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Home > Claim Forms CMS/UB04/ADA  >  CMS-1500 Form (New 02/12 version), 1 Part Continuous, 2500/box
CMS-1500 Form (New 02/12 version), 1 Part Continuous, 2500/box
Laser CMS-1500 Form (New 02/12 version)

CMS-1500 Form (New 02/12 version), 1 Part Continuous, 2500/box

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Your Price:$29.95
Part Number:WEB-WCMS-1500-112
Quantity Pricing
Quantity
Price
  • 5 - 9
  • $28.95
  • 10 - 19
  • $27.95
  • 20+
  • $27.50
1 Part Continuous- 9.5" x 11" for pinfed printers
Box quantity: 2500

Printed in red, OCR scannable ink in compliance with government standards
Medicare approved for billing Medicare Part A claims
Shipping for all claim forms is $9.50/box in the 48 states (not including Alaska, Hawaii & Puerto Rico)

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