PAID CLAIMS DETAIL                                                  
                                              Product/Sub Group-8 Digit                                              

INVOICE NUMBER:     230711585895                                           PAGE:               1 of 59           
BILL ACCOUNT NUMBER:CN02401002                                             PAID CLAIMS MONTH:  July 2023         
BILL ACCOUNT NAME:  Admiral Peary                                          CLAIMS PAID THRU:   07/07/2023        
CLIENT NUMBER:      0240                                                   BILL CYCLE:         1 of 4            
CLIENT NAME:        Admiral Peary                                          PREPARED DATE:      07/11/2023        

            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Drug
  014267-01
    014267-01                101534701001 163661783  MCMAHON          KRISTINA   18   980376881617500401   07/07/2023          25       $86.31       $1.97
    014267-01                113324089001 181506290  MCINTOSH         CONSTANC   18   802746961165400401   07/07/2023          30       $79.11       $6.43
    014267-01                103723995001 190642553  PANEK            REBECCA    18   320766883377800401   07/07/2023          90       $73.44       $1.47
    014267-01                103723995001 190642553  PANEK            REBECCA    18   533696004488220401   07/07/2023         (90)    ($73.44)     ($1.47)
    014267-01                103723995001 190642553  PANEK            REBECCA    18   560006803488220401   07/08/2023          90       $73.44       $1.47
    014267-01                104231917001 196603987  HUTSKY           JOSEPH     18   970651331834479301   07/05/2023          10      $193.31       $0.00
    014267-01                121197523001 204602818  FARABAUGH        EDWARD     01   87224492595459301    07/04/2023          90      $437.04       $0.00
    014267-01                105143186001 207564217  BAUM             SUSAN      18   928291702240889301   07/06/2023          90       $45.64      $10.07
    014267-01                105143186001 207564217  BAUM             SUSAN      18   559782808351310401   07/06/2023          90      $195.81      $16.99
    014267-01                105143186001 207564217  BAUM             SUSAN      18   926068300351310401   07/06/2023         (90)   ($195.81)    ($16.99)
    014267-01                105143186001 207564217  BAUM             SUSAN      18   82978818487789301    07/06/2023          90      $195.81      $16.99
  014267-01 Total                                                                                                                    $1,110.66      $36.93
  014267-03
    014267-03                100658703001 125504688  MULLIGAN         ANDREA     18   824612305389049301   07/03/2023          25       $74.50       $6.97
    014267-03                101220663001 159625419  ECKENRODE        GINA       01   653403896730439301   07/03/2023          33       $68.99       $4.63
    014267-03                101220663001 159625419  ECKENRODE        GINA       01   454709789055679301   07/05/2023          25      $341.99      $58.04
    014267-03                112172536001 159687597  KOKUS            MICHAEL    18   639089929928539301   07/03/2023          30      $227.27      $12.04
    014267-03                110652030001 161544709  ANDREWS          SHANNON    18   658739209743279301   07/03/2023          50      $317.73     $104.75
    014267-03                110652030001 161544709  ANDREWS          EDWARD     01   546522363571639301   07/03/2023          90      $465.57      $16.87
    014267-03                110652030001 161544709  ANDREWS          SHANNON    18   378709859718539301   07/03/2023          50      $280.42     $104.75
    014267-03                110652030001 161544709  ANDREWS          SHANNON    18   658201072643279301   07/03/2023         (50)   ($280.42)   ($104.75)
    014267-03                101369778001 161607101  LACUE            ERIN       18   44712968941420401    07/08/2023          30       $71.19      $29.39
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   77982415730919301    07/02/2023          30       $84.07       $5.42
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   185132445730919301   07/02/2023          30       $23.51       $7.15
    014267-03                101593218001 164562405  HOOVER           SAVANNAH   19   18548680984299301    07/06/2023          30       $58.88       $5.76

                                                                                                                                               PAGE:2 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                101760095001 166629321  BLAKE            JODY       01   442445230432099301   07/06/2023          30      $258.99       $8.97
    014267-03                101913203001 168601612  DUBREUCQ         SARAH      01   912101352838179301   07/05/2023          30      $369.12      $16.80
    014267-03                101913203001 168601612  DUBREUCQ         ALAN       18   580116003750859301   06/19/2023         (50)   ($243.18)    ($10.54)
    014267-03                101913203001 168601612  DUBREUCQ         SARAH      01   852892534048179301   07/05/2023          30      $271.09       $0.00
    014267-03                102137743001 171520828  KOCHINSKY        WILLIAM    01   34945760685279301    07/05/2023          10      $158.86      $61.52
    014267-03                102137743001 171520828  KOCHINSKY        WILLIAM    01   562043936053789301   07/06/2023          30       $58.87      $11.43
    014267-03                102137743001 171520828  KOCHINSKY        DARLA      18   823068978717279301   07/05/2023          90      $365.28       $4.93
    014267-03                102137743001 171520828  KOCHINSKY        WILLIAM    01   830468528320220401   07/08/2023          30      $323.94      $42.31
    014267-03                102137743001 171520828  KOCHINSKY        WILLIAM    01   443902294220220401   07/08/2023          30      $254.09       $8.16
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   784116243499969301   07/05/2023          90       $57.18      $15.14
    014267-03                114762902001 171664326  SOWERS           SAMANTHA   01   334028798552500401   07/07/2023          30       $85.45       $0.00
    014267-03                102406662001 174668462  BENDER           AMANDA     18   930942108718839301   07/03/2023          90      $434.20       $2.43
    014267-03                115784376001 178669991  PARONISH         LOGAN      19   733992964660589301   07/06/2023          30      $150.85       $0.00
    014267-03                119685264001 183723911  STRAYER          LYDIA      18   406017976480878301   06/30/2023          90      $243.10      $31.49
    014267-03                119685264001 183723911  STRAYER          LYDIA      18   879329281480878301   06/30/2023          90      $404.50       $0.00
    014267-03                103373563001 186587333  BEUNIER-SMITH    YVETTE     18   620606683548400401   07/07/2023          30      $353.99      $12.36
    014267-03                103373563001 186587333  BEUNIER-SMITH    YVETTE     18   148681151082600401   07/07/2023          90      $678.81      $54.63
    014267-03                103373563001 186587333  SMITH            ROBERT     01   117446711411400401   07/07/2023         100      $910.34     $137.56
    014267-03                103377064001 186607237  BRACKEN          KELLY      18   426372644654229301   07/02/2023          30      $323.99     $219.00
    014267-03                103377064001 186607237  BRACKEN          KELLY      18   662564912172789301   07/06/2023          30      $280.90       $8.08
    014267-03                103377064001 186607237  BRACKEN          KELLY      18   204888708911079301   07/05/2023          28    $1,198.99     $881.89
    014267-03                103377064001 186607237  BRACKEN          KELLY      18   190522408974229301   06/30/2023         (30)   ($478.99)   ($336.86)
    014267-03                103377064001 186607237  BRACKEN          KELLY      18   133122818533229301   06/30/2023         (30)   ($323.99)   ($219.00)
    014267-03                103377064001 186607237  BRACKEN          KELLY      18   75339479984229301    07/02/2023          90    $1,419.99   $1,009.14
    014267-03                114686704001 186607919  TERZA            ISABELL    19   812082943179739301   07/03/2023          30    $1,576.91     $334.37
    014267-03                114686704001 186607919  TERZA            ISABELL    19   483654312379739301   07/03/2023          30    $1,317.76     $334.37
    014267-03                114686704001 186607919  TERZA            JENNIFER   01   14442733950700401    07/07/2023          10       $68.92      $11.81
    014267-03                103379409001 186624451  LOBICK           ALISON     01   34156594032839301    07/03/2023          56       $16.77       $0.00
    014267-03                103536981001 188580018  MALLOY           KAREN      18   589356763384220401   07/08/2023          90      $660.24     $650.24
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   453368928422539301   07/03/2023          30      $480.53     $361.92
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   378826001343969301   07/05/2023          20       $15.22       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   236751041695219301   07/02/2023          30      $269.15      $89.60

                                                                                                                                               PAGE:3 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   397231632997149301   07/03/2023          30      $326.69      $64.06
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   123001921150889301   07/03/2023         (30)   ($326.69)    ($64.06)
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   697772584373920401   07/08/2023          30      $678.45     $520.75
    014267-03                103710443001 190560450  SHEARMAN         WILLIAM    01   209781151345900401   07/07/2023          20       $12.68       $0.36
    014267-03                103710443001 190560450  SHEARMAN         JOAN       18   216712064957500401   07/07/2023          90      $436.20     $138.23
    014267-03                103818021001 191709419  MULRANEY         VIVIAN     19   265083026904359301   07/04/2023          30      $150.85       $0.00
    014267-03                128460945001 191767401  SCALESE          MORGAN     18   240521671946600401   07/07/2023          28       $42.99      $23.88
    014267-03                103985610001 193685616  SZYMUSIAK        MATTHEW    01   701756233014220401   07/08/2023          90       $10.00       $0.00
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   896682123677969301   07/05/2023          10       $28.45       $0.00
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   418138068477969301   07/05/2023           8       $11.00       $0.00
    014267-03                104051735001 194527150  THOMAS           LAURIE     01   312348550251279301   07/05/2023          90       $36.00       $4.86
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   721816964613179301   07/05/2023           3        $4.00       $4.00
    014267-03                104385940001 198563222  ALBRIGHT         ALEXANDE   19   809438128619220401   07/08/2023          30       $76.84       $0.00
    014267-03                104385940001 198563222  ALBRIGHT         ALEXANDE   19   500172975719220401   07/08/2023          30       $51.80       $1.90
    014267-03                104400727001 198662868  MCGOWAN          MEGAN      19   350693676984910401   07/08/2023          90      $457.48      $14.37
    014267-03                117356283001 199567270  CENCE            JULIE      18   986422514660589301   07/06/2023          30      $763.99     $552.10
    014267-03                120189904001 199707914  KEENER           COREY      01   514181452761220401   07/08/2023          30      $158.01       $0.00
    014267-03                120189904001 199707914  KEENER           CHRISTIN   18   844706401094479301   06/22/2023         (30)   ($158.01)     ($0.65)
    014267-03                120189904001 199707914  KEENER           COREY      01   992438708094479301   06/22/2023         (30)   ($158.01)     ($0.65)
    014267-03                120189904001 199707914  KEENER           COREY      01   170669009094479301   06/22/2023         (30)   ($408.99)    ($66.22)
    014267-03                120189904001 199707914  KEENER           COREY      01   825428058761220401   07/08/2023          14      $195.99      $28.43
    014267-03                120189904001 199707914  KEENER           CHRISTIN   18   346393106094479301   06/22/2023         (30)   ($169.50)     ($0.14)
    014267-03                120189904001 199707914  KEENER           COREY      01   761441892984479301   06/22/2023         (30)   ($173.02)     ($0.56)
    014267-03                104697984001 202442564  MEIDINGER        JEFFREY    18   246242844931700401   07/07/2023          30      $332.01      $10.08
    014267-03                104968290001 205547039  DIAMOND          ROBERT     18   962552185696099301   07/06/2023          30      $462.77      $71.50
    014267-03                104968290001 205547039  DIAMOND          ROBERT     18   84641902696099301    07/06/2023          30      $127.61       $0.00
    014267-03                105154214001 207627750  KLINE            BRANDY     18   860539149604049301   07/03/2023           5       $10.00      $12.00
    014267-03                112953016001 207643714  LEWIS            BRYCE      19   32202683905989301    07/06/2023          30       $36.20       $0.00
    014267-03                105412522001 210627625  KLINE            ANTHONY    18   176092265245739301   07/03/2023          30      $112.00       $1.85
    014267-03                105412522001 210627625  KLINE            ANTHONY    18   334462923245739301   07/03/2023          30       $53.67       $0.00
    014267-03                105481344001 211520772  STRASSER         MICHAEL    18   551431831989400401   07/07/2023          90      $490.44       $9.96
    014267-03                105494211001 211588239  PATRICK          VICKI      18   762747097600288301   06/30/2023          30    $3,019.18   $1,765.76

                                                                                                                                               PAGE:4 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                105507342001 211689914  SCOTT            TAMMY      18   847836164787700401   07/07/2023           7       $43.10       $0.00
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   881493906525079301   07/05/2023           3       $14.78       $0.00
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   499935750725079301   07/05/2023          10       $57.90       $0.00
  014267-03 Total                                                                                                                   $20,502.43   $7,084.58
  014267-05
    014267-05                101460852001 162709665  MARSHALL         NICHOLE    01   509371691661459301   07/04/2023          30      $503.76     $384.21
    014267-05                101460852001 162709665  MARSHALL         NICHOLE    01   460909369601459301   07/04/2023          30       $33.21       $0.00
    014267-05                101460852001 162709665  MARSHALL         NICHOLE    01   430051881601459301   07/04/2023          30      $271.09       $0.00
    014267-05                101665655001 165520467  FISANICK         BASIL      01   602222823245459301   07/04/2023          30       $40.99       $2.53
    014267-05                101665655001 165520467  FISANICK         LAURA      18   950194402441679301   07/05/2023          30    $1,724.99   $1,279.85
    014267-05                101665655001 165520467  FISANICK         BASIL      01   348239389368379301   07/05/2023          10       $38.54       $0.00
    014267-05                101665655001 165520467  FISANICK         LAURA      18   621972978431679301   07/05/2023          90      $775.20      $20.11
    014267-05                101665655001 165520467  FISANICK         BASIL      01   895426074368379301   07/05/2023          10      $314.69       $4.47
    014267-05                101665655001 165520467  FISANICK         BASIL      01   148399509813229301   07/02/2023          90      $213.88       $3.32
    014267-05                101665655001 165520467  FISANICK         BASIL      01   370149139760589301   07/06/2023          12      $133.00      $11.05
    014267-05                101665655001 165520467  FISANICK         LAURA      18   517959979442210401   07/05/2023         (30) ($1,724.99) ($1,279.85)
    014267-05                101665655001 165520467  FISANICK         BASIL      01   652822215631679301   07/05/2023          33      $228.99     $151.83
    014267-05                101825625001 167566948  BROWN            JIM        01   813108358727969301   07/05/2023           1      $276.99     $197.37
    014267-05                101829382001 167588314  LYTLE            ELLA       19   275526494509199301   07/06/2023          30      $297.31      $68.73
    014267-05                101995157001 169643849  WENDEROTH        FRED       18   726785800487179301   06/27/2023          30      $796.85       $7.95
    014267-05                112228663001 170540291  SHERRY           TAYLOR     19   97746464502279301    07/05/2023          30      $365.83       $0.00
    014267-05                110122526001 171629572  MASTRINE         MELISSA    18   851601541147920401   07/08/2023          30       $33.40       $0.00
    014267-05                129935534001 172742640  CAMPBELL         KENNETH    01   888681492033800401   07/07/2023          30      $398.20       $0.00
    014267-05                102567951001 176622574  LOMBARDO         TINA       18   459432665245220401   07/08/2023          90      $114.49      $15.84
    014267-05                102794894001 179527800  MCMULLEN         PATRICK    01   503758500760589301   07/06/2023          90      $283.57      $23.10
    014267-05                102794894001 179527800  MCMULLEN         DIANE      18   108136714276639301   07/03/2023          90       $58.47      $19.27
    014267-05                102801153001 179566492  LANEY            KAREN      18   575692324937789301   07/06/2023          28   $15,807.36   $9,660.57
    014267-05                102801153001 179566492  LANEY            KAREN      18   917149659043479301   07/05/2023          30       $63.92       $0.54
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   862282595903839301   06/20/2023         (90)   ($806.03)    ($57.73)
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   670013066141379301   06/23/2023         (90)   ($693.78)   ($466.46)
    014267-05                102971934001 181603444  NELSON           JULIE      01   368608030370919301   07/02/2023          90      $180.99     $106.09
    014267-05                103380060001 186626373  SCALESE          TRACY      18   677618848465889301   07/06/2023          90        $8.13       $0.00

                                                                                                                                               PAGE:5 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                103380060001 186626373  SCALESE          TRACY      18   478872295750889301   07/06/2023          90      $251.17       $9.76
    014267-05                104213378001 196487222  MICCO            GARY       01   216502095718400401   07/07/2023          28       $19.03       $1.99
    014267-05                104318685001 197640477  HUDAK            DANIEL     01   631878888247789301   07/06/2023          28        $6.97       $0.00
    014267-05                110289777001 198665728  SLAVIK           LORETTA    18   543652718221639301   07/03/2023          30      $123.89      $34.93
    014267-05                114051191001 200641754  STARUCH          ASHLEY     01   936171151976639301   07/03/2023           7       $45.54      $24.86
    014267-05                114051191001 200641754  STARUCH          ASHLEY     01   806862014740679301   07/05/2023          30    $2,141.76   $1,698.71
    014267-05                114051191001 200641754  STARUCH          ASHLEY     01   723962198776639301   07/03/2023           3       $42.80       $1.74
    014267-05                114051191001 200641754  STARUCH          ASHLEY     01   742725170505049301   06/22/2023         (30)    ($69.42)    ($28.00)
    014267-05                114051191001 200641754  STARUCH          ASHLEY     01   104328868325049301   07/03/2023          25      $915.47      $97.30
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   567221712293919301   07/02/2023           7      $128.16       $8.95
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   908776364014919301   07/02/2023           7      $489.00       $0.00
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   389291892267479301   07/04/2023         (30) ($1,214.13)   ($909.82)
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   392251231717789301   07/06/2023          90    $2,890.81      $10.39
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   477313516841639301   07/03/2023          30      $159.01       $0.00
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   944148888927789301   07/06/2023          90      $539.05      $38.62
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   819952405367479301   07/04/2023          30    $1,217.50     $909.82
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   603956921317789301   07/06/2023          14      $262.15     $190.33
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   193859232375588301   06/30/2023          28    $8,307.14   $6,505.26
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   232452863275459301   07/04/2023          30       $77.95       $6.61
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   543431832327759301   07/04/2023          30    $1,214.13     $909.82
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   445462405137789301   07/06/2023          90      $388.81      $25.59
    014267-05                105312745001 209560853  KUDLAWIEC        MARY       19   236846531437800401   07/07/2023          90       $55.00      $42.46
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   921832403483099301   07/06/2023          12       $44.63      $15.10
    014267-05                105322961001 209620623  DELOSH           JOSEPH     01   75992983083059301    07/04/2023          30      $208.83       $3.91
    014267-05                105322961001 209620623  DELOSH           SHERRY     18   56643246987539301    07/03/2023          10      $113.71       $3.75
    014267-05                105322961001 209620623  DELOSH           JOSEPH     01   636893566083059301   07/04/2023          30       $51.99       $0.00
    014267-05                105322961001 209620623  DELOSH           JOSEPH     01   267716694083059301   07/04/2023          30      $858.99     $624.00
    014267-05                105322961001 209620623  DELOSH           JOSEPH     01   541814592083059301   07/04/2023          30       $13.99       $0.00
    014267-05                105322961001 209620623  DELOSH           JOSEPH     01   888028768083059301   07/04/2023          30      $763.99     $552.10
    014267-05                105322961001 209620623  DELOSH           SHERRY     18   442221591154479301   07/05/2023          30       $50.33       $0.00
    014267-05                105322961001 209620623  DELOSH           JOSEPH     01   294202488083059301   07/04/2023          30        $3.99       $1.21
    014267-05                105322961001 209620623  DELOSH           JOSEPH     01   845079489083059301   07/04/2023          30      $164.75       $4.09

