Tops UB-04 Continuous Forms

Mfg Part #:	59770R
Our Part #:	TOP59770R
Manufacturer:	Tops
Billing Forms,Continuos,1-Part,20 lb.,9-1/2"x11",2500/CT,WE. UB-04 continuous forms are designed for hospitals 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). Continuous forms are printed on 20 lb. bond paper.
Office Depot :	$ 302.99
Our Price:	$ 201.36
You Save:	$ 101.63(34%)
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