Eyewear Lens Catalog 2019

Eyewear Lens Catalog

2019 Seven Reasons your eyewear should come from Fig Garden Optometry:

1. Personalized Design - we “design” your eyewear, selecting the material, color, special treatments and overall performance.

2. Great selection of frame styles - With over 800 frames in our inventory, our consultants will find the perfect style, size and color to fit your “look” and price range.

3. We stand behind our prescription - If you don’t “love” the glasses we made for you, we will listen, evaluate and make any changes necessary.

4. Lifetime adjustments and repairs - Replacement of screws, nose-pads as well as lifetime adjustments are always free!

5. Digital measurement system - Exact placement of the powers according to the shape, fit and angle of the frame you have chosen.

6. No Fault Protection Plan Available - If purchased, it extends the manufacturer 30-day warranty to one-year replacement for a low co- payment.

7. Vision for Someone in Need - Through our I Care & Share program - with every pair of eyewear you receive from us, someone in need, either locally or overseas will also receive an exam and eyewear! Eyeglasses provided outside of Fig Garden Optometry: You have a right to your eyeglass prescription and, as a patient at Fig Garden Optometry (FGO), you will always be provided with a copy. We hope you'll want to purchase your eyeglasses from our office and we believe we offer the best value available when you consider service, quality and price. If you decide to shop elsewhere for glasses, we certainly understand and we will be pleased to continue to provide your eye examinations and eye health care.

Local opticians and optical shops generally do a good job of filling our prescriptions, but we have some concern with the use of eyeglass vendors over the Internet. Fitting eyeglasses properly involves precise measurements, unbiased advice based on your needs and skillful adjustments of the frame and lenses. HOWEVER, online/internet vendors do not actually meet with you in person they can't provide those services. We provide all the optical services at no additional cost for patients who buy eyeglasses at FGO, but we can't provide them for glasses purchased elsewhere.

To avoid confusion and disappointment with glasses purchased elsewhere, here is a list of services we provide and those we do not. Please check with the eyeglass vendor to determine return and refund policies in the event problems occur.

We provide only two services for eyeglasses purchased outside of our ofﬁce: 1. PD or pupillary distance – a measurement of the distance between your eyes taken with a pupilometer, not a ruler. This will be given with your eyeglass prescription upon request. 2. Prescription verification – we will verify the basic lens parameters in new glasses to see if it matches your prescription. We will also recheck the refraction test to confirm the prescription is correct if necessary. This will be done at no charge within 30 days of a new eyeglass prescription. We will not troubleshoot optical measurements taken by others. Visual problems may result if a correct prescription is made with inaccurate optical measurements. Correction or changes in the glasses will be up to you and the eyeglass seller.

The following services or measurements are not available from FGO if you purchase glasses elsewhere; these measurements should be provided by the person selling the glasses.

• Segment height (bifocals) • Ongoing adjustments • Vertical optical center (best vision) • Minor repairs • Eye size, Bridge size, temple length • Education and training on lens and • Frame model and color frame features and care • Lens material and index • Multifocal design and brand • Eyeglass dispensing adjustment Eyewear Needs Daily-wear: The “go to” pair of glasses you rely upon

Sun-wear: Fresno has almost 200 sunny days a year 5th among all large cities in the US It is dangerous to drive with GLARE

Work-wear: Today’s work environment is unique Computers, phones, iPads AND paper A unique lens making work more productive

Spare-wear: We have spare batteries, spare tires... A second pair of glasses is essential Eyewear Opportunities* First Pair: Provided through Insurance Benefit OR - 15% off when personally responsible

Next Pair(s): Provided through Insurance Benefits OR - 30% off when personally responsible

Protection Plan* Giving-Back For every pair that you order, someone will receive an For an additional $25 at time of order, your eyewear will eye exam and a pair of glasses through the SEEING EYE be completely REPLACED for ANY reason for a modest TO EYE program - you will be GIVING through SEEING. co-payment ($25 per incident) if the need arises.

*See next page for details on these programs.

2019 Protection Plan Details Included Warranty: All FGO eyewear includes a 30-day no question warranty on manufacturer defects and satisfaction. After 30 days, if the protection plan is not purchased, any replacement items are at regular fees.

Protection Plan: $25 at time of order, $50 at time of delivery of eyewear $75 after delivery but before one year. Good for one full year from the date of the EXAMINATION*. When you have a need, you bring in the damaged eyewear and pay a $25 co-payment for a new same-item replacement. This is a one-time replacement: one time for frame, one time for lenses. LOSS or THEFT is NOT COVERED. If you only need lenses or frame replaced at separate times, the $25 at time of need is collected “per incident” - if you replace both at the same time, the fee is $25 for both. The plan is also available for patients putting new lenses in their own frame (but only lenses are covered). It is not available for Active or Value Eyewear purchases.

Eyewear Opportunities Details Time Period: These courtesy discounts (except for contact lens patients- see below) will be available for 30 days from the day of the eye examination. Fees must be paid when ordered.

First Pair: First pair will be pair of highest Usual and Customary Fee (U&C fee).

Next Pair(s): Additional pair(s) will be second highest U&C fee. All subsequent pair at 30% off U&C fee

Limitations: The courtesy adjustments ABOVE only apply to complete purchases of new frame and new lenses. Frames must be purchased from our inventory. Lens only purchases are not eligible for the courtesy, nor do they count as a “pair” These courtesy adjustments do not apply to Value or Active Eyewear, nor do Value or Active Eyewear purchases count as a “pair.”

Insurance: These courtesy adjustments do not apply to any product being billed to an insurance. However, glasses being billed to insurance do count as “a pair”

Value Eyewear Package

Single: Complete pair of single-vision prescription for $118 Bifocal: Complete pair of bifocal prescription for $168 No-Line: Complete pair of no-line progressive addition for $308 Details: Lens material is standard polycarbonate or standard plastic Entry Level No-Glare is INCLUDED (reduce by $20 if removed) Frames can be chosen from a limited selection of special inventory High Power lenses are charged an additional $32 Solid tint can be added for $28 Selected sports frame can be added for $68 Transitions or Polarized can not be added Not eligible for the Protection Plan Program

2019

This page intentionally left blank. Fig Garden Optometry Item Fees

CUSTOM 5/27/19 PAL Base Fee (CR-39): S.V. – B.F. – T.F. – STD PREMIUM CUSTOM with Ess V2103 V2203 V2303 PAL PAL PAL Blue All fees below add to these amounts $11 $22 $33 $44 $55 $66 $83 BF = ST 25, ST 28 or RT 22 = rest add'l fee Over TF: V2781= $11 $22 $33 Over BF: V2781= $22 $33 $44 $61 If no V-Code listed, use V2799 S.V. B.F. PCB T.F. PREMIUM CUSTOM upgrade V-Codes All M.F. V2784 POLYCARBONATE $12 $12 $12 $12 $12 $12 V2782 TRIVEX $13 $13 $13 $1 $13 $13 $13 V2782 1.60 INDEX $14 $14 $14 $2 n/a $14 n/a V2784 1.67 Index* $15 $15 $15 $3 $15 $15 $15 1.74 Index* $16 $16 n/a n/a $16 $16 V2783 $4 *=must be Aspheric and have Premium AR

TRANSITIONS S.V. All M.F. V2744 Transtions and Transitions Xtra-Active $23 $23 V2762 ADD If Transitons Vantage $24 $24 V2762 ADD if Transitions Drivewear $25 $25

V2762 POLARIZED S.V. All M.F. Solid $34 $34 Gradient $63 $63

Non-Glare Protectant V2750 Anti-Glare Treatment $41 $41 Tech-shield / Viso XC / Sharpview V2755 ADD Back-side UV protection $18 $59 CRIZAL Easy / SunShield or Xperio-UV AR V2750 ADD Anti-static, low-smudge, low-scratch $42 $101 Avance, Sapphire, VISO (XC+UV or PRO), TechShiled Elite UVR V2750 ADD: Special color for Blue-Filtering: $1 $101 Crizal and VISO PREVENCIA / TechShield Blue-UVR

Lens Enhancements: ALL V2760 Anti-Scratch Protection: $26 V2799 Roll and Polish Edges: $27 V2799 Polish Edges: $28 V2745 Solid or Graient "Dip" Tints: $29 V2799 Serengetti or Vuarnet Coating: $35 V2761 Mirror Coating: $36 V2799 Faceted Lenses: $37 V2745 Essential Blue Lens Design: $17 V2755 UV blockage treatment to front or back of lens: $18

Prescription and Frame Considerations: S.V. B.F. T.F. V2781 Near Variable Focus Lenses: $51 V2781 Essilor Computer*: $51 *must be Poly and AR V2799 Digital Aspheric /Eyezen+ $52 V2219 RT 24, ST 35 Bifocal $53 V2319 8x 35 Trifocal (Reg. Plastic clear only) $54 V2299 Double ST-25,28 – V2299 $56 V2399 ED / 14 x 35 TF – V2399: $57 V2399 Double ST-35 – V2399 / Double Exec BF – V2399: $58 ST-45 BF/Executive/Blended Bifocal/Rt-28 – V2299: $59 $67 V2299 ALL V2780 Oversize (Eyesize 60mm and up)-V2780: $38 V2715 Prism (OVER 6 total): $39 V2710 Slab-Off- V2710: $97 High Power: $41 (Sphere 8.00 & up, Cyl 4.00 & up, Add 3.00 – 4.75)

Maui Jim Lenses in POF (Maui Jim Frame): SV PAL Polycarbonate $ 444 $ 555 Evolution $ 666 $ 777

