UB-04 (CMS-1450) Health Hospital Insurance Claim Form, Laser 8-1/2" x 11" - Pack of 100 Forms
$21.14
Description
UB-04 (CMS-1450) Health Insurance Claim Form.Laser / Inkjet Format.24-lb, 8.5 x 11-inch (Letter Size).100% Compliant with Approved Update to HCFA / CMS 1450 Health Claim Form