The following modifiers are allowable for contracted hearing aid models.
| Modifier | Description |
|---|---|
| LT | Left side |
| RR* | Rental |
| RT | Right side |
| *The maximum allowable fee for all rentals is $27.34 per 30-day period. All rented hearing instruments require PA. Wisconsin Medicaid and BadgerCare Plus do not reimburse providers for dispensing fees for rental hearing instruments. | |
Wisconsin Medicaid and BadgerCare Plus will approve only medically necessary hearing aid models available through a volume purchase contract. The following procedure codes are allowable for the corresponding hearing aid models. Many of the manufacturers and models listed in this table are registered or trademarked by the manufacturer. All new hearing aid orders have a two-year manufacturer warranty.
Note: There is a five-year life expectancy on hearing aids for adults and a three-year life expectancy on hearing aids for children ages 17 and younger.
V5170 — Hearing aid, CROS; in the ear (Applicable modifiers: LT, RR, RT) | |||||
Manufacturer and Style | Model(s) | Purchase Rate for CROS | Purchase Rate for BICROS | Repair Rate Per Unit | Repair Warranty |
Phonak Hearing Systems, LLC Notes:
|
Package 30 | $678.00 | $678.00 | $110.00 | 12 months |
| Package 50 | $764.00 | $764.00 | |||
V5180 — Hearing aid, CROS; behind the ear (Applicable modifiers: LT, RR, RT) | |||||
Manufacturer and Style | Model(s) | Purchase Rate for CROS | Purchase Rate for BICROS | Repair Rate Per Unit | Repair Warranty |
| Oticon, Inc. | Chili SP5 | $350.00 | $525.00 | $80.00 $100.00 |
6 months 12 months |
| Chili SP7 | $474.00 | $773.00 | |||
| Chili SP9 | $540.72 | Not Covered | |||
| Nera2, Nera2 Power | $474.00 | $773.00 | |||
| Nera2 Pro, Nera2 Pro Power | $575.00 | Not Covered | |||
| Ria2, Ria2 Power | $350.00 | $525.00 | |||
| Ria2 Pro, Ria2 Pro Power | $375.00 | $575.00 | |||
| Safari 300 Super Power | $350.00 | $525.00 | |||
| Safari 600 Super Power | $474.00 | $773.00 | |||
| Safari 900 Super Power | $524.00 | Not Covered | |||
| Sensei | $350.00 | $525.00 | |||
| Sensei Pro | $524.00 | Not Covered | |||
| Sumo DM | $524.00 | Not Covered | |||
Phonak Hearing Systems, LLC Notes:
|
CROS II Package 30 | $678.00 | $678.00 | $110.00 | 12 months |
| CROS II Package 50 | $764.00 | $764.00 | CROS BTE +50 | $764.00 | $764.00 |
| CROS BTE +50 H2O | $764.00 | $764.00 | |||
| Widex USA Inc. | Dream 110: D1-9-CROS, D1-9 VC-CROS, D1FA VC-CROS, or D1-MR CB-CROS | $848.40 | $848.40 | $100.00 | 12 months |
| Dream 110: D1-FS-CROS | $780.96 | $780.96 | |||
V5210 — Refer to V5170. |
V5220 — Refer to V5180. |
V5256 — Hearing aid, digital, monaural, ITE (Applicable modifiers: LT, RR, RT) | |||||
Manufacturer and Style | Model(s) | Purchase Rate for Monaural | Purchase Rate for Binaural | Repair Rate Per Unit | Repair Warranty |
| Audina Hearing Instruments, Inc. — Full Shell and Half Shell | Intuition 2+ | $205.00 | $410.00 | $85.00 $100.00 |
