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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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 $33.19
Unit of measure 250/Pack
Delivery by Fri, Aug 29
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Over 30
Price is $49.89
Unit of measure 100/Box
Free delivery by Thu, Sep 04
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Price is $34.19
Unit of measure 100/Box
Delivery by Fri, Aug 29
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Over 30
Price is $35.39
Unit of measure 100/Box
Free delivery by Fri, Aug 29
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Over 30
Price is $96.79
Unit of measure 25/Pack
Free delivery by Fri, Aug 29
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Over 30
Price is $23.09
Unit of measure 6/Pack
Delivery by Fri, Aug 29
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Over 30
Price is $25.39
Unit of measure 250/Box
Delivery by Thu, Sep 04
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Over 30
Price is $49.49
Unit of measure 25/Box Price per unit $1.98/File Pocket
Free delivery by Fri, Aug 29
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Over 30
Price is $35.99
Unit of measure 100/Box Price per unit $0.36/Envelope
Free delivery by Fri, Aug 29
30-min pickup
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Over 30
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Price is $499.99
Free delivery by Thu, Oct 09
30-min pickup
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Over 30
Price is $0.50, Regular price was $4.09, You save 87%
Delivery by Fri, Aug 29
30-min pickup
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Price is $59.99, Regular price was $129.99, You save 53%
Free delivery by Fri, Aug 29
30-min pickup
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Over 30
Price is $449.99, Regular price was $719.99, You save 37%
Free delivery by Wed, Sep 03
30-min pickup
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Over 30
Price is $149.99, Regular price was $319.99, You save 53%
Free delivery by Fri, Aug 29
30-min pickup
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Over 30
Price is $249.99, Regular price was $529.99, You save 52%
Free delivery by Fri, Aug 29
30-min pickup
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Over 30
Price is $1.99, Regular price was $6.36, You save 68%
Delivery by Fri, Aug 29
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Price is $0.25, Regular price was $0.79, You save 68%
Delivery by Fri, Aug 29
30-min pickup
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Over 30
Price is $70.09
Unit of measure 4000/Carton
Free delivery by Fri, Aug 29
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Compare similar items
| Attributes | ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) | ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250) | ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 500 (CMS12LC500) | 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 $33.19 |  Price is $46.89 |  Price is $42.49 |  Price is $130.39 | |
| Reviews | |||||
| Delivery Information | Delivery by Tue, Sep 09 | Delivery by Fri, Aug 29 | Free delivery by Fri, Sep 05 | Free delivery by Fri, Sep 05 | Free delivery by Fri, Sep 05 |
| Available in my store | No | No | No | No | No |
| Medical Form Pack Size | 500 | 250 | 500 | 500 | 2500 |
| Width in Inches | 8.5 | 8.5 | 8.5 | 8.5 | 8.5 |
| Medical Form Type | Health Insurance Claims | Health Insurance Claims | Health Insurance Claims | Dental Claims | Dental Claims |
| Length in Inches | 11 | 11 | 11 | 11 | 11 |
| Print Type | Laser | Laser | Laser | Laser | Laser |
| Acid Free | Acid Free | Data not available | Acid Free | 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 $79.69
Unit of measure 500/Box
Free delivery by Thu, Sep 04
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Over 30
Price is $45.79
Unit of measure 100/Pack
Free delivery by Thu, Sep 04
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Over 30
Price is $49.59
Unit of measure 250/Box
Free delivery by Thu, Sep 04
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Over 30
Price is $12.69
Delivery by Mon, Sep 08
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Over 30
Price is $26.49
Unit of measure 50/Pack
Delivery by Thu, Sep 04
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Price is $17.39
Unit of measure 50/Pack
Delivery by Thu, Sep 04
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Over 30
Price is $58.79
Unit of measure 50/Pack
Free delivery by Thu, Sep 04
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Price is $33.29
Delivery by Mon, Sep 08
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Over 30
Price is $57.29
Free delivery by Mon, Sep 08
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Over 30
Price is $64.19
Unit of measure 50/Pack
Free delivery by Thu, Sep 04
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Price is $56.19
Free delivery by Mon, Sep 08
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Over 30
Price is $29.29
Delivery by Mon, Sep 08
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Over 30
Price is $19.59
Delivery by Mon, Sep 08
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Over 30
Price is $60.79
Unit of measure 50/Pack
Free delivery by Thu, Sep 04
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Over 30
Price is $52.19
Unit of measure 50/Pack
Free delivery by Mon, Sep 08
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