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Claim Forms CMS/UB04/ADA
> UB-04 Forms, 1 Part Continuous
Laser UB-04 Form
UB-04 Forms, 1 Part Continuous
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Price
Your Price:
$35.50
Availability:
In Stock.
Part Number:
WEB-CCF-UB04-1
Quantity
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Quantity Pricing
Quantity
Price
5 - 9
$33.50
10 - 19
$32.50
20+
$31.50
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Description
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1 Part Continuous- 9.5 x 11 for pin fed printers
Box quantity: 2500
Printed in red, OCR scannable ink in complaince with government standards
Medicare approved for billing Medicare Part A claims
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