6 months 12 months |
| Intuition 2ER | $275.00 | $550.00 | |||
| Intuition 2FC+ | $250.00 | $500.00 | |||
| Intuition 4+ | $325.00 | $650.00 | |||
| Intuition 4AD | $350.00 | $700.00 | |||
| Intuition 6 | $350.00 | $700.00 | |||
| Intuition 6AD | $375.00 | $750.00 | |||
| Intuition 12 | $400.00 | $799.99 | |||
| Intuition 12AD | $425.00 | $850.00 | |||
| Simplex | $165.00 | $330.00 | |||
| Simplex FC | $180.00 | $360.00 | |||
| Beltone Electronics — Full Shell | Origin 2-Optima | $201.00 | $402.00 | $97.30 | 12 months |
| Origin 3-Optima | $317.25 | $634.50 | |||
| Promise 6-Optima | $366.50 | $733.00 | |||
| True 3-Optima | $349.80 | $699.60 | |||
| Beltone Electronics — Half Shell | Origin 2-Optima | $238.50 | $477.00 | ||
| Origin 3-Optima | $354.75 | $709.50 | |||
| Promise 6-Optima | $391.50 | $783.00 | |||
| True 3-Optima | $379.80 | $759.60 | |||
| Beltone Electronics — Low Profile | Origin 2-Optima | $216.00 | $432.00 | ||
| Origin 3-Optima | $332.25 | $664.50 | |||
| Promise 6-Optima | $376.50 | $753.00 | |||
| True 3-Optima | $361.80 | $723.60 | |||
Hansaton Acoustics, Inc. — Full Shell, Half Shell, and Low Profile Note: There is no charge for directional microphone, telecoil, volume control, or push button. |
Jam 3 | $276.00 | $552.00 | $100.00 | 12 months |
| Jam 5 | $357.60 | $715.20 | |||
Oticon, Inc. — Full Shell Note: There is no charge for VC, TC, or Auto TC. |
Nera2, Nera2 Power | $349.00 | $698.00 | $80.00 $100.00 |
6 months 12 months |
| Nera2 Pro, Nera2 Pro Power | $450.00 | $900.00 | |||
| Ria2, Ria2 Power | $225.00 | $450.00 | |||
| Ria2 Pro, Ria2 Pro Power | $250.00 | $500.00 | |||
Oticon, Inc. — Half Shell Note: There is no charge for VC, TC, or Auto TC. |
Agil HS, Agil HS Power | $450.00 | $900.00 | ||
| Get, Get Power | $199.00 | $398.00 | |||
| Nera2, Nera2 Power | $349.00 | $698.00 | |||
| Nera2 Pro, Nera2 Pro HS Power | $349.00 | $698.00 | |||
| Ria2, Ria2 Power | $225.00 | $450.00 | |||
| Ria2 Pro, Ria2 Pro Power | $250.00 | $500.00 | |||
Oticon, Inc. — Low Profile Note: There is no charge for VC, TC, or Auto TC. |
Agil, Agil Power | $450.00 | $900.00 | ||
| Get, Get Power | $199.00 | $398.00 | |||
| Phonak Hearing Systems, LLC — Full Shell | Virto Q30 13 | $299.00 | $598.00 | $110.00 | 12 months |
| Virto Q50 13 | $385.00 | $770.00 | |||
| Phonak Hearing Systems, LLC — Half Shell | Virto Q30 or Q30 NW | $299.00 | $598.00 | ||
| Virto Q50 or Q50 NW | $385.00 | $770.00 | |||
| Virto V30 | $299.00 | $598.00 | |||
| Virto V50 | $385.00 | $770.00 | |||
| Phonak Hearing Systems, LLC — Low Profile | Virto Q50 NW O or Q50 Nano NW O | $385.00 | $770.00 | ||
| ReSound — Full Shell and Half Shell | LiNX2 5: DIR HP; DIR MP; DIR UP; Wireless or Non-Wireless | $397.00 | $794.00 | $95.00 |
12 months |
| Vea 2: DIR, DIR P, P | $247.50 | $495.00 | |||
| Vea 3: DIR, DIR P, P | $277.50 | $555.00 | |||
| Verso 5: DIR, DIR P, P; Wireless or Non-Wireless | $397.00 | $794.00 | |||