VALUES necessary for calculations on other pages - do not delete this page. VALUES in BLACK can be entered by practice and are carried to other pages VALUES in ORANGE are calculated - do not replace VALUES in WHITE were formerly used for different material charges for different lens types - they have been abandoned

Confidential 5/27/19 LENS SELECTION GUIDE CUSTOM* PREMIUM (Cat N) (Cat F) Standard PAL SV- EyeZEN Computer Comfort - no plus: SV or ZEN-0 Essilor Computer Varilux-X Fit W2+ IDEAL plus = ZEN 1-2-3 Dr adjusted RX

VSP-SIG CRIZAL Sapphire-UV CRIZAL Sapphire-UV or Saphhire-UV Alize-UV Crizal-Easy or PREVENCIA PREVENCIA

UNITY VIA- no plus- SV or UNITY VIA OFFICE-PRO VSP- ELITE UNITY VIA ETHOS svXTRA Regular PAL RX CHOICE plus- Relieve* 050, / when 070 Essilor TechShield TechShield 5 feet - sit all day lab ELITE- UV Plus TechShield TechShield BLUE-UVR 10 feet - up and around unable or TechShild Elite-UV to be *TechShield BLUE-UVR *TechShield BLUE-UVR used (only) (only)

no plus= SV CompuCLEAR TruClear-XD2 TruClear PalZ plus = ZEN 1-2-3 Dr adjusted Rx

THE SV-VISO ZEN- REST VISO-PRO VISOXC + VISOXC CRIZAL VISO PRO or PREVENCIA

PRO/Sapphire or PREV

Strategy: * Customized First for Multifocal, Essential Blue Blocking * Single power - EyeZEN-0 (svXTRA) If plus - use EyeZEN 1,2,3 (Relieve 050,070) / SV if tint * Material: NO CR39 * “Low” Powers: Polycarbonate / “High” Power: 1.67 * Drill=Trivex * Ultra High Power : 1.74 Dr Choice = what powers * Photochromic: * CHOICE LAB- SunSync ELITE or SunSync XT * Signature / Rest= Transitions: Signature-VII or XTRA-Active * Drop to Premium for reduced patient cost * Reduce AR to Crizal-Easy or TechShield (no UV) if necessary * Change PREVENCIA to “non purple” version as needed (except as noted) * SUN= Xperio-UV or change to Grey-3 if necessary * use Crizal AR on EyeZEN * Sapphire/Viso-PRO = slight blue color / Avance/VisoXC+ = slight green

Confidential 5/27/19 FGOlens

Ultimate VSP VSP Clarity VSP SIG CHOICE EyeMED ADVNTG Single Vision $124 $108 $126 $121 $107 Bi-Focal $135 $113 $130 $121 $111 Progressive-Premium $168 $191 $219 * $219 Progressive-Custom $196 $285 $315 * $145

Polycarbonate included in above + Trivex (Drill) $1 * * ($30) * + “High” : 1.67 $3 * * ($28) * + Ultra High : 1.74 $31 * * ($27) *

+ Transitions $23 $76 * $75 $82 + Polarized $34 $76 $27 $27 $27 + Solid Tint** $29 $13 $15 $15 $15 + Gradient Tint** $29 $15 $17 $15 $17

+ EyeZEN or Digital Aspheric $52 $43 * add to Single Vision + CompuCLEAR $51 $46 $41 * add to Bifocal

- Change to XC+ or Easy for AR -$42 deduct from total above *

* LOOK UP exact amount from MVC plan schedule

1.74 amount above also includes polished edges 1.74 amount above does not include aspheric, but is prescribed for high power SV

** The tint amounts are ENTERED on this page for MVC

Confidential 5/27/19 VSP-Signature U&C Vlux X-FIT Comfort-W2+ IDEAL*

Progressive $196 $ 285 $ 168 $ 191 $ 115 $ 91 V220x $22 copay $ - $ 22 $ - $ 22 Widest Clarity Zones - CUSTOMized V2781 $61 NA $ 160 $ 33 FA $ 90 $ 22 KA $ - CM $ 10 Clear, thin, light, durable material V2784 $12 ND $ 30 $ 12 FD $ 30 $ 12 KD $ 30 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 75 $ 83 QT $ 61 $ 41 QN $ 51 Backside UV protection V2755 $18 BV $ 10 $ 18 BV $ 10 $ 18 BV $ 10 *= Fee for Standard PAL assumes level K is $0 to patient

With Photochromic $219 $361 $ 191 $267 $ 138 $167 V2744 $23 PP $ 76 $ 23 PP $ 76 $ 23 PP $ 76

With Polarized $219 $ 361 $ 191 $ 267 $ 138 $ 167 *May need to check proper AR with polarized V2762 $34 NP $76 $ 23 FP $76 $ 23 KP $ 76

Bi-Focal $135 $113 V220x $22 copay $ - Clear, thin, light, durable material V2784 $12 AD $ 28 $101 QV= [Crizal:Avance-Prevencia-Sapphire] CLEAREST and best NO-GLARE surface V2750 $83 QV 75 $101 QT= [Crizal-Alize] Backside UV protection V2755 $18 BV 10 $59 QN= [Crizal-Easy]

Computer Design $186 $ 159 V2781 $51 IA $46

With Photochromic $158 $ 189 V2744 $23 PP $76

With Polarized $169 $184 V2762 $34 DA $71

Single Power $124 $ 108 V210x $11 copay $ - Clear, thin, light, durable material V2784 $12 AD $ 23 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 75 Backside UV protection V2755 $18 BV $ 10 EZ-0 EZ-1,2,3 With EyeZEN $176 $ 118 $ 128 Edge-Edge Clarity V2799 $52 BD $ 33 $ 33 *REPLACE for AD / $0 if PCB "covered in full" *Nearpoint focus relief TA n/a $ 10 *Always add if EZ-1,2,3 - even if PCB "covered"

With Photochromic $147 V2744 $23 PP $62

With Polarized $158 V2762 $34 DA $53

Other Materials *Swap out V2784 Polycarbonate and VSP Polycarb *D code for this new code/charge Cus MF Prem MF STD BF SV Trivex ® V2782 $13 NB FB KB $ 42 AB $ 55 $ 51 1.67 Thin and Lite V2784 $15 NH FH KH $ 72 AH $ 90 $ 76 1.74 Ultra-thin V2783 $16 NJ FJ KJ $ 115 BA+BJ $ 115 ST BF n/a in 1.74 5/27/19 FGO_Lens_Book_2019_Share.xlsx / VSP-SIG VSP-Choice U&C VIA ELITE Unity-VIA ETHOS*

Progressive $196 $ 315 $ 168 $ 219 $ 115 $ 96 V220x $22 copay $ - $ 22 $ - $ 22 Widest Clarity Zones - CUSTOMized V2781 $61 NA $ 175 $ 33 FA $ 105 $ 22 KA $ - CM $ 10 Clear, thin, light, durable material V2784 $12 ND $ 35 $ 12 FD $ 35 $ 12 KD $ 35 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 85 $ 83 QT $ 69 $ 41 QN $ 51 Backside UV protection V2755 $18 BV $ 10 $ 18 BV $ 10 $ 18 BV $ 10 *= Fee for Standard PAL assumes level K is $0 to patient

With Photochromic $219 $397 $ 191 $301 $ 138 $178 V2744 $23 PP $ 82 $ 23 PP $ 82 $ 23 PP $ 82

With Polarized $219 $ 342 $ 191 $ 237 $ 138 $ 114 *May need to check proper AR with polarized V2762 $34 NP $27 $ 23 FP $18 $ 23 KP $ 18

Bi-Focal $135 $130 V220x $22 copay $ - $101 QV= Unity : TechSHIELD / Elite UV or BLUE UV Clear, thin, light, durable material V2784 $12 AD $ 35 $ 101 QT= Unity : TechSHIELD Plus UV CLEAREST and best NO-GLARE surface V2750 $83 QV 85 $ 59 QN= Unity : TechSHIELD Backside UV protection V2755 $18 BV 10

Computer Design $186 $ 171 Photo= SunSync Plus or SunSync XT V2781 $51 IA $41

With Photochromic $158 $ 212 V2744 $23 PP $ 82

With Polarized $169 $157 V2762 $34 DA $27

Single Power $124 $ 126 V210x $11 copay $ - Clear, thin, light, durable material V2784 $12 AD $ 31 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 85 Backside UV protection V2755 $18 BV $ 10 svXtra RELIEVE 050,070 With EyeZEN $176 $ 134 $ 144 Edge-Edge Clarity V2799 $52 BD $ 39 $ 39 *REPLACE for AD / $0 if PCB "covered in full" *Nearpoint focus relief TA n/a $ 10 *Always add if RELIEVE - even if PCB "covered"

With Photochromic $147 V2744 $23 PP $70

With Polarized $158 V2762 $34 DA $27 *just Add DA if EyeZEN

Other Materials *Swap out V2784 Polycarbonate and VSP Polycarb *D code for this new code/charge Cus MF Prem MF STD BF SV Trivex ® V2782 $13 NB FB KB $ 10 AB $ 10 $ 10 1.67 Thin and Lite V2784 $15 NH FH KH $ 12 AH $ 12 $ 12 1.74 Ultra-thin V2783 $16 NJ FJ KJ $ 13 AJ $ 13 ST BF n/a in 1.74 5/27/19 FGO_Lens_Book_2019_Share.xlsx / VSP-CHOICE VSP-Advantage [assumes use of regular -not VSP- lab] U&C Vlux X-FIT Comfort-W2+ IDEAL*

