ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
$29.39
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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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$29.39
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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 $14.49
Unit of measure 24/Pack Price per unit $0.60/Wipe
Next-Day Delivery by tomorrow
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Price is $34.09
Unit of measure 250/Pack
Next-Day Delivery by tomorrow
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Price is $16.39
Unit of measure 6/Pack Price per unit $2.73/Roll
Next-Day Delivery by tomorrow
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Price is $4.59
Unit of measure 2/Pack Price per unit $2.30/Refill
Next-Day Delivery by tomorrow
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Over 30
Price is $17.99, Regular price was $26.79, You save 32%
Unit of measure 100/Box Price per unit $0.18/Envelope
Next-Day Delivery by tomorrow
30-min pickup
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Over 30
Price is $4.49
Next-Day Delivery by tomorrow
30-min pickup
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Price is $129.99, Regular price was $299.99, You save 56%
Free Next-Day eligible by tomorrow
30-min pickup
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Price is $7.99
Next-Day Delivery by tomorrow
30-min pickup
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Price is $16.99, Regular price was $26.14, You save 35%
Unit of measure 1500/Carton
Next-Day Delivery by tomorrow
30-min pickup
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Over 30
Price is $109.99, Regular price was $179.99, You save 38%
Free Next-Day eligible by tomorrow
30-min pickup
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Over 30
Price is $6.89
Next-Day Delivery by tomorrow
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Price is $14.99, Regular price was $20.59, You save 27%
Unit of measure 100/Box Price per unit $0.15/File Folder
Next-Day Delivery by tomorrow
30-min pickup
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Over 30
Price is $2.69
Price per unit $2.69/Folder
Next-Day Delivery by tomorrow
30-min pickup
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Price is $349.99, Regular price was $579.99, You save 39%
Free Next-Day eligible by tomorrow
30-min pickup
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Over 30
Price is $49.99, Regular price was $129.99, You save 61%
Free Next-Day eligible by tomorrow
30-min pickup
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Over 30
Price is $59.99, Regular price was $89.99, You save 33%
Free Next-Day eligible by tomorrow
30-min pickup
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Price is $149.99, Regular price was $319.99, You save 53%
Free Next-Day eligible by tomorrow
30-min pickup
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Over 30
Price is $34.99, Regular price was $68.99, You save 49%
Unit of measure 4000/Carton
Next-Day Delivery by tomorrow
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Price is $39.99, Regular price was $79.99, You save 50%
Unit of measure 5000/Carton
Free Next-Day eligible by tomorrow
30-min pickup
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Compare similar items
| Attributes | ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) | ComplyRight 2024 ADA Dental Claim Forms, 500 Forms/Pack (20241500) | ComplyRight 2024 ADA Dental Claim Forms, 2,500 Forms/Pack (20241) | ComplyRight 2024 ADA Dental Claim Forms, 100 Forms/Pack (20241100) | ComplyRight 2024 ADA Dental Claim Forms, 1,000 Forms/Pack (202411) |
|---|---|---|---|---|---|
Your product ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) Price is $29.39 |  Price is $43.59 |  Price is $133.69 |  Price is $16.79 |  Price is $66.89 | |
| Reviews | |||||
| Delivery Information | Delivery by Fri, Oct 17 | Free delivery by Tue, Oct 14 | Free delivery by Tue, Oct 14 | Delivery by Tue, Oct 14 | Free delivery by Tue, Oct 14 |
| Available in my store | No | No | No | No | No |
| Width in Inches | 8.5 | 8.5 | 8.5 | 8.5 | 8.5 |
| Medical Form Pack Size | 500 | 500 | 2500 | 100 | 1000 |
| Length in Inches | 11 | 11 | 11 | 11 | 11 |
| Medical Form Type | Health Insurance Claims | Dental Claims | Dental Claims | Dental Claims | Dental Claims |
| Print Type | Laser | Laser | Laser | Laser | Laser |
| Acid Free | Acid Free | Acid Free | 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 $14.19
Delivery by Thu, Oct 16
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Price is $20.19
Delivery by Thu, Oct 16
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Price is $15.59
Unit of measure 50/Pack
Delivery by Mon, Oct 13
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Price is $66.29
Unit of measure 50/Pack
Free delivery by Mon, Oct 13
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Price is $52.19
Unit of measure 50/Pack
Free delivery by Thu, Oct 16
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Price is $166.39
Free delivery by Thu, Oct 16
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Price is $21.95
Delivery by Thu, Oct 16
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Price is $17.39
Unit of measure 50/Pack
Delivery by Mon, Oct 13
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Price is $59.59
Free delivery by Thu, Oct 16
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Price is $306.69
Free delivery by Thu, Oct 16
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Price is $15.99
Unit of measure 10/Pack
Delivery by Mon, Oct 13
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Price is $24.49
Unit of measure 50/Pack
Delivery by Mon, Oct 13
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Over 30
Price is $12.69
Unit of measure 50/Pack
Delivery by Mon, Oct 13
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Price is $32.09
Unit of measure 100/Pack
Delivery by Mon, Oct 13
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Price is $57.29
Free delivery by Thu, Oct 16
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