| Verso 7: DIR, DIR P, P; Wireless or Non-Wireless | $448.00 | $896.00 | |||
Rexton — Full Shell and Half Shell Note: There is no charge for directional microphone, telecoil, or switchless telecoil. |
Arena 1S | $200.85 | $401.43 | $155.00 | 12 months |
| Joy 6 2c | $272.13 | $544.26 | |||
| Joy 8 2c | $328.53 | $657.06 | |||
| Siemens Hearing Instruments, Inc. — Full Shell |
Insio 3Bx | $431.55 | $863.10 | $95.00 | 12 months |
| Nitro 3mi custom | $449.55 | $899.10 | |||
| Orion2 custom | $382.05 | $764.10 | |||
| Sirion2 custom | $283.05 | $566.10 | |||
| Siemens Hearing Instruments, Inc. — Half Shell |
Insio 3Bx | $422.74 | $845.48 | ||
| Nitro 3mi custom | $422.74 | $845.48 | |||
| Orion2 custom | $328.53 | $657.06 | |||
| Sirion2 custom | $272.13 | $544.26 | |||
| Sonic Innovations — Full Shell | Charm 40 D | $244.63 | $489.25 | $175.00 | 12 months | Charm 60 D | $342.00 | $684.00 | Charm 60 PDW | $342.00 | $684.00 |
| Starkey Laboratories, Inc. — Full Shell and Half Shell | 3 Series 20 | $299.00 | $598.00 | $84.99 | 12 months |
| 3 Series 30 | $329.00 | $658.00 | |||
| 3 Series 70 | $389.00 | $778.00 | |||
| 3 Series 90 | $409.00 | $818.00 | |||
| 3 Series 110 | $429.00 | $858.00 | |||
| 3 Series i20 | $339.00 | $678.00 | |||
| 3 Series i30 | $359.00 | $718.00 | |||
| 3 Series i70 | $389.00 | $778.00 | |||
| 3 Series i90 | $409.00 | $818.00 | |||
| 3 Series i110 | $429.00 | $858.00 | |||
| Z Series i20 | $339.00 | $678.00 | |||
| Z Series i30 | $359.00 | $718.00 | |||
| Z Series i70 | $389.00 | $778.00 | |||
| Z Series i90 | $409.00 | $818.00 | |||
| Z Series i110 | $429.00 | $858.00 | |||
Unitron Hearing, Inc. — Full Shell, Half Shell, and Low Profile
|
Quantum2 E | $320.22 | $640.44 | $75.00 | 12 months |
| Quantum2 10 | $395.00 | $790.00 | |||
| Quantum2 16 | $448.00 | $896.00 | |||
| Widex Hearing — Full Shell and Half Shell | Clear 220 | $400.00 | $800.00 | $100.00 | 12 months |
| Dream 110 | $377.00 | $754.00 | |||
| Menu 3 ME3 | $199.00 | $398.00 | |||
| Mind 220 m2 | $350.00 | $700.00 | |||
V5257 — Hearing aid, digital, monaural, BTE (Applicable modifiers: LT, RR, RT) | |||||
Manufacturer and Style | Model(s) | Purchase Rate for Monaural | Purchase Rate for Binaural | Repair Rate Per Unit | Repair Warranty |
| Audina Hearing Instruments, Inc. | 478 or 478P+ | $245.00 | $490.00 | $150.00 | 12 months |
| 6 AD | $250.00 | $500.00 | |||
| Intuition 2 | $200.00 | $400.00 | |||
| Intuition 2 FC | $225.00 | $450.00 | |||
| Intuition 4+ | $300.00 | $600.00 | |||
| Octane 4 | $425.00 | $850.00 | $220.00 | 12 months | |
| Octane 6 | $450.00 | $900.00 | |||
| Opti-Trim | $175.00 | $350.00 | $150.00 | 12 months | |
| Simplex | $200.00 | $400.00 | |||
| Simplex 2P+ | $175.00 | $350.00 | |||
| FLX: 4, 6, or 12 | $400.00 | $800.00 | $200.00 | 12 months | |
| Sparo | $325.00 | $650.00 | |||
| Sparo 2+ | $250.00 | $500.00 | |||