Progressive $196 $ 145 $ 168 $ 219 $ 115 $ 158 V220x $22 copay $ - $ 22 $ - $ 22 Widest Clarity Zones - CUSTOMized V2781 $61 NA $ 49 $ 33 FA $ 105 $ 22 KA $ 55 CM $ 10 Clear, thin, light, durable material V2784 $12 ND $ 10 $ 12 FD $ 35 $ 12 KD $ 35 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 66 $ 83 QT $ 69 $ 41 QN $ 58 Backside UV protection V2755 $18 BV $ 10 $ 18 BV $ 10 $ 18 BV $ 10 *= Fee for Standard PAL assumes level K is $55 to patient

With Photochromic $219 $227 $ 191 $301 $ 138 $240 V2744 $23 PP $ 82 $ 23 PP $ 82 $ 23 PP $ 82

With Polarized $219 $ 172 $ 191 $ 237 $ 138 $ 176 *May need to check proper AR with polarized V2762 $34 NP $27 $ 23 FP $18 $ 23 KP $ 18

Bi-Focal $135 $111 V220x $22 copay $ - $101 QV= [Crizal:Avance-Prevencia-Sapphire] Clear, thin, light, durable material V2784 $12 AD $ 35 $ 101 QT= [Crizal-Alize] CLEAREST and best NO-GLARE surface V2750 $83 QV 66 $ 59 QN= [Crizal-Easy] Backside UV protection V2755 $18 BV 10

Computer Design $186 $ 152 V2781 $51 IA $41

With Photochromic $158 $ 193 V2744 $23 PP $ 82

With Polarized $169 $138 V2762 $34 DA $27

Single Power $124 $ 107 V210x $11 copay $ - Clear, thin, light, durable material V2784 $12 AD $ 31 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 66 Backside UV protection V2755 $18 BV $ 10 With EyeZEN EZ-0 EZ-1,2,3 $176 $ 122 $ 132 Edge-Edge Clarity V2799 $52 BD $ 46 $ 46 *REPLACE for AD / $0 if PCB "covered in full" *Nearpoint focus relief TA n/a $ 10 *Always add if EZ-1,2,3 - even if PCB "covered"

With Photochromic $147 $ 177 V2744 $23 PP $70

With Polarized $158 V2762 $34 DA $27

5/27/19 FGO_Lens_Book_2019_Share.xlsx / VSP-ADV Eye-MED U&C TruCLR XD2 TruClear Palz

Progressive $ 197 $ 136 $ 168 $ 118 $ 115 $ 98 V220x $22 copay $ - $ 22 $ - $ 22 $ - Widest Clarity Zones - CUSTOMized V2781 $44 Tier 4 $ - $ 33 Tier 2 $ - $ 22 STD $ - Clear, thin, light, durable material V2784 $12 $ 40 $ 12 $ 40 $ 12 $ 40 CLEAREST and best NO-GLARE surface V2750 $83 Tier 3 $ 66 $ 83 Tier 2 $ 68 $ 41 Tier 1 $ 58 Backside UV protection V2755 $18 UV $ 15 $ 18 UV $ 10 $ 18 Essential Blue Blocking V2745 $18 Tint $ 15 PAL: Tier1,23 & STD - add COPAY to GREEN box With Photochromic $220 EyeMED Tier 4: 80% of $ 66 = $ 53 =the amount V2744 $23 $ 75 PLUS Tier 4 CO-Pay = $ 65 =example MINUS Tier 4 Allowance = $ 120 =example With Polarized $220 Add this to GREEN BOX = $ (2) =example

*May need to check proper AR with polarized V2762 $34 $27

Bi-Focal $135 $121 V220x $22 copay $ - $ 81 Tier 3 [VISO:Pro-XC+ UV & VISO:PREVENCIA] Clear, thin, light, durable material V2784 $12 $ 40 $ 78 Tier 2 [VISO:XC UV] CLEAREST and best NO-GLARE surface V2750 $83 Tier 3 66 $ 58 Tier 1 [VISO] Backside UV protection V2755 $18 UV 15

Computer Design $186 * PRICE same as PalZ / UPGRADE AR to Tier 3 + UV for PREVENCIA V2781 $51

With Photochromic $158 $ 196 V2744 $23 $ 75

With Polarized $169 $148 V2762 $34 $27

Single Power $124 $ 121 V210x $11 copay $ - Clear, thin, light, durable material V2784 $12 $ 40 CLEAREST and best NO-GLARE surface V2750 $83 Tier 3 $ 66 Backside UV protection V2755 $18 UV $ 15

With EyeZEN $176 $ 163 Edge-Edge Clarity V2799 $52 $ 42 *Nearpoint focus relief

With Photochromic $147 $ 191 V2744 $23 PP $70

With Polarized $158 $ 190 V2762 $34 DA $27

Other Materials *Swap out V2784 Polycarbonate and Vcode for this new code/charge ALL Trivex ® V2782 $13 $ 10 1.67 Thin and Lite V2784 $15 $ 12 1.74 Ultra-thin V2783 $16 $ 13 ST BF n/a in 1.74

5/27/19 FGO_Lens_Book_2019_Share.xlsx / Eye-MED

This page intentionally left blank. Value Lens Package Meant to provide a well-made but "basic" pair of back-up or spare glasses at the lowest out of pocket cost.

* Includes a new frame from our "Value" line only - no "upgrades" to a different frame available. * Can be used as a "lens only" package - at the same fee: the included frame is forfeited - no difference in fee. * Lens material is standard polycarbonate (when available) or standard plastic (if available) - office discretion. * Entry level NO-GLARE is INCLUDED. No drop in fee to "leave off." * Selected SPORTS frame can be substituted for an addional: $68 * High power : greater than 4D in sphere, cylinder or total power : An additional $32 * Solid tint can be added for $28

Value Progressive - $308* $97 Normal "lens only" fee V220x $22 Basic Progressive Design V2781 $22 Clear, thin, light, durable material V2784 $12 STANDARD NO-GLARE surface V2750 $41 *=includes value FRAME

Lined Bifocal - $168* $ 66 Normal "lens only" fee V220x $13 Clear, thin, light, durable material V2784 $12 STANDARD NO-GLARE surface V2750 $41 *=includes value FRAME

Single Vision - $118* $64 Normal "lens only" fee V210x $11 Clear, thin, light, durable material V2784 $12 STANDARD NO-GLARE surface V2750 $41 *=includes value FRAME

TECH NOTES: Standard PAL PalZ Standard AR Viso-XC The Guidelines: * Upgrade to Transitions or other light-activated photochromic NOT available. * Upgrade to Polarized NOT available. * Upgrades to any other lens style (i.e. other PAL, other SV-aspheric, computer design, etc) NOT available. * Upgrades to any other NO-GLARE treatments NOT available. * Protection plan program NOT available - warranty for defective materials for 30-days only. * "Time of service" discount NOT available. - cost above is full and final cost.

5/27/19 FGO_Lens_Book_2019_Share.xlsx / Value ULTRA-Thin 1.74 Eyewear Packages

must be DELUXE AR SIG CHC ADV EyeZEN 0 / svXTRA EYE- $ 208 $ 214 $ 172 $ 153 MED $ 158 V2103 $11 copay $ - $ - $ - Edge-Edge Clarity V2799 $52 BA $ 33 $ 42 $ 42 $ 42 for the strongest prescriptions V2783 $16 BJ $ 82 $ 13 $ 13 $ 13 Polished Edges V2799 $28 SP $ 14 $ 22 $ 22 $ 22 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 75 $ 85 $ 66 $ 66 Backside UV protection V2755 $18 BV $ 10 $ 10 $ 10 $ 15

EyeZEN 1-2-3 / RELIEVE

*Nearpoint focus relief no extra TA $ 10 $ 10 incl sp.lens= $73 $99 may vary EYE- Custom Progressive $228 SIG $ 384 $ 315 $ 146 MED $ 231 V220x $22 copay $ - $ - $ 65 Widest Clarity Zones - CUSTOMized V2781 $44 NA $ 170 $ 185 $ 35 $ 35 for the strongest prescriptions V2783 $16 NJ $ 115 $ 13 $ 13 $ 13 Polished Edges V2799 $28 SP $ 14 $ 22 $ 22 $ 22 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 75 $ 85 $ 66 $ 66 Backside UV protection V2755 $18 BV $ 10 $ 10 $ 10 $ 15 Essential Blue Blocking V2745 $17 incl $ 15

EYE- Premium Progressive $200 SIG $ 304 $ 235 $ 216 MED $ 221 V220x $22 copay $ - $ - $ - Smooth Clarity Zones -Optimized V2781 $33 FA $ 90 $ 105 $ 105 $ 105 for the strongest prescriptions V2783 $16 FJ $ 115 $ 13 $ 13 $ 13 Polished Edges V2799 $28 SP $ 14 $ 22 $ 22 $ 22 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 75 $ 85 $ 66 $ 66 Backside UV protection V2755 $18 BV $ 10 $ 10 $ 10 $ 15

NOTE: Not all 1.74 is AVAILABLE AT THIS TIME IN TRANSITIONS or HIGHER CYL - check 5/27/19 availability prior to orderFGO_Lens_Book_2019_Share.xlsx / 1.74 Very-Thin 1.67 Eyewear Packages

SIG CH ADV EYE- EyeZEN 0 / svXTRA $ 179 $ 174 $ 149 $ 130 MED $ 135 V2103 $11 copay $ - $ - $ - Edge-Edge Clarity V2799 $52 BA $ 33 $ 42 $ 42 $ 42 for moderately strong prescriptions V2784 $15 BH $ 56 $ 12 $ 12 $ 12 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 75 $ 85 $ 66 $ 66 Backside UV protection V2755 $18 BV $ 10 $ 10 $ 10 $ 15

