OTHER CLAIM RELATED FEE SUMMARY                                           
                     Other Claim Related Fee Description/Incurred Date/Product/Sub Group-8 Digit                     

INVOICE NUMBER:     230718587835                                           PAGE:               1 of 2            
BILL ACCOUNT NUMBER:CN02401002                                             PAID CLAIMS MONTH:  July 2023         
BILL ACCOUNT NAME:  Admiral Peary                                          CLAIMS PAID THRU:   07/14/2023        
CLIENT NUMBER:      0240                                                   BILL CYCLE:         2 of 4            
CLIENT NAME:        Admiral Peary                                          PREPARED DATE:      07/18/2023        

Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Prepay Claims Savings Fee
  06/23
    Prepay Claims Savings Fee
      014267-05                                                                                                         $0.18
      014267-07                                                                                                        $94.52
      014267-08                                                                                                        $37.34
      014267-37                                                                                                         $0.18
      014267- Total                                                                                                   $132.22
    Prepay Claims Savings Fee Total                                                                                   $132.22
  06/23 Total                                                                                                         $132.22
  07/23
    Prepay Claims Savings Fee
      014267-36                                                                                                         $0.00
      014267- Total                                                                                                     $0.00
      017697-00                                                                                                        $31.39
      017697- Total                                                                                                    $31.39
      104272-02                                                                                                        $44.40
      104272- Total                                                                                                    $44.40
    Prepay Claims Savings Fee Total                                                                                    $75.79
  07/23 Total                                                                                                          $75.79
Prepay Claims Savings Fee Total                                                                                       $208.01
                                                                                                                                                            
Reprocessing Fee
  10/22
    Reprocessing Fee
      014267-03                                                                                                        $25.00
      014267-54                                                                                                        $50.00

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Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
      014267- Total                                                                                                    $75.00
    Reprocessing Fee Total                                                                                             $75.00
  10/22 Total                                                                                                          $75.00
  06/23
    Reprocessing Fee
      014267-54                                                                                                        $25.00
      014267- Total                                                                                                    $25.00
    Reprocessing Fee Total                                                                                             $25.00
  06/23 Total                                                                                                          $25.00
Reprocessing Fee Total                                                                                                $100.00
                                                                                                                                                            
Other Claims Related Fee Summary Total                                                                                $308.01