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Home > Claim Forms CMS/UB04/ADA  >  CMS-1500 Form (New 02/12 version), Unit Set, 8.5 x 11
CMS-1500 Form (New 02/12 version), Unit Set, 8.5 x 11
Laser CMS-1500 Form (New 02/12 version)

CMS-1500 Form (New 02/12 version), Unit Set, 8.5 x 11

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Your Price:$32.00
Part Number:WEB-WCMS1500U2-2012
Quantity Pricing
Quantity
Price
  • 5 - 9
  • $31.00
  • 10 - 19
  • $30.00
  • 20+
  • $29.55
Unit Set- 8-1/2" x 11" (glued edge at top of 8-1/2" side)
Box quantity: 1000

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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