EyeZEN 1-2-3 / RELIEVE

*Nearpoint focus relief no extra TA $ 10 $ 10 $ 10 incl

Bifocal $138 $175 $107 $ 88 V2203 $22 copay $ - $ - for moderately strong prescriptions V2784 $15 AH $ 90 $ 12 $ 12 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 75 $ 85 $ 66 Backside UV protection V2755 $18 BV $ 10 $ 10 $ 10

Computer Lens

Computer/Indoor Range of Focus V2781 $51 IA $ 46 $ 41 sp.lens= $54 $80 may vary EYE- Custom Progressive $199 SIG $327 $292 $ 123 MED $ 208 V220x $22 copay $ - $ - $ 65 Widest Clarity Zones - CUSTOMized V2781 $44 NA/CM $ 170 $ 185 $ 35 $ 35 for moderately strong prescriptions V2784 $15 NH $ 72 $ 12 $ 12 $ 12 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 75 $ 85 $ 66 $ 66 Backside UV protection V2755 $18 BV $ 10 $ 10 $ 10 $ 15 Essential Blue Blocking V2745 $17 incl $ 15

EYE- Premium Progressive $172 SIG $290 $213 $ 194 MED $ 199 V220x $22 copay $ - $ - $ - Smooth Clarity Zones -Optimized V2781 $33 FA $ 90 $ 105 $ 105 $ 105 for moderately strong prescriptions V2784 $16 FJ $ 115 $ 13 $ 13 $ 13 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 75 $ 85 $ 66 $ 66 Backside UV protection V2755 $18 BV $ 10 $ 10 $ 10 $ 15

Polished Edges V2799 $28 SP $ 14 $ 22 $ 22 Polarized for maximum GLARE reduction V2762 $34 DH $82 $27 Solid Tint V2745 $29 MN $13 $15 Transitions - Single Power V2744 $23 PP $62 $70 Transitions - Multifocals V2744 $23 PP $76 $82

5/27/19 FGO_Lens_Book_2019_Share.xlsx / 1.67 Trivex (Drill material) Eyewear Packages

SIG CH ADV EYE- EyeZEN 0 / svXTRA $ 177 $ 145 $ 147 $ 128 MED $ 133 V2103 $11 copay $ - copay $ - $ - Edge-Edge Clarity V2799 $52 BA $ 33 $ 42 $ 42 $ 42 Best for Drill / Matl Sens. V2782 $13 BB $ 27 $ 10 $ 10 $ 10 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 75 $ 85 $ 66 $ 66 Backside UV protection V2755 $18 BV $ 10 $ 10 $ 10 $ 15

EyeZEN 1-2-3 / RELIEVE

*Nearpoint focus relief no extra TA $ 10 $ 10 $ 10 incl

Bifocal $136 $140 $105 $ 86 V2203 $22 copay $ - $ - Best for Drill / Matl Sens. V2782 $13 AB $ 55 $ 10 $ 10 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 75 $ 85 $ 66 Backside UV protection V2755 $18 BV $ 10 $ 10 $ 10

Computer Lens

Computer/Indoor Range of Focus V2781 $51 IA $ 46 $ 41 $ 41 sp.lens= $53 sp.lens= $79 may vary EYE- Custom Progressive $197 SIG $297 CH $ 290 $ 121 MED #REF! V220x $22 copay $ - copay $ - $ 65 Widest Clarity Zones - CUSTOMized V2781 $44 NA/CM $ 170 $ 185 $ 35 $ 35 Best for Drill / Matl Sens. V2782 $13 NB $ 42 $ 10 $ 10 $ 10 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 75 $ 85 $ 66 $ 66 Backside UV protection V2755 $18 BV $ 10 $ 10 $ 10 $ 15 Essential Blue Blocking V2745 $17 incl incl $ 15

EYE- Premium Progressive $169 SIG $217 CH $210 $ 86 MED #REF! V220x $22 copay $ - copay $ - $ - Smooth Clarity Zones -Optimized V2781 $33 FA $ 90 $ 105 $ 105 Best for Drill / Matl Sens. V2782 $13 FB $ 42 $ 10 $ 10 $ 10 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 75 $ 85 $ 66 $ 66 Backside UV protection V2755 $18 BV $ 10 $ 10 $ 10 $ 15

Polished Edges V2799 $28 SP $ 14 $ 22 $ 22 Polarized for maximum GLARE reduction V2762 $34 DB $70 $27 Solid Tint V2745 $29 MN $13 $15 Transitions - Single Power V2744 $23 PP $62 $70 Transitions - Multifocals V2744 $23 PP $76 $82

5/27/19 FGO_Lens_Book_2019_Share.xlsx / Trivex Basic Eyewear (CR39) Packages

SIG CH ADV EYE- EyeZEN 0 / svXTRA $ 164 $ 118 $ 137 $ 118 MED $ 123 V2103 $11 copay $ - $ - $ - Edge-Edge Clarity V2799 $52 BA $ 33 $ 42 $ 42 $ 42 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 75 $ 85 $ 66 $ 66 Backside UV protection V2755 $18 BV $ 10 $ 10 $ 10 $ 15

EyeZEN 1-2-3 / RELIEVE

*Nearpoint focus relief no extra TA $ 10 $ 10 incl

Bifocal $123 $85 $95 $76 V2203 $22 copay $ - $ - CLEAREST and best NO-GLARE surface V2750 $83 QV $ 75 $ 85 $ 66 Backside UV protection V2755 $18 BV $ 10 $ 10 $ 10

Round 24, 25 or ST 35 V2219 $53 incl

Computer/Indoor Range of Focus V2781 $51 IA $ 46 $ 41 $ 41

Trifocal $134 $85 $95 $76 7*28 V2303 $33 copay $ - $ - CLEAREST and best NO-GLARE surface V2750 $83 QV $ 75 $ 85 $ 66 Backside UV protection V2755 $18 BV $ 10 $ 10 $ 10

8*35 V2319 $54 incl may vary

EYE- Custom Progressive $184 SIG $255 $280 $ 111 MED $ 196 V220x $22 copay $ - $ - $ 65 Widest Clarity Zones - CUSTOMized V2781 $44 NA/CM $ 170 $ 185 $ 35 $ 35 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 75 $ 85 $ 66 $ 66 Backside UV protection V2755 $18 BV $ 10 $ 10 $ 10 $ 15 Essential Blue Blocking V2745 $17 incl $ 15

EYE- Premium Progressive $156 SIG $175 $200 $ 181 MED #REF! V220x $22 copay $ - $ - $ - Smooth Clarity Zones -Optimized V2781 $33 FA $ 90 $ 105 $ 105 $ 105 CLEAREST and best NO-GLARE surface V2750 $83 QV $ 75 $ 85 $ 66 $ 66 Backside UV protection V2755 $18 BV $ 10 $ 10 $ 10 $ 15

Polished Edges V2799 $28 SP $ 14 $ 22 $ 22 $ 22 Polarized for maximum GLARE reduction V2762 $34 DA $82 $27 $ 27 Solid Tint V2745 $29 MN $13 $15 $15 Transitions - Single Power V2744 $23 PP $62 $70 $70 Transitions - Multifocals V2744 $23 PP $76 $82 $82

5/27/19 FGO_Lens_Book_2019_Share.xlsx / CR39 Maui Jim® Sunwear Packages

Non-Rx Lenses

Maui Jim ® products without prescription are set at the lowest price to our patients that is allowed: MSRP + Sales Tax NO Courtesy, discounts or special promotions allowed

Replacement Lenses in "own frame": $135 + Sales Tax

Maui Jim® Rx Lenses - added to frame cost

SV Polycarbonate $444 SV Evolution $666

Premium PAL Polycarbonate $555 Premium PAL Evolution $777 When no insurance is being used and a new frame and new Rx lenses are being ordered, patients will receive a 15% prompt-pay courtesy off the total cost of the Sunglasses + the prescription lenses (above). When using an existing Maui Jim® frame, the courtesy does not apply (use amounts above).

Maui Jim® using a vision plan: Non-Covered but vision plan "courtesy" is applicable: Add [frame with non-Rx lenses fee] and [Rx lens fee-above] and determine cost after courtesy. By agreement with Maui Jim®, cost to patient can never be below MSRP (check book)

Patient using vision plan toward Maui Jim® sunglasses

VSP Signature and Choice Value Plans: Frame: Subtract "Frame Allowance" from MSRP+tax of frame Multiply that amount by 0.80 = What patient pays 0.80 * ([MSRP+tax] - [frame allowance]) = patient amount for frame

Lenses: Rx Lens Amount above * 0.80 [20% courtesy] Subtract VSP lens allowance and Dispensing Fee Result = what patient pays for lenses. NOTE- ADD any co-payments Table below gives resultant amount with $0 co-pay

Other insurances (and other VSP types): Frame = Subtract "Frame Allowance" from frame MSRP+tax Lenses = Subtract U&C for SV or BF (as appropriate -see below)

Other Patient amount (Rx Lenses) before adding co-pays:PatientPatient amount amount (Rx (Rx Lenses) Lenses)Sig before before addingChoice adding co-pays: co-pays:Insurance Single Vision Polycarbonate $292.70 $319.20 $433.00 Single Vision Evolution $470.30 $496.80 $655.00 Premium Progressive Polycarbonate $345.50 $388.50 $533.00 Premium Progressive Evolution $523.10 $566.10 $755.00

These calculations are dependent on individual practice assigned fees from VSP.

