE Earmold $38.40 *** $72.00 Yes Encased receiver mold $38.40 *** $276.00 Yes CHARGERS Allure WPC301 Charge n Clean $55.00 *** $99.00 No- Request Permission Allure WPT301 Charger $219.00 V5256.36-95500691 $394.00 Yes Portable Charger (Smart RIC) $232.00 No- Request Permission