The UB-04 is the standard claim form used by all institutional providers to bill for medical and mental health services.

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• Sale!

  

  UB-04 Billing Claim Form – Paper forms – FREE Priority Shipping

  $29.00 – $49.00 Select options
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  UB-04 Fillable PDF – Uniform Billing Claim Form (CMS-1450)

  $45.00 Add to cart
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  UB-04 Billing Package – 200 Forms w PDF – FREE Priority Shipping

  $69.00 $59.00 Add to cart
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  UB-04 Billing Package

  $85.00 $75.00 Add to cart