5/27/19 FGO_Lens_Book_2019_Share.xlsx / MauiJim Oakley® Sunwear Packages

Frame and Non-Rx Lenses / Non-Rx Lenses only in "own frame"

Oakley® products are available in a variety of different methods. This page is meant to detail the process for ordering Oakley® "Frame and Lens" package from the Oakley labs Oakley® products are priced individually due to great variability in styles and lens features.

Oakley® Rx Lenses = without mirror coating:

SV Clear - $266 $266 SV Transitions - $382 $382

SV Sun Polar/PRIZM* - $342 $342 SV sun tint (non polarized) - $286 $286

PAL/SS-SV Clear - $482 $482 PAL/SS-SV Transitions - $622 $622

PAL/SS-SV Sun Polar/PRIZM* - $592 $592 PAL/SS-SV Sun tint - $512 $512

An IRIDIUM front mirror coating can be added to "Some" lens designs: IRIDIUM front surface mirror coating: $36 V2761 add to above fee. Deduct 20% for insurance

SV-SS = Sport Shield Impant/Insert is only available in Single Vision, but at the PAL fee.

*PRIZM is a special "Color enhancement feature" and is priced at polarized level. When no insurance is being used and a new frame and new Rx lenses are being ordered, patients will receive a 15% prompt-pay courtesy off the total cost of the Sunglasses + the prescription lenses (above). When using an existing Oakley® frame, the courtesy does ALSO apply.

Oakley® Frame and Lens "package" using a vision plan:

VSP Signature and Choice Value Plans: Frame: 80% of amount frame-only [MSRP+tax] exceeds frame allowance Lenses: Table below gives resultant amount with $0 co-pay

Rx Lenses before adding co-pays: Sig Choice Other Insurance SV Clear $150 $177 $255 SV Tint $166 $193 $275 SV Polar/PRIZM $211 $238 $331 SV Transitions $243 $270 $371

PAL/SS-SV Clear $287 $330 $460 PAL/SS-SV Tint $311 $354 $490 PAL/SS-SV Polar/PRIZM $375 $418 $570 PAL/SS-SV Transitions $399 $442 $600

*Other Insurance - deducts SV or BF amount from U&C These calculations are dependent on individual practice assigned fees from VSP.

5/27/19 FGO_Lens_Book_2019_Share.xlsx / Oakley

5/27/19

VSP COB AMOUNTS: DEDUCT secondary plan COPAY AMOUNTS from the below amounts.

SIGNATURE Eye exam $ 66.00 Lenses $ 51.00 Frame $ 76.00

Secondary allowances are cumulative. The maximum secondary allowance available for exam, lenses and frame services is $ 193.00

CHOICE Eye exam $ 66.00 Lenses $ 51.00 Frame $ 76.00

Secondary allowances are cumulative. The maximum secondary allowance available for exam, lenses and frame services is $ 193.00

Advantage Eye exam $ 50.00 Lenses $ 36.00 Frame $ 58.00

Secondary allowances are cumulative. The maximum secondary allowance available for exam, lenses and frame services is $ 144.00

These amounts are from the Eyefinity website and are standard for every practice. - but they may CHANGE in the future. 5/27/19

VSP Special Lens Procedure:

Confirm that lens is not given option codes in Product Index but instead is listed as "use Special Lens Procedure" Figure TOTAL Usual & Customary fee for lens and ALL add-ons:

Calculate a 20% Discount by multiplying TOTAL above by X 0.80

SIGNATURE SV MF

SUBTRACT the VSP Dispensing Fee$ & 42.50 $ 63.50 The VSP Special Lens Allowance: $ 20.00 $ 35.00 TOTAL TO SUBTRACT: $ 62.50 $ 98.50

CHOICE SV MF

SUBTRACT the VSP Dispensing Fee$ & 16.00 $ 20.50 The VSP Special Lens Allowance: $ 20.00 $ 35.00 TOTAL TO SUBTRACT: $ 36.00 $ 55.50

COPAY

Patient portion is TOTAL U&C fee, minus discount, minus VSP Dispensing fee and VSP Special Lens Allowanc, plus copay: VSP Signature Plan® Lens Enhancements Chart

Eﬀective July 1, 2018

Use this chart to determine what to charge patients and reconcile your VSP® Vision Care Explanation of Payment.

Copay All lens enhancements are covered after a copay. Charge patient the listed copay or your usual and customary fee (U&C), whichever is lower.

Charge Back This is the amount charged to you for lab fees. You won’t be charged for covered lens enhancements.

Service Fee You’ll receive the listed service fee. VSP will reimburse this fee for covered lens enhancements. For other enhancements, this will be included in the copay you collect from the patient. Eﬀective July 1, 2018 VSP Signature Plan Charge patients the listed patient copay or your U&C fee, whichever is lower.

Aspherical and Spherical Lens Styles Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay

AA Aspheric Plastic 1.50 $10 $13 $23 $14 $14 $28 AB High-index Plastic 1.53-1.60/Trivex $29 $22 $51 $33 $22 $55 AH High-index Plastic 1.66/1.67 $48 $28 $76 $58 $32 $90 AJ High-index Plastic 1.70 & Above $68 $34 $102 ------AD Polycarbonate $10 $13 $23 $14 $14 $28 AE (Lab Use Only) ------AF High-index Glass 1.60–1.80 (Clear) $35 $20 $55 $85 $42 $127

Digital Aspheric Lens Styles Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay

BA Digital Aspheric Lenses – Plastic $19 $14 $33 $26 $14 $40 BA + BB Digital Aspheric Lenses – High-index Plastic 1.53-1.60/Trivex $16 $11 $33 + $27 $16 $11 $40 + $27 BA + BH Digital Aspheric Lenses – High-index Plastic 1.66/1.67 $37 $19 $33 + $56 $40 $25 $40 + $65 BA + BJ Digital Aspheric Lenses – High-index Plastic 1.70 & Above $57 $25 $33 + $82 ------BD Digital Aspheric Lenses – Polycarbonate $19 $14 $33 $26 $14 $40

Occupational Lens Styles Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay

CA (Lab Use Only) ------CE (Lab Use Only) ------

Polarized Lens Styles Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay

DA Polarized Lenses – Plastic A $36 $17 $53 $48 $23 $71 DA + DB Polarized Lenses – High-index Plastic 1.53-1.60/Trivex $47 $23 $53 + $70 $59 $29 $71 + $88 DA + DH Polarized Lenses – High-index Plastic 1.66/1.67 $55 $27 $53 + $82 ------DA + DD Polarized Lenses – Polycarbonate $13 $14 $53 + $27 $13 $14 $71 + $27 DE Polarized/Laminated Lenses – Glass $49 $23 $72 $63 $30 $93

Bifocal Lens Styles (Mark bifocal box.) Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay

IA Near Variable Focus – Plastic ------$26 $20 $46 +IB Near Variable Focus – High-index Plastic 1.53-1.60 ------$11 $10 $21 +II Near Variable Focus – High-index Plastic 1.66/1.67 ------$27 $18 $45 +ID Near Variable Focus – Polycarbonate ------$7 $10 $17 GA Blended Bifocal – Plastic ------$14 $13 $27

Plastic Dyes Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay MM (Lab Use Only) ------MN Plastic Dyes – Solid Color (Except Pink I & II) $5 $8 $13 $5 $8 $13 MP Plastic Dyes – Gradient $7 $8 $15 $7 $8 $15

+This lens enhancement code is always in conjunction with a base lens enhancement code [shaded], e.g., IB is charged with IA. Please note: If the patient is covered for plastic dyes, glass tints, or photochromics, there is no service fee for those lens enhancements. Additionally, for children or handicapped patients, there is no Service Fee for covered polycarbonate lenses when dispensed. Eﬀective July 1, 2018 VSP Signature Plan Charge patients the listed patient copay or your U&C fee, whichever is lower.

Glass Tints and Color Coatings Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay MQ (Lab Use Only) ------MR Glass Tints Solid (Except Pink I & II & Yellow) $16 $14 $30 $24 $17 $41 MS Glass Color Coatings – Solid $22 $16 $38 $22 $16 $38 MT Glass Color Coatings – Gradient $25 $17 $42 $25 $17 $42

Photochromics Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay PM Photochromics – Glass $15 $14 $29 $23 $14 $37 PP Photochromics – Plastic $42 $20 $62 $51 $25 $76 ^PP Photochromics – Mid-index $42 $20 $62 $51 $25 $76

Other Coatings Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay QM Anti-reflective Coating A $21 $16 $37 $21 $16 $37 QN Anti-reflective Coating B $34 $17 $51 $34 $17 $51 QT Anti-reflective Coating C $41 $20 $61 $41 $20 $61 QV Anti-reflective Coating D $52 $23 $75 $52 $23 $75 QP Mirror – Solid & Single Gradient (Includes Base Color) $26 $18 $44 $26 $18 $44 QR Ski Type (Includes Base Tint and Backside Color) $30 $20 $50 $30 $20 $50 QQ Scratch-resistant Coating A – Factory Applied $7 $8 $15 $7 $8 $15 QS Scratch-resistant Coating B – Other Approved Coatings $15 $14 $29 $15 $14 $29

Oversize Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay RM Frames Stamped 61mm Eye Size or Greater – Plastic $5 $5 $10 $6 $6 $12 RN Frames Stamped 61mm Eye Size or Greater – Glass $7 $5 $12 $10 $6 $16

Miscellaneous Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay SP High-luster Edge Polish $6 $8 $14 $6 $8 $14 SQ Edge Coating $17 $15 $32 $17 $15 $32 SR Faceted Lenses (Includes Polishing) $41 $20 $61 $41 $20 $61 SV UV Protection $6 $8 $14 $6 $8 $14 BV UV Protection – Backside $7 $3 $10 $7 $3 $10 TA Technical Addon $8 $2 $10 ------SH (Lab Use Only) ------ST (Lab Use Only) ------SW (Lab Use Only) ------

Doctor Supplied Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay IM Plastic Dyes – Solid Color (Pink I & II) $5 -- -- $5 -- -- IN Plastic Dyes – Solid Color (Except Pink I & II) $5 $8 $13 $5 $8 $13 IP Plastic Dyes – Gradient $7 $8 $15 $7 $8 $15 IV UV Protection $6 $8 $14 $6 $8 $14

^If ordered with SunSensors or SunGray photochromics, lens enhancement code PP includes payment for mid-index materials. Please note: If the patient is covered for plastic dyes, glass tints, or photochromics, there is no service fee for those lens enhancements. 1. In-office Lab: For the patient lens enhancements your office can fulfill in-house, you’ll be reimbursed this listed fee for covered lens enhancements. For all other lens enhancements, this will be included in the patient copay you collect from the patient. Eﬀective July 1, 2018 VSP Signature Plan Charge patients the listed patient copay or your U&C fee, whichever is lower.