                                                                                                                                               PAGE:6 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                105408339001 210604721  MULLEN           THOMAS     18   358598800428200401   07/07/2023          90       $94.81       $7.66
    014267-05                127479959001 210721282  DOUGHERTY        AMBER      18   593342863229889301   07/06/2023           6       $35.64       $2.54
    014267-05                127479959001 210721282  DOUGHERTY        AMBER      18   605096704098889301   07/06/2023           7       $14.94       $0.00
    014267-05                105507489001 211702122  BASSETT          SOPHIA     19   597886601442279301   07/05/2023          60      $246.45     $177.72
    014267-05                105507489001 211702122  BASSETT          SOPHIA     19   144911611961559301   07/03/2023         (60)   ($246.45)   ($177.72)
    014267-05                105507489001 211702122  BASSETT          SOPHIA     19   70432265192839301    07/03/2023          60      $246.45     $177.72
    014267-05                105507594001 211703743  TENEROWICZ       JUDE       01   409182168540379301   07/05/2023         125        $2.94       $0.00
    014267-05                105507594001 211703743  TENEROWICZ       BANE       19   97918250751579301    07/05/2023           7      $138.86      $16.43
    014267-05                105507594001 211703743  TENEROWICZ       BANE       19   560493746561579301   07/05/2023           5       $13.80       $0.00
    014267-05                105507594001 211703743  TENEROWICZ       BANE       19   354056744260679301   07/05/2023           1      $694.81     $372.09
  014267-05 Total                                                                                                                   $41,248.29  $21,512.71
  014267-06
    014267-06                101824877001 167564735  LANZENDORFER     CLEMENT    01   228456593661249301   07/03/2023          50       $33.19       $0.14
    014267-06                101904370001 168545436  BORING           BETTY      18   442292404415889301   07/06/2023          90      $163.19     $106.04
    014267-06                101904370001 168545436  BORING           BETTY      18   826181771123579301   07/05/2023          90      $245.26      $14.15
    014267-06                102234268001 172609097  SMITH            BRIANA     19   517833356327539301   07/03/2023          30       $21.05       $0.00
    014267-06                103211068001 184601686  LEFFERTS         SARA       19   90931101175889301    07/06/2023          84      $441.04      $39.59
    014267-06                103211068001 184601686  LEFFERTS         SARA       19   851654062745220401   07/08/2023          30       $25.51       $0.44
    014267-06                103272483001 185482246  MOSCHGAT         CONNIE     01   532342315669199301   07/06/2023          30       $10.54       $0.00
    014267-06                103272483001 185482246  DUMM             RALPH      18   372985930336639301   07/03/2023         100        $3.58       $2.75
    014267-06                103272483001 185482246  DUMM             RALPH      18   227846501790129301   07/02/2023          90       $87.40       $4.79
    014267-06                103272483001 185482246  DUMM             RALPH      18   757701681816639301   07/03/2023          90    $1,891.30   $1,441.01
    014267-06                103272483001 185482246  MOSCHGAT         CONNIE     01   177128990136889301   07/06/2023          30       $33.21       $0.00
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   973762308890049301   07/03/2023           4       $11.50       $0.00
    014267-06                126568873001 188582035  MYERS            KEVIN      01   13393466465720401    07/08/2023          90       $51.15      $28.43
    014267-06                104212846001 196485949  DAISLEY          TODD       18   348666841721010401   06/25/2023         (90)   ($365.28)     ($4.14)
    014267-06                104212846001 196485949  DAISLEY          TODD       18   199848070521010401   06/25/2023         (90)   ($972.10)    ($20.05)
    014267-06                119289043001 201600245  NEUMANN          MARIE      19   391003466992539301   06/30/2023         (30)   ($530.43)   ($135.24)
    014267-06                105148829001 207601138  MESSINA          AUSTIN     19   463142933672200401   07/07/2023          30      $150.85       $0.00
  014267-06 Total                                                                                                                    $1,300.96   $1,477.91
  014267-07
    014267-07                113678744001 162669503  MICHAEL          KAYLA      18   674621772183179301   07/05/2023          10      $201.99       $0.72

                                                                                                                                               PAGE:7 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-07                102000987001 169688887  VAN CASTER       TARA       18   82512014846639301    07/03/2023           6       $35.64       $0.00
    014267-07                102000987001 169688887  VAN CASTER       TARA       18   450132815476639301   07/03/2023           1        $6.91       $0.00
    014267-07                102080665001 170683038  MICHINA          BRIDGET    18   835059409635900401   07/07/2023           1      $249.05     $160.62
    014267-07                123674799001 172727548  BROWN            JOHN       01   431736494505939301   07/03/2023          30       $82.42       $0.00
    014267-07                123674799001 172727548  BROWN            AMBER      18   974495220122819301   07/02/2023          25      $146.57      $23.92
    014267-07                102562858001 176587306  GIBBONS          ANGELA     18   154864082540079301   07/05/2023          30      $145.55      $28.79
    014267-07                102562858001 176587306  GIBBONS          ANGELA     18   864063556940079301   07/05/2023         210      $639.19     $375.80
    014267-07                102970458001 181589405  BROWN            TAYLOR     19   58603916245079301    07/05/2023           3       $30.61       $0.00
    014267-07                102970458001 181589405  BROWN            TAYLOR     19   204582531010401      07/07/2023           7      $102.86       $0.00
    014267-07                113012253001 183647983  WATT             NATALIE    01   168022333117600401   07/07/2023           1      $200.22     $160.62
    014267-07                113012253001 183647983  WATT             NATALIE    01   858854592399819301   07/02/2023          30      $378.08     $165.94
    014267-07                103271964001 185481106  ZELENSKI         MARIA      18   128931601968700401   07/07/2023          90       $63.56      $10.07
    014267-07                103537202001 188580615  DAVIS            LAURIE     18   607335760260859301   06/20/2023         (90)    ($96.73)     ($5.46)
    014267-07                103537202001 188580615  DAVIS            LAURIE     18   985665290950859301   06/20/2023         (90)   ($443.83)    ($19.47)
    014267-07                103537202001 188580615  DAVIS            LAURIE     18   969743416341279301   07/05/2023          90       $96.40       $2.66
    014267-07                103537202001 188580615  DAVIS            LAURIE     18   819072458241279301   07/05/2023          90      $443.83      $13.15
    014267-07                103879349001 192529999  WATT             LISA       01   139502984150859301   06/19/2023         (50)   ($740.55)    ($20.63)
    014267-07                103879349001 192529999  WATT             LISA       01   555896911050859301   06/19/2023         (50)    ($56.50)       $0.00
    014267-07                135720029001 196765983  MYERS            MARISSA    18   242296681059039301   07/03/2023          84      $116.30      $31.08
    014267-07                135720029001 196765983  MYERS            MARISSA    18   356441811421849301   07/04/2023          30      $148.69      $36.39
    014267-07                105235875001 208589040  EVANS            CRISTIAN   18   531978898518919301   07/02/2023           7       $50.49       $5.84
    014267-07                105308353001 209527301  HABERKORN        TIMOTHY    01   365444672595579301   07/04/2023          30      $673.90     $510.75
    014267-07                105308353001 209527301  HABERKORN        TIMOTHY    01   84334982944989301    07/04/2023         (30)   ($673.90)   ($510.75)
    014267-07                105308353001 209527301  HABERKORN        TIMOTHY    01   990612763654989301   07/06/2023          30      $673.90     $510.75
    014267-07                105413169001 210629784  HARROLD          GAVIN      19   129856813912800401   07/07/2023          18       $85.26      $25.66
    014267-07                105484472001 211540040  WALTERS          RONALD     18   719965880998400401   07/07/2023          50       $11.11       $0.00
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   425973856932800401   07/07/2023           5       $20.00      $12.00
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   276242525440010401   07/07/2023           5       $20.00      $12.00
  014267-07 Total                                                                                                                    $2,611.02   $1,530.45
  014267-08
    014267-08                101817845001 167523794  LEGROS           LOU ANN    18   160392863520359301   07/04/2023          10      $314.69       $4.47
    014267-08                101817845001 167523794  LEGROS           LOU ANN    18   76725610420359301    07/04/2023          10      $102.28       $7.50

                                                                                                                                               PAGE:8 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-08                116193139001 168527313  CYMBOR           PATRICIA   18   594419159795079301   07/05/2023          50      $118.72      $31.99
    014267-08                116871611001 173605841  MURPHY           JANELL     18   658662183747539301   07/03/2023          90      $188.19     $136.17
    014267-08                116871611001 173605841  MURPHY           JANELL     18   902003456847539301   07/03/2023          90      $805.05      $20.11
    014267-08                132465085001 175547949  VENESKY          KIM        18   460253816538620401   06/30/2023         (30)   ($454.92)   ($356.77)
    014267-08                102490553001 175663819  TAYLOR           SCOTT      01   105928740973049301   07/03/2023          90      $270.72      $23.32
    014267-08                102576284001 176682098  YARNISH          MISTY      18   59401411018739301    07/03/2023          10      $881.19       $0.00
    014267-08                103036754001 182545346  DELOZIER         BARBARA    01   991996301020520401   07/08/2023          30      $391.99     $109.92
    014267-08                103046886001 182605120  HENDRICK         JILL       18   381994199145888301   06/30/2023          90       $87.70       $0.00
    014267-08                103300419001 185649604  CAMPBELL         BROOKE     18   654112688287299301   07/06/2023          30       $15.33       $0.00
    014267-08                103537183001 188580574  HEBERT           LINDA      18   241629149716939301   07/03/2023          30      $985.99     $720.41
    014267-08                121090722001 192600296  PACKARD          BRENNA     19   705451751639379301   07/05/2023          84      $148.23      $51.05
    014267-08                104393562001 198605554  MCBREEN          AMBER      19   477126521574779301   07/05/2023           5       $47.69       $0.00
    014267-08                104393562001 198605554  MCBREEN          AMBER      19   720875180774779301   07/05/2023           6       $35.64       $2.54
    014267-08                110998339001 200645662  FEES             JENNY      18   66852945057539301    07/03/2023          30      $239.40      $27.29
    014267-08                105482197001 211523563  STEVENS          PATRICK    18   181515850595079301   07/05/2023          30      $244.96     $177.33
  014267-08 Total                                                                                                                    $4,422.85     $955.33
  014267-12
    014267-12                101592912001 164561540  KIVISTO          MARY       18   640753866712839301   07/03/2023          27      $703.46     $543.27
    014267-12                101592912001 164561540  KIVISTO          DAVID      01   137263126248689301   07/06/2023          30      $103.37      $10.21
    014267-12                101592912001 164561540  KIVISTO          DAVID      01   567953966412539301   07/03/2023          30      $169.28     $115.79
    014267-12                101592912001 164561540  KIVISTO          DAVID      01   383862035217839301   07/03/2023          30      $271.86      $43.11
    014267-12                101592912001 164561540  KIVISTO          DAVID      01   886183746248689301   07/06/2023          30       $81.72       $0.00
    014267-12                103337724001 186380155  LASOTA           DAVID      01   311875000516519301   07/02/2023          90      $434.20       $2.43
  014267-12 Total                                                                                                                    $1,763.89     $714.81
  014267-13
    014267-13                102552483001 176526359  CALDWELL         DAVID      18   735648418271639301   07/03/2023          50      $357.95      $38.16
    014267-13                102552483001 176526359  CALDWELL         DAVID      18   790691281232800401   07/07/2023          90      $804.04      $19.33
    014267-13                105133450001 207506102  VESCOVI          MARY       18   792115100741079301   07/05/2023          34      $200.34       $8.35
    014267-13                105133450001 207506102  VESCOVI          MARY       18   422192708347179301   07/05/2023          10      $211.06      $79.50
    014267-13                105133450001 207506102  VESCOVI          MARY       18   474758840927099301   06/16/2023        (100)   ($639.19)   ($385.80)
  014267-13 Total                                                                                                                      $934.20   ($240.46)
  014267-15

                                                                                                                                               PAGE:9 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   373929049667989301   07/06/2023          90      $518.16       $9.18
    014267-15                101825051001 167565230  PARONISH         THOMAS     18   345636334105889301   07/06/2023          50      $297.88     $219.00
    014267-15                102057315001 170525384  LEAHEY           BRADY      18   986362225857919301   07/02/2023          90      $709.40      $16.36
    014267-15                103115531001 183523270  SHEA             EDWARD     18   160182435770379301   07/05/2023           1      $133.99      $50.42
    014267-15                104458562001 199522908  SERAFIN          SANDRA     18   920743176083059301   07/04/2023          30      $879.99     $639.88
    014267-15                104458562001 199522908  SERAFIN          SANDRA     18   774952465280939301   07/03/2023          30       $65.99      $40.95
    014267-15                104466514001 199567150  KIRSCH           JENNIFER   18   829036673932500401   07/07/2023          30      $524.33     $401.52
    014267-15                104466514001 199567150  KIRSCH           JENNIFER   18   760015870932500401   07/07/2023          30      $158.01       $0.00
    014267-15                104466514001 199567150  KIRSCH           JENNIFER   18   477901371932500401   07/07/2023          90      $706.64      $16.36
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   712734602793989301   07/06/2023           7       $30.61       $0.00
    014267-15                105490873001 211568528  MATTIS           KATHRYN    18   846226474740379301   07/05/2023          90       $88.60       $3.88
    014267-15                105490873001 211568528  MATTIS           KATHRYN    18   331362274740379301   07/05/2023          90       $67.05       $5.35
    014267-15                105490873001 211568528  MATTIS           KATHRYN    18   289632783740379301   07/05/2023          90      $431.45      $35.42
    014267-15                105490873001 211568528  MATTIS           KATHRYN    18   250662105840379301   07/05/2023          90       $72.45       $6.47
  014267-15 Total                                                                                                                    $4,684.55   $1,444.79
  014267-19
    014267-19                105488365001 211561553  MCDERMOTT        KIMBERLY   18   275271110993388301   06/30/2023          84      $173.38       $0.00
  014267-19 Total                                                                                                                      $173.38       $0.00
  014267-34
    014267-34                103601825001 189449008  MARKOVICH        FRANCIS    18   189049269744899301   07/07/2023          90      $175.69       $0.00
    014267-34                104563160001 200641847  SCHILLING        JASON      18   704139819585199301   06/23/2023         (30)   ($142.45)       $0.00
    014267-34                104563160001 200641847  SCHILLING        JASON      18   669013316785199301   06/23/2023         (30)   ($174.20)     ($7.70)
    014267-34                104563160001 200641847  SCHILLING        JASON      18   511051302485199301   06/23/2023         (30)    ($47.71)     ($4.90)
    014267-34                104563160001 200641847  SCHILLING        JASON      18   376722813685199301   06/23/2023         (30)   ($281.89)    ($14.84)
  014267-34 Total                                                                                                                    ($470.56)    ($27.44)
  014267-36
    014267-36                101597846001 164585882  BECQUET          DAWN       18   488656734380739301   07/03/2023           6       $36.71       $2.54
    014267-36                101609657001 164662147  BYRNE            VANESSA    01   722319029428839301   07/03/2023          25       $57.10      $25.02
    014267-36                101694701001 165742506  STRAPLE          KOTY       18   96265464721400401    11/21/2022          20       $53.83      $34.22
    014267-36                101694701001 165742506  STRAPLE          KOTY       18   18795904424400401    12/21/2022          23      $412.32     $391.60
    014267-36                101694701001 165742506  STRAPLE          KOTY       18   966465364721400401   11/21/2022          23      $412.32     $391.60
    014267-36                101742475001 166526179  CLAYCOMB         MORGAN     19   643633556170919301   07/02/2023          10       $18.59       $0.00

                                                                                                                                              PAGE:10 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-36                103457061001 187582626  BAILEY           NATHAN     19   323519499316099301   06/22/2023         (30) ($2,596.49) ($2,059.98)
    014267-36                103457061001 187582626  BAILEY           DAVID      18   579973106109220401   07/08/2023          30      $172.85       $3.03
    014267-36                103457061001 187582626  BAILEY           DAVID      18   168731572009220401   07/08/2023          30      $174.20       $0.00
    014267-36                103555014001 188707325  BATEMAN          NICOLE     01   733519169241679301   07/05/2023          30      $170.19       $0.00
    014267-36                103555014001 188707325  BATEMAN          NICOLE     01   397131601866279301   07/05/2023          30       $22.06       $0.00
    014267-36                118690744001 203684634  BEHORY           JESSICA    01   412172864313149301   07/03/2023          28       $14.18      $14.18
    014267-36                130843123001 206742135  SETTLE           SUNNY      18   605433056900320401   07/08/2023          30       $14.03       $0.00
    014267-36                105326129001 209640969  WURM             ISAAC      19   144534362256939301   07/03/2023          34      $640.83     $402.61
    014267-36                105326129001 209640969  WURM             GARRY      01   766781721616969301   07/05/2023          30       $20.50       $0.00
    014267-36                105326129001 209640969  WURM             GARRY      01   880702105616969301   07/05/2023          30      $159.01       $0.00
    014267-36                129022752001 211720568  BAKER            JESSICA    18   229901102912819301   07/02/2023          30      $143.10       $0.00
  014267-36 Total                                                                                                                     ($74.67)   ($795.18)
  014267-37
    014267-37                102139943001 171527840  TARWATER         PATRICIA   18   134945670955600401   07/07/2023          25       $86.15       $0.00
    014267-37                103459963001 187600390  BRYAN            KAREN      18   677992505716769301   07/05/2023          30      $156.60       $0.00
    014267-37                103459963001 187600390  BRYAN            KAREN      18   941812933095459301   07/04/2023          10       $99.71       $0.00
  014267-37 Total                                                                                                                      $342.46       $0.00
  014267- Total                                                                                                                     $78,549.46  $33,694.43
Drug Total                                                                                                                          $78,549.46  $33,694.43
                                                                                                                                                            
Facility
  053264-01
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22112742130          06/29/2023           5    $2,940.00       $0.00
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22112742130          06/29/2023           1      $361.00       $0.00
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22112742130          06/29/2023           1        $4.55       $0.00
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22112742130          06/29/2023           2       $50.00       $0.00
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22112742130          06/29/2023           1       $12.87       $0.00
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22112742130          06/29/2023           1      $941.00       $0.00
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22112742130          06/29/2023           1        $2.51       $0.00
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22112742130          06/29/2023           1   $34,427.00       $0.00
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22112742130          06/29/2023           1   $92,662.00  $39,591.51
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22112742130          06/29/2023           1    $7,178.00       $0.00

                                                                                                                                              PAGE:11 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22112742130          06/29/2023           1      $388.00       $0.00
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22112742130          06/29/2023          14       $62.33       $0.00
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22112742130          06/29/2023           1      $327.00       $0.00
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22112742130          06/29/2023           4        $2.51       $0.00
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22112742130          06/29/2023           1      $405.00       $0.00
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22112742130          06/29/2023           2        $1.39       $0.00
  053264-01 Total                                                                                                                  $139,765.16  $39,591.51
  053264- Total                                                                                                                    $139,765.16  $39,591.51
Facility Total                                                                                                                     $139,765.16  $39,591.51
                                                                                                                                                            
