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Home > Medical Forms > CMS/UB04  >  UB-04 Forms, Laser, 8.5 x 11
UB-04 Forms, Laser, 8.5 x 11
Laser UB-04 Form

UB-04 Forms, Laser, 8.5 x 11

review
1 Review(s)
5
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Your Price:$34.50
Part Number:WEB-NLCF-UB04-1
Quantity Pricing
Quantity
Price
  • 5 - 9
  • $32.50
  • 10 - 19
  • $31.50
  • 20+
  • $30.50
Laser- 8 1/2" x 11" for laser or inkjet printers
Box quantity: 2500

Printed in red, OCR scannable ink in compliance with government standards
Medicare approved for billing Medicare Part A claims
5 Stars
accounting assistant
good
Did you find this helpful?  1 of 1 Found Helpful
Reviewed by: (Verified Buyer)  from oakland. on 11/17/2015
5/5

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