TOPS® UB-04 Forms, 1 Part, White, 8 1/2" x 11", Box Of 2,500 59870R
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Buy TOPS® UB-04 Forms, 1 Part, White, 8 1/2" x 11", Box Of 2,500 59870R
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TOPS® UB-04 Forms, 1 Part, White, 8 1/2" x 11", Box Of 2,500 59870R | $261.49 |  | |||
TOPS Tops 59870R UB04 Hospital Insurance Claim Form, 8-1/2 x 11, 2,500 Forms | $192.99 |  | |||
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.
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