HDHP PPO
  014267-54
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22712789651          07/03/2023           1       $80.00      $22.60
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22712585914          06/29/2023           2      $168.00      $49.16
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22712585914          06/29/2023           1       $50.00      $10.45
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22712585914          06/29/2023           1       $80.00      $22.60
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22712789651          07/03/2023           1       $50.00      $10.45
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22712789651          07/03/2023           2      $168.00      $49.16
    014267-54                101290691001 160589924  BORLIE           MARGARET   18   22212483410          06/27/2023           1       $67.00      $19.59
    014267-54                101290691001 160589924  BORLIE           MARGARET   18   22212672454          06/30/2023           1      $421.00      $41.08
    014267-54                101290691001 160589924  BORLIE           MARGARET   18   22212483410          06/27/2023           1      $127.00      $15.23
    014267-54                101290691001 160589924  BORLIE           MARGARET   18   22212672454          06/30/2023           1      $418.00      $41.08
    014267-54                101290691001 160589924  BORLIE           MARGARET   18   22212483410          06/27/2023           1      $108.00      $26.63
    014267-54                101290691001 160589924  BORLIE           MARGARET   18   22212672454          06/30/2023           1      $816.00      $40.52
    014267-54                101290691001 160589924  BORLIE           MARGARET   18   22212483410          06/27/2023           1       $23.00       $0.00
    014267-54                101299088001 160644992  MARTINAZZI       BRANDON    18   471642728449299301   06/21/2023         (30)    ($13.22)       $0.00
    014267-54                101299088001 160644992  MARTINAZZI       REBECCA    01   22212613129          06/26/2023           1      $142.00       $0.00
    014267-54                101299088001 160644992  MARTINAZZI       REBECCA    01   22212565165          06/26/2023           1      $237.00      $88.49
    014267-54                101299088001 160644992  MARTINAZZI       BRANDON    18   295578270929299301   07/06/2023          30       $28.97       $0.00
    014267-54                101299088001 160644992  MARTINAZZI       BRANDON    18   424424422749299301   07/06/2023          30       $25.45       $0.00
    014267-54                101299088001 160644992  MARTINAZZI       REBECCA    01   22212565165          06/26/2023           1      $237.00      $88.49
    014267-54                101363408001 161569102  COOK             SCOTT      18   833556961441079301   07/05/2023           4      $268.51       $0.00

                                                                                                                                              PAGE:12 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                101514808001 163542690  FULLER           KEVIN      01   219176601318739301   07/03/2023          30      $713.46     $549.96
    014267-54                101589732001 164542342  ROBERTS          DAVID      01   22031468556          06/22/2023           1      $108.00       $0.00
    014267-54                101589732001 164542342  ROBERTS          DAVID      01   22031468556          06/22/2023           1      $172.00       $0.00
    014267-54                101589732001 164542342  ROBERTS          DAVID      01   22031468556          06/22/2023           1       $44.00       $0.00
    014267-54                101599698001 164601083  SWATSWORTH       DAVID      01   595331871689400401   07/07/2023          30       $68.45       $0.00
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   22512778797          06/29/2023           1       $36.50      $25.42
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22512587518          06/30/2023           1       $20.00      $12.84
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   22512778797          06/29/2023           1       $15.00      $11.00
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   22512778797          06/29/2023           6       $30.00      $19.80
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22512587518          06/30/2023           3      $108.00      $73.74
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   406759049771789301   07/06/2023           5       $47.69       $6.85
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   22512778797          06/29/2023           1       $41.00      $28.14
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22512587518          06/30/2023           1       $33.00      $22.60
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   992268840416819301   07/02/2023          30       $15.88       $8.86
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   385981521416819301   07/02/2023          30       $25.72       $6.97
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   22512776010          06/16/2023           1      $242.00     $157.86
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   889174132839439301   07/03/2023          10      $162.54      $62.52
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   22512443252          06/20/2023           3      $378.00     $241.80
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   698546751119439301   07/03/2023          10      $105.88      $47.74
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   22512778797          06/29/2023           1      $100.00      $84.40
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   22512778797          06/29/2023           5      $200.00     $145.40
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   22512778797          06/29/2023           1       $20.00      $14.00
    014267-54                131732377001 167623544  MARSH            RAYMOND    01   22712704548          06/29/2023           1      $150.00      $12.36
    014267-54                131732377001 167623544  MARSH            RAYMOND    01   22712743027          06/29/2023           1       $53.00       $0.00
    014267-54                131732377001 167623544  MARSH            SHELLY     18   22712767691          07/05/2023           1       $23.00      $10.07
    014267-54                131732377001 167623544  MARSH            RAYMOND    01   22712873396          07/07/2023           1       $35.00      $23.27
    014267-54                131732377001 167623544  MARSH            SHELLY     18   22712514566          06/23/2023           1       $96.00      $42.37
    014267-54                131732377001 167623544  MARSH            SHELLY     18   22712514566          06/23/2023           1      $167.00      $74.65
    014267-54                131732377001 167623544  MARSH            RAYMOND    01   22712873396          07/07/2023           1       $42.00      $22.60
    014267-54                131732377001 167623544  MARSH            RAYMOND    01   22712743027          06/29/2023           1      $270.00       $0.00
    014267-54                131732377001 167623544  MARSH            RAYMOND    01   22712873396          07/07/2023           1       $30.00       $9.55
    014267-54                131732377001 167623544  MARSH            RAYMOND    01   22712743027          06/29/2023           1       $23.00       $0.00

                                                                                                                                              PAGE:13 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                131732377001 167623544  MARSH            SHELLY     18   22712514566          06/23/2023           1       $86.00      $22.75
    014267-54                131732377001 167623544  MARSH            RAYMOND    01   22712704548          06/29/2023           1      $150.00      $12.36
    014267-54                131732377001 167623544  MARSH            SHELLY     18   22712514566          06/23/2023           1      $102.00      $21.33
    014267-54                131732377001 167623544  MARSH            SHELLY     18   22712514566          06/23/2023           1      $107.00      $20.60
    014267-54                131732377001 167623544  MARSH            SHELLY     18   22712514566          06/23/2023           1       $67.00      $19.59
    014267-54                131732377001 167623544  MARSH            RAYMOND    01   707795200052839301   07/03/2023          30    $1,619.80   $1,299.85
    014267-54                131732377001 167623544  MARSH            RAYMOND    01   22712743027          06/29/2023           1      $270.00     $243.35
    014267-54                131732377001 167623544  MARSH            RAYMOND    01   22712743027          06/29/2023           1       $91.00       $0.00
    014267-54                131732377001 167623544  MARSH            RAYMOND    01   22712873396          07/07/2023           1       $30.00      $24.58
    014267-54                131732377001 167623544  MARSH            RAYMOND    01   22712743027          06/29/2023           1       $37.00       $0.00
    014267-54                131732377001 167623544  MARSH            SHELLY     18   22712514566          06/23/2023           1       $23.00       $0.00
    014267-54                131732377001 167623544  MARSH            SHELLY     18   22712514566          06/23/2023           1      $104.00      $16.90
    014267-54                131732377001 167623544  MARSH            SHELLY     18   22712514566          06/23/2023           1       $67.00      $33.77
    014267-54                131732377001 167623544  MARSH            SHELLY     18   22712514566          06/23/2023           1       $91.00      $11.95
    014267-54                131732377001 167623544  MARSH            SHELLY     18   22712514566          06/23/2023           1       $67.00      $24.49
    014267-54                125745578001 169687605  SMITH            AMY        18   22812801687          06/27/2023           1      $140.00     $110.01
    014267-54                102080764001 170683398  STRAZISAR        ROBERT     01   287878458877789301   07/06/2023          30       $30.70       $5.13
    014267-54                122307690001 171640335  WIEGAND          AARON      18   344081042807939301   07/03/2023          30      $249.81       $0.00
    014267-54                102159846001 171648736  PALKO            JONAH      19   22031425281          07/05/2023           1       $88.00      $46.36
    014267-54                112685074001 175662935  KOLARIK          NICHOLE    18   21795416661          07/22/2022           1       $25.00       $4.01
    014267-54                112685074001 175662935  KOLARIK          NICHOLE    18   21795416661          07/22/2022           1      $150.00      $85.00
    014267-54                112685074001 175662935  KOLARIK          NICHOLE    18   21791158878          07/22/2022          (1)   ($150.00)    ($51.00)
    014267-54                112685074001 175662935  KOLARIK          NICHOLE    18   21791158878          07/22/2022          (1)    ($25.00)     ($3.00)
    014267-54                112685074001 175662935  KOLARIK          BROOKE     19   312768860763179301   07/05/2023          13       $80.30       $0.00
    014267-54                112685074001 175662935  KOLARIK          NICHOLE    18   21791158878          07/22/2022           1       $25.00       $4.01
    014267-54                112685074001 175662935  KOLARIK          NICHOLE    18   21791158878          07/22/2022           1      $150.00      $85.00
    014267-54                117041830001 177705872  GALLAGHER        MATTHEW    01   22712771582          06/02/2023           1      $200.00       $0.00
    014267-54                103127832001 183589717  EDWARDS          AMY        18   22031468507          06/30/2023           1       $27.78      $10.52
    014267-54                103127832001 183589717  EDWARDS          AMY        18   22031257729          06/30/2023           1      $736.00     $221.14
    014267-54                103127832001 183589717  EDWARDS          AMY        18   17452975797489301    07/06/2023          30       $31.99       $0.00
    014267-54                103127832001 183589717  EDWARDS          AMY        18   22031468507          06/30/2023           1    $1,456.00   $1,632.71
    014267-54                103127832001 183589717  EDWARDS          AMY        18   22031468507          06/30/2023           1      $180.00       $0.00

                                                                                                                                              PAGE:14 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                103127832001 183589717  EDWARDS          AMY        18   22031468507          06/30/2023           1      $557.00       $0.00
    014267-54                103127832001 183589717  EDWARDS          AMY        18   22031468507          06/30/2023          25       $27.57       $8.25
    014267-54                103127832001 183589717  EDWARDS          AMY        18   22031468507          06/30/2023           1       $22.05       $0.00
    014267-54                116625941001 183628434  LITZINGER        LYDIA      19   22811201220          06/12/2023           1      $195.00      $74.94
    014267-54                121194993001 185622463  WENDEROTH        HANNAH     19   22312467358          07/01/2023           1      $300.00       $0.00
    014267-54                121194993001 185622463  BEAMER           HAYLEE     19   326926513357500401   07/07/2023          28      $102.30      $15.13
    014267-54                121194993001 185622463  WENDEROTH        LUKE       01   22312442393          06/28/2023           1       $42.00       $0.00
    014267-54                121194993001 185622463  WENDEROTH        AVA        19   180271802586539301   07/03/2023          28      $147.68      $13.70
    014267-54                121194993001 185622463  WENDEROTH        LUKE       01   22312442393          06/28/2023           1       $82.00       $0.00
    014267-54                103303874001 185683958  GEISER           RANDY      01   22212689497          06/27/2023           1      $250.00     $190.12
    014267-54                103303874001 185683958  GEISER           RANDY      01   22212689497          06/30/2023           2      $160.00      $91.49
    014267-54                103379738001 186625394  RHINE            HEATHER    18   22512591959          06/29/2023           2      $160.00      $45.20
    014267-54                103379738001 186625394  RHINE            HARVEY     01   243989419079379301   07/05/2023           6       $43.12      $11.79
    014267-54                103379738001 186625394  RHINE            HARVEY     01   370156663906600401   07/07/2023          30      $317.02      $15.70
    014267-54                103379738001 186625394  RHINE            HEATHER    18   586072084332110401   06/24/2023          (1)    ($14.93)     ($3.76)
    014267-54                103379738001 186625394  RHINE            HEATHER    18   22512591959          06/29/2023           2      $112.00      $49.16
    014267-54                103379738001 186625394  RHINE            HEIDI      19   22512590877          06/29/2023           1      $209.00     $126.85
    014267-54                103884128001 192564580  ALEXANDER        EMMA       19   22810263157          05/22/2023          (1)   ($125.00)    ($39.17)
    014267-54                103884128001 192564580  ALEXANDER        EMMA       19   22812727452          05/22/2023           1      $187.00      $67.86
    014267-54                103884128001 192564580  ALEXANDER        EDWARD     18   22812720193          06/15/2023           3      $504.00       $0.00
    014267-54                103884128001 192564580  ALEXANDER        EDWARD     18   22812720193          06/15/2023           2      $500.00      $81.28
    014267-54                103884128001 192564580  ALEXANDER        EMMA       19   22812727452          05/22/2023           1      $165.00      $67.86
    014267-54                103884128001 192564580  ALEXANDER        EMMA       19   22812727452          05/22/2023           1      $168.00      $67.86
    014267-54                103884128001 192564580  ALEXANDER        EMMA       19   22810263157          05/22/2023          (1)   ($165.00)    ($67.86)
    014267-54                103884128001 192564580  ALEXANDER        EDWARD     18   22812720193          06/15/2023           1      $168.00       $0.00
    014267-54                103884128001 192564580  ALEXANDER        EMMA       19   22812727452          05/22/2023           1      $125.00      $39.17
    014267-54                103884128001 192564580  ALEXANDER        EMMA       19   22810263157          05/22/2023          (1)   ($168.00)    ($67.86)
    014267-54                104054990001 194546961  KANICH           CHRISTIA   19   721536274702539301   07/03/2023          30       $82.99       $7.97
    014267-54                104054990001 194546961  KANICH           WILLIAM    18   408706141940700401   07/07/2023          30      $120.75       $8.16
    014267-54                104322714001 197666714  ZAMBONI          KATE       01   218991892641379301   07/05/2023          28       $42.98      $19.05
    014267-54                117170403001 197701125  BARELICH         RIVER      19   22612718555          07/03/2023           1      $140.00      $89.99
    014267-54                104402015001 198667995  KOSS             SHANNON    18   842313556997179301   07/05/2023          12    $2,444.31     $326.34

                                                                                                                                              PAGE:15 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                104402015001 198667995  KOSS             SUMMER     19   544209399025199301   07/06/2023          21       $44.38      $14.74
    014267-54                104402015001 198667995  KOSS             SUMMER     19   902328130329199301   07/06/2023          30      $172.71       $9.88
    014267-54                104472618001 199605677  RHOADES          SHERRIE    01   417719499878439301   07/03/2023          90      $458.50      $27.06
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22612790200          07/03/2023           1       $70.87       $7.00
    014267-54                104472618001 199605677  RHOADES          RONALD     18   673791921088649301   07/04/2023          90      $407.20      $19.01
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   133215210109819301   07/02/2023          10      $102.03      $16.29
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22612790200          07/03/2023           1       $88.07      $10.00
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22612655635          06/30/2023           1      $150.00      $90.10
    014267-54                104472618001 199605677  RHOADES          RONALD     18   774238328088649301   07/04/2023          90      $235.30      $14.18
    014267-54                104472618001 199605677  RHOADES          RONALD     18   337953626088649301   07/04/2023          90      $392.41      $15.17
    014267-54                104472618001 199605677  RHOADES          RONALD     18   275279339088649301   07/04/2023          90      $105.70      $13.13
    014267-54                104536194001 200467259  MULATO           ANDREW     18   803164662057789301   07/06/2023          30      $148.61       $5.87
    014267-54                104536194001 200467259  MULATO           JUDITH     01   50632443021889301    07/06/2023          30      $737.02     $175.51
    014267-54                104557985001 200604757  RUDNIK           ELI        19   22812625456          06/30/2023           1       $25.00       $2.48
    014267-54                104557985001 200604757  RUDNIK           ELI        19   22812625456          06/30/2023           1      $135.00     $130.20
    014267-54                104557985001 200604757  RUDNIK           KEIRA      19   372228498617179301   07/05/2023           1       $15.95       $0.00
    014267-54                104565994001 200663669  GERGELY          JANEL      18   188538538985379301   07/05/2023          30      $816.04     $654.82
    014267-54                104717677001 202546801  CHUHRAN          BREANA     19   22412422256          06/29/2023           1       $35.00      $16.70
    014267-54                104717677001 202546801  CHUHRAN          BREANA     19   22412422256          06/29/2023           1       $40.00       $4.95
    014267-54                104717677001 202546801  CHUHRAN          BREANA     19   22412422256          06/29/2023           1      $185.00     $116.03
    014267-54                104717677001 202546801  CHUHRAN          STACIE     18   766108038449079301   07/05/2023           7        $9.99       $2.01
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031256957          06/27/2023           1      $161.00      $85.70
    014267-54                104738058001 202684807  REPINE           MARK       01   22031451308          07/03/2023           1       $66.00      $11.87
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031256968          06/27/2023           1      $261.00     $170.43
    014267-54                104738058001 202684807  REPINE           MARK       01   22031282196          06/28/2023           1       $86.00      $24.58
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031254269          06/12/2023           1      $696.20     $348.10
    014267-54                104738058001 202684807  REPINE           MARK       01   22031451308          07/03/2023           1       $86.00      $24.58
    014267-54                104738058001 202684807  REPINE           MARK       01   22031451308          07/03/2023           1       $69.00      $10.45
    014267-54                104738058001 202684807  REPINE           MARK       01   22031282196          06/28/2023           1       $76.00      $28.53
    014267-54                104738058001 202684807  REPINE           MARK       01   22031282196          06/28/2023           1       $69.00      $10.45
    014267-54                104738058001 202684807  REPINE           MARK       01   22031451308          07/03/2023           1       $76.00      $28.53
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031254272          06/12/2023           1      $708.00     $348.10

                                                                                                                                              PAGE:16 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                104738058001 202684807  REPINE           MARK       01   22031282196          06/28/2023           1       $66.00      $11.87
    014267-54                104738058001 202684807  REPINE           MARCY      18   399095680270989301   07/06/2023           2      $219.99     $160.62
    014267-54                104738058001 202684807  REPINE           MARK       01   22031256969          06/27/2023           1      $186.00     $120.81
    014267-54                104788273001 203482794  PALKO            DANIEL     18   22412700747          06/29/2023           1    $1,050.00     $238.39
    014267-54                104788273001 203482794  PALKO            DANIEL     18   22412704104          06/29/2023           1    $1,275.00     $856.55
    014267-54                104897053001 204622866  BENNETT          EMILY      19   22031175682          06/05/2023           1       $40.00       $0.00
    014267-54                104897053001 204622866  BENNETT          EMILY      19   22031175682          06/05/2023           1       $55.00       $0.00
    014267-54                126258506001 207609840  KIRSCH           SHELLEY    18   22812767009          06/26/2023           1       $30.00       $0.00
    014267-54                126258506001 207609840  KIRSCH           CHELSEA    19   118526281877779301   07/05/2023           7       $10.80       $0.00
    014267-54                105155289001 207641433  DUGAS            CHRISTOP   01   204382774170220401   07/08/2023          10       $57.45       $0.00
    014267-54                105312729001 209560824  LAUER            MARIA      18   22312462217          06/27/2023           1      $406.00     $264.39
    014267-54                105312729001 209560824  LAUER            GENO       19   22552105060039301    07/03/2023          28    $8,459.21   $6,758.91
    014267-54                105312729001 209560824  LAUER            GENO       19   22312717521          06/03/2023           1      $225.00     $105.99
    014267-54                105312729001 209560824  LAUER            MARIA      18   22312462217          06/27/2023           1      $554.00       $0.00
    014267-54                105312729001 209560824  LAUER            JEFFREY    01   22312756798          07/03/2023           1       $23.00       $0.00
    014267-54                105312729001 209560824  LAUER            JEFFREY    01   22312756798          07/03/2023           1       $98.00      $47.34
    014267-54                120307645001 210683109  MCCORMICK        SARAH      18   22112842061          07/06/2023           1      $142.00       $0.00
    014267-54                122643511001 211720938  CONRAD           SAMANTHA   18   22712771558          06/03/2023           1      $100.00       $0.00
    014267-54                122643511001 211720938  CONRAD           SAMANTHA   18   22712771558          06/03/2023           1      $200.00       $0.00
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22512447791          06/27/2023           1       $55.00      $11.87
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22512447791          06/27/2023           1       $84.00      $24.58
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22512625153          07/03/2023           1       $84.00      $24.58
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22512447791          06/27/2023           1      $115.00      $83.63
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22512625153          07/03/2023           1       $50.00      $14.41
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22512625153          07/03/2023           1       $55.00      $11.87
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22512447791          06/27/2023           1       $80.00      $22.60
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22512625153          07/03/2023           2      $160.00      $45.20
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22512447791          06/27/2023           1      $105.00      $40.68
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22512447791          06/27/2023           1       $50.00      $14.41
  014267-54 Total                                                                                                                   $41,051.48  $18,676.08
  014267- Total                                                                                                                     $41,051.48  $18,676.08
  017697-00

