Adams UB-04 Continuous Hospital Insurance Claim Form, 1 Part, Laser, 8.5 x 11 Inches, 2500 Sets per Carton, White (59870R)

Compare price from $20.99 ~ $481.98

Compare Buying Options

Sort by Lowest Price	Item price	Delivery
Walmart Tops Ub-04 Continuous Forms 1 Part - 11 inch x 9.50 inch Form Size - White - Red Print Color - 2500 / Carton, Size: 8 1/2 In X 11 In	$126.64	Delivery date & cost shown at checkout

Walmart Ub04 Hospital Insurance Claim Form 8 1/2 x 11, Laser Printer, 2500 Forms, White	$80.25	Delivery date & cost shown at checkout

Bulk Office Supply TOPS 1-part UB-04 Laser-cut Forms	$217.25	Delivery date & cost shown at checkout

Bluedogink TOPS UB04 Hospital Insurance Claim Form, 8.5 x 11, 1/Page, 2,500 Forms (59870R)	$175.28	Delivery date & cost shown at checkout

myElite Products UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total	$258.88	Delivery date & cost shown at checkout

Lower Huron Company TOPS UB04 Hospital Insurance Claim Form for Laser Printers One-Part No Copies 8.5 x 11 2500 Forms Total	$436.60	Delivery date & cost shown at checkout

Digital Dolphin Products UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total	$283.18	Delivery date & cost shown at checkout

Envision Xpress TOPS UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total	$223.99	Delivery date & cost shown at checkout

shopaustin.org UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total	$230.73	Delivery date & cost shown at checkout

T & G Chemical and Supply Co TOPS UB04 Hospital Insurance Claim Form for Laser Printers One-Part No Copies 8.5 x 11 2500 Forms Total	$392.46	Delivery date & cost shown at checkout

OfficeSupplyInc.com TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - W	$184.41	Delivery date & cost shown at checkout

compsource.com Tops UB-04 Hospital Claim Form 59870R	$185.32	Delivery date & cost shown at checkout

Shoplet Tops UB04 Hospital Insurance Claim Form - TOP59870R at Shoplet	$140.16	Delivery date & cost shown at checkout

2xSavings.com TOPS UB04 Hospital Insurance Claim Form, 8.5 x 11, 1/Page, 2,500 Forms	$181.68	Delivery date & cost shown at checkout

Supply Warehouse UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total	$337.80	Delivery date & cost shown at checkout

Zoro Tops TOP59870R Form, Ub-04, 1Part Laser Pk	$173.99	Delivery date & cost shown at checkout

W.B. Mason TOPS UB04 Hospital Insurance Claim Form, 8 1/2 x 11, 2,500 Forms	$260.99	Delivery date & cost shown at checkout

Direct Supply Billing Forms, 20 lb., 8-1/2"x11", 2500/CT, White - Paper & Stationery, General Forms	$339.99	Delivery date & cost shown at checkout

Direct Supply TOPS UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms - Paper & Stationery, General Forms	$384.99	Delivery date & cost shown at checkout

Office Depot TOPS UB-04 Forms, 1 Part, White, 8 1/2" x 11", Box Of 2,500	$261.49	Delivery date & cost shown at checkout

Zerbee.com TOPS 1-part UB-04 Laser-cut Forms	$159.52	Delivery date & cost shown at checkout

officesupply.com TOP59870R - TOPS UB-04 Forms, 1 Part, White, 8 1/2" x 11", Box Of 2,500	$159.53	Delivery date & cost shown at checkout

Office Supply Hut TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton	$195.94	Delivery date & cost shown at checkout

Newegg.com Tops 59870R UB04 Hospital Insurance Claim Form, 8-1/2 x 11, 2,500 Forms	$184.99	Delivery date & cost shown at checkout

OfficeCrave.com TOPS UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total (59870R)	$159.54	Delivery date & cost shown at checkout

Advanced Safety Supply UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total	$481.98	Delivery date & cost shown at checkout

Nordisco UB-04 Claim Form, CMS-1450	$20.99	Delivery date & cost shown at checkout

ReStockIt TOPS UB04 Hospital Insurance Claim Form, 8.5 x 11, 1/Page, 2,500 Forms (TOP59870R)	$223.44	Delivery date & cost shown at checkout

