The following is a schedule of amounts to be charged by a vision care provider for lens options not covered by the basic program.
| Lens Options | Pricing |
|---|---|
| Anti-Reflective Coating | $40.00 |
| Blended Bifocal | $30.00 |
| Edge Coat | $16.00 |
| Faceted | $50.00 |
| High Index (Single Vision) | $30.00 |
| High Index (Single Vision) Spectralite | $40.00 |
| High Index (Single Vision) 1.66 | $54.00 |
| High Index (Multifocal) | $50.00 |
| High Index (Multifocal) Spectralilte | $60.00 |
| High Index (Multifocal) | $69.00 |
| Oversize (eye size over 55) | $10.00 |
| Photochromatic (Single Vision) | $20.00 |
| Photochromatic (Multifocal) | $30.00 |
| Polycarbonate (Single Vision) | $25.00 |
| Polycarbonate (Multifocal) | $30.00 |
| Progressive (Basic) | $50.00 |
| W / AR Coating | $90.00 |
| W / Solid Coating | $60.00 |
| Roll & Polish | $13.00 |
| Scratch Resistant Coating | $10.00 |
| Fashion Gradient Tints | $12.00 |
| Transitions (Single Vision) | $65.00 |
| Transition (Multifocal) | $70.00 |
| Polarized | $75.00 |
If you select options listed in the schedule and you receive treatment through an NVA network provider, the provider cannot charge you more than the amount shown above for any listed option. If you select an option not included in the schedule, the provider should not charge you more than the lessor of the provider’s normal charge or the wholesale cost plus 25%.