UB-04 Hospital Claim Form for Laser Printers

Item: 683689Model: UB04LC
$68.99
2,500/Box
(2)
Only Available Online
  • Easily file a medical claim with a patient's insurance carrier
  • File a hard copy of each claim with patient records in case you need to resubmit a claim
  • Compatible with laser printers
Read More
AboutPrivacy & TermsHelpFeedback© 2017 Staples, Inc.