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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$195.39
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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Unit of measure 4000/Carton
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Unit of measure 100/Box Price per unit $0.17/File Folder
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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 Claims, 2500/Pack (CMS12LC) | TOPS CMS-1500 Health Insurance Claims, 500/Pack (TOP 50126RV) | 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 $195.39 Out of Stock |  Price is $89.59 | Price is $50.59 |  Price is $46.89 | Price is $83.79 | |
| Reviews | |||||
| Delivery Information | Data not available | Free delivery by Wed, Sep 10 | Free Next-Day eligible by tomorrow | Free delivery by Wed, Sep 10 | Free Next-Day eligible by tomorrow |
| Available in my store | No | No | No | No | No |
| Length in Inches | 11 | 11 | 11 | 11 | 11 |
| Medical Form Pack Size | 2500 | 2500 | 500 | 500 | 1000 |
| Width in Inches | 8.5 | 8.5 | 8.5 | 8.5 | 8.5 |
| Medical Form Type | Health Insurance Claims | Health Insurance Claims | Health Insurance Claims | Health Insurance Claims | Health Insurance Claims |
| True Color | White | White / Red | White / Red | White / Red | White / Red |
| Print Type | Continuous | Laser | Laser | Laser | Laser |
| Number of Parts | 1 | 1 | 1 | 1 | 1 |
| 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 |
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Unit of measure 100/Pack
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