                                                                                                                                              PAGE:17 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-00                116971091001 085705608  TOMASELLI        PETER      19   22812769291          06/04/2023           1      $200.00       $0.00
    017697-00                116971091001 085705608  TOMASELLI        MELISSA    01   813752344685079301   07/05/2023          30       $78.94       $0.00
    017697-00                116971091001 085705608  TOMASELLI        PETER      19   22812769291          06/04/2023           1       $47.00       $0.00
    017697-00                113918356001 162669421  ROSSMAN          PAUL       01   145378928165079301   07/05/2023          30      $148.61       $9.88
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   158622895065079301   07/05/2023          30      $159.01       $8.23
    017697-00                101684237001 165626002  EDGELL           JOHN       18   815006213692149301   07/03/2023           5       $23.60       $5.67
    017697-00                101684237001 165626002  EDGELL           PENNE      01   786781112211049301   06/18/2023         (30)   ($142.45)     ($8.58)
    017697-00                101684237001 165626002  EDGELL           JOHN       18   990315920303149301   07/03/2023          10       $20.52       $6.25
    017697-00                101684237001 165626002  EDGELL           JOHN       18   438442685499910401   07/08/2023          30       $17.49       $4.42
    017697-00                118886334001 165662521  MENTO            KAYLEE     19   318961392312500401   07/07/2023          28       $40.32      $11.92
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $10.00       $5.00
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $10.00       $5.50
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $10.00       $3.50
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $10.00       $5.00
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $10.00       $5.00
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $70.00      $17.61
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $14.00       $6.50
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $10.00       $4.00
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1      $235.00     $157.86
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $10.00       $4.50
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $10.00       $5.00
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $30.00       $7.50
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $13.00       $4.00
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $10.00       $4.50
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $12.00       $6.00
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22030863700          06/27/2023           1      $250.00      $64.62
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $10.00       $4.00
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $10.00       $4.50
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $12.00       $5.00
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $12.00       $6.50
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22030863700          06/27/2023           1    $1,200.00     $364.28
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $11.00       $7.00

                                                                                                                                              PAGE:18 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $10.00       $5.00
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22030863700          06/27/2023           1       $35.00      $35.00
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031144641          06/27/2023           1       $10.00       $4.50
    017697-00                102072716001 170622250  MCCOMBIE         JARROD     18   22812475031          06/28/2023           1       $80.00       $0.00
    017697-00                102072716001 170622250  MCCOMBIE         CHRISTIN   01   687156683117149301   07/03/2023          28       $35.96      $13.04
    017697-00                102072716001 170622250  MCCOMBIE         JARROD     18   22812475031          06/28/2023           1       $50.00       $0.00
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22212698879          06/14/2023           1      $968.75     $385.00
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22212698879          06/14/2023          19      $354.38     $218.11
    017697-00                113204987001 176509888  DORSCH           CHRISTIN   18   22812697627          06/30/2023           6      $150.00       $0.00
    017697-00                113204987001 176509888  DORSCH           CHRISTIN   18   22812697627          06/30/2023           1       $40.00       $0.00
    017697-00                102722130001 178545437  FULTON           BETH       18   91896634776359301    07/04/2023          30      $170.68       $0.00
    017697-00                102722130001 178545437  FULTON           BETH       18   294132013776359301   07/04/2023          30      $222.86       $0.00
    017697-00                102722130001 178545437  FULTON           BETH       18   442732164776359301   07/04/2023          30       $51.16       $0.00
    017697-00                102722130001 178545437  FULTON           BETH       18   140821942676359301   07/04/2023          30       $82.99       $0.00
    017697-00                102722130001 178545437  FULTON           BETH       18   227222284776359301   07/04/2023          30      $228.35       $0.00
    017697-00                102742521001 178682192  WHEELER          JUSTIN     19   22612786478          06/29/2023           1       $93.00       $0.00
    017697-00                102742521001 178682192  WHEELER          JUSTIN     19   22612786479          07/03/2023           1      $121.00       $0.00
    017697-00                102742521001 178682192  WHEELER          JUSTIN     19   325771851789639301   07/03/2023          13       $39.09       $0.00
    017697-00                102742521001 178682192  WHEELER          JUSTIN     19   22612786478          06/29/2023           1       $78.00       $0.00
    017697-00                102884338001 180600186  KIRSCH           BRIDGET    18   22112728058          06/02/2023           1       $47.00       $0.00
    017697-00                102884338001 180600186  KIRSCH           BRIDGET    18   22112728058          06/02/2023           1       $90.00       $0.00
    017697-00                102884338001 180600186  KIRSCH           BRIDGET    18   22112728058          06/02/2023           1      $200.00       $0.00
    017697-00                115794029001 180664146  KUDLAWIEC        BRYAN      01   22212567315          06/27/2023           1      $207.00      $65.00
    017697-00                115794029001 180664146  KUDLAWIEC        BRYAN      01   22212567315          06/27/2023           1       $29.50       $0.00
    017697-00                115794029001 180664146  KUDLAWIEC        BRYAN      01   22212567315          06/27/2023           1      $225.00      $66.99
    017697-00                123414108001 183723909  MCMULLEN         JOCELYN    18   408621281113179301   07/05/2023          30      $164.80       $0.00
    017697-00                123414108001 183723909  MCMULLEN         EDEN       19   588441101553179301   07/05/2023           5       $17.48       $0.00
    017697-00                103299423001 185646090  NILESKI          KERRY      18   624302743600919301   07/02/2023          30       $38.83       $9.11
    017697-00                103299423001 185646090  NILESKI          KERRY      18   22612301579          06/26/2023           1      $270.00      $83.63
    017697-00                103299423001 185646090  NILESKI          KERRY      18   196128208600919301   07/02/2023          30      $122.42       $5.48
    017697-00                103299423001 185646090  NILESKI          KERRY      18   22612301579          06/26/2023           1       $70.50      $24.58
    017697-00                103299423001 185646090  NILESKI          KERRY      18   634401611790639301   07/03/2023          30      $262.60      $45.61

                                                                                                                                              PAGE:19 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-00                103299423001 185646090  NILESKI          KERRY      18   893172054591029301   07/02/2023          30       $30.70       $5.13
    017697-00                103299423001 185646090  NILESKI          KERRY      18   343196331297789301   07/06/2023          30       $11.77       $8.95
    017697-00                103468306001 187645700  GERGELY          LILY       19   22412417332          06/21/2023           1      $145.00       $0.00
    017697-00                103468306001 187645700  GERGELY          LILY       19   22412751614          06/04/2023           1      $110.00       $0.00
    017697-00                103468306001 187645700  GERGELY          LILY       19   22412751614          06/04/2023           1      $170.00       $0.00
    017697-00                103468306001 187645700  GERGELY          LILY       19   22412751614          06/04/2023           1      $200.00       $0.00
    017697-00                115603314001 187702712  MARINO           AMANDA     18   22612617142          06/12/2023           1      $399.00      $78.22
    017697-00                115603314001 187702712  MARINO           AMANDA     18   262171252628700401   07/07/2023          20      $141.70      $20.77
    017697-00                115603314001 187702712  MARINO           AMANDA     18   516413196016889301   07/06/2023          30       $76.27      $20.62
    017697-00                128188608001 187709950  LANE             MADELYN    19   22612663938          06/30/2023           1      $248.00     $221.58
    017697-00                128188608001 187709950  LANE             MADELYN    19   22612663938          06/30/2023           1       $49.00      $21.21
    017697-00                128188608001 187709950  LANE             RYAN       19   22612663939          06/30/2023           1      $130.00       $0.00
    017697-00                128188608001 187709950  LANE             MADELYN    19   22612663938          06/30/2023           2       $50.00      $32.03
    017697-00                128188608001 187709950  LANE             MADELYN    19   22612663938          06/30/2023           1      $210.00     $101.46
    017697-00                128188608001 187709950  LANE             MADELYN    19   22612663938          06/30/2023           1       $49.00      $21.21
    017697-00                128188608001 187709950  LANE             MADELYN    19   22612663938          06/30/2023           1       $73.00      $56.17
    017697-00                128188608001 187709950  LANE             MADELYN    19   22612663938          06/30/2023           1       $49.00      $21.21
    017697-00                128188608001 187709950  LANE             MADELYN    19   22612663938          06/30/2023           2       $50.00      $32.03
    017697-00                128188608001 187709950  LANE             MADELYN    19   22612663938          06/30/2023           1      $147.00     $124.04
    017697-00                128188608001 187709950  LANE             MADELYN    19   22612663938          06/30/2023           1       $49.00      $21.21
    017697-00                128188608001 187709950  LANE             MADELYN    19   22612663938          06/30/2023           1       $62.00      $38.33
    017697-00                103542040001 188603765  CONRAD           CARRIE     18   388843916382759301   07/01/2023          30       $82.42       $8.55
    017697-00                103542040001 188603765  CONRAD           CARRIE     18   652501412382759301   07/01/2023         (30)    ($86.53)     ($8.55)
    017697-00                103542040001 188603765  CONRAD           SETH       19   846548130536939301   07/03/2023          90      $383.35      $22.92
    017697-00                103799754001 191568518  GIBSON           AMY        18   22031246873          06/30/2023           1      $497.00     $220.83
    017697-00                103799754001 191568518  GIBSON           AMY        18   22031246873          06/30/2023           1       $48.00      $57.40
    017697-00                103799754001 191568518  GIBSON           AMY        18   22031291747          06/30/2023           1      $358.00      $30.99
    017697-00                103799754001 191568518  GIBSON           AMY        18   22031291747          06/30/2023           1      $715.00      $38.56
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22312685142          07/05/2023           1       $27.00      $24.58
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22312411340          06/29/2023           2      $141.00      $49.16
    017697-00                103977327001 193622433  SHOW             LUKE       19   22312685141          07/05/2023           1       $27.00      $24.58
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22312685142          07/05/2023           1       $15.00      $10.45

                                                                                                                                              PAGE:20 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-00                103977327001 193622433  SHOW             LUKE       19   22312685141          07/05/2023           1       $42.00      $33.32
    017697-00                103977327001 193622433  SHOW             LUKE       19   22312685141          07/05/2023           1       $15.00      $10.45
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22312411340          06/29/2023           1       $60.00      $12.84
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22312411340          06/29/2023           1       $69.00      $28.53
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22312411340          06/29/2023           1       $69.00      $22.60
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22312685142          07/05/2023           1       $15.00      $11.87
    017697-00                103977327001 193622433  SHOW             JESSICA    18   420392834452200401   07/07/2023          28      $896.99     $673.16
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22312588788          07/03/2023           1       $69.00      $22.60
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22312588788          07/03/2023           2      $141.00      $49.16
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22312588788          07/03/2023           1       $60.00      $12.84
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22312685142          07/05/2023           1       $42.00      $33.32
    017697-00                103977327001 193622433  SHOW             LUKE       19   22312685141          07/05/2023           1       $15.00      $11.87
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22312588788          07/03/2023           1       $69.00      $28.53
    017697-00                122764620001 194708330  MONTAG           JENNA      18   851878348417900401   07/07/2023          28       $37.92      $10.86
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22712641564          06/27/2023           1      $880.00     $126.67
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22712644961          06/26/2023           1      $209.00     $120.81
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22712514571          06/27/2023           1    $3,616.00     $838.90
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22712514571          06/27/2023          12      $378.31       $0.00
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22712771572          06/01/2023           1      $150.00      $85.70
    017697-00                104228854001 196584813  FARREN           HEATHER    18   829856631066839301   07/03/2023          30       $76.27      $20.62
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   514283376086359301   07/04/2023          30      $269.34      $10.28
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   667051941186359301   07/04/2023          30       $37.20       $7.55
    017697-00                104565684001 200662396  WEAKLAND         TAMMY      18   806942093523789301   07/06/2023          30       $70.69      $31.95
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   17862415186359301    07/04/2023          30       $72.19       $4.94
    017697-00                104565684001 200662396  WEAKLAND         GAVIN      19   486373246069700401   07/07/2023          30       $70.69      $31.95
    017697-00                104568282001 200683607  RAKAR            ADDISON    19   22031425275          07/05/2023           1       $35.00      $16.70
    017697-00                104568282001 200683607  RAKAR            REAGAN     19   22031425282          07/05/2023           1      $185.00     $118.97
    017697-00                104568282001 200683607  RAKAR            ADDISON    19   22031425275          07/05/2023           1       $40.00       $2.99
    017697-00                104568282001 200683607  RAKAR            ADDISON    19   22031425275          07/05/2023           1      $185.00     $118.97
    017697-00                104568282001 200683607  RAKAR            REAGAN     19   22031425282          07/05/2023           1       $35.00      $16.70
    017697-00                104568282001 200683607  RAKAR            REAGAN     19   22031425282          07/05/2023           1       $40.00       $2.99
    017697-00                104816797001 203661805  ORAVEC           CHRISTOP   18   196856224079210401   06/24/2023         (30)   ($127.40)    ($18.82)

                                                                                                                                              PAGE:21 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-00                136097805001 204765386  MARDULA          MARK       18   22312525460          06/26/2023           1      $220.00     $109.89
    017697-00                136097805001 204765386  MARDULA          MARK       18   22312451173          06/24/2023           1      $169.85       $8.07
    017697-00                136097805001 204765386  MARDULA          MARK       18   22312525460          06/26/2023           1      $100.00      $41.08
    017697-00                136097805001 204765386  MARDULA          MARK       18   22312451173          06/24/2023           1       $60.75       $9.00
    017697-00                136097805001 204765386  MARDULA          MARK       18   22312451173          06/24/2023           1       $74.25       $9.50
    017697-00                136097805001 204765386  MARDULA          MARK       18   22312451173          06/24/2023           1      $130.49      $16.00
    017697-00                136097805001 204765386  MARDULA          MARK       18   22312667960          07/03/2023          90    $3,452.91   $1,035.00
    017697-00                136097805001 204765386  MARDULA          MARK       18   22312451173          06/24/2023           1       $70.48       $8.00
    017697-00                136097805001 204765386  MARDULA          MARK       18   22312451173          06/24/2023           1      $148.10      $13.00
    017697-00                104978752001 205608860  LEWIS            BETHANY    01   22712601290          06/30/2023           1       $55.00       $0.00
    017697-00                104978752001 205608860  LEWIS            BETHANY    01   22712601290          06/30/2023           1       $40.00       $0.00
    017697-00                104978752001 205608860  LEWIS            BETHANY    01   22712601290          06/30/2023           1       $40.00       $0.00
    017697-00                118583174001 206701815  BURLINGAME       OLIVER     19   22212449893          06/30/2023           1      $240.00     $178.53
    017697-00                118583174001 206701815  BURLINGAME       OWEN       19   22212449899          06/30/2023           1      $240.00     $178.53
    017697-00                118583174001 206701815  BURLINGAME       OWEN       19   22212736550          06/30/2023           1       $35.00       $8.50
    017697-00                118583174001 206701815  BURLINGAME       OLIVER     19   22212736551          06/30/2023           1       $35.00       $8.50
    017697-00                128450687001 207721532  SCHLUEP          JESSICA    01   22510650205          05/31/2023           1      $638.40     $227.15
    017697-00                112057371001 208660347  RAINEY           LUCAS      19   22031112521          06/28/2023           1        $6.00       $4.95
    017697-00                112057371001 208660347  RAINEY           LUCAS      19   22031112521          06/28/2023           1      $390.00     $372.36
    017697-00                112057371001 208660347  RAINEY           LUCAS      19   22031112521          06/28/2023           1      $120.00     $120.00
    017697-00                112057371001 208660347  RAINEY           LUCAS      19   22031112521          06/28/2023           1       $27.00      $21.21
    017697-00                105299927001 209482347  DELANEY          SUZANN     01   22812847539          06/29/2023           1      $156.00     $100.00
    017697-00                105299927001 209482347  DELANEY          WILLIAM    18   565453936484220401   07/08/2023          30       $20.49      $10.26
    017697-00                111665958001 210543123  TEREK            KIMBERLY   01   22610519607          06/01/2023           1       $69.00       $0.00
    017697-00                111665958001 210543123  TEREK            KIMBERLY   01   22610519607          06/01/2023           2      $141.00       $0.00
    017697-00                111665958001 210543123  TEREK            KIMBERLY   01   22610519607          06/01/2023           1       $55.50       $0.00
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   22512579977          06/29/2023           1       $67.00      $19.59
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   22512579977          06/29/2023           1       $67.00      $13.06
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   22512579977          06/29/2023           1       $38.00       $6.81
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   22512579977          06/29/2023           1      $108.00      $13.37
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   22512579977          06/29/2023           1       $23.00       $0.00
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   22512579977          06/29/2023           1       $96.00      $42.37

                                                                                                                                              PAGE:22 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   22512579977          06/29/2023           1      $102.00      $21.33
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   22512579977          06/29/2023           1       $91.00      $13.06
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   22512579977          06/29/2023           1       $67.00      $24.49
  017697-00 Total                                                                                                                   $27,003.49   $8,133.28
  017697-01
    017697-01                101514236001 163541163  ARFORD           MARYLOU    18   887582708990039301   07/03/2023          28    $4,916.74   $4,163.99
    017697-01                125903440001 164764926  NOVAK            RYAN       18   22112536131          06/28/2023           1      $220.00       $0.00
    017697-01                101979949001 169547153  PROSSER          NATALIE    18   537822088675519301   07/02/2023          90      $157.90     $101.48
    017697-01                101979949001 169547153  PROSSER          NATALIE    18   364372384675519301   07/02/2023          90      $279.56      $25.99
    017697-01                110205080001 172527634  HELDIBRIDLE      LORI       18   309936663041279301   07/05/2023          84      $159.10       $0.00
    017697-01                110205080001 172527634  HELDIBRIDLE      LORI       18   793332013263479301   07/05/2023          67       $77.86       $0.00
    017697-01                110205080001 172527634  HELDIBRIDLE      LORI       18   486004182041279301   07/05/2023          90      $376.60       $0.00
    017697-01                110205080001 172527634  HELDIBRIDLE      LORI       18   662695670041279301   07/05/2023          90      $393.64       $0.00
    017697-01                110205080001 172527634  HELDIBRIDLE      LORI       18   356208268041279301   07/05/2023          90      $435.52       $0.00
    017697-01                110205080001 172527634  HELDIBRIDLE      LORI       18   910448370041279301   07/05/2023          90      $404.50       $0.00
    017697-01                110205080001 172527634  HELDIBRIDLE      LORI       18   351792965041279301   07/05/2023          90      $146.00       $0.00
    017697-01                102730783001 178600938  STASIK           MELANIE    19   22412712358          06/30/2023           1      $145.00     $110.01
    017697-01                102730783001 178600938  STASIK           ROBIN      18   304092745643839301   07/03/2023          30      $102.55       $5.06
    017697-01                103056572001 182667400  MORELAND         MELISSA    18   22212668789          06/28/2023           1      $220.00     $109.89
    017697-01                103056572001 182667400  MORELAND         MELISSA    18   22212668789          06/28/2023           1       $20.00       $5.91
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   22512721709          06/30/2023           1       $17.00       $0.00
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   22512721709          06/30/2023           1       $35.00      $22.10
    017697-01                103625384001 189584284  STOY             KAMRYN     19   22512684413          06/26/2023           1       $52.00      $11.81
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   22512721709          06/30/2023           1       $47.00      $33.32
    017697-01                103625384001 189584284  STOY             KAMRYN     19   22512684413          06/26/2023           1       $20.00      $12.84
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   993638360227179301   07/05/2023          30       $67.16       $2.55
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   22512721709          06/30/2023           1       $34.00      $24.58
    017697-01                103625384001 189584284  STOY             KAMRYN     19   22512684413          06/26/2023           1       $20.00      $11.50
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   22512721709          06/30/2023           1       $22.00       $0.00
    017697-01                104882005001 204526094  BEM              REGINA     18   22112536132          06/27/2023           1       $20.00       $0.00
  017697-01 Total                                                                                                                    $8,389.13   $4,641.03
  017697-10

