Benefits

What You Can Expect To Pay At The Eye Doctor

Vision Fee Schedule

Code
Service
Discounted Rate
Routine eye exam including refraction (new patient)
$65.00
Routine eye exam including refraction (established patient)
$65.00

Frames

30% Discount

Lenses

Code
Service
Discounted Rate
Single Vision (conventional plastic)
Lenses
$50.00
Bifocals (conventional plastic)
Lenses
$75.00
Trifocals (conventional plastic)
Lenses
$105.00
Standard Progressive (no-line bifocal)
Lenses
$145.00
Premium Progressive
Lenses
20% Discount
Ultra (HD)
Lenses
20% Discount
Polycarbonate
Lenses
$40.00
Trivex
Lenses
20% Discount
Hi-Index
Lenses
$80.00
Polarized
Lenses
$75.00
Blended Segment
Lenses
$20.00

Contact Lenses

Code
Service
Discounted Rate
Conventional/Disposable
Contact Lenses
10% Discount

Coating

Code
Service
Discounted Rate
Standard Anti-Reflective
Coating
$45.00
Ultraviolet
Coating
$15.00
Scratch-Resistant
Coating
$15.00
Transitions
Coating
20% Discount

All other services not listed

20% Discount

Medical claims (without insurance)

20% Discount
ntiDirectCare Progressive Lens Formulary
StandardMin Fit HeightStandardMin Fit Height
AO Compact15 mmSola VIP18 mm
AO Compact Ultra13 mmSola VIP Gold18 mm
Armorlite Navigator20 mmVision Ease Outlook18 mm
Armorlite Navigator Short14 mmVision Ease Tegra Outlook18 mm
Essilor Adaptar20 mmX-Cel Freedom ID17 mm
Essilor Natural18 mmYounger Image18 mm
Hoya GP Wide18 mmClarity (Proprietary Design)17 mm
KbCo Fusion II20 mmClarity Short (Proprietary Design)14 mm
Sola Instinctiv17 mm
PremiumMin Fit HeightStandardMin Fit Height
AO Easy18 mmSola SolaMax17 mm
Armorlite Kodak Concise14 mmSola SolaOne18 mm
Armorlite Kodak Precise17 mmVarilux Ellipse14 mm
Armorlite Kodak Precise Short13 mmVarilux New Comfort17 mm
Essilor Accolade17 mmVarilux Physio17 mm
Essilor Ovation17 mmVarilux Physio Short14 mm
Essilor Smallfit14 mmVision Ease Illumina17 mm
Hoya Summit CD14 mmYounger Adage13 mm
Hoya Summit ECP18 mmZeiss GT217 mm
Seiko Proceed II18 mmZeiss GT2 Short13 mm
Seiko Proceed III16 mmClarity HD (Proprietary Free Form)16 mm
Some Frames not eligible due to manufacturer restrictions
Special lens designs, materials and powers may require additional cost
Depending on manufacturer discount rules, Contact Lens discounts may not be available
Discounts applied to providers retail price list
This formulary is subject to change. Effective 4/15/2016.sc
Last Revised: 10/17/2016