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TOPS®: CMS Health Insurance Claim 1500, Lttr, 2-Part, 1500 Continuous Form Sts/Ctn
	Quantity in Basket: None Code: TOP-50124R Price: $137.95
	Quantity:
TOPS® Centers for Medicare and Medicaid Services (CMS) Forms without Sensor Bar Centers for Medicare and Medicaid Services (CMS) claim form without sensor bar. CMS-1500 claim forms (formerly known as HCFA-1500 claim forms) expedite Medicare, Medicaid or private insurance benefits. OCR red ink for scanning. • UPC = 025932501241 • Weight = 31 lbs/CT • Mfgr Code: 50124R • Mfgr Name: TOPS BUSINESS FORMS • PRICED PER CT List Price = $155.97 Our Price = $137.95 Your Savings = $18.02 If your SHIP TO address is in California, you will receive a second invoice showing the California SALES TAX that you paid for this item