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TOPS UB-04 Forms, 1 Part, White, 8 1/2in x 11in, Box Of 2,500
$289.56
In stock
SKU
526935
FORM,UB92,LSR,2500
Used by hospitals and institutions to file a medical claim with a patients 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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