TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2" X 11", 2500/Carton (59770R
$95.59
Highlights
View all details
- 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
No reviews yet
$95.59
2500/carton
Free Returns
Online. In store. Always free.
Learn More
Add to list
Consider these alternatives
Page 1 of 2
No reviews yet
Price is $54.19
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
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
Frequently bought together
Page 1 of 4
Price is $18.49
Delivery by Fri, Aug 07
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Add to list
Price is $279.99, Regular price was $399.99, You save 30%
Delivery fees may apply
30-min pickup
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Add to list
Price is $154.99, Regular price was $299.99, You save 48%
Free Next-Day eligible by tomorrow
30-min pickup
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Add to list
Price is $49.99, Regular price was $83.19, You save 39%
Unit of measure 5000/Carton
Free Next-Day eligible by tomorrow
30-min pickup
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Add to list
Price is $0.25, Regular price was $0.79, You save 68%
Next-Day Delivery by tomorrow
30-min pickup
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Add to list
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 500 (CMS12LC500) | 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 $48.09 |  Price is $85.89 |  Price is $34.09 |  Price is $34.59 | |
| Reviews | |||||
| Delivery Information | Data not available | Free delivery by Tue, Aug 11 | Free Next-Day eligible by tomorrow | Next-Day Delivery by tomorrow | Next-Day Delivery by tomorrow |
| Available in my store | No | No | No | No | No |
| Medical Form Pack Size | 2500 | 500 | 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 |
Featured Products
Page 1 of 3
Price is $49.59
Unit of measure 250/Box
Free delivery by Wed, Aug 05
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Add to list
Price is $81.69
Unit of measure 500/Box
Free delivery by Wed, Aug 05
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Add to list
Price is $65.39
Unit of measure 500/Ream
Free delivery by Wed, Aug 05
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Add to list
Price is $26.49
Unit of measure 50/Pack
Delivery by Wed, Aug 05
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Add to list
Price is $14.39
Unit of measure 50/Pack
Delivery by Wed, Aug 05
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
Add to list
