ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
$28.59
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Highlights
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- Designed for hospitals to file a medical claim with the patient's insurance carrier
- One-part health insurance forms
- Printed with OCR dropout red ink on white paper
MADE IN AMERICA
ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
Item #: 24614845Model #: UB04LC5
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$28.59
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Price is $143.09
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About this product
Complete billing tasks with these TFP UB-04 one-part hospital claim forms
Ensure proper processing of medical procedures and patient care with these hospital claim forms. The 20-pound bond paper offers added durability and is easy to load in office printers, while the one-part format creates a crisp, high-quality master copy. Each of these TFP UB-04 hospital claim forms features preprinted sections for services, codes, and rates, along with each patient's personal information for accurate reporting.
- Designed for hospitals to file a medical claim with the patient's insurance carrier
- One-part health insurance forms
- Printed with OCR dropout red ink on white paper
- Developed in conjunction with all the governing agencies
- Comes in laser-cut sheet format
Frequently bought together
Price is $23.09
Unit of measure 6/Pack
Next-Day Delivery by tomorrow
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Price is $8.89
Unit of measure 36/Pack Price per unit $0.25/Pen
Next-Day Delivery by tomorrow
1-hr pickup
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Over 30
Price is $15.99, Regular price was $19.49, You save 17%
Unit of measure 10/Pack Price per unit $1.60/Correction Tape
Next-Day Delivery by tomorrow
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Over 30
Price is $0.50, Regular price was $3.09, You save 83%
Unit of measure 8/Pack Price per unit $0.06/Pencil
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Price is $16.99, Regular price was $20.59, You save 17%
Unit of measure 100/Box Price per unit $0.17/File Folder
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1-hr pickup
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Staples Block Erasers, Pink, 3/Pack (10433-CC) is In-store only
Price is $1.00, Regular price was $3.79, You save 73%
Unit of measure 3/Pack Price per unit $0.33/Eraser
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1-hr pickup
Price is $1.99, Regular price was $4.29, You save 53%
Unit of measure 5/Pack Price per unit $0.40/Highlighter
Next-Day Delivery by tomorrow
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Price is $0.50, Regular price was $2.19, You save 77%
Unit of measure Dozen Price per unit $0.04/Eraser
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Price is $9.99, Regular price was $12.69, You save 21%
Unit of measure Dozen Price per unit $0.83/Marker
Next-Day Delivery by tomorrow
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Price is $6.99, Regular price was $8.69, You save 19%
Unit of measure 60/Pack Price per unit $0.12/Pen
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Over 30
Price is $0.25, Regular price was $0.79, You save 68%
Next-Day Delivery by tomorrow
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Over 30
Price is $15.69
Unit of measure Dozen Price per unit $0.01/Post-it® Note
Next-Day Delivery by tomorrow
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Over 30
Price is $16.99, Regular price was $19.59, You save 13%
Unit of measure Dozen Price per unit $1.42/Pad
Next-Day Delivery by tomorrow
1-hr pickup
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Over 30
Price is $6.99, Regular price was $8.19, You save 14%
Unit of measure 4/Pack Price per unit $1.75/Correction Tape
Next-Day Delivery by tomorrow
1-hr pickup
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Over 30
Price is $9.99
Unit of measure 1000/Pack Price per unit $0.01/Paper Clip
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Over 30
Price is $4.29, Regular price was $7.29, You save 41%
Unit of measure 18/Pack Price per unit $0.24/Pencil
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Over 30
Price is $27.99, Regular price was $31.69, You save 11%
Unit of measure 250/Box Price per unit $0.11/File Folder
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Over 30
Price is $0.55, Regular price was $2.49, You save 77%
Price per unit $0.55/Folder
Next-Day Delivery by tomorrow
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Price is $0.55, Regular price was $2.59, You save 78%
Price per unit $0.55/Folder
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Price is $8.69
Unit of measure 12/Pack Price per unit $0.72/Binder Clip
Next-Day Delivery by tomorrow
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Compare similar items
| Attributes | ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) | ComplyRight CMS-1500 Jumbo Health Care Billing Envelope, 500/Pack (1500LR500) | ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250) | ComplyRight 2024 ADA Dental Claim Forms, 500 Forms/Pack (20241500) | ComplyRight 2024 ADA Dental Claim Forms, 2,500 Forms/Pack (20241) |
|---|---|---|---|---|---|
Your product ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) Price is $28.59 |  Price is $143.09 |  Price is $33.19 |  Price is $42.49 |  Price is $130.39 | |
| Reviews | |||||
| Delivery Information | Delivery by Mon, Jul 28 | Free delivery by Thu, Jul 24 | Next-Day Delivery by tomorrow | Free delivery by Thu, Jul 24 | Free delivery by Thu, Jul 24 |
| Available in my store | No | No | No | No | No |
| Width in Inches | 8.5 | Data not available | 8.5 | 8.5 | 8.5 |
| Length in Inches | 11 | Data not available | 11 | 11 | 11 |
| Medical Form Pack Size | 500 | 500 | 250 | 500 | 2500 |
| Medical Form Type | Health Insurance Claims | Health Insurance Claims | Health Insurance Claims | Dental Claims | Dental Claims |
| Print Type | Laser | Data not available | Laser | Laser | Laser |
| Acid Free | Acid Free | Data not available | Data not available | Acid Free | Acid Free |
| Price Per Unit | Data not available | Data not available | Data not available | Data not available | Data not available |
| Add To Cart | Add To Cart | Add To Cart | Add To Cart |
Featured Products
Price is $37.99
Unit of measure 100/Pack
Free delivery by Tue, Jul 22
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Price is $45.79
Unit of measure 100/Pack
Free delivery by Tue, Jul 22
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Over 30
Price is $45.12, Regular price was $56.40, You save 20%
Unit of measure 25/Pack
Free delivery by Tue, Jul 22
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Price is $38.89
Unit of measure 50/Pack
Free delivery by Tue, Jul 22
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Price is $26.49
Unit of measure 50/Pack
Delivery by Tue, Jul 22
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Over 30
Price is $21.95
Delivery by Fri, Jul 25
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Over 30
Price is $32.09
Unit of measure 100/Pack
Delivery by Tue, Jul 22
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Price is $32.09
Unit of measure 100/Pack
Delivery by Tue, Jul 22
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Price is $51.95
Unit of measure 50/Pack
Free delivery by Tue, Jul 22
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Price is $45.79
Unit of measure 100/Pack
Free delivery by Tue, Jul 22
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Over 30
Price is $32.09
Unit of measure 100/Pack
Delivery by Tue, Jul 22
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Over 30
Price is $32.09
Unit of measure 50/Pack
Delivery by Tue, Jul 22
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Over 30
Price is $45.79
Unit of measure 100/Pack
Free delivery by Tue, Jul 22
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Over 30
Price is $20.79
Unit of measure 50/Pack
Delivery by Tue, Jul 22
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Over 30
Price is $32.09
Unit of measure 50/Pack
Delivery by Tue, Jul 22
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