| Sparo 12 | $400.00 | $800.00 | |||
| Sparo AD | $350.00 | $700.00 | |||
| Beltone Electronics | Bold 3 95 D | $404.50 | $809.00 | $97.30 | 12 months |
| Origin 2-75D | $337.35 | $674.70 | |||
| Origin 2-85D | $395.85 | $791.70 | |||
| Origin 3-64D | $341.25 | $682.50 | |||
| Origin 3-65D | $369.85 | $739.70 | |||
| Origin 3-75D | $369.85 | $739.70 | |||
| Origin 3-85D | $367.95 | $735.90 | |||
| Promise 6 62 D | $431.20 | $862.40 | |||
| Promise 6 63 DW | $422.95 | $845.90 | |||
| Promise 6 64 DW | $444.95 | $889.90 | |||
| Promise 6 66 DW | $410.40 | $820.80 | |||
| Promise 6 78 DW | $403.70 | $807.40 | |||
| True 3-66DW | $391.28 | $782.56 | |||
| Turn TN1T75 | $160.30 | $320.60 | |||
| Turn TN3T85 | $226.85 | $453.70 | |||
| Turn TN3T95 | $317.85 | $635.70 | |||
| Hansaton Acoustics, Inc. | Beat 3 | $253.00 | $506.00 | $100.00 | 12 months |
| Beat 7 | $418.00 | $836.00 | |||
| Flow 1 | $191.25 | $382.50 | |||
| Flow 2 | $232.75 | $465.50 | |||
| Jam 3 | $253.00 | $506.00 | |||
| Jam 5 | $312.90 | $625.80 | |||
| Jam 7 | $418.00 | $836.00 | |||
| Sound HD 3 | $253.00 | $506.00 | |||
| Sound HD 5 | $312.90 | $625.80 | |||
| Sound HD 7 | $438.90 | $877.80 | |||
| Oticon, Inc. | Agil; Agil Mini, Mini RITE, Power, or RITE | $450.00 | $900.00 | $80.00 $100.00 |
6 months 12 months |
| Chili SP5 | $225.00 | $450.00 | |||
| Chili SP7 | $349.00 | $698.00 | |||
| Get; Get Power | $199.00 | $398.00 | |||
| Nera2; Nera2 Mini, Mini RITE, Power, or RITE | $349.00 | $698.00 | |||
| Nera2 Pro; Nera2 Pro Design RITE, Mini, Mini RITE, Power, or RITE | $450.00 | $900.00 | |||
| Ria2; Ria2 Mini, Mini RITE, Power, or RITE | $225.00 | $450.00 | |||
| Ria2 Pro; Ria2 Pro Design RITE, Mini, Mini RITE, Power, or RITE | $250.00 | $500.00 | |||
| Safari 300 Super Power | $225.00 | $450.00 | |||
| Safari 600 Super Power | $349.00 | $698.00 | |||
| Safari 900 Super Power | $399.00 | $798.00 | |||
| Sensei; Sensei RITE | $225.00 | $450.00 | |||
| Sensei Pro; Sensei Pro RITE | $399.00 | $798.00 | |||
| Sumo DM | $399.00 | $798.00 | |||
| Phonak Hearing Systems, LLC | Audeo Q30 or Q30 T | $299.00 | $598.00 | $110.00 | 12 months |
| Audeo Q50 or Q50 T | $385.00 | $770.00 | |||
| Audeo V30 | $299.00 | $598.00 | |||
| Audeo V50 | $385.00 | $770.00 | |||
| Bolero Q30 M, Q30 P, or Q30 SP | $299.00 | $598.00 | |||
| Bolero Q50 M, Q50 P, or Q50 SP | $385.00 | $770.00 | |||
| Bolero V30: V30M, P | $299.00 | $598.00 | |||
| Bolero V50: V50M, P | $385.00 | $770.00 | |||
| Nadia Q30 RIC, Q30 SP, or Q30 UP | $299.00 | $598.00 | |||
| Nadia Q50 RIC, Q50 SP, or Q50 UP | $385.00 | $770.00 | |||
| Sky Q50 M, Q50 RIC, Q50 SP, or Q50 UP | $385.00 | $770.00 | |||
| ReSound | Enzo 5 Super Power | $397.00 | $794.00 | $95.00 | 12 months |
| Enzo 7 Super Power | $448.00 | $896.00 | |||
| LiNX2 5 Standard, Mini, RIE, Power | $397.00 | $794.00 | |||
| LiNX 7 Mini RIE, Power, Standard | $448.00 | $896.00 | |||
| Vea 2 Standard or Power | $247.50 | $495.00 | |||
