Bill To:


USAA INSURANCE – MEDICAL CLAIMS
PO BOX 5000
DAPHNE, AL 36526-5000

Services Rendered To:


Megan McDonald
2305 Griffen Dr
Copperas Cove, TX
POLICY# 0161860297104


Product
Price
Qty
Amount
  1. 406 Medical Extrication – Lvl 2

    Patient

    Megan McDonald
    2305 Griffen Dr
    Copperas Cove, TX
    POLICY# 0161860297104

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 15222 RM 620- Round Rock, TX

    Ordinance Info: Sam Bass Fire Dept. Resolution

Subtotal $1,500.00
Total Due $1,500.00


Updated
November 14, 2023 @ 9:51 am

Invoice updated by Geoffrey.