|
COPYRIGHTED
OPTOMETRY FORMS PRICING
Superbill 11 Inch
|
Quantity |
1 Part |
2 Part |
3 Part |
| 1,250
|
$269.90 |
$375.75
|
$452.30 |
| 2,500
|
$334.55 |
$594.15 |
$807.20 |
5,000
|
$599.75
|
$1,047.20
|
$1,436.80
|
Extra
Charges
Superbills can be customized as needed.
Call AmeriForms for costs.
|
HCFA-1500 Forms
|
Quantity |
1 Part
|
2 Part |
|
| 500 |
$27.00 |
$47.50 |
| 1,000
|
$38.00 |
$58.75 |
2,000
|
$69.50
|
$102.75 |
| 5,000 |
$185.60 |
$265.80 |
Rx Pads
|
Quantity |
1 Part
|
2 Part |
|
| 5 Pads |
$35.00 |
$52.00 |
| 10
Pads |
$47.50
|
$82.50
|
15
Pads
|
$62.50
|
$102.75
|
| 20 Pads |
$75.25 |
$127.75 |
Contact Lens Prescription Form
|
100 CL97 (2 Part NCR
Forms) $25.00
|
T O A File Forms
(500 per Pack)
|
Form |
Price |
Form |
Price |
| TOA-101
|
$22.50
|
TOA-108
|
$27.75
|
| TOA-102
|
$22.50
|
TOA-109
|
$29.50
|
| TOA-103
|
$22.50
|
TOA-110
|
$51.75
|
| TOA-104
|
$22.50
|
TOA-111
|
$29.50
|
| TOA-105
|
$22.50
|
TOA-112
|
$29.50
|
| TOA-106
|
$27.75
|
TOA-114
|
$25.50 |
| TOA-107
|
$22.50
|
TOA-115
|
$29.50
|
|
| |
|
