| Quantity Number of | Lot Price |
| 50 | $19.20 |
| 100 | $36.60 |
| 200 | $64.03 |
| 300 | $77.76 |
| 500 | $105.77 |
| 1000 | $181.25 |
| >1000 | Call us at 1-800-982-3676 or Email Us For Price |
If your employee has more than 6 people covered on their insurance, use this form (with the 1095-B) for the extra people