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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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 $21.19
Unit of measure 100/Box Price per unit $0.21/File Folder
Delivery by Tue, May 20
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Unit of measure Dozen Price per unit $0.01/Post-it® Note
Delivery by Tue, May 20
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Price is $19.49
Unit of measure 10/Pack Price per unit $1.95/Correction Tape
Delivery by Tue, May 20
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Unit of measure 60/Pack Price per unit $0.14/Pen
Delivery by Tue, May 20
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Unit of measure 1000/Pack Price per unit $0.01/Paper Clip
Delivery by Tue, May 20
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Unit of measure 4/Pack Price per unit $2.05/Correction Tape
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Delivery by Tue, May 20
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Unit of measure 12/Pack Price per unit $0.83/Pad
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Unit of measure 144/Pack Price per unit $0.10/Binder Clip
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Unit of measure 12/Pack Price per unit $0.72/Binder Clip
Delivery by Tue, May 20
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Unit of measure 10/Pack Price per unit $2.05/Roll
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Unit of measure 24/Pack Price per unit $0.32/Binder Clip
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Unit of measure 12/Pack Price per unit $1.52/Roll
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Unit of measure 1000/Pack Price per unit $0.02/Paper Clip
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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 Claims, 2500/Pack (CMS12LC) | ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 1,000 (CMS12LC1) | 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 $26.29 |  Price is $89.59 |  Price is $83.79 | Price is $50.59 | |
| Reviews | |||||
| Delivery Information | Data not available | Delivery by Wed, May 28 | Free delivery by Wed, May 28 | Free delivery by Tue, May 20 | Free delivery by Tue, May 20 |
| Available in my store | No | No | No | No | No |
| Medical Form Pack Size | 2500 | 250 | 2500 | 1000 | 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 / 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" | Data not available | 8 1 / 2" x 11" | Data not available | 8 1 / 2" x 11" |
| Series or Collection | UB04 Health Care Form | Data not available | CMS-1500 | Data not available | CMS-1500 |
| Add To Cart | Add To Cart | Add To Cart | Add To Cart |
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Price is $21.95
Delivery by Thu, May 29
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Price is $20.19
Delivery by Thu, May 29
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Over 30
Price is $32.09
Unit of measure 100/Pack
Delivery by Fri, May 23
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Over 30
Price is $63.59
Unit of measure 25/Pack
Free delivery by Fri, May 23
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Price is $21.19
Unit of measure 50/Pack
Delivery by Fri, May 23
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Price is $38.89
Unit of measure 50/Pack
Free delivery by Fri, May 23
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Over 30
Price is $40.19
Unit of measure 50/Pack
Free delivery by Fri, May 23
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Price is $58.59
Unit of measure 50/Pack
Free delivery by Fri, May 23
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Over 30
Price is $52.59
Unit of measure 50/Pack
Free delivery by Fri, May 23
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Over 30
Price is $45.79
Unit of measure 50/Pack
Free delivery by Fri, May 23
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Over 30
Price is $21.69
Delivery by Thu, May 29
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Over 30
Price is $25.89
Unit of measure 50/Pack
Delivery by Fri, May 23
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Price is $24.49
Unit of measure 100/Pack
Delivery by Fri, May 23
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Over 30
Price is $25.29
Unit of measure 50/Pack
Delivery by Fri, May 23
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Over 30
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Unit of measure 5000/Carton
Free delivery by Tue, May 20
1-hr pickup
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