Publications

CMS 1500 Claim Form

Quantity	ABB OneBill Price	List Price
100	13.20	14.40
500	37.20	40.80
1000	63.00	67.20

Co-Management Transfer of Care Form

Quantity	ABB OneBill Price	List Price
1 Pad	21.60	24.00
2 Pads	32.40	36.00
4 Pads	52.80	60.00
6 Pads	63.60	72.00

Consent For Treatment of Minor Form

Quantity	ABB OneBill Price	List Price
1 Pad	21.60	24.00
2 Pads	32.40	36.00
4 Pads	52.80	60.00
6 Pads	63.60	72.00

Customized Medicare Fee Schedule

Quantity	ABB OneBill Price	List Price
1	24.00	36.00

Dilation Consent and Notification Form

Quantity	ABB OneBill Price	List Price
1 Pad	21.60	24.00
2 Pads	32.40	36.00
4 Pads	52.80	60.00
6 Pads	63.60	72.00

Quantity	ABB OneBill Price	List Price
100	16.80	19.80
200	25.20	29.40
500	56.40	63.60
1000	96.00	105.60

Examination - Supplementary Tests Form

Quantity	ABB OneBill Price	List Price
50	14.40	18.00
100	19.80	24.00
200	33.00	38.40
500	72.60	82.80

Glaucoma Assessment and Referral Audit Form

Quantity	ABB OneBill Price	List Price
1 Pad	26.40	30.00
2 Pads	37.20	42.00
4 Pads	60.00	67.20
6 Pads	79.20	90.00

Informed Consent - Eye and Eyelid Treatment

Quantity	ABB OneBill Price	List Price
1 Pad	14.40	18.00
2 Pads	19.80	24.00
4 Pads	33.00	38.40
6 Pads	46.80	53.40

Informed Consent - Re-Use of Patient-Owned Frame Form

Quantity	ABB OneBill Price	List Price
1 Pad	24.00	26.40
2 Pads	36.00	39.60
4 Pads	60.00	67.20
6 Pads	72.00	80.40

Medical History Questionnaire

Quantity	ABB OneBill Price	List Price
100	19.80	24.00
200	33.00	38.40
500	72.60	82.80
1000	132.00	145.20

Treatments Sheets

Quantity	ABB OneBill Price	List Price
1 Pad	12	15
2 Pads	16.50	20
4 Pads	27.50	32
6 Pads	39	44.50
10 Pads	60.50	69