TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2" X 11", 2500/Carton (59770R

$95.59

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TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2" X 11", 2500/Carton (59770R~#|#~s0320918_sc7

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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

Name: TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2" X 11", 2500/Carton (59770R
Brand: TOPS
SKU: 890389
Price: 95.59 USD
Availability: OutOfStock

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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Product specifications table
Attributes	TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2" X 11", 2500/Carton (59770R	Adams CMS-1500 Health Insurance Claims, 100/Pack (CMS1500L1V)	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 CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 1,000 (CMS12LC1)
	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 $24.79	Price is $91.89	Price is $49.29	Price is $85.89
Reviews	No reviews yet	4.73 71	4.82 60	4.75 36	4.82 87
Delivery Information	Data not available	Next-Day Delivery by Mon, Nov 09	Free delivery by Fri, Nov 13	Free delivery by Fri, Nov 13	Free Next-Day eligible by Mon, Nov 09
Available in my store	No	Yes	No	No	No
Medical Form Pack Size	2500	100	2500	500	1000
Medical Form Type	Health Insurance Claims	Health Insurance Claims	Health Insurance Claims	Health Insurance Claims	Health Insurance Claims
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	White / Red
Number of Parts	1	1	1	1	1
Print Type	Continuous	Data not available	Laser	Laser	Laser
Form Size	8 1 / 2" x 11"	8 1 / 2" x 11"	8 1 / 2" x 11"	Data not available	Data not available
Series or Collection	UB04 Health Care Form	CMS-1500	CMS-1500	Data not available	Data not available
	Add To Cart	Add To Cart	Add To Cart	Add To Cart