TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2" X 11", 2500/Carton (59770R
$95.59
Highlights
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- Revised Format
- AMA approved format
- Use TOPS UB-04 forms with confidence
MADE IN AMERICA
TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2" X 11", 2500/Carton (59770R
Item #: 890389Model #: 59770R
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$95.59
2500/carton
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About this product
The UB-04 is the form hospitals and institutions use to file a medical claim with the patient's insurance company
- Revised Format
- AMA approved format
- Use TOPS UB-04 forms with confidence
- They meet the requirements of the Centers for Medicare and Medicaid Services (CMS) and are available in Laser and Continuous formats
- Made in the USA
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Price is $39.99, Regular price was $89.99, You save 55%
Free delivery by Mon, Mar 16
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Price is $48.99, Regular price was $81.99, You save 40%
Unit of measure 5000/Carton
Free delivery by Tue, Mar 10
30-min pickup
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Price is $16.59, Regular price was $26.19, You save 36%
Unit of measure 1500/Carton
Delivery by Tue, Mar 10
30-min pickup
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Price is $379.99, Regular price was $579.99, You save 34%
Free delivery by Wed, Mar 11
30-min pickup
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Price is $40.99, Regular price was $70.59, You save 41%
Unit of measure 4000/Carton
Free delivery by Tue, Mar 10
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Compare similar items
| Attributes | TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2" X 11", 2500/Carton (59770R | ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 250 (CMS12LC250) | ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 1,000 (CMS12LC1) | ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250) | TOPS Centers for Medicare and Medicaid Services Forms, 8-1/2" x 11", 250/Pack (50135RV) |
|---|---|---|---|---|---|
Your product TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2" X 11", 2500/Carton (59770R Price is $95.59 Out of Stock |  Price is $26.99 |  Price is $85.89 |  Price is $34.09 |  Price is $34.59 | |
| Reviews | |||||
| Delivery Information | Data not available | Delivery by Mon, Mar 16 | Free delivery by Tue, Mar 10 | Delivery by Tue, Mar 10 | Delivery by Tue, Mar 10 |
| Available in my store | No | No | No | No | No |
| Medical Form Pack Size | 2500 | 250 | 1000 | 250 | 250 |
| Medical Form Type | Health Insurance Claims | Health Insurance Claims | Health Insurance Claims | Health Insurance Claims | Consent |
| Length in Inches | 11 | 11 | 11 | 11 | 11 |
| Width in Inches | 8.5 | 8.5 | 8.5 | 8.5 | 8.5 |
| True Color | White | White / Red | White / Red | White | Red and White |
| Print Type | Continuous | Laser | Laser | Laser | Continuous |
| Number of Parts | 1 | 1 | 1 | Data not available | 1 |
| Form Size | 8 1 / 2" x 11" | Data not available | Data not available | 8 1 / 2" x 11" | 8 1 / 2" x 11" |
| Series or Collection | UB04 Health Care Form | Data not available | Data not available | CMS-1500 | Centers for Medicare and Medicaid Services |
| Add To Cart | Add To Cart | Add To Cart | Add To Cart |
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