                                                                                                                                              PAGE:23 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-10                117140617001 165402030  HABER            SANDRA     01   458568578036339301   07/03/2023          30    $3,019.18   $2,522.52
  017697-10 Total                                                                                                                    $3,019.18   $2,522.52
  017697-70
    017697-70                102057668001 170526421  LENZ             SALLY      18   839880142155498301   07/01/2023          90      $112.00       $0.00
    017697-70                102057668001 170526421  LENZ             SALLY      18   179381549155498301   07/01/2023          90       $46.30       $0.00
  017697-70 Total                                                                                                                      $158.30       $0.00
  017697- Total                                                                                                                     $38,570.10  $15,296.83
  017728-00
    017728-00                102646677001 177602042  ABEL             KELLY      18   22312676441          06/23/2023           1       $75.00       $0.00
    017728-00                102646677001 177602042  ABEL             KELLY      18   22312650758          06/23/2023           1      $545.00       $0.00
    017728-00                102646677001 177602042  ABEL             KELLY      18   22312543428          06/28/2023           1       $67.27       $0.00
    017728-00                102646677001 177602042  ABEL             KELLY      18   22312650758          06/23/2023           1      $574.00       $0.00
    017728-00                102646677001 177602042  ABEL             KELLY      18   22312543428          06/28/2023           1      $162.00       $0.00
    017728-00                102646677001 177602042  ABEL             KELLY      18   22312676441          06/23/2023           1      $220.00       $0.00
    017728-00                102646677001 177602042  ABEL             KELLY      18   22312676441          06/23/2023           1      $450.00       $0.00
    017728-00                102646677001 177602042  ABEL             KELLY      18   22312712603          07/05/2023           1      $175.00       $0.00
    017728-00                102646677001 177602042  ABEL             KELLY      18   22312543428          06/28/2023           1       $16.00       $0.00
    017728-00                102646677001 177602042  ABEL             KELLY      18   22312543428          06/28/2023           1       $55.00       $0.00
    017728-00                110124768001 177620071  KUHN             MARK       01   712664962027279301   07/05/2023           1      $104.68      $50.42
    017728-00                103807190001 191609569  PARONISH         ANDREW     18   790591961731079301   07/05/2023          30       $14.94       $5.16
    017728-00                114875891001 204664917  LUTHER           JOSEPH     18   22812626057          06/30/2023           1      $230.00     $124.83
    017728-00                114875891001 204664917  LUTHER           JOSEPH     18   22812626057          06/30/2023           1       $10.00       $4.95
    017728-00                115593107001 208604479  HARR             CHRISTIN   01   275782394272620401   07/07/2023          (8)     ($7.05)     ($4.20)
    017728-00                115593107001 208604479  HARR             CHRISTIN   01   278601521372620401   07/08/2023           8        $7.05       $4.20
    017728-00                115593107001 208604479  HARR             CHRISTIN   01   312861912180900401   07/07/2023           8        $7.05       $4.20
    017728-00                115941556001 210707006  LOWMASTER        TIMOTHY    01   22112591059          06/30/2023           1      $136.00       $0.00
  017728-00 Total                                                                                                                    $2,841.94     $189.56
  017728- Total                                                                                                                      $2,841.94     $189.56
  104272-02
    104272-02                101295757001 160624529  HOOVER           MARIA      18   22112536130          06/27/2023           1       $30.00       $0.00
    104272-02                101295757001 160624529  HOOVER           MARIA      18   22112723192          06/27/2023           1       $56.00       $0.00
    104272-02                101295757001 160624529  HOOVER           MARIA      18   22112536130          06/27/2023           1      $145.00       $0.00

                                                                                                                                              PAGE:24 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                101376005001 161646259  DAUBERT          NADIA      19   412131851055420401   07/08/2023          30       $24.65      $10.59
    104272-02                101437249001 162546576  CARBONARA        THERESA    18   574846261619379301   07/05/2023          30       $83.60       $6.07
    104272-02                101437249001 162546576  CARBONARA        MICHAEL    01   958578638412639301   07/03/2023          30      $177.92      $16.28
    104272-02                101448839001 162609446  MARTIN           MAKENZIE   19   447065660810049301   07/03/2023          21       $44.38      $14.74
    104272-02                101448839001 162609446  MARTIN           BROCK      19   22212783350          07/06/2023           1       $50.00      $33.32
    104272-02                101448839001 162609446  MARTIN           MAKENZIE   19   22212814674          07/06/2023           1       $40.00      $12.84
    104272-02                101448839001 162609446  MARTIN           BROCK      19   22212783350          07/06/2023           1       $40.00      $22.41
    104272-02                101448839001 162609446  MARTIN           MAKENZIE   19   221011542710049301   07/03/2023          16       $98.81      $43.30
    104272-02                101448839001 162609446  MARTIN           NATHAN     01   689388988835400401   07/07/2023          30      $217.84       $8.54
    104272-02                101448839001 162609446  MARTIN           NATHAN     01   514336993735400401   07/07/2023          30      $197.91      $12.36
    104272-02                101448839001 162609446  MARTIN           MAKENZIE   19   275042955283049301   07/03/2023          30      $404.31     $264.45
    104272-02                101448839001 162609446  MARTIN           NATHAN     01   72659929994400401    07/07/2023          30      $236.65      $16.71
    104272-02                101451955001 162628734  NIEBAUER         ANNALIES   19   666558990494479301   07/05/2023          28       $18.27      $16.53
    104272-02                121084549001 162722491  GEORGE           JARED      18   22712722889          06/29/2023           1      $106.00      $22.60
    104272-02                121084549001 162722491  GEORGE           JARED      18   22712471554          06/27/2023           1      $106.00      $22.60
    104272-02                121084549001 162722491  GEORGE           JARED      18   22712722889          06/29/2023           1      $114.00      $57.92
    104272-02                126386044001 164702873  JEFFERSON        EASTON     19   388229759367279301   07/05/2023          10      $331.42      $63.40
    104272-02                126386044001 164702873  JEFFERSON        BOBBI      01   22712767006          06/21/2023           1      $201.00     $105.27
    104272-02                126386044001 164702873  JEFFERSON        EASTON     19   22712578867          06/29/2023           1       $93.00      $71.89
    104272-02                119564703001 164728504  HILDEBRAND       JESSIE     18   13719389050619301    07/02/2023          90      $393.64      $19.21
    104272-02                135710323001 165723208  RANCK            LANDON     19   230882884797489301   07/06/2023          30       $31.99       $9.62
    104272-02                101838197001 167645469  PERSIO           LILY       19   774275370733800401   07/07/2023          30      $195.10       $0.00
    104272-02                101838197001 167645469  PERSIO           LILY       19   571995130874400401   07/07/2023          28      $186.01      $13.70
    104272-02                101838197001 167645469  PERSIO           ELLA       19   921382473897479301   07/05/2023          28      $186.01      $13.70
    104272-02                101903657001 168543440  WEILAND          ANNETTE    01   975695040554739301   07/03/2023          20      $620.99      $85.99
    104272-02                101903657001 168543440  WEILAND          ANNETTE    01   22512489688          06/26/2023           1      $303.63      $65.36
    104272-02                101903657001 168543440  WEILAND          JAMES      18   802562194984910401   07/08/2023          30      $158.01       $8.23
    104272-02                101903657001 168543440  WEILAND          ANNETTE    01   22512489688          06/26/2023           1      $263.00      $85.70
    104272-02                101903657001 168543440  WEILAND          JAMES      18   910612804094910401   07/08/2023          30       $68.01       $7.97
    104272-02                101903657001 168543440  WEILAND          ANNETTE    01   22512489688          06/26/2023           2      $168.00      $13.14
    104272-02                101903657001 168543440  WEILAND          JAMES      18   988836813653320401   07/08/2023          30      $698.99     $523.13
    104272-02                101903657001 168543440  WEILAND          JAMES      18   288421792294910401   07/08/2023          30      $408.99      $81.50

                                                                                                                                              PAGE:25 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                101918329001 168627615  MCCOMBIE         KIMBERLY   01   544951571349079301   07/05/2023          10       $10.96       $6.80
    104272-02                101918329001 168627615  MCCOMBIE         KENNETH    19   412396761094179301   07/05/2023           7       $10.81       $5.97
    104272-02                101918329001 168627615  MCCOMBIE         KENNETH    19   773715280323179301   07/05/2023           8        $7.25       $5.77
    104272-02                101918329001 168627615  MCCOMBIE         KIMBERLY   01   408556151117179301   07/05/2023           6       $35.64      $12.54
    104272-02                101918687001 168628770  STEVENS          DOMINIC    19   730862434655739301   07/03/2023          30      $190.03       $0.00
    104272-02                101918687001 168628770  STEVENS          DOMINIC    19   690594602435739301   07/03/2023          28       $73.37       $0.00
    104272-02                101918687001 168628770  STEVENS          DOMINIC    19   3268470525739301     07/03/2023          10       $22.00       $0.00
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   329404472469400401   07/07/2023          30        $8.28       $0.00
    104272-02                132053569001 168749233  DUMAN            MARIAH     01   812096984765720401   06/29/2023         (30)    ($15.00)       $0.00
    104272-02                101993438001 169628033  BALL             CARLEEN    18   154452454638400401   07/07/2023          30       $43.56       $0.00
    104272-02                101993438001 169628033  BALL             JEFFREY    01   208416074994400401   07/07/2023          30      $155.97       $0.00
    104272-02                113905772001 169663596  WAGNER           WILLIAM    18   22412755577          06/19/2023           1       $32.00       $0.00
    104272-02                113905772001 169663596  WAGNER           WILLIAM    18   22412755577          06/23/2023           1       $32.00       $0.00
    104272-02                113905772001 169663596  WAGNER           WILLIAM    18   22412755577          06/23/2023           1       $32.00       $0.00
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   22030353677          06/05/2023           1       $60.00       $0.00
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   22030353677          04/14/2023           1      $200.00       $0.00
    104272-02                102055671001 170520271  GIBSON           MICHELLE   18   890521772206819301   07/02/2023          30       $15.88       $8.86
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   22030353677          05/08/2023           1       $60.00       $0.00
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   22030353677          04/14/2023           1      $110.00       $0.00
    104272-02                102055671001 170520271  GIBSON           MICHELLE   18   61426103306819301    07/02/2023          30       $82.42       $8.55
    104272-02                102055671001 170520271  GIBSON           MICHELLE   18   982486641206819301   07/02/2023          30      $269.33       $7.20
    104272-02                102055671001 170520271  GIBSON           MICHELLE   18   220902013996359301   07/04/2023          30      $146.34       $5.45
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   255862178582759301   06/21/2023         (30) ($1,123.92)   ($901.89)
    104272-02                115236308001 171640207  GRASSI           KAREN      01   22212483415          06/26/2023           1       $48.00       $0.00
    104272-02                115236308001 171640207  GRASSI           KAREN      01   22212483415          06/26/2023           1       $78.00       $0.00
    104272-02                102243890001 172685116  KUKLA            DONALD     01   576192054267539301   07/03/2023          30       $27.98      $15.36
    104272-02                102243890001 172685116  KUKLA            MADISON    19   835408708697700401   07/07/2023          30      $469.56     $376.77
    104272-02                102243890001 172685116  KUKLA            MADISON    19   993386321363789301   07/06/2023          30       $53.92      $28.08
    104272-02                119564810001 172728244  SEDLOCK          BRITTANY   18   959442955441249301   07/03/2023          30       $74.91       $0.00
    104272-02                135851965001 172764065  LOCHER           MARISA     18   22712587569          06/28/2023           1       $95.00       $0.00
    104272-02                135851965001 172764065  LOCHER           MARISA     18   22712493014          06/29/2023           1       $75.00       $0.00
    104272-02                135851965001 172764065  LOCHER           MARISA     18   22712493014          06/29/2023           1       $65.00       $0.00

                                                                                                                                              PAGE:26 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                135851965001 172764065  PISCATELLO       MAYLEE     19   712075230167329301   06/30/2023         (30)   ($337.92)       $0.00
    104272-02                135851965001 172764065  PISCATELLO       MAYLEE     19   239256491477329301   07/02/2023          30      $337.92       $0.00
    104272-02                110157934001 173649775  OSTINOWSKY       SARA       18   22412444374          06/27/2023           1       $90.00      $89.99
    104272-02                110157934001 173649775  OSTINOWSKY       SARA       18   577745540550739301   07/03/2023          30      $281.50      $22.04
    104272-02                102327164001 173700970  FORCELLINI       CANNON     19   642176511766789301   07/06/2023          30       $85.26      $20.62
    104272-02                102403638001 174646831  GERNEY           SCOTT      01   22031162882          06/27/2023           1       $23.00       $0.00
    104272-02                102403638001 174646831  GERNEY           SCOTT      01   22031162882          06/27/2023           1       $67.00       $0.00
    104272-02                102403638001 174646831  GERNEY           SCOTT      01   22031162882          06/27/2023           1      $108.00       $0.00
    104272-02                102403638001 174646831  GERNEY           SCOTT      01   420812295120739301   07/03/2023          30       $18.58       $0.00
    104272-02                102403638001 174646831  GERNEY           SCOTT      01   22031162882          06/27/2023           1       $38.00       $0.00
    104272-02                102403638001 174646831  GERNEY           SCOTT      01   22031162882          06/27/2023           1      $133.00       $0.00
    104272-02                102403638001 174646831  GERNEY           SCOTT      01   22031162882          06/27/2023           1       $42.00       $0.00
    104272-02                122695741001 174663939  BEDNAR           EMILY      19   38173731705          05/23/2023           1      $270.00      $59.00
    104272-02                122695741001 174663939  BEDNAR           EMILY      19   38173731705          05/23/2023           1      $295.00     $295.00
    104272-02                122695741001 174663939  BEDNAR           EMILY      19   38173731705          05/23/2023           1      $285.00     $276.40
    104272-02                122695741001 174663939  BEDNAR           EMILY      19   38173731705          05/23/2023           1      $285.00     $276.40
    104272-02                122695741001 174663939  BEDNAR           EMILY      19   38173731705          05/23/2023           1      $285.00     $276.40
    104272-02                122695741001 174663939  BEDNAR           CHELSEA    19   22112432009          06/29/2023           3      $105.00      $73.74
    104272-02                122695741001 174663939  BEDNAR           EMILY      19   38173731705          05/23/2023           1      $285.00     $276.40
    104272-02                102484817001 175624053  DEMI             WILLIAM    19   837731702401639301   07/03/2023          30      $130.27      $12.36
    104272-02                102484817001 175624053  DEMI             RACHEL     19   109123356750889301   07/06/2023          30       $81.04       $6.60
    104272-02                102484817001 175624053  DEMI             THERESA    18   96865170275379301    07/05/2023          30      $115.99      $11.39
    104272-02                102484817001 175624053  DEMI             ISABELLA   19   22812729564          06/15/2023           1      $190.00     $120.81
    104272-02                102484817001 175624053  DEMI             THERESA    18   948158950194479301   07/05/2023          30      $464.92      $36.55
    104272-02                102484817001 175624053  DEMI             WILLIAM    19   843386291701639301   07/03/2023          30      $180.35      $16.71
    104272-02                102484817001 175624053  DEMI             THERESA    18   22812642348          04/20/2023           1      $733.58      $73.36
    104272-02                102484817001 175624053  DEMI             RACHEL     19   337231562786359301   07/04/2023          28       $36.16      $13.04
    104272-02                102567140001 176620059  GIRONDA          SHANNON    18   877138178912279301   07/05/2023          30      $184.41       $5.45
    104272-02                102567140001 176620059  GIRONDA          SLOANE     19   22812696638          07/03/2023           1      $140.00      $89.99
    104272-02                102567140001 176620059  GIRONDA          SHANNON    18   22812511386          06/27/2023           1       $27.78       $0.00
    104272-02                102567140001 176620059  GIRONDA          SHANNON    18   22812511386          06/27/2023           1    $1,791.00   $1,892.26
    104272-02                102567140001 176620059  GIRONDA          SHANNON    18   22812511386          06/27/2023          30       $33.08       $0.00

                                                                                                                                              PAGE:27 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                102567140001 176620059  GIRONDA          SHANNON    18   22812511386          06/27/2023           1      $605.00       $0.00
    104272-02                102567140001 176620059  GIRONDA          SLOANE     19   138146583970049301   07/03/2023          30      $387.67      $22.09
    104272-02                102567140001 176620059  GIRONDA          SHANNON    18   940162853191099301   07/06/2023          30      $104.24       $7.20
    104272-02                102567140001 176620059  GIRONDA          SHANNON    18   22812511386          06/27/2023           2      $376.00       $0.00
    104272-02                102655122001 177649243  MOORE            DAVID      18   992066271301249301   07/03/2023           7       $25.26       $4.49
    104272-02                102655122001 177649243  MOORE            DAVID      18   22612905011          07/05/2023           1      $355.00      $38.95
    104272-02                102717987001 178523742  LEWIS            TINA       18   22612626107          06/29/2023           1      $142.00      $89.99
    104272-02                117984805001 180681319  WARNER           BROOKE     18   596712635729639301   07/03/2023          28       $34.74      $14.99
    104272-02                110617661001 182683831  GOCHNOUR         CLINTON    18   709332585739379301   07/05/2023          30      $155.97       $8.23
    104272-02                110617661001 182683831  GOCHNOUR         JULIE      01   22212433420          06/26/2023           1        $6.00       $4.95
    104272-02                110617661001 182683831  GOCHNOUR         JULIE      01   820425230432199301   07/06/2023          10      $115.55      $13.75
    104272-02                110617661001 182683831  GOCHNOUR         JULIE      01   64622503964199301    07/06/2023          10       $22.00       $4.10
    104272-02                110617661001 182683831  GOCHNOUR         PEYTON     19   985952375379600401   07/07/2023          10      $110.43      $35.11
    104272-02                110617661001 182683831  GOCHNOUR         PEYTON     19   117351552579600401   07/07/2023           7      $129.77      $75.34
    104272-02                110617661001 182683831  GOCHNOUR         PYPER      19   186282053535379301   07/05/2023           5       $51.85      $14.28
    104272-02                110617661001 182683831  GOCHNOUR         CLINTON    18   542763376239379301   07/05/2023           4       $24.54       $9.21
    104272-02                110617661001 182683831  GOCHNOUR         JULIE      01   149058138120700401   07/07/2023          30       $47.93       $9.11
    104272-02                110617661001 182683831  GOCHNOUR         JULIE      01   22212433420          06/26/2023           1      $120.00     $116.03
    104272-02                110617661001 182683831  GOCHNOUR         PYPER      19   980632168635379301   07/05/2023           5       $84.85      $47.37
    104272-02                103127176001 183587982  CAMERON          DANIELLE   01   704712964432200401   07/07/2023          30       $14.03       $0.00
    104272-02                103127176001 183587982  CAMERON          DANIELLE   01   672832668432200401   07/07/2023          30       $36.21       $0.00
    104272-02                103127176001 183587982  CAMERON          DANIELLE   01   397736714087500401   07/07/2023          30        $4.00       $0.00
    104272-02                103127176001 183587982  CAMERON          DANIELLE   01   977749629087500401   07/07/2023          30        $4.00       $0.00
    104272-02                103127176001 183587982  CAMERON          DANIELLE   01   411029619087500401   07/07/2023          30        $4.00       $0.00
    104272-02                124119460001 183588004  BELL             SHAWN      18   22112657295          06/29/2023           1      $205.00       $0.00
    104272-02                124119460001 183588004  BELL             SHAWN      18   22112595215          06/29/2023           1       $88.07       $0.00
    104272-02                103223419001 184685904  DUMM             MADELINE   19   22712771568          05/31/2023           1      $150.00      $85.70
    104272-02                103223419001 184685904  DUMM             MADELINE   19   765451481588400401   07/07/2023          30      $105.56      $53.93
    104272-02                103223419001 184685904  DUMM             MADELINE   19   22712464136          06/26/2023           1       $24.00      $12.84
    104272-02                121084536001 184727534  REESE            ISAAC      19   22312412075          06/28/2023           1       $27.00      $21.21
    104272-02                121084536001 184727534  REESE            ISAAC      19   22312412075          06/28/2023           1       $40.00      $38.33
    104272-02                121084536001 184727534  REESE            SCOTT      01   22312412076          06/26/2023           1       $65.00      $52.59

