UB-04 (CMS 1450) Health Hospital Insurance Claim Form, Laser 8-1/2 x 11" 100 Forms Per Pack
| Country | USA |
| Brand | NextDayLabels |
| Manufacturer | Next Day Labels |
| Binding | Office Product |
| ItemPartNumber | HCFA1500-100 |
| Model | DNT-15238 |
| Color | Red |
| Size | 100 |
| UPCs | 646437575973 |
| EANs | 0646437575973 |
| ReleaseDate | 0000-00-00 |