123 Office TOPS Ub04 Hospital Insurance Claim Form, 8.5 X 11, 1/page, 2,500 Forms ( TOP59870R )	$175.65	Delivery date & cost shown at checkout

FoodServiceDirect.com TOPS UB04 Hospital Insurance Claim Form, 8 1/2 x 11, 2,500 Forms	$208.95	Delivery date & cost shown at checkout

Ace Office Machines Tops Ub04 Hospital Insurance Claim Form, 8-1/2 X 11, 2,500 Forms	$155.56	Delivery date & cost shown at checkout

winderstexas.com TOPS UB04 Hospital Insurance Claim Form for Laser Printers One-Part No Copies 8.5 x 11 2500 Forms Total	$417.62	Delivery date & cost shown at checkout

Amazon.com Adams UB-04 Continuous Hospital Insurance Claim Form, 1 Part, Laser, 8.5 x 11 Inches, 2500 Sets per Carton, White (59870R)	$103.52	Delivery date & cost shown at checkout

Fix Supply UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total	$328.56	Delivery date & cost shown at checkout

ForMyDesk.com TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - Red Print Color - 2500 / Carton	$255.15	Delivery date & cost shown at checkout

BusinessSourceProducts.com TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11 x 8.50 Form Size - White - Red Print Color - 2500 /	$208.64	Delivery date & cost shown at checkout

DigitalBuyer.com TOPS 8-1/2" x 11" UB04 Hospital Insurance Claim Form, 2500 Forms (59870R)	$187.00	Delivery date & cost shown at checkout

Industrial Formulators UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total	$275.26	Delivery date & cost shown at checkout

Flipcost UB04 Hospital Insurance Claim Form for Laser Printers \| Flipcost.com	$191.28	Delivery date & cost shown at checkout

National TOPS 59870R UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms	$300.51	Delivery date & cost shown at checkout

Rapid Supplies TOPS 59870R, UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms	$266.06	Delivery date & cost shown at checkout

missionlinen.com UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms	$433.40	Delivery date & cost shown at checkout

San-A-Care TOPS UB04 Hospital Insurance Claim Form for Laser Printers One-Part No Copies 8.5 x 11 2500 Forms Total	$333.15	Delivery date & cost shown at checkout

Global Industrial Tops Laser UB-04 Claim Forms, 1-Part, 8-1/2" x 11", White, 2500 Forms/Carton	$279.95	Delivery date & cost shown at checkout

