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Tops 59870R UB04 Hospital Insurance Claim Form, 8-1/2 x 11, 2,500 Forms

Photos - Accessory Tops 59870R UB04 Hospital Insurance Claim Form, 8-1/2 x 11, 2,500 Forms
$193.00 

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TOPS Tops 59870R UB04 Hospital Insurance Claim Form, 8-1/2 x 11, 2,500 Forms

White
Newegg.com
Delivery: in USA
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$192.99
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TOPS® UB-04 Forms, 1 Part, White, 8 1/2" x 11", Box Of 2,500 59870R

Used by hospitals and institutions to file a medical claim with a patient's insurance company Meets the requirements of the Centers for Medicare and Medicaid Services (CMS). Printed on carbonless, 20-lb bond, 1-ply paper with red ink.
Officedepot.com
Delivery: in USA
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$261.49
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