Progressive

Code Lens Enhancement Description Charge Back Service Fee2 Patient Copay CM Custom Measurements (on Eligible Progressive N or O) Lenses $2 $8 $10 NA Progressive N – Plastic $95 $65 $160 NA + NB Progressive N – High-index Plastic 1.53-1.60/Trivex $25 $17 $160 + $42 NA + NH Progressive N – High-index Plastic 1.66/1.67 $48 $24 $160 + $72 NA + NJ Progressive N – High-index Plastic 1.70 & Above $77 $38 $160 + $115 NA + ND Progressive N – Polycarbonate $15 $15 $160 + $30 NA + NP Progressive N – Polarized $51 $25 $160 + $76 OA Progressive O – Plastic $75 $45 $120 OA + OB Progressive O – High-index Plastic 1.53-1.60/Trivex $25 $17 $120 + $42 OA + OH Progressive O – High-index Plastic 1.66/1.67 $48 $24 $120 + $72 OA + OJ Progressive O – High-index Plastic 1.70 & Above $77 $38 $120 + $115 OA + OD Progressive O – Polycarbonate $15 $15 $120 + $30 OA + OP Progressive O – Polarized $51 $25 $120 + $76 FA Progressive F – Plastic $54 $36 $90 FA + FB Progressive F – High-index Plastic 1.53-1.60/Trivex $25 $17 $90 + $42 FA + FH Progressive F – High-index Plastic 1.66/1.67 $48 $24 $90 + $72 FA + FJ Progressive F – High-index Plastic 1.70 & Above $77 $38 $90 + $115 FA + FD Progressive F – Polycarbonate $15 $15 $90 + $30 FA + FP Progressive F – Polarized $51 $25 $90 + $76 FE Progressive F – Glass/High-index Glass (Clear) $59 $36 $95 JA Progressive J – Plastic $46 $34 $80 JA + JB Progressive J – High-index Plastic 1.53-1.60/Trivex $25 $17 $80 + $42 JA + JH Progressive J – High-index Plastic 1.66/1.67 $48 $24 $80 + $72 JA + JJ Progressive J – High-index Plastic 1.70 & Above $77 $38 $80 + $115 JA + JD Progressive J – Polycarbonate $15 $15 $80 + $30 JA + JP Progressive J – Polarized $51 $25 $80 + $76 JE Progressive J – Glass/High-index Glass (Clear) $56 $34 $90 KA Progressive K – Plastic $30 $20 $50 KA + KB Progressive K – High-index Plastic 1.53-1.60/Trivex $25 $17 $50 + $42 KA + KH Progressive K – High-index Plastic 1.66/1.67 $48 $24 $50 + $72 KA + KJ Progressive K – High-index Plastic 1.70 & Above $77 $38 $50 + $115 KA + KD Progressive K – Polycarbonate $15 $15 $50 + $30 KA + KP Progressive K – Polarized $51 $25 $50 + $76 KE Progressive K – Glass/High-index Glass (Clear) $50 $20 $70 +This lens enhancement code is always charged in conjunction with its base lens enhancement code [shaded], e.g., KD is charged with KA. 2. The Service Fee for progressives is paid in addition to your VSP Signature Plan bifocal dispensing fee. Please note: For children or handicapped patients, there is no Service Fee for covered polycarbonate lenses when dispensed.

Progressive Categories3 as of 7/1/2018

Autograph III*, Hoyalux iD LifeStyle/2*, UNITY® Via Elite*, Varilux Physio Enhanced Fit/W3+ Fit*, Varilux X Fit Technology*, ZEISS DriveSafe N Individual*, ZEISS Individual 2* Custom Autograph II+*, Kodak Unique, Shamir Intouch, synchrony Performance HDV, UNITY Via Plus/Mobile/Wrap*, Varilux Comfort W2+ Fit*, Varilux O Physio Enhanced/W3+*, Varilux X Design Technology*, ZEISS Precision KODAK Digital Precise, Shamir Spectrum+, synchrony Performance HD, UNITY Via, Varilux Comfort 2 DRx/Enhanced/W2+, Varilux Physio/DRx, F ZEISS GT2, ZEISS Choice Premium J Ethos Plus, Hoyalux GP Wide, Ideal, Kodak Precise/PB/Short, Shamir Element, synchrony Easy Adapt, Varilux Comfort 2, Varilux Ellipse

Accolade, Adaptar, Amplitude/Mini/BKS, Ethos, Image, Kodak Concise, Natural/Digital, Navigator, Ovation, SmallFit, synchrony Easy View/HD, Standard K VIP

3. If a lens is not shown, please refer to the Product Index in the Manuals on VSPOnline at eyefinity.com. *This progressive lens is customizable for the most preise prescription. You’ll receive the additional CM service fee when the frame wrap, pantoscopic tilt, and vertex distance measurements are submitted with your lab order via eClaim at eyefinity.com. All three measurements are required. Refer to the Product Index in your VSPManual for additional eligible lenses.

©2018 Vision Service Plan. All rights reserved. VSP and VSP Signature Plan are registered trademarks of Vision Service Plan. UNITY is a registered trademark of Plexus Optix, Inc. All other brands are trademarks or registered trademarks of their respective owners. 21552 VCDR VSP Choice Plan® Lens Enhancements Chart

Eﬀective July 1, 2018

Use this chart to determine what to charge patients and reconcile your VSP® Vision Care Explanation of Payment.

Copay All lens enhancements are covered after a copay. Charge patients the listed copay or 80% of your usual and customary fee (U&C), whichever is lower. For lens enhancements without a copay listed, charge 80% of your U&C.

Charge Back This is the amount charged to you for lab fees. You won’t be charged for covered lens enhancements.

Service Fee You’ll receive the listed service fee. VSP will reimburse this fee for covered lens enhancements. For other enhancements, this will be included in the copay you collect from the patient. Eﬀective July 1, 2018 VSP Choice Plan Charge patients the listed patient copay or 80% of your U&C, whichever is lower. If no patient copay is listed, charge 80% of your U&C.

Aspherical and Spherical Lens Styles Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay

AA Aspheric Plastic 1.50 $10 $21 80% of U&C $14 $21 80% of U&C AB High-index Plastic 1.53-1.60/Trivex $29 $27 80% of U&C $33 $27 80% of U&C AH High-index Plastic 1.66/1.67 $48 $35 80% of U&C $58 $40 80% of U&C AJ High-index Plastic 1.70 & Above $68 $43 80% of U&C ------AD Polycarbonate $10 $21 $31 $14 $21 $35 AE (Lab Use Only) ------AF High-index Glass 1.60–1.80 (Clear) $35 $25 80% of U&C $85 $53 80% of U&C

Digital Aspheric Lens Styles Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay

BA Digital Aspheric Lenses – Plastic $19 $20 80% of U&C $26 $20 80% of U&C BA + BB Digital Aspheric Lenses – High-index Plastic 1.53-1.60/Trivex $16 $12 80% of U&C $16 $12 80% of U&C BA + BH Digital Aspheric Lenses – High-index Plastic 1.66/1.67 $37 $21 80% of U&C $40 $28 80% of U&C BA + BJ Digital Aspheric Lenses – High-index Plastic 1.70 & Above $57 $29 80% of U&C ------BD Digital Aspheric Lenses – Polycarbonate $19 $20 $39 $26 $20 $46

Occupational Lens Styles Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay

CA (Lab Use Only) ------CE (Lab Use Only) ------

Polarized Lens Styles Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay

DA Polarized Lenses – Plastic A $36 $21 80% of U&C $48 $29 80% of U&C DA + DB Polarized Lenses – High-index Plastic 1.53-1.60/Trivex $47 $29 80% of U&C $59 $36 80% of U&C DA + DH Polarized Lenses – High-index Plastic 1.66/1.67 $55 $34 80% of U&C ------DA + DD Polarized Lenses – Polycarbonate $13 $18 80% of U&C $13 $18 80% of U&C DE Polarized/Laminated Lenses – Glass $49 $29 80% of U&C $63 $38 80% of U&C

Bifocal Lens Styles (Mark bifocal box.) Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay

IA Near Variable Focus – Plastic ------$26 $24 80% of U&C +IB Near Variable Focus – High-index Plastic 1.53-1.60 ------$11 $13 80% of U&C +II Near Variable Focus – High-index Plastic 1.66/1.67 ------$27 $23 80% of U&C +ID Near Variable Focus – Polycarbonate ------$7 $13 80% of U&C GA Blended Bifocal – Plastic ------$14 $16 80% of U&C

Plastic Dyes Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay MM (Lab Use Only) ------MN Plastic Dyes – Solid Color (Except Pink I & II) $5 $10 $15 $5 $10 $15 MP Plastic Dyes – Gradient $7 $10 $17 $7 $10 $17

+This lens enhancement code is always in conjunction with a base lens enhancement code [shaded], e.g., IB is charged with IA. Please note: For children, handicapped patients, or for patients under the Federal Plan, there is no Service Fee for covered polycarbonate lenses when dispensed. Eﬀective July 1, 2018 VSP Choice Plan Charge patients the listed patient copay or 80% of your U&C, whichever is lower. If no patient copay is listed, charge 80% of your U&C.

