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

INVOICE NUMBER:     230725589774                                           PAGE:               1 of 2            
BILL ACCOUNT NUMBER:CN02401002                                             PAID CLAIMS MONTH:  July 2023         
BILL ACCOUNT NAME:  Admiral Peary                                          CLAIMS PAID THRU:   07/21/2023        
CLIENT NUMBER:      0240                                                   BILL CYCLE:         3 of 4            
CLIENT NAME:        Admiral Peary                                          PREPARED DATE:      07/25/2023        

Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Prepay Claims Savings Fee
  04/23
    Prepay Claims Savings Fee
      104272-02                                                                                                        $36.05
      104272- Total                                                                                                    $36.05
    Prepay Claims Savings Fee Total                                                                                    $36.05
  04/23 Total                                                                                                          $36.05
  06/23
    Prepay Claims Savings Fee
      104272-02                                                                                                        $51.40
      104272- Total                                                                                                    $51.40
    Prepay Claims Savings Fee Total                                                                                    $51.40
  06/23 Total                                                                                                          $51.40
  07/23
    Prepay Claims Savings Fee
      014267-05                                                                                                        $46.50
      014267-07                                                                                                         $0.28
      014267- Total                                                                                                    $46.78
    Prepay Claims Savings Fee Total                                                                                    $46.78
  07/23 Total                                                                                                          $46.78
Prepay Claims Savings Fee Total                                                                                       $134.23
                                                                                                                                                            
Reprocessing Fee
  10/22
    Reprocessing Fee
      014267-03                                                                                                        $25.00
      014267- Total                                                                                                    $25.00

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Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    Reprocessing Fee Total                                                                                             $25.00
  10/22 Total                                                                                                          $25.00
Reprocessing Fee Total                                                                                                 $25.00
                                                                                                                                                            
Other Claims Related Fee Summary Total                                                                                $159.23