                                                                                                                                              PAGE:28 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                121084536001 184727534  REESE            SCOTT      01   22312412076          06/26/2023           1        $6.00       $4.95
    104272-02                121084536001 184727534  REESE            ISAAC      19   22312412075          06/28/2023           1      $105.00     $105.00
    104272-02                121084536001 184727534  REESE            SCOTT      01   22312412076          06/26/2023           1      $120.00     $116.03
    104272-02                103291874001 185601588  CRISTE           JEANENE    18   22812740455          06/30/2023           6      $642.00       $0.00
    104272-02                103291874001 185601588  CRISTE           JEANENE    18   22812740455          06/30/2023           1       $67.00      $33.77
    104272-02                103291874001 185601588  CRISTE           JEANENE    18   22812740455          06/30/2023           1       $96.00       $0.00
    104272-02                103291874001 185601588  CRISTE           JEANENE    18   22812740455          06/30/2023           1      $226.00       $0.00
    104272-02                103291874001 185601588  CRISTE           JEANENE    18   22812740455          06/30/2023           1      $133.00       $0.00
    104272-02                103291874001 185601588  CRISTE           JEANENE    18   22812468230          06/29/2023           1      $209.00       $0.00
    104272-02                103291874001 185601588  CRISTE           JEANENE    18   22812740455          06/30/2023           1       $42.00       $0.00
    104272-02                103291874001 185601588  CRISTE           JEANENE    18   22812740455          06/30/2023           1       $67.00       $0.00
    104272-02                103291874001 185601588  CRISTE           JEANENE    18   22812740455          06/30/2023           1      $108.00       $0.00
    104272-02                103291874001 185601588  CRISTE           JEANENE    18   22812740455          06/30/2023           1       $23.00       $0.00
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   21893586843          09/22/2022           1       $19.00       $0.00
    104272-02                103293323001 185606084  MORRISON         ERIN       18   453009019683059301   07/04/2023          30      $235.55      $15.25
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   21893586843          09/22/2022           3       $67.50      $18.07
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   21893586843          09/22/2022           1      $422.00     $286.86
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   21893586843          09/22/2022           4       $69.00      $36.65
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   21893586843          09/22/2022           1    $8,323.00   $1,373.96
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   21893586843          09/22/2022           1    $8,323.00     $726.37
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   21893586843          09/22/2022           6      $105.00      $57.28
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   21893586843          09/22/2022           2    $5,248.00   $1,212.03
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   21893586843          09/22/2022          20      $280.00      $15.38
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   21893586843          09/22/2022          10       $47.50      $28.19
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   21893586843          09/22/2022           1      $485.00       $0.00
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   21893586843          09/22/2022           4      $211.00      $79.97
    104272-02                103293323001 185606084  MORRISON         ERIN       18   22812477795          06/30/2023           1      $240.00     $178.53
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   21893586843          09/22/2022           1    $8,323.00   $1,115.41
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   21893586843          09/22/2022           2       $96.00     $105.60
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   21893586843          09/22/2022           1    $8,323.00   $4,348.38
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   21893586843          09/22/2022           2    $2,040.00       $0.00
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   21893586843          09/22/2022           1       $65.25      $28.83

                                                                                                                                              PAGE:29 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   21893586843          09/22/2022         150      $225.00      $86.50
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   21893586843          09/22/2022           7    $5,614.00       $0.00
    104272-02                115775315001 187704817  SIPE             SCOTT      01   22812740451          07/01/2023           1      $108.00      $27.19
    104272-02                115775315001 187704817  SIPE             JULIE      18   22812791398          06/30/2023           1      $234.00      $38.55
    104272-02                115775315001 187704817  SIPE             JULIE      18   22812808689          06/30/2023           1      $691.00     $243.35
    104272-02                115775315001 187704817  SIPE             SCOTT      01   22812740451          07/01/2023           1       $67.00      $25.00
    104272-02                115775315001 187704817  SIPE             SCOTT      01   813781031774919301   07/01/2023         (25)    ($78.16)    ($57.25)
    104272-02                115775315001 187704817  SIPE             SCOTT      01   22812740451          07/01/2023           1       $23.00       $0.00
    104272-02                115775315001 187704817  SIPE             SCOTT      01   127239369774919301   07/02/2023          25       $78.16      $57.25
    104272-02                115775315001 187704817  SIPE             JULIE      18   22812604823          06/27/2023           1      $200.00     $100.00
    104272-02                115775315001 187704817  SIPE             SCOTT      01   638172985562149301   07/03/2023          30       $15.00       $5.80
    104272-02                103551054001 188665731  KIM              MADISON    19   688571251532839301   07/03/2023           5       $94.41       $0.00
    104272-02                103553425001 188685513  KIRSCH           EMMA       19   22112656842          07/03/2023           1       $40.00      $12.84
    104272-02                103625291001 189584046  WILLETT          AIMEE      01   297953266769400401   07/07/2023          30       $15.88       $8.86
    104272-02                103625291001 189584046  WESTRICK         STEPHEN    18   22211822485          04/10/2023           1    $2,269.00     $655.44
    104272-02                111045735001 189641841  MILLER           MYAH       19   22031443076          06/28/2023           4      $420.00     $184.57
    104272-02                111045735001 189641841  MILLER           JOHN       01   22031443079          06/28/2023           3      $299.00     $131.58
    104272-02                111045735001 189641841  MILLER           JOHN       01   177662294301889301   07/06/2023          30       $16.28       $6.03
    104272-02                111045735001 189641841  MILLER           JOHN       01   22031443079          06/26/2023           3      $299.00     $131.58
    104272-02                111045735001 189641841  MILLER           MYAH       19   22031443076          06/13/2023           1      $250.00     $190.12
    104272-02                111045735001 189641841  MILLER           JOHN       01   818251841301889301   07/06/2023          30      $117.40      $17.80
    104272-02                111045735001 189641841  MILLER           MYAH       19   22031443076          06/15/2023           3      $374.00     $141.64
    104272-02                111045735001 189641841  MILLER           JOHN       01   22031443079          06/21/2023           2      $160.00      $80.18
    104272-02                111045735001 189641841  MILLER           JOHN       01   22031443079          06/19/2023           1      $250.00     $190.12
    104272-02                111045735001 189641841  MILLER           MYAH       19   22031443076          06/26/2023           4      $420.00     $184.57
    104272-02                111045735001 189641841  MILLER           MYAH       19   22031443076          06/19/2023           3      $315.00     $141.64
    104272-02                111045735001 189641841  MILLER           MYAH       19   22031443076          06/21/2023           3      $315.00     $141.64
    104272-02                111045735001 189641841  MILLER           JOHN       01   22031443079          06/21/2023           1      $164.00      $55.77
    104272-02                111045735001 189641841  MILLER           JOHN       01   208385980201889301   07/06/2023          30       $47.20      $11.90
    104272-02                111045735001 189641841  MILLER           JOHN       01   605632175596579301   07/05/2023          10      $315.69      $14.47
    104272-02                103643051001 189746790  VANFOSSEN        ALESHA     18   22512561054          06/23/2023           1      $118.00      $35.95
    104272-02                103699741001 190489435  SMITH            DORIS      18   22412188938          06/23/2023           1       $70.00       $0.00

                                                                                                                                              PAGE:30 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22312412077          06/26/2023           1       $27.00      $15.94
    104272-02                103713375001 190569811  SCHWEITZER       DAVID      19   733258720287579301   07/05/2023          30      $145.33       $5.45
    104272-02                103713375001 190569811  SCHWEITZER       DAVID      19   111212183186579301   07/05/2023          30      $199.99      $30.63
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22312412077          06/26/2023           1        $5.00       $1.92
    104272-02                115278421001 190668800  DUGAN            JOLENE     18   299962835616900401   07/03/2023          30      $194.09       $0.00
    104272-02                115278421001 190668800  DUGAN            JOLENE     18   938532104536129301   07/02/2023          30      $170.68       $0.00
    104272-02                115278421001 190668800  DUGAN            JOLENE     18   827806463251639301   07/03/2023          30      $194.09       $0.00
    104272-02                115278421001 190668800  DUGAN            BRADLEY    01   22412530064          05/16/2023           1      $734.12      $24.60
    104272-02                115278421001 190668800  DUGAN            JOLENE     18   325304562316900401   07/03/2023         (30)   ($194.09)       $0.00
    104272-02                103812819001 191649655  PROKOP           ALEC       19   22612866132          07/06/2023           1       $35.00      $16.70
    104272-02                103812819001 191649655  PROKOP           DAVID      01   22612660344          06/29/2023           1      $358.00     $118.40
    104272-02                103812819001 191649655  PROKOP           ALEC       19   22612866132          07/06/2023           1       $40.00       $4.95
    104272-02                103812819001 191649655  PROKOP           BOBBI      18   344128980218839301   07/03/2023          90      $196.13      $16.88
    104272-02                103812819001 191649655  PROKOP           ALEC       19   22612866132          07/06/2023           1       $40.00       $2.99
    104272-02                103812819001 191649655  PROKOP           ALEC       19   22612866132          07/06/2023           1      $185.00     $130.20
    104272-02                103814953001 191669673  LAMARK           TAWNYA     01   376401261340599301   06/23/2023         (21)    ($40.99)    ($17.07)
    104272-02                103815975001 191683834  RHODES           LORI       18   22312551833          06/28/2023           1      $345.00       $0.00
    104272-02                131255944001 192742848  ENGEL            CARSON     19   22712700158          07/03/2023           1      $185.00     $112.39
    104272-02                131255944001 192742848  DUFFY-ENGEL      MELANIE    01   682836661104839301   07/03/2023          13      $503.50      $47.53
    104272-02                131255944001 192742848  ENGEL            CARSON     19   22712700631          06/29/2023           1      $346.00     $159.19
    104272-02                131255944001 192742848  DUFFY-ENGEL      MELANIE    01   351171341323839301   07/03/2023          17       $75.02      $43.30
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22212756057          06/30/2023           1       $70.00      $10.45
    104272-02                103958453001 193504313  SHAFFER          GREGORY    18   276912915336519301   07/02/2023          90      $280.30      $16.49
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22212756057          06/30/2023           1      $150.00      $83.63
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22212756057          06/30/2023           2       $70.00      $49.16
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22212483411          06/26/2023           1      $383.00     $197.84
    104272-02                103958453001 193504313  SHAFFER          GREGORY    18   164677056063598301   07/01/2023          90      $109.30      $19.92
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22212432762          06/26/2023           1      $150.00      $10.43
    104272-02                103960961001 193522698  PAGANO           ALBERT     01   22812843172          07/05/2023           1      $125.00      $72.85
    104272-02                103960961001 193522698  PAGANO           ALBERT     01   22812843172          07/05/2023           1      $125.00      $58.91
    104272-02                116900492001 193709853  MAZZARELLA       JAMIE      18   22512706529          06/29/2023           1       $29.50       $0.00
    104272-02                116900492001 193709853  MAZZARELLA       JAMIE      18   22512706529          06/29/2023           1      $260.00      $61.89

                                                                                                                                              PAGE:31 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                117718876001 193709854  QUAGLIA          LATRACE    18   22112472649          06/27/2023           1    $3,509.00   $6,085.48
    104272-02                117718876001 193709854  QUAGLIA          LATRACE    18   22112472649          06/27/2023           1      $277.00       $0.00
    104272-02                117718876001 193709854  QUAGLIA          LATRACE    18   22112472649          06/27/2023           1       $52.71       $0.00
    104272-02                117718876001 193709854  QUAGLIA          LATRACE    18   22112472649          06/27/2023           4       $22.05       $0.00
    104272-02                117718876001 193709854  QUAGLIA          LATRACE    18   22112472649          06/27/2023           1       $22.05       $0.00
    104272-02                117718876001 193709854  QUAGLIA          LATRACE    18   22112472649          06/27/2023           4       $22.05       $0.00
    104272-02                117718876001 193709854  QUAGLIA          LATRACE    18   22112428628          06/27/2023           1      $142.00      $40.64
    104272-02                117718876001 193709854  QUAGLIA          LATRACE    18   22112472649          06/27/2023           4       $55.22       $0.00
    104272-02                117718876001 193709854  QUAGLIA          LATRACE    18   22112472649          06/27/2023           2      $376.00       $0.00
    104272-02                117718876001 193709854  QUAGLIA          LATRACE    18   22112472649          06/27/2023           1       $25.47       $0.00
    104272-02                117718876001 193709854  QUAGLIA          LATRACE    18   22112472649          06/27/2023           4    $1,630.00       $0.00
    104272-02                117718876001 193709854  QUAGLIA          LATRACE    18   22112472649          06/27/2023           2       $22.05       $0.00
    104272-02                117718876001 193709854  QUAGLIA          LATRACE    18   22112472649          06/27/2023          20       $22.05       $0.00
    104272-02                117718876001 193709854  QUAGLIA          LATRACE    18   22112472649          06/27/2023           2       $27.78       $0.00
    104272-02                117718876001 193709854  QUAGLIA          LATRACE    18   22112472649          06/27/2023           1       $22.05       $0.00
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   22512422375          06/22/2023           1      $420.00     $200.27
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   22512498520          06/27/2023           1       $14.00       $0.00
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   185572034072789301   07/06/2023          28      $837.90     $673.16
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   22512498520          06/27/2023           1      $141.00     $104.38
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   22512498520          06/27/2023           1      $102.00      $75.31
    104272-02                119714565001 194708189  HRITZ            BRENNAN    18   936391121774739301   07/03/2023          30      $146.57       $0.00
    104272-02                119714565001 194708189  HRITZ            BRENNAN    18   608206364774739301   07/03/2023          30      $170.68       $0.00
    104272-02                119714565001 194708189  HRITZ            BRENNAN    18   277191041774739301   07/03/2023          30      $146.30       $0.00
    104272-02                119714565001 194708189  HRITZ            BRENNAN    18   395256104774739301   07/03/2023          30      $267.93       $0.00
    104272-02                119714565001 194708189  HRITZ            JESSICA    01   22312555193          06/29/2023           1      $209.00       $0.00
    104272-02                104227685001 196581553  BEYER            JODI       18   457553046081879301   07/05/2023          30        $5.91       $4.47
    104272-02                104227685001 196581553  BEYER            JODI       18   28284112175079301    07/05/2023          30       $82.42       $8.55
    104272-02                104227685001 196581553  BEYER            JODI       18   22812635003          06/26/2023           1      $187.86      $78.26
    104272-02                115959714001 196664113  HOFFMAN          AMELIA     19   22612554825          06/30/2023           1      $160.00     $118.97
    104272-02                115959714001 196664113  HOFFMAN          KARTER     19   22612554823          06/30/2023           1       $96.00       $0.00
    104272-02                126459656001 196721440  SCOTT            JESSICA    18   492952495132499301   07/06/2023          15        $9.36       $0.00
    104272-02                126459656001 196721440  SCOTT            JESSICA    18   270326331733179301   07/05/2023          28       $18.27      $16.53

                                                                                                                                              PAGE:32 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                135291530001 196767240  FARABAUGH        ERICA      01   22212668893          06/28/2023           1    $1,700.00     $826.72
    104272-02                135291530001 196767240  FARABAUGH        ERICA      01   22212668893          06/28/2023           1      $255.00      $82.21
    104272-02                110735193001 198603232  DAVIS            JUSTIN     01   199962193528700401   07/07/2023          28    $1,198.99     $901.89
    104272-02                110735193001 198603232  DAVIS            JUSTIN     01   387648870528700401   07/07/2023          30       $37.99      $10.76
    104272-02                110735193001 198603232  DAVIS            JUSTIN     01   545115520628700401   07/07/2023          30       $17.09       $9.99
    104272-02                110735193001 198603232  DAVIS            JUSTIN     01   864161971528700401   07/07/2023          30      $129.01       $7.16
    104272-02                110735193001 198603232  DAVIS            JUSTIN     01   203948598528700401   07/07/2023          30       $58.11       $9.28
    104272-02                133177478001 198763668  FOUST            CASIDY     18   22512832679          07/05/2023           1      $190.00     $100.00
    104272-02                104473668001 199609100  MCHUGH           SANDRA     01   492046223153359301   07/04/2023          30      $169.50       $7.95
    104272-02                104473668001 199609100  MCHUGH           PATRICK    18   55585840604359301    07/04/2023          30      $169.50       $7.95
    104272-02                104473668001 199609100  MCHUGH           SANDRA     01   22310577216          05/24/2023          (1)   ($336.00)   ($144.29)
    104272-02                104561618001 200626571  MYERS            JULIA      19   759286134987400401   07/07/2023          30      $391.34       $0.00
    104272-02                104561618001 200626571  MCMAHON          JAMES      01   820332223843579301   07/05/2023          30      $260.25       $0.00
    104272-02                104561618001 200626571  MCMAHON          JAMES      01   793942805243479301   07/05/2023          30       $54.18       $0.00
    104272-02                111760051001 200724515  BARTO            REBECCA    18   200918648649889301   07/06/2023          28        $9.00       $9.00
    104272-02                115775312001 201600981  SEDOR            MORGAN     19   22512683282          07/03/2023           1       $40.00      $21.21
    104272-02                115775312001 201600981  SEDOR            MORGAN     19   22512683282          07/03/2023           1      $385.00     $292.72
    104272-02                115775312001 201600981  SEDOR            MORGAN     19   22512683282          07/03/2023           1       $40.00       $4.95
    104272-02                115775312001 201600981  SEDOR            MORGAN     19   22512683282          07/03/2023           1      $185.00     $130.20
    104272-02                115775312001 201600981  SEDOR            MORGAN     19   22512683282          07/03/2023           1       $40.00       $2.99
    104272-02                115775312001 201600981  SEDOR            MORGAN     19   22512683282          07/03/2023           1       $35.00      $16.70
    104272-02                121180930001 201720071  FINI-DOMONKOS    CHRISTIN   01   22712609702          06/14/2023           1      $175.00     $110.01
    104272-02                131156919001 202748584  MCCABE           THOMAS     01   77186944048220401    07/08/2023          21      $288.81       $0.00
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   22412612239          06/30/2023           1      $302.58     $120.81
    104272-02                104801669001 203563037  JENKINS          DAWN       18   12602705453989301    07/06/2023          30      $145.33       $5.45
    104272-02                104801669001 203563037  JENKINS          DAWN       18   22812642306          06/15/2023           1       $42.57      $25.42
    104272-02                104801669001 203563037  JENKINS          DAWN       18   22812642306          06/15/2023           1       $18.40      $11.00
    104272-02                104801669001 203563037  JENKINS          DAWN       18   22812642306          06/15/2023           1       $25.00      $14.00
    104272-02                104801669001 203563037  JENKINS          DAWN       18   22812642306          06/15/2023           1       $83.85      $50.07
    104272-02                104801669001 203563037  JENKINS          DAWN       18   22803052501          08/17/2022           1      $242.00      $84.89
    104272-02                104801669001 203563037  JENKINS          DAWN       18   315986753897489301   07/06/2023          30       $19.25       $4.31
    104272-02                104811837001 203624160  DORSCH           ALEXANDE   19   22612866222          07/06/2023           1      $195.00      $74.94

