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TOPS UB 04 Forms 1 Part White 8 12 x 11 Box Of 2500
Original price was: $185.89.$92.95Current price is: $92.95.
(In Stock)
Used by hospitals and institutions to file a medical claim with a patient’s 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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