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

$195.39

Out of stock for delivery to

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: 195.39 USD
Availability: OutOfStock

Item #: 890389Model #: 59770R

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Final price is $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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Product specifications table
Attributes	TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2" X 11", 2500/Carton (59770R	ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)	ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 1,000 (CMS12LC1)	Adams CMS-1500 Health Insurance Claims, 100/Pack (CMS1500L1V)	TOPS CMS-1500 Health Insurance Claims, 500/Pack (TOP 50126RV)
	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 $34.09	Price is $85.89	Price is $24.79	Price is $51.89
Reviews	No reviews yet	4.76 49	4.8 82	4.72 68	4.92 12
Delivery Information	Data not available	Delivery by Tue, Dec 02	Free delivery by Wed, Nov 26	Delivery by Wed, Nov 26	Free delivery by Wed, Nov 26
Available in my store	No	No	No	Yes	No
Medical Form Pack Size	2500	250	1000	100	500
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	White / Red	White / Red	White / Red
Print Type	Continuous	Laser	Laser	Data not available	Laser
Number of Parts	1	Data not available	1	1	1
Form Size	8 1 / 2" x 11"	8 1 / 2" x 11"	Data not available	8 1 / 2" x 11"	8 1 / 2" x 11"
Series or Collection	UB04 Health Care Form	CMS-1500	Data not available	CMS-1500	CMS-1500
	Add To Cart	Add To Cart	Add To Cart	Add To Cart