TOPS® UB-04 Forms, 1 Part, White, 8 1/2" x 11", Box Of 2,500

TOPS® UB-04 Forms, 1 Part, White, 8 1/2" x 11", Box Of 2,500
1 / 1
$261.49/carton

Description

    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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    $261.49/carton