• TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton
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TOPS

TOP59870R

TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton

TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton

$332.06 USD
$343.14 USD $332.06 USD
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Made in USA TAA Compliant
US-manufactured goods qualify under the Trade Agreements Act (FAR 25.4). Country of origin as reported by the manufacturer.
Item #TOP59870R
UPC025932598708
BrandTOPS

UB-04 laser-cut forms are designed for medical offices to file a claim with the patient's insurance company. The Health Care Finance Administration format ensures accuracy in reporting all necessary information. Forms meet the requirements of the Centers for Medicare and Medicaid Services (CMS). Forms are printed on 20 lb. bond paper.

Country of Origin: United States

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