                                                                                                                                              PAGE:33 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                104816750001 203661643  RODKEY           MICHAEL    01   151892515609889301   07/06/2023          30       $78.70      $21.25
    104272-02                104816750001 203661643  RODKEY           MICHAEL    01   650916281397839301   07/03/2023          28      $661.58     $530.87
    104272-02                104821606001 203721732  SHANER           JESSICA    18   349936567708288301   06/30/2023          28    $9,796.91   $8,400.85
    104272-02                104900285001 204643617  PABLIC           LISA       18   22212433422          06/26/2023           1      $133.00       $0.00
    104272-02                104900285001 204643617  PABLIC           LISA       18   22212433422          06/26/2023           1       $90.00       $0.00
    104272-02                119571853001 205587218  GWIZDAK          LORI       18   22412616789          06/30/2023           1       $40.00      $10.45
    104272-02                119571853001 205587218  GWIZDAK          LORI       18   22412616789          06/30/2023           1       $40.00      $11.87
    104272-02                119571853001 205587218  GWIZDAK          THOMAS     01   22412751585          07/03/2023           1       $40.00      $11.87
    104272-02                119571853001 205587218  GWIZDAK          THOMAS     01   22412751585          07/03/2023           1       $50.00      $33.32
    104272-02                119571853001 205587218  GWIZDAK          THOMAS     01   22412751585          07/03/2023           1       $40.00      $10.45
    104272-02                119571853001 205587218  GWIZDAK          LORI       18   22412616789          06/30/2023           1       $50.00      $33.32
    104272-02                119571853001 205587218  GWIZDAK          THOMAS     01   22412751585          07/03/2023           1       $60.00      $22.41
    104272-02                119571853001 205587218  GWIZDAK          LORI       18   22412616789          06/30/2023           1       $60.00      $22.41
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22512804952          06/29/2023           1       $79.00      $32.87
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22512652276          06/27/2023           1       $56.00      $22.46
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22512804952          06/29/2023           1       $89.00      $31.52
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22512804952          06/29/2023           1       $75.00      $26.36
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22512804952          06/29/2023           1       $56.00      $22.62
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22512652276          06/27/2023           1       $89.00      $31.35
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22512652276          06/27/2023           1       $42.00      $17.89
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22512652276          06/27/2023           1       $79.00      $32.70
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22512652276          06/27/2023           1       $75.00      $26.19
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22512652276          06/27/2023           1      $101.00      $42.78
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22512804952          06/29/2023           1      $101.00      $42.95
    104272-02                105070575001 206649577  RIBARICH         ROBIN      18   22312678518          07/03/2023           1       $75.00       $0.00
    104272-02                110609957001 210620704  STRUNK           JEREMIAH   19   22212701177          07/05/2023           1      $120.00       $0.00
    104272-02                105413964001 210642710  ROBERTSON        RONALD     18   22612532401          06/27/2023           3      $581.00       $0.00
    104272-02                105413964001 210642710  ROBERTSON        RONALD     18   22612532401          06/27/2023           1    $2,187.00     $849.47
    104272-02                105413964001 210642710  ROBERTSON        RONALD     18   22612651174          06/30/2023           1      $302.58     $120.81
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212668933          06/28/2023           1       $25.00       $8.28
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212472761          06/28/2023           1      $103.48      $33.50
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212734672          06/24/2023           1      $330.00     $141.73

                                                                                                                                              PAGE:34 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212606786          06/28/2023           1       $60.75       $7.50
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212606786          06/28/2023           1       $29.24       $8.00
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212472761          06/28/2023           1      $103.49      $33.50
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22312756796          07/03/2023           1      $104.00      $16.66
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22312756796          07/03/2023           1       $23.00       $0.00
    104272-02                111997101001 211626742  DUNCAN           SIMON      19   22312555323          06/27/2023           1      $637.00     $355.38
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22312756797          07/03/2023           1      $497.00     $225.44
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22312756796          07/03/2023           1      $108.00      $27.19
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22312756796          07/03/2023           1       $65.00      $35.09
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22312756796          07/03/2023           1       $80.00      $22.50
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22312756786          06/30/2023           1      $691.00     $243.35
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22312756797          07/03/2023           1       $48.00      $58.59
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22312756796          07/03/2023           1       $67.00      $13.34
    104272-02                111997101001 211626742  DUNCAN           SIMON      19   22312555323          06/27/2023           1      $211.00     $105.99
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22312756796          07/03/2023           1       $44.00      $16.66
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22312739857          06/30/2023           1      $234.00      $38.55
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22312756796          07/03/2023           1       $38.00       $6.95
    104272-02                122787528001 258714403  MCGREGOR         SHANE      18   22612481677          03/06/2023           1      $133.00       $0.00
    104272-02                128385523001 305155123  LOHR             SYDNEY     18   22112428619          06/25/2023           1       $96.00      $31.80
    104272-02                107536593001 391923055  SHAFFER          THERESE    01   927606724562200401   07/07/2023          30      $135.60       $9.88
    104272-02                107536593001 391923055  SHAFFER          NICHOLAS   18   157416563662200401   07/07/2023          30      $162.44      $28.75
    104272-02                107536593001 391923055  SHAFFER          NICHOLAS   18   219071562662200401   07/07/2023          30       $53.67       $3.96
    104272-02                114286162001 394927245  SHAFFER          RENEE      18   22412494208          06/26/2023           1      $104.00       $0.00
    104272-02                114286162001 394927245  SHAFFER          RENEE      18   22412494208          06/26/2023           1       $96.00       $0.00
    104272-02                114286162001 394927245  SHAFFER          RENEE      18   22412494208          06/26/2023           1      $102.00       $0.00
    104272-02                114286162001 394927245  SHAFFER          RENEE      18   22412494208          06/26/2023           1      $107.00       $0.00
    104272-02                114286162001 394927245  SHAFFER          RENEE      18   22412494208          06/26/2023           1      $167.00       $0.00
    104272-02                114286162001 394927245  SHAFFER          RENEE      18   22412494208          06/26/2023           1       $86.00       $0.00
    104272-02                114286162001 394927245  SHAFFER          RENEE      18   22412494208          06/26/2023           1       $67.00       $0.00
    104272-02                114286162001 394927245  SHAFFER          RENEE      18   22412494208          06/26/2023           1       $67.00      $33.77
    104272-02                114286162001 394927245  SHAFFER          RENEE      18   22412494208          06/26/2023           1       $91.00       $0.00
    104272-02                114286162001 394927245  SHAFFER          RENEE      18   22412494208          06/26/2023           1       $67.00       $0.00

                                                                                                                                              PAGE:35 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                114286162001 394927245  SHAFFER          RENEE      18   22412494208          06/26/2023           1       $23.00       $0.00
    104272-02                113079956001 576474798  REYNOLDS         BRIAN      18   22112751662          07/05/2023           1      $150.00      $73.36
  104272-02 Total                                                                                                                  $118,489.51  $42,291.07
  104272-09
    104272-09                101226816001 159666231  STIFFLER         GABRIELL   19   283971151708049301   07/03/2023          30      $145.23      $53.93
    104272-09                101226816001 159666231  STIFFLER         GABRIELL   19   22031232084          06/30/2023           1      $160.00     $126.85
    104272-09                101226816001 159666231  STIFFLER         GABRIELL   19   22031351316          07/03/2023           1      $140.00      $89.99
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22712440700          05/24/2023           1      $243.60     $203.55
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22711459713          05/22/2023          13      $182.00      $48.87
    104272-09                122665066001 163589264  KASCHALK         CARLY      19   427928410444559301   07/04/2023          30      $247.11      $72.95
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22712606355          06/30/2023           4    $1,144.00     $972.00
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22712606354          06/28/2023          80      $429.34     $104.80
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22712440686          05/24/2023           1      $596.40     $203.55
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22711459713          05/22/2023           1    $3,289.00     $883.27
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22711459713          05/22/2023           2    $6,852.00   $1,840.12
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22711459713          05/22/2023         100    $4,153.24   $1,115.36
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22711459713          05/22/2023          14   $54,516.00  $14,640.43
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22711459713          05/22/2023          50    $3,531.00     $948.26
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22711459713          05/22/2023           2   $13,356.00   $3,586.79
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22711459713          05/22/2023         999    $5,504.66   $1,478.39
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22711459713          05/22/2023           1      $335.00      $89.96
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22711459713          05/22/2023           1       $47.00      $12.62
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22711459713          05/22/2023           3    $1,533.00     $411.69
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22711459713          05/22/2023          14      $980.00     $263.18
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22712606355          06/30/2023          18      $317.23     $198.18
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22711459713          05/22/2023           2      $171.37      $46.02
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22712789944          07/02/2023          40      $214.67      $52.40
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22712606355          06/30/2023           4      $256.80      $30.28
    104272-09                112895895001 171602746  MESORAS          JENNIFER   18   22312462251          06/27/2023           1       $61.00      $20.35
    104272-09                118503729001 181720719  SANTINI          EMILY      01   114588700773700401   07/07/2023          28    $1,228.64     $985.94
    104272-09                105389627001 210488446  MCGILL           ROGER      01   22512628462          06/27/2023           1      $209.00     $120.81
    104272-09                105389627001 210488446  MCGILL           LAURA      18   127994372289049301   07/03/2023          30      $159.60      $25.11

                                                                                                                                              PAGE:36 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-09                105389627001 210488446  MCGILL           LAURA      18   870776213389049301   07/03/2023          30      $227.44      $11.61
    104272-09                105389627001 210488446  MCGILL           ROGER      01   215026821206819301   07/02/2023          30       $20.50       $4.31
    104272-09                105389627001 210488446  MCGILL           LAURA      18   492152593562200401   07/07/2023          28    $1,309.99     $985.94
    104272-09                105389627001 210488446  MCGILL           LAURA      18   688978448289049301   07/03/2023          30       $71.22       $4.94
  104272-09 Total                                                                                                                  $101,632.04  $29,632.45
  104272-12
    104272-12                102143206001 171547133  AURANDT          MICHELE    18   22112421647          06/12/2023           1      $129.00      $59.12
    104272-12                122684848001 186522645  DAMIN            PERRY      18   22712514526          06/27/2023           1       $65.00       $0.00
    104272-12                122684848001 186522645  DAMIN            PERRY      18   22712889782          06/30/2023           1      $130.00     $124.83
    104272-12                122684848001 186522645  DAMIN            PERRY      18   22712596954          06/30/2023           1       $37.00       $0.00
    104272-12                122684848001 186522645  DAMIN            PERRY      18   22712514526          06/27/2023           1      $424.00       $0.00
    104272-12                122684848001 186522645  DAMIN            PERRY      18   22712514526          06/27/2023           1       $97.00       $0.00
    104272-12                122684848001 186522645  DAMIN            PERRY      18   22712514526          06/27/2023           1       $65.00       $0.00
    104272-12                122684848001 186522645  DAMIN            PERRY      18   22712514526          06/27/2023           1       $92.00       $0.00
    104272-12                122684848001 186522645  DAMIN            PERRY      18   22712464135          06/27/2023           1       $34.00       $0.00
    104272-12                122684848001 186522645  DAMIN            PERRY      18   22712889782          06/30/2023           1        $6.00       $4.95
    104272-12                122684848001 186522645  DAMIN            PERRY      18   22712889782          06/30/2023           1        $7.00       $0.00
    104272-12                122684848001 186522645  DAMIN            PERRY      18   22712596954          06/30/2023           1       $69.00       $0.00
    104272-12                122684848001 186522645  DAMIN            PERRY      18   22712464135          06/27/2023           1       $10.00       $0.00
    104272-12                104708810001 202489252  NICOLOFF         GREGORY    18   665684812296600401   07/07/2023          12       $92.89       $0.00
  104272-12 Total                                                                                                                    $1,257.89     $188.90
  104272- Total                                                                                                                    $221,379.44  $72,112.42
HDHP PPO Total                                                                                                                     $303,842.96 $106,274.89
                                                                                                                                                            
Major Medical
  053264-01
    053264-01                107311465001 363488272  DONGELL          EDWARD     01   38173727901          06/17/2023           1        $6.00       $4.80
  053264-01 Total                                                                                                                        $6.00       $4.80
  053264- Total                                                                                                                          $6.00       $4.80
Major Medical Total                                                                                                                      $6.00       $4.80
                                                                                                                                                            
PPO

                                                                                                                                              PAGE:37 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  014267-01
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712701509          06/22/2023           1      $285.00     $222.35
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712437723          06/22/2023           1       $32.00      $10.00
    014267-01                101818644001 167526324  PETERS           CAROL      01   22612808250          06/23/2023           1      $418.00      $41.08
    014267-01                101818644001 167526324  PETERS           CAROL      01   22612808250          06/23/2023           1    $1,520.00      $37.77
    014267-01                101818644001 167526324  PETERS           CAROL      01   22612475393          06/23/2023           1      $200.00     $151.71
    014267-01                101818644001 167526324  PETERS           CAROL      01   22612475393          06/23/2023           1      $200.00     $160.18
    014267-01                101818644001 167526324  PETERS           CAROL      01   22612475393          06/23/2023           1       $75.00      $44.01
    014267-01                101818644001 167526324  PETERS           CAROL      01   22612808250          06/23/2023           1      $421.00      $41.08
    014267-01                101911501001 168586533  GEORGE           TERESA     18   22112766491          06/24/2023           1       $61.00       $0.00
    014267-01                113324089001 181506290  MCINTOSH         CONSTANC   18   22412703032          06/29/2023           1      $235.00     $102.26
    014267-01                113324089001 181506290  MCINTOSH         CONSTANC   18   22412703032          06/29/2023           1      $235.00     $102.26
  014267-01 Total                                                                                                                    $3,682.00     $912.70
  014267-03
    014267-03                110652030001 161544709  ANDREWS          EDWARD     01   22031502860          07/03/2023           1      $145.00     $101.05
    014267-03                101375474001 161644485  DAVIS            DANA       18   22510629912          05/31/2023           1    $1,579.90   $1,164.50
    014267-03                101375474001 161644485  DAVIS            DANA       18   22512579979          06/30/2023           1       $96.00      $42.37
    014267-03                101375474001 161644485  DAVIS            DANA       18   22510629912          05/31/2023           1       $92.00      $69.66
    014267-03                101375474001 161644485  DAVIS            DANA       18   22512579979          06/30/2023           1       $67.00      $33.77
    014267-03                101375474001 161644485  DAVIS            DANA       18   22509672681          05/17/2023          (1)    ($92.00)    ($69.66)
    014267-03                101375474001 161644485  DAVIS            DANA       18   22509672681          05/17/2023           1       $92.00      $69.66
    014267-03                101375474001 161644485  DAVIS            DANA       18   22512579979          06/30/2023           1       $67.00      $19.59
    014267-03                101375474001 161644485  DAVIS            DANA       18   22510629912          05/31/2023          (1)    ($92.00)    ($69.66)
    014267-03                101375474001 161644485  DAVIS            DANA       18   22512579979          06/30/2023           1      $108.00      $26.63
    014267-03                101375474001 161644485  DAVIS            DANA       18   22512579672          06/28/2023           1       $92.00      $69.66
    014267-03                101375474001 161644485  DAVIS            DANA       18   22512579979          06/30/2023           1      $127.00      $15.23
    014267-03                101375474001 161644485  DAVIS            DANA       18   22512579979          06/30/2023           1       $86.00      $22.75
    014267-03                101375474001 161644485  DAVIS            DANA       18   22509672681          05/17/2023           1    $1,579.90   $1,164.50
    014267-03                101375474001 161644485  DAVIS            DANA       18   22512579979          06/30/2023           1       $23.00       $0.00
    014267-03                101375474001 161644485  DAVIS            DANA       18   22512579672          06/28/2023           1    $1,579.90   $1,164.50
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   21593248564          09/15/2022           1   $11,252.00     $726.37
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   21593248564          09/15/2022           1   $11,252.00   $1,373.96

                                                                                                                                              PAGE:38 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   21593248564          09/15/2022           4      $211.00      $79.97
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   21593248564          09/15/2022           4       $69.00      $36.65
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   21593248564          09/15/2022           1       $46.00      $24.79
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   21593248564          09/15/2022           1       $19.00       $0.00
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   21593248564          09/15/2022         100      $100.00      $51.26
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   21593248564          09/15/2022          10       $47.50      $28.19
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   21593248564          09/15/2022           1       $65.25      $28.83
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   21593248564          09/15/2022          20      $280.00      $15.38
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   21593248564          09/15/2022           6      $105.00      $57.28
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   21593248564          09/15/2022           1   $11,252.00   $4,348.38
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   21593248564          09/15/2022           1      $422.00     $286.86
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   21593248564          09/15/2022           7    $5,614.00       $0.00
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   21593248564          09/15/2022           1      $485.00       $0.00
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   21593248564          09/15/2022           3    $7,872.00   $1,818.04
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   21593248564          09/15/2022         150      $225.00      $86.50
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   21593248564          09/15/2022           2    $2,040.00       $0.00
    014267-03                101995873001 169646253  MANACK           BRANDON    01   22712578350          06/23/2023           1      $252.00     $102.66
    014267-03                101995873001 169646253  MANACK           BRANDON    01   22712578349          06/23/2023           1       $45.00      $12.00
    014267-03                102151761001 171602272  MISLEVY          NATHAN     19   22612480724          06/29/2023           3      $252.00      $73.74
    014267-03                102151761001 171602272  MISLEVY          NATHAN     19   22612623920          06/30/2023           3      $252.00      $73.74
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22612660192          07/03/2023           2      $168.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22612660192          07/03/2023           1       $50.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22612660192          07/03/2023           1       $80.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22612480722          06/29/2023           1       $50.00      $11.87
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22612480722          06/29/2023           2      $168.00      $49.16
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22612660192          07/03/2023           1       $50.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22612480722          06/29/2023           1       $80.00      $22.60
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22612480722          06/29/2023           1       $50.00      $10.45
    014267-03                120477354001 172722160  KISS             JENNIFER   01   22612805149          06/09/2023           3      $374.00     $141.64
    014267-03                120477354001 172722160  KISS             JENNIFER   01   22612805149          06/21/2023           1      $118.00      $17.57
    014267-03                120477354001 172722160  KISS             JENNIFER   01   22612805149          06/21/2023           3      $374.00     $141.64
    014267-03                120477354001 172722160  KISS             JENNIFER   01   22612805149          06/09/2023           1      $118.00      $17.57