| Vea 3 Standard, Mini, or Power | $277.50 | $555.00 | |||
| Verso 5; Verso 5 Micro RIE, Mini, Mini RIE, Power, or RIE | $397.00 | $794.00 | |||
| Verso 7; Verso 7 Micro RIE, Mini, Mini RIE, Power, or RIE | $448.00 | $896.00 | |||
| Verso 7 TS; Verso 7 TS Micro RIE, Mini, Mini RIE, Power, or RIE | $448.00 | $896.00 | |||
| Rexton | Arena 1S | $200.85 | $401.70 | $155.00 | 12 months |
| Joy 6 M 2c, P 2c, or S 2c | $272.13 | $544.26 | |||
| Joy 8 M 2c, P 2c, or S 2c | $328.53 | $657.06 | |||
| Onyx 8+ RIC | $441.35 | $882.70 | |||
| Onyx EOC+RIC | $324.35 | $648.70 | |||
| Strata 8 2c RIC | $328.53 | $657.06 | |||
| Siemens Hearing Instruments, Inc. |
Acquaris 3mi | $422.55 | $845.10 | $95.00 | 12 months |
| Motion 3Bx: PX, SA, SX | $431.55 | $863.10 | |||
| Nitro 3mi | $429.57 | $859.14 | |||
| Orion2: RIC | $382.05 | $629.10 | |||
| Orion2: M, P, or S | $382.05 | $764.10 | |||
| Pure Carat 3Bx, Pure 3Bx Carat, Pure 3Bx | $431.55 | $863.10 | |||
| Sirion2: M, P, or S | $283.05 | $566.10 | |||
| Sonic Innovations | Bliss 80 NanoRITE | $427.50 | $855.00 | $175.00 |
12 months |
| Charm 40, Charm 40 Mini, Charm 40 NanoRITE | $244.63 | $489.25 | |||
| Charm 60, Charm 60 Mini, Charm 60 NanoRITE | $342.00 | $684.00 | |||
| Flip 60 Mini RIC | $332.50 | $665.00 | |||
| Journey 40 P | $251.75 | $503.50 | |||
| Starkey Laboratories, Inc. | 3 Series 20; 3 Series 20 Mini, P+, or RIC | $299.00 | $598.00 | $84.99 | 12 months |
| 3 Series 30; 3 Series 30 Mini, P+, or RIC | $329.00 | $658.00 | |||
| 3 Series 70; 3 Series 70 Mini, P+, or RIC | $389.00 | $778.00 | |||
| 3 Series 90; 3 Series 90 P+ or RIC | $409.00 | $818.00 | |||
| 3 Series 110; 3 Series 110 m, P+, or RIC | $429.00 | $858.00 | |||
| 3 Series i20; 3 Series i20 Mini, P+, or RIC | $349.00 | $698.00 | |||
| 3 Series i30; 3 Series i30 Mini, P+, or RIC | $369.00 | $738.00 | |||
| 3 Series i70; 3 Series i70 Mini or P+ | $399.00 | $798.00 | |||
| 3 Series i90; 3 Series i90 m, P+, or RIC | $419.00 | $838.00 | |||
| 3 Series i110; 3 Series i110 m, P+, or RIC | $439.00 | $878.00 | |||
| Halo i70 and Halo i70 RIC | $399.00 | $798.00 | |||
| Halo i90 and Halo i90 RIC | $419.00 | $838.00 | |||
| Halo i110 and Halo i110 RIC | $439.00 | $878.00 | |||
| Xino Classic 20 RIC | $299.00 | $598.00 | |||
| Xino Classic 30 RIC | $329.00 | $658.00 | |||
| Xino Classic 70 RIC | $389.00 | $778.00 | |||
| Xino Classic 90 Micro RIC | $409.00 | $818.00 | |||
| Xino Classic 110 RIC | $429.00 | $858.00 | |||
| Xino 110 Micro RIC | $429.00 | $858.00 | |||
| Xino i20 Micro RIC | $349.00 | $698.00 | |||
| Xino i30 Micro RIC | $369.00 | $738.00 | |||
| Xino i70 Micro RIC | $399.00 | $798.00 | |||
| Xino i90 Micro RIC | $419.00 | $838.00 | |||
| Xino i110 Micro RIC | $439.00 | $878.00 | |||
| Xino Classic 20 RIC | $299.00 | $598.00 | |||
| Xino Classic 30 RIC | $329.00 | $658.00 | |||
| Xino Classic 70 RIC | $389.00 | $778.00 | |||
