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
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 $41.99, Regular price was $70.59, You save 40%
Unit of measure 4000/Carton
Free Next-Day eligible by tomorrow
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 $179.99, Regular price was $319.99, You save 43%
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 $119.99, Regular price was $189.99, You save 36%
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 $139.99, Regular price was $299.99, You save 53%
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 $39.99, Regular price was $81.99, You save 51%
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
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 Claim Forms (02/12), 8-1/2" x 11", Box of 1,000 (CMS12LC1) | ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 500 (CMS12LC500) | 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 $27.69 |  Price is $85.89 |  Price is $48.09 |  Price is $34.59 | |
| Reviews | |||||
| Delivery Information | Delivery by Mon, Apr 06 | Delivery by Mon, Apr 06 | Free Next-Day eligible by tomorrow | Free delivery by Mon, Apr 06 | Next-Day Delivery by tomorrow |
| Available in my store | No | No | No | No | No |
| Length in Inches | 11 | 11 | 11 | 11 | 11 |
| Medical Form Pack Size | 250 | 250 | 1000 | 500 | 250 |
| 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 | Consent |
| True Color | White / Red | White / Red | White / Red | White / Red | Red and White |
| Print Type | Laser | Laser | Laser | Laser | Continuous |
| Number of Parts | 1 | 1 | 1 | 1 | 1 |
| Form Size | Data not available | Data not available | Data not available | Data not available | 8 1 / 2" x 11" |
| Series or Collection | Data not available | Data not available | Data not available | Data not available | 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 $81.69
Unit of measure 500/Box
Free delivery by Fri, Apr 03
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 $24.49
Unit of measure 100/Pack
Delivery by Fri, Apr 03
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 Fri, Apr 03
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 Fri, Apr 03
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 $24.49
Unit of measure 50/Pack
Delivery by Fri, Apr 03
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
