ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
$30.19
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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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$30.19
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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
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Price is $75.89
Unit of measure 1500/Box
Free delivery by Fri, May 22
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Price is $45.99
Unit of measure 6/Carton Price per unit $0.55/Oz
Free Next-Day eligible by tomorrow
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Price is $155.99
Unit of measure 25/Pack
Free Next-Day eligible by tomorrow
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Mr. Clean PRO All Surface Cleaner Commercial Grade, 1 Gallon (24345) is New at Staples
Price is $18.49
Next-Day Delivery by tomorrow
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Price is $12.29
Price per unit $0.88/Oz
Next-Day Delivery by tomorrow
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Compare similar items
| Attributes | ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) | TFP UB-04 CMS-1450 Health Insurance Claims, 2500/Carton (UB04LC) | ComplyRight CMS-1500 Health Insurance Claims, 2500/Pack (CMS12LC) | ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 500 (CMS12LC500) | 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 $30.19 |  Price is $93.89 |  Price is $91.89 |  Price is $48.09 |  Price is $133.69 | |
| Reviews | |||||
| Delivery Information | Delivery by Wed, May 27 | Free delivery by Thu, May 21 | Free delivery by Thu, May 21 | Free delivery by Thu, May 21 | Free delivery by Thu, May 21 |
| Available in my store | No | No | No | No | No |
| Medical Form Pack Size | 500 | 2500 | 2500 | 500 | 2500 |
| Length in Inches | 11 | Data not available | 11 | 11 | 11 |
| Width in Inches | 8.5 | Data not available | 8.5 | 8.5 | 8.5 |
| Medical Form Type | Health Insurance Claims | Health Insurance Claims | Health Insurance Claims | Health Insurance Claims | Dental Claims |
| Print Type | Laser | Laser | Laser | Laser | Laser |
| Acid Free | Acid Free | Data not available | Acid Free | Acid Free | Acid Free |
| Add To Cart | Add To Cart | Add To Cart | Add To Cart |
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Page 1 of 3
Price is $49.59
Unit of measure 250/Box
Free delivery by Wed, May 20
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Price is $16.79
Unit of measure 100/Pack
Delivery by Wed, May 20
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Price is $28.69
Unit of measure 50/Pack
Delivery by Wed, May 20
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Price is $16.19
Delivery by Tue, May 26
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Price is $53.79
Unit of measure 50/Pack
Free delivery by Wed, May 20
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