126.64
Walmart
Tops Ub-04 Continuous Forms 1 Part - 11 inch x 9.50 inch Form Size - White - Red Print Color - 2500 / Carton, Size: 8 1/2 In X 11 In
Delivery date & cost shown at checkout
80.25
Walmart
Ub04 Hospital Insurance Claim Form 8 1/2 x 11, Laser Printer, 2500 Forms, White
Delivery date & cost shown at checkout
217.25
Bulk Office Supply
TOPS 1-part UB-04 Laser-cut Forms
Delivery date & cost shown at checkout
175.28
Bluedogink
TOPS UB04 Hospital Insurance Claim Form, 8.5 x 11, 1/Page, 2,500 Forms (59870R)
Delivery date & cost shown at checkout
258.88
myElite Products
UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total
Delivery date & cost shown at checkout
436.60
Lower Huron Company
TOPS UB04 Hospital Insurance Claim Form for Laser Printers One-Part No Copies 8.5 x 11 2500 Forms Total
Delivery date & cost shown at checkout
283.18
Digital Dolphin Products
UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total
Delivery date & cost shown at checkout
223.99
Envision Xpress
TOPS UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total
Delivery date & cost shown at checkout
230.73
shopaustin.org
UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total
Delivery date & cost shown at checkout
392.46
T & G Chemical and Supply Co
TOPS UB04 Hospital Insurance Claim Form for Laser Printers One-Part No Copies 8.5 x 11 2500 Forms Total
Delivery date & cost shown at checkout
184.41
OfficeSupplyInc.com
TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - W
Delivery date & cost shown at checkout
185.32
compsource.com
Tops UB-04 Hospital Claim Form 59870R
Delivery date & cost shown at checkout
140.16
Shoplet
Tops UB04 Hospital Insurance Claim Form - TOP59870R at Shoplet
Delivery date & cost shown at checkout
181.68
2xSavings.com
TOPS UB04 Hospital Insurance Claim Form, 8.5 x 11, 1/Page, 2,500 Forms
Delivery date & cost shown at checkout
337.80
Supply Warehouse
UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total
Delivery date & cost shown at checkout
173.99
Zoro
Tops TOP59870R Form, Ub-04, 1Part Laser Pk
Delivery date & cost shown at checkout
260.99
W.B. Mason
TOPS UB04 Hospital Insurance Claim Form, 8 1/2 x 11, 2,500 Forms
Delivery date & cost shown at checkout
339.99
Direct Supply
Billing Forms, 20 lb., 8-1/2"x11", 2500/CT, White - Paper & Stationery, General Forms
Delivery date & cost shown at checkout
384.99
Direct Supply
TOPS UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms - Paper & Stationery, General Forms
Delivery date & cost shown at checkout
261.49
Office Depot
TOPS UB-04 Forms, 1 Part, White, 8 1/2" x 11", Box Of 2,500
Delivery date & cost shown at checkout
159.52
Zerbee.com
TOPS 1-part UB-04 Laser-cut Forms
Delivery date & cost shown at checkout
159.53
officesupply.com
TOP59870R - TOPS UB-04 Forms, 1 Part, White, 8 1/2" x 11", Box Of 2,500
Delivery date & cost shown at checkout
195.94
Office Supply Hut
TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton
Delivery date & cost shown at checkout
184.99
Newegg.com
Tops 59870R UB04 Hospital Insurance Claim Form, 8-1/2 x 11, 2,500 Forms
Delivery date & cost shown at checkout
159.54
OfficeCrave.com
TOPS UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total (59870R)
Delivery date & cost shown at checkout
481.98
Advanced Safety Supply
UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total
Delivery date & cost shown at checkout
20.99
Nordisco
UB-04 Claim Form, CMS-1450
Delivery date & cost shown at checkout
223.44
ReStockIt
TOPS UB04 Hospital Insurance Claim Form, 8.5 x 11, 1/Page, 2,500 Forms (TOP59870R)
Delivery date & cost shown at checkout
175.65
123 Office
TOPS Ub04 Hospital Insurance Claim Form, 8.5 X 11, 1/page, 2,500 Forms ( TOP59870R )
Delivery date & cost shown at checkout
208.95
FoodServiceDirect.com
TOPS UB04 Hospital Insurance Claim Form, 8 1/2 x 11, 2,500 Forms
Delivery date & cost shown at checkout
155.56
Ace Office Machines
Tops Ub04 Hospital Insurance Claim Form, 8-1/2 X 11, 2,500 Forms
Delivery date & cost shown at checkout
417.62
winderstexas.com
TOPS UB04 Hospital Insurance Claim Form for Laser Printers One-Part No Copies 8.5 x 11 2500 Forms Total
Delivery date & cost shown at checkout
103.52
Amazon.com
Adams UB-04 Continuous Hospital Insurance Claim Form, 1 Part, Laser, 8.5 x 11 Inches, 2500 Sets per Carton, White (59870R)
Delivery date & cost shown at checkout
328.56
Fix Supply
UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total
Delivery date & cost shown at checkout
255.15
ForMyDesk.com
TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - Red Print Color - 2500 / Carton
Delivery date & cost shown at checkout
208.64
BusinessSourceProducts.com
TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11 x 8.50 Form Size - White - Red Print Color - 2500 /
Delivery date & cost shown at checkout
187.00
DigitalBuyer.com
TOPS 8-1/2" x 11" UB04 Hospital Insurance Claim Form, 2500 Forms (59870R)
Delivery date & cost shown at checkout
275.26
Industrial Formulators
UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total
Delivery date & cost shown at checkout
191.28
Flipcost
UB04 Hospital Insurance Claim Form for Laser Printers | Flipcost.com
Delivery date & cost shown at checkout
300.51
National
TOPS 59870R UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms
Delivery date & cost shown at checkout
266.06
Rapid Supplies
TOPS 59870R, UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms
Delivery date & cost shown at checkout
433.40
missionlinen.com
UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms
Delivery date & cost shown at checkout
333.15
San-A-Care
TOPS UB04 Hospital Insurance Claim Form for Laser Printers One-Part No Copies 8.5 x 11 2500 Forms Total
Delivery date & cost shown at checkout
279.95
Global Industrial
Tops Laser UB-04 Claim Forms, 1-Part, 8-1/2" x 11", White, 2500 Forms/Carton
Delivery date & cost shown at checkout