Glass Tints and Color Coatings Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay MQ (Lab Use Only) ------MR Glass Tints Solid (Except Pink I & II & Yellow) $16 $18 $34 $24 $20 $44 MS Glass Color Coatings – Solid $22 $20 80% of U&C $22 $20 80% of U&C MT Glass Color Coatings – Gradient $25 $21 80% of U&C $25 $21 80% of U&C

Photochromics Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay PM Photochromics – Glass $15 $18 $33 $23 $18 $41 PP Photochromics – Plastic $42 $28 $70 $51 $31 $82 ^PP Photochromics – Mid-index $42 $28 $70 $51 $31 $82

Other Coatings Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay QM Anti-reflective Coating A $21 $20 $41 $21 $20 $41 QN Anti-reflective Coating B $34 $24 $58 $34 $24 $58 QT Anti-reflective Coating C $41 $28 $69 $41 $28 $69 QV Anti-reflective Coating D $52 $33 $85 $52 $33 $85 QP Mirror – Solid & Single Gradient (Includes Base Color) $26 $23 80% of U&C $26 $23 80% of U&C QR Ski Type (Includes Base Tint and Backside Color) $30 $25 80% of U&C $30 $25 80% of U&C QQ Scratch-resistant Coating A – Factory Applied $7 $10 $17 $7 $10 $17 QS Scratch-resistant Coating B – Other Approved Coatings $15 $18 $33 $15 $18 $33

Oversize Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay RM Frames Stamped 61mm Eye Size or Greater – Plastic $5 $6 $11 $6 $8 $14 RN Frames Stamped 61mm Eye Size or Greater – Glass $7 $6 $13 $10 $8 $18

Miscellaneous Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay SP High-luster Edge Polish $6 $10 80% of U&C $6 $10 80% of U&C SQ Edge Coating $17 $19 80% of U&C $17 $19 80% of U&C SR Faceted Lenses (Includes Polishing) $41 $25 80% of U&C $41 $25 80% of U&C SV UV Protection $6 $10 $16 $6 $10 $16 BV UV Protection – Backside $7 $3 $10 $7 $3 $10 TA Technical Add On $8 $2 $10 ------SH (Lab Use Only) ------ST (Lab Use Only) ------SW (Lab Use Only) ------

Doctor Supplied Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay IM Plastic Dyes – Solid Color (Pink I & II) $5 -- -- $5 -- -- IN Plastic Dyes – Solid Color (Except Pink I & II) $5 $10 $15 $5 $10 $15 IP Plastic Dyes – Gradient $7 $10 $17 $7 $10 $17 IV UV Protection $6 $10 $16 $6 $10 $16

Îf ordered with SunSensors or SunGray photochromics, lens enhancement code PP includes payment for mid-index materials. 1. In-office Lab: For the patient lens enhancements your office can fulfill in-house, you’ll be reimbursed this listed fee for covered lens enhancements. For all other lens enhancements, this will be included in the patient copay you collect from the patient. Effective July 1, 2018 VSP Choice Plan Charge patients the listed patient copay or 80% of your U&C, whichever is lower. If no patient copay is listed, charge 80% of your U&C.

Progressive

Code Lens Enhancement Description Charge Back Service Fee2 Patient Copay CM Custom Measurements (on Eligible Progressive N or O) Lenses $2 $8 $10 NA Progressive N – Plastic $95 $80 $175 NA + NB Progressive N – High-index Plastic 1.53-1.60/Trivex $25 $22 $175 + 80% of U&C3 NA + NH Progressive N – High-index Plastic 1.66/1.67 $48 $30 $175 + 80% of U&C3 NA + NJ Progressive N – High-index Plastic 1.70 & Above $77 $48 $175 + 80% of U&C3 NA + ND Progressive N – Polycarbonate $15 $20 $175 + $35 NA + NP Progressive N – Polarized $51 $31 $175 + 80% of U&C3 OA Progressive O – Plastic $79 $71 $150 OA + OB Progressive O – High-index Plastic 1.53-1.60/Trivex $25 $22 $150 + 80% of U&C3 OA + OH Progressive O – High-index Plastic 1.66/1.67 $48 $30 $150 + 80% of U&C3 OA + OJ Progressive O – High-index Plastic 1.70 & Above $77 $48 $150 + 80% of U&C3 OA + OD Progressive O – Polycarbonate $15 $20 $150 + $35 OA + OP Progressive O – Polarized $51 $31 $150 + 80% of U&C3 FA Progressive F – Plastic $54 $51 $105 FA + FB Progressive F – High-index Plastic 1.53-1.60/Trivex $25 $22 $105 + 80% of U&C3 FA + FH Progressive F – High-index Plastic 1.66/1.67 $48 $30 $105 + 80% of U&C3 FA + FJ Progressive F – High-index Plastic 1.70 & Above $77 $48 $105 + 80% of U&C3 FA + FD Progressive F – Polycarbonate $15 $20 $105 + $35 FA + FP Progressive F – Polarized $51 $31 $105 + 80% of U&C3 FE Progressive F – Glass/High-index Glass (Clear) $59 $51 $110 JA Progressive J – Plastic $46 $49 $95 JA + JB Progressive J – High-index Plastic 1.53-1.60/Trivex $25 $22 $95 + 80% of U&C3 JA + JH Progressive J – High-index Plastic 1.66/1.67 $48 $30 $95 + 80% of U&C3 JA + JJ Progressive J – High-index Plastic 1.70 & Above $77 $48 $95 + 80% of U&C3 JA + JD Progressive J – Polycarbonate $15 $20 $95 + $35 JA + JP Progressive J – Polarized $51 $31 $95 + 80% of U&C3 JE Progressive J – Glass/High-index Glass (Clear) $56 $49 $105 KA Progressive K – Plastic $28 $27 $55 KA + KB Progressive K – High-index Plastic 1.53-1.60/Trivex $25 $22 $55 + 80% of U&C3 KA + KH Progressive K – High-index Plastic 1.66/1.67 $48 $30 $55 + 80% of U&C3 KA + KJ Progressive K – High-index Plastic 1.70 & Above $77 $48 $55 + 80% of U&C3 KA + KD Progressive K – Polycarbonate $15 $20 $55 + $35 KA + KP Progressive K – Polarized $51 $31 $55 + 80% of U&C3 KE Progressive K – Glass/High-index Glass (Clear) $53 $27 $80 2. The Service Fee for progressives is paid in addition to your VSP Choice Plan bifocal lens dispensing fee. Please note: For children, handicapped patients, or for patients under the Federal Plan, there is no Service Fee for covered polycarbonate lenses when dispensed. 3. To determine the lens enhancement price, subtract your U&C price of the standard lens enhancement, (i.e., KA progressive), from your U&C price of the premium material lens enhancement, (i.e., KP polarized).

Progressive Categories3 as of 7/1/2018

Accolade, Adaptar, Amplitude/Mini/BKS, Ethos, Image, Kodak Concise, Natural/Digital, Navigator, Ovation, SmallFit, Standard K synchrony Easy View/HD, VIP

4. If a lens is not shown, please refer to the Product Index in the Manuals on VSPOnline at eyeﬁnity.com. *This progressive lens is customizable for the most preise prescription. You’ll receive the additional CM service fee when the frame wrap, pantoscopic tilt, and vertex distance measurements are submitted with your lab order via eClaim at eyeﬁnity.com. All three measurements are required. Refer to the Product Index in your VSPManual for additional eligible lenses.

©2018 Vision Service Plan. All rights reserved. VSP and VSP Choice Plan are registered trademarks of Vision Service Plan. UNITY is a registered trademark of Plexus Optix, Inc. All other brands are trademarks or registered trademarks of their respective owners. 21553 VCDR Advantage Network Lens Enhancements Chart

Eﬀective July 1, 2018

Use this chart to determine what to charge patients and reconcile your VSP® Vision Care Explanation of Payment.

Charge Back This is the amount charged to you for lab fees. You won’t be charged for covered lens enhancements.

