Speed third-party billing! Available in 1990, 1995, 2000 and 2002 versions. Accepts updated CDT-4 codes. Convenient fold lines for easy placement of address in window envelope.
1,000 2,000 5,000
$64.60 111.35 254.15
Companion ADA Insurance Form Envelopes
Perfectly sized and aligned to accept ADA forms. Right window and handy self-seal. Size 4-1/8" x 9-1/2". Printed or unimprinted.
