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 UB92 Hospital Claim Form

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UB92 Hospital Claim Form                                                                            To see the quantity available in the closest warehouse to you, please
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UB92 Hospital Claim Form

• American Medical Association (AMA) approved format For filing claims with patient’s insurance carrier. Forms are printed to Government Printing Office standards with OCR red ink for scanning. 20-lb. paper.

Item #   Your
Low,
Low,
ChallengeBP
Price
    Unit of
Measure
Qty  
 
TOP-59770 2500 Forms per Carton Continuous Form One-Part Form 8-1/2 x 11 detached size.    $132.54       CT 
TOP-59870 2500 Forms per Carton For Laser Printers One-Part Form 8-1/2 x 11.    $141.16       CT 



 
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