UB04 Insurance Claim Form, 2-Part, White/Canary, 9 1/2 x 11, 1000 Forms

Product ID:

190863

(0)
$166.93 / CT
$150.11 / CT
when buying 4+
Price Quote
when buying in bulk
List Price: $183.63
You Save: -$16.70 (-9%)
Price: $166.93 / CT and get $8.41 back in Rewards
Qty:
  Free Shipping
  Estimated delivery time 2-3 business days
  • Expedite Medicare, Medicaid or private insurance claims processing.
  • Forms meet all Federal regulations.
  • Formerly known as HCFA-1500 forms.

Expedite Medicare, Medicaid or private insurance claims processing. Forms meet all Federal regulations. Formerly known as HCFA-1500 forms.

Includes 1,000 forms.

Specifications

Global Product Type Forms-Insurance
Form Size 9 1/2 x 11
Forms Per Page 1
Form Quantity 1000
Sheet Size 9 1/2 x 11
Copy Types Continuous Feed
Paper Stock 20 lb.
Paper Color White, Canary
Footnote 1 Two-part continuous feed, white/white. Carbonless
Special Features UB04 Hospital Insurance Claim Forms
Sign Up for Special Savings!
Follow Us