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Envelopes & Forms > Forms & Certificates > Claim Forms

Metro Forms 1 PLY- Laser Cut Sheet UB-04 Hospital Claim Form

SKU: 310987
UPC:
Model: 310987

List Price: $ 130.41
Our Price: $ 61.60
Qty
Quantity Discounts
QuantityDiscounted PriceValid For
3-959.75 (per item)all customers
10-1959.14 (per item)all customers
20-4958.52 (per item)all customers
50+56.98 (per item)all customers
310987, 1 PLY- Laser Cut Sheet UB-04 Hospital Claim Form. 310987- THIS IS THE NEW VERSION OF OLD UB-92 FORM.
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