Product Details

UB-04 claim forms used by hospitals file a claim with the patient's insurance company, replaces the UB-92 form

Forms are printed to GPO standards in OCR ink on 20 pound stock bond

Laser cut sheets

2,500 sets per carton

8.5 x 11 inch sheet size

Popular Products

Callaway Men's Short Sleeve Opti-Dri™ Performance Golf Polo Shirt (Size Small - 4X Big & Tall)

$26.04

Compare at 50 stores

Lands' End Men's Supima Cotton Mock Turtleneck Shirt

$29.97

Compare at 52 stores

WOLFORD Merino Tights for Women

$95

Compare at 47 stores

YTD Mens Flower Hawaiian 2 Piece Outfit Sets Short Sleeve Beach Casual Button Down Shirt and Shorts Suits

$25.99

Compare at 49 stores

Ariat Unisex Kids' Aptos Show Shirt

$44.95

Compare at 44 stores

Adams UB-04 Continuous Hospital Insurance Claim Form, 1 Part, Laser, 8.5 x 11 Inches, 2500 Sets per Carton, White (59870R)

Compare Buying Options

Tops Ub-04 Continuous Forms 1 Part - 11 inch x 9.50 inch Form Size - White - Red Print Color - 2500 / Carton, Size: 8 1/2 In X 11 In

Ub04 Hospital Insurance Claim Form 8 1/2 x 11, Laser Printer, 2500 Forms, White

TOPS 1-part UB-04 Laser-cut Forms

TOPS UB04 Hospital Insurance Claim Form, 8.5 x 11, 1/Page, 2,500 Forms (59870R)

UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total

TOPS UB04 Hospital Insurance Claim Form for Laser Printers One-Part No Copies 8.5 x 11 2500 Forms Total

UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total

TOPS UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total

UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total

TOPS UB04 Hospital Insurance Claim Form for Laser Printers One-Part No Copies 8.5 x 11 2500 Forms Total

TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - W

Tops UB-04 Hospital Claim Form 59870R

Tops UB04 Hospital Insurance Claim Form - TOP59870R at Shoplet

TOPS UB04 Hospital Insurance Claim Form, 8.5 x 11, 1/Page, 2,500 Forms

UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total

Tops TOP59870R Form, Ub-04, 1Part Laser Pk

TOPS UB04 Hospital Insurance Claim Form, 8 1/2 x 11, 2,500 Forms

Billing Forms, 20 lb., 8-1/2"x11", 2500/CT, White - Paper & Stationery, General Forms

TOPS UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms - Paper & Stationery, General Forms

TOPS UB-04 Forms, 1 Part, White, 8 1/2" x 11", Box Of 2,500

TOPS 1-part UB-04 Laser-cut Forms

TOP59870R - TOPS UB-04 Forms, 1 Part, White, 8 1/2" x 11", Box Of 2,500

TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton

Tops 59870R UB04 Hospital Insurance Claim Form, 8-1/2 x 11, 2,500 Forms

TOPS UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total (59870R)

UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total

UB-04 Claim Form, CMS-1450

TOPS UB04 Hospital Insurance Claim Form, 8.5 x 11, 1/Page, 2,500 Forms (TOP59870R)

TOPS Ub04 Hospital Insurance Claim Form, 8.5 X 11, 1/page, 2,500 Forms ( TOP59870R )

TOPS UB04 Hospital Insurance Claim Form, 8 1/2 x 11, 2,500 Forms

Tops Ub04 Hospital Insurance Claim Form, 8-1/2 X 11, 2,500 Forms

TOPS UB04 Hospital Insurance Claim Form for Laser Printers One-Part No Copies 8.5 x 11 2500 Forms Total