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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Final price is $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
Page 1 of 1
Price is $36.49
Free delivery by Wed, Apr 15
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Price is $14.99
Delivery by Mon, Apr 13
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Price is $14.99
Delivery by Mon, Apr 13
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Price is $8.29
Delivery by Wed, Apr 08
30-min pickup
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Price is $19.99
Unit of measure 22/Box
Delivery by Tue, Apr 07
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Price is $11.99
Unit of measure 2/Pack
Delivery by Tue, Apr 07
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Price is $10.99
Unit of measure Dozen Price per unit $0.92/Highlighter
Delivery by Wed, Apr 08
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Price is $20.39
Delivery by Tue, Apr 07
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Price is $12.99
Unit of measure 160/Pack Price per unit $0.08/Flag
Delivery by Tue, Apr 07
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Price is $5.49
Delivery by Tue, Apr 07
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Price is $3.79
Unit of measure Dozen Price per unit $0.32/Pen
Delivery by Tue, Apr 07
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Price is $7.89
Price per unit $0.81/Fl Oz
Delivery by Tue, Apr 07
30-min pickup
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Febreze Air Mist Air Freshener Spray, Lilac Sunrise/Juicy Summer Peaches/Mango Splash Scent, 8 oz., 3/Pack (21291) is New at Staples
Price is $11.29
Delivery by Tue, Apr 07
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Price is $3.99
Unit of measure 4/Pack
Delivery by Tue, Apr 07
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Price is $24.59
Unit of measure 180/Carton Price per unit $0.14/Tub
Delivery by Tue, Apr 07
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Price is $19.99
Unit of measure 24/Box Price per unit $0.83/Pod
Delivery by Tue, Apr 07
30-min pickup
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Price is $43.99, Regular price was $76.99, You save 42%
Unit of measure 96/Carton Price per unit $0.46/Pod
Free delivery by Tue, Apr 07
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Price is $41.99, Regular price was $70.59, You save 40%
Unit of measure 4000/Carton
Free delivery by Tue, Apr 07
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Price is $329.99, Regular price was $469.99, You save 29%
Free delivery by Tue, Apr 07
30-min pickup
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Price is $399.99, Regular price was $579.99, You save 31%
Free delivery by Tue, Apr 07
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, 2,500 Forms/Pack (20241) | ComplyRight 2024 ADA Dental Claim Forms, 1,000 Forms/Pack (202411) | ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250) | ComplyRight Notice of Privacy Practice, 100/Pack (A1349) |
|---|---|---|---|---|---|
Your product ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) Price is $30.19 |  Price is $133.69 |  Price is $66.89 |  Price is $34.09 |  Price is $19.59 | |
| Reviews | |||||
| Delivery Information | Delivery by Thu, Apr 16 | Free delivery by Tue, Apr 14 | Free delivery by Tue, Apr 14 | Delivery by Tue, Apr 07 | Delivery by Wed, Apr 15 |
| Available in my store | No | No | No | No | No |
| Width in Inches | 8.5 | 8.5 | 8.5 | 8.5 | 8.5 |
| Length in Inches | 11 | 11 | 11 | 11 | 11 |
| Medical Form Pack Size | 500 | 2500 | 1000 | 250 | 100 |
| Medical Form Type | Health Insurance Claims | Dental Claims | Dental Claims | Health Insurance Claims | Privacy Practice |
| Print Type | Laser | Laser | Laser | Laser | Data not available |
| Acid Free | Acid Free | Acid Free | Acid Free | Data not available | Data not available |
| 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 |