| Xino Classic 90 RIC | $409.00 | $818.00 | |||
| Xino Classic 110 RIC | $429.00 | $858.00 | |||
| Xino Tinnitus 30 RIC | $329.00 | $658.00 | |||
| Xino Tinnitus 90 RIC | $409.00 | $818.00 | |||
| Z Series i20: Z Series i20, m, mRIC, P+, RIC | $349.00 | $698.00 | |||
| Z Series i30: Z Series i30, m, mRIC, P+, RIC | $369.00 | $738.00 | |||
| Z Series i70: Z Series i70, m, mRIC, P+, RIC | $419.00 | $838.00 | |||
| Z Series i90: Z Series i90, m, mRIC, P+, RIC | $419.00 | $838.00 | |||
| Z Series i110: Z Series, RIC, m, mRIC, P+ | $439.00 | $878.00 | |||
| Unitron Hearing, Inc. | MAX E SP or SP M | $352.43 | $704.86 | $75.00 | 12 months |
| Max 6: SP or SPM | $447.94 | $895.88 | |||
| Moxi 2E CRT S, CRT P, or CRT SP | $320.22 | $640.44 | |||
| Moxi 2E Kiss P or Kiss SP | $320.22 | $640.44 | |||
| Moxi 210 CRT S, CRT P, or CRT SP | $395.00 | $790.00 | |||
| Moxi 210 Dura S, Dura P, or Dura SP | $395.00 | $790.00 | |||
| Moxi 210 Kiss S, Kiss P, or Kiss SP | $395.00 | $790.00 | |||
| Moxi 216 CRT S, CRT P, or CRT SP | $448.00 | $896.00 | |||
| Moxi 216 Dura S, Dura P, or Dura SP | $448.00 | $896.00 | |||
| Moxi 216 Dura CRT: P, S, SP | $448.00 | $896.00 | |||
| Moxi 216 Kiss S, Kiss P, or Kiss SP | $448.00 | $896.00 | |||
| North Moxi 500: CRT P Rec, CRT S, CRT SP Rec | $182.32 | $364.64 | |||
| North Moxi Dura 500: CRT P Rec, CRT S, CRT SP Rec | $182.32 | $364.64 | |||
| North Moxi Kiss 500: CRT P Rec, CRT S, CRT SP Rec | $182.34 | $364.64 | |||
| North Moxi 600: CRT P Rec, Dig, CRT S Rec, Dig, CRT SP Rec, Dig | $265.34 | $530.69 | |||
| North Moxi Kiss 600: CRT P Rec, Dig, CRT S Rec, Dig, CRT SP Rec, Dig | $265.34 | $530.69 | |||
| North Moxi Dura: CRT P Rec, Dig, CRT S Rec, Dig, CRT SP Rec, Dig | $265.34 | $530.69 | |||
| North Moxi 700: CRT P Rec, CRT S Rec, CRT SP Rec | $331.77 | $663.53 | |||
| North Moxi Dura 700: CRT SP Rec, Dig, CRT P Rec, Dig, CRT S Rec, Dig | $331.77 | $663.53 | |||
| North Moxi Kiss 700: CRT P Rec, CRT S Rec, CRT SP Rec | $331.77 | $663.53 | |||
| Quantum 2E P or 2E HP | $320.22 | $640.44 | |||
| Quantum 210 S or 210 HP | $395.00 | $790.00 | |||
| Quantum 216 or 216 HP | $448.00 | $896.00 | |||
| Widex Hearing | Clear 220: C2 FS, C2 MR, C2 MR CB, or C2 PA | $400.00 | $800.00 | $100.00 | 12 months |
| Clear 220: C29 or C29 VC | $400.00 | $800.00 | |||
| Dream 110: D1-9, D1-9 VC, D1-FS, or D1-MR CB | $377.00 | $754.00 | |||
| Dream 110 Fashion: D1-FA-VC | $377.00 | $754.00 | |||
| Dream 220: D2-9, D2-9VC, D2-FS, D2-MR CB | $419.00 | $838.00 | |||
| Dream 220 Fashion: D2-FA-VC, D2-FAP-VC | $419.00 | $838.00 | |||
| Menu ME 3-m, ME 3-9, or ME 3-19 | $199.00 | $398.00 | |||
| Mind 220 m2-9 or m2-9 VC | $350.00 | $700.00 | |||
| Mind 220 m2-19 or m2-19 VC | $350.00 | $700.00 | |||
| Mind 220 m2-m | $350.00 | $700.00 | |||
| Super 220 S2-VS-P or S2-VS-SP | $400.00 | $800.00 | |||
| Super S2-VSD-P or S2-VSD-SP | $400.00 | $800.00 | |||
V5260 — Refer to V5256. |
V5261 — Refer to V5257. |