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UB04 Hospital Billing Claim Form LASER UB-04
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UB04 Hospital Billing Claim Form LASER UB-04
Back of UB04 Hospital Billing Claim Form LASER UB-04

Hospital Billing Claim Form UB-04 (CMS 1450, UB04) Laser Cut Sheet, 2500/Carton - UB04 LC

Item #: UB04LC
Availability: In Stock
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Retail: $56.16 Our Price:$37.44

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Hospital billing claim laser UB-04 cut sheet forms. Also known as the CMS 1450 form and UB04 form by the Centers for Medicare and Medicaid Services.
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nvelope UB92 / UB04 Hospital Billing Claim Form
Standard Register Hospital Billing Envelope UB92 / UB04 Hospital Billing Claim Form Left Window 9 X 12 1/2", 500/Carton - 1492LL
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Retail: $158.57 Our Price:$105.71
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  • CMS-compliant hospital billing claim form
  • Form code: UB04 (UB-04 or CMS 1450)
  • Form type: cut sheet
  • For use in laser printers
  • Sold by carton, 2,500 forms per carton
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