Service Fee VSP will reimburse this fee for covered lens enhancements. For other enhancements, this will be included in the copay you collect from the patient. Eﬀective July 1, 2018 Advantage Network

Aspherical and Spherical Lens Styles Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay

AA Aspheric Plastic 1.50 $10 $21 80% of U&C $14 $21 80% of U&C AB High-index Plastic 1.53–1.60/Trivex $29 $27 80% of U&C $33 $27 80% of U&C AH High-index Plastic 1.66/1.67 $48 $35 80% of U&C $58 $40 80% of U&C AJ High-index Plastic 1.70 & Above $68 $43 80% of U&C ------AD Polycarbonate $10 $21 $31 $14 $21 $35 AE (Lab Use Only) ------AF High-index Glass 1.60–1.80 (Clear) $35 $25 80% of U&C $85 $53 80% of U&C

Digital Aspheric Lens Styles Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay

BA Digital Aspheric Lenses – Plastic $19 $20 80% of U&C $26 $20 80% of U&C BA + BB Digital Aspheric Lenses – High-index Plastic 1.53–1.60/Trivex $16 $12 80% of U&C $16 $12 80% of U&C BA + BH Digital Aspheric Lenses – High-index Plastic 1.66/1.67 $37 $21 80% of U&C $40 $28 80% of U&C BA + BJ Digital Aspheric Lenses – High-index Plastic 1.70 & Above $57 $29 80% of U&C ------BD Digital Aspheric Lenses – Polycarbonate $19 $20 $39 $26 $20 $46

Occupational Lens Styles Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay

CA (Lab Use Only) ------CE (Lab Use Only) ------

Polarized Lens Styles Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay

DA Polarized Lenses – Plastic A $36 $21 80% of U&C $48 $29 80% of U&C DA + DB Polarized Lenses – High-index Plastic 1.53–1.60/Trivex $47 $29 80% of U&C $59 $36 80% of U&C DA + DH Polarized Lenses – High-index Plastic 1.66/1.67 $55 $34 80% of U&C ------DA + DD Polarized Lenses – Polycarbonate $13 $18 80% of U&C $13 $18 80% of U&C DE Polarized/Laminated Lenses – Glass $49 $29 80% of U&C $63 $38 80% of U&C

Bifocal Lens Styles (Mark bifocal box.) Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay

IA Near Variable Focus – Plastic ------$26 $24 80% of U&C +IB Near Variable Focus – High-index Plastic 1.53–1.60 ------$11 $13 80% of U&C +II Near Variable Focus – High-index Plastic 1.66/1.67 ------$27 $23 80% of U&C +ID Near Variable Focus – Polycarbonate ------$7 $13 80% of U&C GA Blended Bifocal – Plastic ------$14 $16 80% of U&C

Plastic Dyes Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay MM (Lab Use Only) ------MN Plastic Dyes – Solid Color (Except Pink I & II) $5 $10 $15 $5 $10 $15 MP Plastic Dyes – Gradient $7 $10 $17 $7 $10 $17

1. For VSP Essentials Plan: Refer to Patient Record Report for Patient Copay information. See the Advantage Network Manual to learn more. +This lens enhancement code is always in conjunction with a base lens enhancement code [shaded], e.g., IB is charged with IA. Please note: For children, handicapped patients, or for patients under the Federal Plan, there is no Service Fee for covered polycarbonate lenses when dispensed. Eﬀective July 1, 2018 Advantage Network

Glass Tints and Color Coatings Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay MQ (Lab Use Only) ------MR Glass Tints Solid (Except Pink I & II & Yellow) $16 $18 $34 $24 $20 $44 MS Glass Color Coatings – Solid $22 $20 80% of U&C $22 $20 80% of U&C MT Glass Color Coatings – Gradient $25 $21 80% of U&C $25 $21 80% of U&C

Photochromics Single Vision Multifocal

Other Coatings Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay QM Anti-reflective Coating A $21 $20 $41 $21 $20 $41 QN Anti-reflective Coating B $34 $24 $58 $34 $24 $58 QT Anti-reflective Coating C $41 $28 $69 $41 $28 $69 QV Anti-reflective Coating D $52 $33 80% of U&C $52 $33 80% of U&C QP Mirror – Solid & Single Gradient (Includes Base Color) $26 $23 80% of U&C $26 $23 80% of U&C QR Ski Type (Includes Base Tint and Backside Color) $30 $25 80% of U&C $30 $25 80% of U&C QQ Scratch-resistant Coating A – Factory Applied $7 $10 80% of U&C $7 $10 80% of U&C QS Scratch-resistant Coating B – Other Approved Coatings $15 $18 80% of U&C $15 $18 80% of U&C

Oversize Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay RM Frames Stamped 61mm Eye Size or Greater – Plastic $5 $6 80% of U&C $6 $8 80% of U&C RN Frames Stamped 61mm Eye Size or Greater – Glass $7 $6 80% of U&C $10 $8 80% of U&C

Miscellaneous Single Vision Multifocal

Doctor Supplied Single Vision Multifocal

Code Lens Enhancement Description Charge Back Service Fee Patient Copay Charge Back Service Fee Patient Copay IM Plastic Dyes – Solid Color (Pink I & II) $5 -- -- $5 -- -- IN Plastic Dyes – Solid Color (Except Pink I & II) $5 $10 $15 $5 $10 $15 IP Plastic Dyes – Gradient $7 $10 $17 $7 $10 $17 IV UV Protection $6 $10 $16 $6 $10 $16

Progressive

Code Lens Enhancement Description Charge Back Service Fee2 Patient Copay CM Custom Measurements (on Eligible Progressive N or O) Lenses $2 $8 80% of U&C NA Progressive N – Plastic $95 $80 80% of U&C NA + NB Progressive N – High-index Plastic 1.53–1.60/Trivex $25 $22 80% of U&C NA + NH Progressive N – High-index Plastic 1.66/1.67 $48 $30 80% of U&C NA + NJ Progressive N – High-index Plastic 1.70 & Above $77 $48 80% of U&C NA + ND Progressive N – Polycarbonate $15 $20 80% of U&C NA + NP Progressive N – Polarized $51 $31 80% of U&C OA Progressive O – Plastic $79 $71 80% of U&C OA + OB Progressive O – High-index Plastic 1.53–1.60/Trivex $25 $22 80% of U&C OA + OH Progressive O – High-index Plastic 1.66/1.67 $48 $30 80% of U&C OA + OJ Progressive O – High-index Plastic 1.70 & Above $77 $48 80% of U&C OA + OD Progressive O – Polycarbonate $15 $20 80% of U&C OA + OP Progressive O – Polarized $51 $31 80% of U&C FA Progressive F – Plastic $54 $51 $105 FA + FB Progressive F – High-index Plastic 1.53–1.60/Trivex $25 $22 $105 + 80% of U&C3 FA + FH Progressive F – High-index Plastic 1.66/1.67 $48 $30 $105 + 80% of U&C3 FA + FJ Progressive F – High-index Plastic 1.70 & Above $77 $48 $105 + 80% of U&C3 FA + FD Progressive F – Polycarbonate $15 $20 $105 + $35 FA + FP Progressive F – Polarized $51 $31 $105 + 80% of U&C3 FE Progressive F – Glass/High-index Glass (Clear) $59 $51 $110 JA Progressive J – Plastic $46 $49 $95 JA + JB Progressive J – High-index Plastic 1.53–1.60/Trivex $25 $22 $95 + 80% of U&C3 JA + JH Progressive J – High-index Plastic 1.66/1.67 $48 $30 $95 + 80% of U&C3 JA + JJ Progressive J – High-index Plastic 1.70 & Above $77 $48 $95 + 80% of U&C3 JA + JD Progressive J – Polycarbonate $15 $20 $95 + $35 JA + JP Progressive J – Polarized $51 $31 $95 + 80% of U&C3 JE Progressive J – Glass/High-index Glass (Clear) $56 $49 $105 KA Progressive K – Plastic $28 $27 $55 KA + KB Progressive K – High-index Plastic 1.53–1.60/Trivex $25 $22 $55 + 80% of U&C3 KA + KH Progressive K – High-index Plastic 1.66/1.67 $48 $30 $55 + 80% of U&C3 KA + KJ Progressive K – High-index Plastic 1.70 & Above $77 $48 $55 + 80% of U&C3 KA + KD Progressive K – Polycarbonate $15 $20 $55 + $35 KA + KP Progressive K – Polarized $51 $31 $55 + 80% of U&C3 KE Progressive K – Glass/High-index Glass (Clear) $53 $27 $80 2. The Service Fee for progressives is paid in addition to your VSP Choice Plan® bifocal lens dispensing fee. Please note: For children, handicapped patients, or for patients under the Federal Plan, there is no Service Fee for covered polycarbonate lenses when dispensed. 3. To determine the lens enhancement price, subtract your U&C price of the standard lens enhancement, (i.e., KA progressive), from your U&C price of the premium material lens enhancement, (i.e., KP polarized).

Progressive Categories4 as of 7/1/2018

Autograph III*, Hoyalux iD LifeStyle/2*, UNITY® Via Elite*, Varilux Physio Enhanced Fit/W3+ Fit*, Varilux X Fit Technology*, ZEISS DriveSafe N Individual*, ZEISS Individual 2* Custom Autograph II+*, Kodak Unique, Shamir Intouch, synchrony Performance HDV, UNITY Via Plus/Mobile/Wrap*, Varilux Comfort W2+ Fit*, Varilux O Physio Enhanced/W3+*, Varilux X Design Technology*, ZEISS Precision KODAK Digital Precise, Shamir Spectrum+, synchrony Performance HD, UNITY Via, Varilux Comfort 2 DRx/Enhanced/W2+, Varilux Physio/DRx, F ZEISS GT2, ZEISS Choice Premium J Ethos® Plus, Hoyalux GP Wide, Ideal, Kodak Precise/PB/Short, Shamir Element, synchrony Easy Adapt, Varilux Comfort 2, Varilux Ellipse

Accolade, Adaptar, Amplitude/Mini/BKS, Ethos, Image, Kodak Concise, Natural/Digital, Navigator, Ovation, SmallFit, Standard K synchrony Easy View/HD, VIP

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