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TOPS UB-04 Continuous Forms 1 Part - 11 x 9.50 Form Size - White - Red Print Color - 2500 / Carton
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Product info
Product Name
TOPS UB-04 Continuous Forms 1 Part - 11 x 9.50 Form Size - White - Red Print Color - 2500 / Carton
Product Description
UB-04 continuous forms are designed for hospitals to file a claim with the patient s insurance company. The Health Care Finance Administration format ensures accuracy in reporting all necessary information. Forms meet the requirements of the Centers for Medicare and Medicaid Services (CMS). Continuous forms are printed on 20 lb. bond paper.
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Oldest Price
$98.01
Highest Price
$322.98
Lowest Price
$98.01
Last updated
January 30, 2025