UB-O4 LASER FORMS

UB-04 (UB92)

According to CMS, a CMS 1500 (HCFA 1500) form is used by non-institutional providers to bill Medicare Part B covered services and some Medicaid services. UB-04 (UB-92) forms are generally used for Medicare Part A services. Some private insurance carriers may also accept claims filed on CMS 1500 (HCFA 1500) forms. For more information go to http://www.cms.hhs.gov or http://www.nucc.org

GROUND FREIGHT PAID WITHIN THE 48 CONTIGUOUS UNITED STATES - FOR EXPEDITED OR SPECIALTY SHIPPING COSTS MUST BE CALCULATED SEPARATELY - ANY QUESTIONS CALL 800-841-0200

(If you are outside the 48 contiguous United States please call 800-841-0200 or 912-437-3192 to place your order - shipping costs for you must be calculated separately.)

IF YOU CAN'T FIND YOUR PRODUCT HERE OR IF YOU NEED LARGE QUANTITY PRICING CALL 800-841-0200

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(31-0987CASE) LASER UB-04 (UB92) BY THE CASE (2500 SHEETS) LASER UB-04 (31-0987CASE)$52.80, 3/$149.40, 8/$384.00, 10/$465.40
(31-0987REAM) LASER UB-04 (UB92) BY THE REAM (500 SHEETS) LASER UB-04 (31-0987REAM)$22.80, 2/$42.00, 3/$57.00