                                                                                                                                              PAGE:39 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                102741496001 178667598  KOSS             SUMMER     19   22712596957          06/28/2023           1       $53.00      $53.00
    014267-03                102741496001 178667598  KOSS             SUMMER     19   22712464137          06/28/2023           1        $4.00       $0.16
    014267-03                102741496001 178667598  KOSS             SUMMER     19   22712464137          06/28/2023           1      $129.00     $106.85
    014267-03                102741496001 178667598  KOSS             SUMMER     19   22712464137          06/28/2023           1       $27.00      $15.94
    014267-03                102741496001 178667598  KOSS             SUMMER     19   22712464137          06/28/2023           1        $7.00       $6.07
    014267-03                102741496001 178667598  KOSS             SUMMER     19   22712596957          06/28/2023           1       $50.00      $50.00
    014267-03                116282269001 179701087  COMMONS          MEGAN      18   22112766436          07/03/2023           1      $327.00       $0.00
    014267-03                116282269001 179701087  COMMONS          MEGAN      18   22112766436          07/03/2023           1       $80.00     $116.84
    014267-03                116282269001 179701087  COMMONS          MEGAN      18   22112766436          07/03/2023           1      $408.00     $425.23
    014267-03                113722774001 180661551  DUCLO            ALLISON    18   22712700506          06/26/2023           1      $457.00     $117.08
    014267-03                102894572001 180662763  HOLTZ            BRANDON    01   22212739498          06/01/2023           1      $200.00     $100.81
    014267-03                102898332001 180688012  HITE             HEIDI      18   22031351771          06/29/2023           1       $55.00      $37.00
    014267-03                102898332001 180688012  HITE             HEIDI      18   22031377811          06/29/2023           1      $512.00     $173.73
    014267-03                102898332001 180688012  HITE             HEIDI      18   22031351771          06/29/2023           1       $50.00      $31.00
    014267-03                102898332001 180688012  HITE             HEIDI      18   22031377811          06/29/2023           1       $75.00      $46.15
    014267-03                102972300001 181604543  SCHIRATO         MARIA      18   22612762112          06/28/2023           1      $144.00     $144.00
    014267-03                102972300001 181604543  SCHIRATO         MARIA      18   22612660112          06/28/2023           1      $150.00       $9.66
    014267-03                102986121001 181726473  SMITH            LAKEN      18   22312546389          06/27/2023           1       $29.50       $0.00
    014267-03                102986121001 181726473  SMITH            LAKEN      18   22312546389          06/27/2023           1      $129.00       $0.00
    014267-03                102986121001 181726473  SMITH            LAKEN      18   22312546389          06/27/2023           1      $156.00       $0.00
    014267-03                102986121001 181726473  SMITH            LAKEN      18   22312756809          07/01/2023           1       $61.00       $0.00
    014267-03                103039127001 182562529  BEACH            THERESA    18   22812593496          06/30/2023           1      $427.00     $427.00
    014267-03                103039127001 182562529  BEACH            THERESA    18   22812593496          06/30/2023           1       $53.00      $53.00
    014267-03                103039127001 182562529  BEACH            THERESA    18   22812638043          06/30/2023           1      $715.00      $38.56
    014267-03                103039127001 182562529  BEACH            THERESA    18   22812638043          06/30/2023           1      $358.00      $30.99
    014267-03                103039127001 182562529  BEACH            THERESA    18   22812593497          06/29/2023           1       $65.00      $48.58
    014267-03                103039127001 182562529  BEACH            THERESA    18   22812593497          06/29/2023           1      $424.00      $52.84
    014267-03                103039127001 182562529  BEACH            THERESA    18   22812593497          06/29/2023           1       $92.00      $84.06
    014267-03                103039127001 182562529  BEACH            THERESA    18   22812593497          06/29/2023           1       $97.00      $67.00
    014267-03                103039127001 182562529  BEACH            THERESA    18   22812593497          06/29/2023           1       $65.00      $38.88
    014267-03                103039127001 182562529  BEACH            THERESA    18   22812593497          06/29/2023           1      $259.00     $148.11
    014267-03                103039127001 182562529  BEACH            THERESA    18   22812593497          06/29/2023           1       $14.00       $0.00

                                                                                                                                              PAGE:40 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                111759150001 183628110  BENDER           DANA       18   22312418736          06/20/2023           1      $209.00      $90.81
    014267-03                119685264001 183723911  STRAYER          LYDIA      18   22612647336          07/03/2023           2        $4.00       $0.00
    014267-03                119685264001 183723911  STRAYER          LYDIA      18   22612647336          07/03/2023           1       $30.00       $0.00
    014267-03                103288637001 185583037  FARABAUGH        SYDNEY     19   22412507054          05/26/2023           1      $211.00       $0.00
    014267-03                103288637001 185583037  FARABAUGH        SYDNEY     19   22412507054          05/26/2023           1      $237.00       $0.00
    014267-03                103288637001 185583037  FARABAUGH        SYDNEY     19   22412507054          05/26/2023           1      $237.00       $0.00
    014267-03                128049898001 185589266  O'HARA           DAVID      01   22412458631          06/28/2023           1       $50.00       $0.00
    014267-03                128049898001 185589266  O'HARA           DAVID      01   22412458631          06/28/2023           1       $80.00       $3.32
    014267-03                103373563001 186587333  BEUNIER-SMITH    YVETTE     18   22412621399          06/29/2023           1      $484.00     $127.86
    014267-03                114686704001 186607919  TERZA            ISABELL    19   22112680025          07/03/2023           1       $15.00       $0.00
    014267-03                114686704001 186607919  TERZA            ISABELL    19   22112680025          07/03/2023           1      $109.30      $23.48
    014267-03                103379409001 186624451  LOBICK           ALISON     01   22031298242          07/03/2023           1       $90.00       $0.00
    014267-03                103379409001 186624451  LOBICK           ALISON     01   22031298242          07/03/2023           1      $150.00      $75.99
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22209939208          05/19/2023          (1) ($1,120.00)   ($264.28)
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194116          05/19/2023           1      $210.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         KEITH      19   22212755253          06/29/2023           1      $223.46      $38.94
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194116          05/19/2023           1      $236.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22209939208          05/19/2023          (1)   ($150.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22212668015          06/28/2023           1      $276.00      $78.01
    014267-03                103624049001 189580744  SPRENGER         KEITH      19   22212585831          07/03/2023           1      $125.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22212432510          06/28/2023           3      $549.00     $249.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22209939208          05/19/2023          (1)    ($59.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194116          05/19/2023           1      $265.00     $214.82
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194116          05/19/2023           1       $59.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22209939208          05/19/2023          (1) ($2,134.00)   ($843.56)
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194116          05/19/2023           1    $1,120.00     $264.28
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22212553973          06/14/2023           1      $300.00     $117.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22209939208          05/19/2023          (1)   ($210.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22209939208          05/19/2023          (1)   ($265.00)   ($214.82)
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22212432510          06/28/2023           8       $74.02      $21.52
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194116          05/19/2023           1    $2,134.00     $843.56
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194116          05/19/2023           1       $83.00       $0.00

                                                                                                                                              PAGE:41 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194116          05/19/2023           1      $150.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22209939208          05/19/2023          (1)   ($145.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194116          05/19/2023           1      $145.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22209939208          05/19/2023          (1)    ($83.00)       $0.00
    014267-03                103710443001 190560450  SHEARMAN         WILLIAM    01   22512776801          06/29/2023           1      $835.00     $305.03
    014267-03                103710443001 190560450  SHEARMAN         JOAN       18   22512411763          06/19/2023           1      $806.00     $227.44
    014267-03                103710443001 190560450  SHEARMAN         JOAN       18   22512411763          06/19/2023           1      $359.00      $60.43
    014267-03                103710443001 190560450  SHEARMAN         JOAN       18   22512411763          06/19/2023           1        $8.00       $4.38
    014267-03                103710443001 190560450  SHEARMAN         WILLIAM    01   22512776800          06/29/2023           3      $426.00     $121.92
    014267-03                111593010001 191660151  CHAPMAN          ELIZABET   18   22312576320          07/03/2023           2        $4.00       $0.00
    014267-03                111593010001 191660151  CHAPMAN          ELIZABET   18   22312576320          07/03/2023           1       $30.00       $0.00
    014267-03                111593010001 191660151  CHAPMAN          ELIZABET   18   22312647351          06/05/2023           1      $150.00      $87.19
    014267-03                111593010001 191660151  CHAPMAN          ELIZABET   18   22312647351          06/05/2023           1      $145.00      $44.97
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22512785519          07/06/2023           1       $25.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22512785519          07/06/2023           1       $50.00       $3.32
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22512785519          06/29/2023           1       $40.00      $40.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22512785519          07/06/2023           1       $25.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22512785519          06/29/2023           1       $40.00       $1.33
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22512785519          06/29/2023           1      $110.00      $75.99
    014267-03                103818021001 191709419  MULRANEY         VIVIAN     19   22612733712          06/20/2023           1      $100.00      $56.77
    014267-03                103818021001 191709419  MULRANEY         AVA        19   22612733703          06/20/2023           1      $100.00      $56.77
    014267-03                128460945001 191767401  SCALESE          MORGAN     18   22312813523          07/07/2023           1      $120.00     $100.00
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22812641512          06/30/2023           1      $589.00      $89.55
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22812786411          07/02/2023           1      $150.00       $0.00
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22812604829          06/27/2023           1      $566.00     $187.21
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22812511389          06/27/2023           2      $815.00       $0.00
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22812511389          06/27/2023           1       $27.78       $0.00
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22812641512          06/30/2023           2      $176.00      $24.84
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22812786410          07/03/2023           1    $1,370.00       $0.00
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22812511389          06/27/2023           1      $188.00       $0.00
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22812786411          07/02/2023           1      $150.00       $0.00
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22812511389          06/27/2023           1       $23.15       $0.00

                                                                                                                                              PAGE:42 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22812511389          06/27/2023           1    $1,791.00   $1,892.26
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22812511389          06/27/2023          20       $22.05       $0.00
    014267-03                115783835001 194687195  BENDER           SHANON     18   22512706482          06/30/2023           1      $512.00     $173.73
    014267-03                115783835001 194687195  BENDER           SHANON     18   22512706482          06/30/2023           1       $75.00      $46.15
    014267-03                115783835001 194687195  BENDER           SHANON     18   22512749729          06/30/2023           1       $55.00      $37.00
    014267-03                115783835001 194687195  BENDER           SHANON     18   22512749729          06/30/2023           1       $50.00      $31.00
    014267-03                135232407001 195780857  VENESKY          AMANDA     18   22031351701          12/07/2022           1      $220.00      $79.89
    014267-03                117356283001 199567270  CENCE            WILLIAM    01   22028899943          03/30/2023           1      $856.80     $135.70
    014267-03                117356283001 199567270  CENCE            WILLIAM    01   22028899944          03/30/2023           1      $868.00     $135.70
    014267-03                119613821001 199689276  ZADZILKO         MEGAN      18   22512726448          06/30/2023           1       $96.00       $0.00
    014267-03                119613821001 199689276  ZADZILKO         MEGAN      18   22512628471          06/28/2023           1      $200.00     $100.00
    014267-03                119613821001 199689276  ZADZILKO         MEGAN      18   22512726448          06/30/2023           1      $108.00       $0.00
    014267-03                119613821001 199689276  ZADZILKO         MEGAN      18   22512590879          06/30/2023           1      $260.00     $129.90
    014267-03                119613821001 199689276  ZADZILKO         MEGAN      18   22512726448          06/30/2023           1       $67.00       $0.00
    014267-03                119613821001 199689276  ZADZILKO         MEGAN      18   22512726448          06/30/2023           1       $67.00      $33.77
    014267-03                120189904001 199707914  KEENER           CHRISTIN   18   22712771573          06/01/2023           1      $290.00     $137.86
    014267-03                120189904001 199707914  KEENER           CHRISTIN   18   22712771573          06/01/2023           1       $90.00       $8.50
    014267-03                120189904001 199707914  KEENER           CHRISTIN   18   22712771573          06/01/2023           1       $47.00      $10.50
    014267-03                104567865001 200681648  MCCULLOUGH       KIMBERLY   18   22612785679          07/05/2023           1      $175.00      $85.99
    014267-03                104567865001 200681648  MCCULLOUGH       KIMBERLY   18   22612785679          07/05/2023           1      $160.00       $0.00
    014267-03                110124351001 202707741  MANIFEST         OWEN       19   22031246596          06/30/2023           1      $300.00      $81.56
    014267-03                110124351001 202707741  MANIFEST         OWEN       19   22031246596          06/30/2023           1       $14.00       $0.00
    014267-03                110124351001 202707741  MANIFEST         OWEN       19   22031246596          06/30/2023           1      $351.00     $193.24
    014267-03                105151459001 207608668  LEAMER           MARY       18   22412587210          06/29/2023           1       $30.00       $0.00
    014267-03                112953016001 207643714  LEWIS            BLAKE      19   22112744931          07/06/2023           1      $358.00      $77.50
    014267-03                112953016001 207643714  LEWIS            BLAKE      19   22112744927          07/06/2023          40    $7,200.00     $304.40
    014267-03                105161905001 207722715  BERZONSKY        ALYSSA     18   22112435845          06/28/2023           1       $50.00       $0.00
    014267-03                105161905001 207722715  BERZONSKY        ALYSSA     18   22112435845          06/28/2023           1       $80.00      $33.32
    014267-03                105161905001 207722715  BERZONSKY        ALYSSA     18   22112435845          06/28/2023           1       $66.00      $23.48
    014267-03                115784377001 208708748  THOMAS           MELODY     18   22712764797          07/05/2023           1       $30.00       $0.00
    014267-03                115784377001 208708748  THOMAS           MELODY     18   22712764797          07/05/2023           2        $4.00       $0.00
    014267-03                105399036001 210547835  MCEVOY           REBECCA    18   22031291749          06/30/2023           1      $715.00      $38.56

                                                                                                                                              PAGE:43 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                105399036001 210547835  MCEVOY           REBECCA    18   22031246872          06/30/2023           1       $48.00      $57.40
    014267-03                105399036001 210547835  MCEVOY           REBECCA    18   22031291749          06/30/2023           1      $358.00      $30.99
    014267-03                105399036001 210547835  MCEVOY           REBECCA    18   22031246872          06/30/2023           1      $497.00     $220.83
    014267-03                105494211001 211588239  PATRICK          VICKI      18   22031291966          06/29/2023           1      $215.00      $52.85
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   22031468539          06/30/2023           2      $134.00      $39.19
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   22031468539          06/30/2023           1      $144.00      $21.89
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   22031468539          06/30/2023           1       $23.00       $0.00
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   22025018263          03/17/2023           1    $1,488.00     $283.20
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   22031468539          06/30/2023           1      $168.00      $21.74
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   22031468539          06/30/2023           1      $104.00      $16.90
  014267-03 Total                                                                                                                   $94,565.51  $22,732.26
  014267-05
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22812720431          06/30/2023           1    $2,447.00   $1,765.80
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22812718820          06/29/2023           3      $147.00      $92.40
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22812718819          06/27/2023           3      $147.00      $92.40
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22812720431          06/30/2023           1    $2,447.00   $1,788.26
    014267-05                101665655001 165520467  FISANICK         LAURA      18   22812790639          06/27/2023           1      $110.00       $9.15
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22712700734          06/29/2023           1    $4,494.00     $697.85
    014267-05                101825625001 167566948  BROWN            JIM        01   22312581375          06/29/2023           1      $187.00      $95.81
    014267-05                101825625001 167566948  BROWN            JIM        01   22312544007          06/29/2023           1      $100.00      $92.01
    014267-05                101825625001 167566948  BROWN            JIM        01   22312581375          06/29/2023           1       $18.00       $3.25
    014267-05                101995157001 169643849  WENDEROTH        FRED       18   22212439283          06/27/2023           1      $175.00      $95.81
    014267-05                112228663001 170540291  SHERRY           TAYLOR     19   22412592521          06/28/2023           1      $120.00     $110.01
    014267-05                129935534001 172742640  CAMPBELL         KENNETH    01   22512620808          07/03/2023           1       $45.00       $8.32
    014267-05                117733515001 177721457  SEDLOCK          KATELYN    18   22612790838          05/31/2023           1      $290.00     $132.86
    014267-05                102794894001 179527800  MCMULLEN         DIANE      18   22812593494          06/30/2023           1       $92.00       $0.00
    014267-05                102794894001 179527800  MCMULLEN         DIANE      18   22812593494          06/30/2023           1       $14.00       $0.00
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   22612843793          06/27/2023           3      $215.00      $93.75
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   22612691252          06/27/2023           1    $3,476.00   $1,577.73
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   22612843793          06/27/2023           2      $452.00     $196.30
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   22612843793          06/27/2023           2       $77.10      $34.09
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   22612843793          06/27/2023           1      $223.00      $97.21

                                                                                                                                              PAGE:44 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   22612843793          06/27/2023           1        $3.05       $2.06
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   22612843793          06/27/2023           4       $17.10       $8.13
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   22612843793          06/27/2023           1        $2.00       $1.59
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   22612691252          06/27/2023           1      $267.00      $11.34
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   22612843793          06/27/2023           1      $112.00      $49.19
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   22612843793          06/27/2023           1      $307.00     $133.58
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   22612843793          06/27/2023           1      $571.00     $247.79
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   22612843793          06/27/2023           1       $16.15       $7.71
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   22612843793          06/27/2023           2       $19.20       $9.05
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   22612843793          06/27/2023           1   $13,361.00   $5,781.66
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   22612843793          06/27/2023           3       $81.00      $35.78
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   22612843793          06/27/2023         150      $522.00     $226.59
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   22612691252          06/27/2023           2      $266.00      $11.29
    014267-05                102971934001 181603444  NELSON           JULIE      01   22031420105          07/05/2023          30      $660.00     $496.20
    014267-05                102971934001 181603444  NELSON           JULIE      01   22031279318          06/29/2023           1       $30.00      $12.22
    014267-05                102971934001 181603444  NELSON           JULIE      01   22031279318          06/29/2023           2        $4.00       $0.80
    014267-05                104078368001 194767581  BRADY            CHELSEA    18   22112399665          06/28/2023           1      $200.00     $120.00
    014267-05                104144215001 195582778  DUMM             TY         19   22412590941          07/03/2023           1       $30.00      $15.90
    014267-05                104144215001 195582778  DUMM             TY         19   22412590941          07/03/2023           1       $28.00       $2.84
    014267-05                104144215001 195582778  DUMM             TY         19   22412590941          07/03/2023           2       $60.00      $40.40
    014267-05                104144215001 195582778  DUMM             TY         19   22412590941          07/03/2023           1      $375.00     $278.78
    014267-05                104144215001 195582778  DUMM             TY         19   22412590941          07/03/2023           1      $210.00     $195.83
    014267-05                104144215001 195582778  DUMM             TY         19   22412590941          07/03/2023           1      $150.00     $124.00
    014267-05                104144215001 195582778  DUMM             TY         19   22412590941          07/03/2023           1       $30.00       $4.71
    014267-05                104241138001 196668859  MCCRACKEN        KIMBERLY   18   22612812736          06/29/2023           1      $200.00     $100.00
    014267-05                110816430001 196703109  TEMPLETON        BELLA      19   22612790839          06/04/2023           1      $200.00      $95.81
    014267-05                110816430001 196703109  TEMPLETON        BELLA      19   22612790839          06/04/2023           1      $110.00       $0.00
    014267-05                110816430001 196703109  TEMPLETON        KRISTA     18   22612523141          06/11/2023           1    $1,868.00     $115.44
    014267-05                110816430001 196703109  TEMPLETON        BELLA      19   22612790839          06/04/2023           1      $110.00       $0.00
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22612824384          06/05/2023           1      $342.00       $0.00
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22612824384          06/05/2023           1      $610.00     $510.76
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22612719946          06/27/2023           1      $346.00     $134.19

                                                                                                                                              PAGE:45 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22612719581          06/27/2023           1       $31.00      $15.41
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22612491564          06/12/2023           1      $350.00      $95.81
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22612824384          06/05/2023           3      $345.00       $0.00
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22612824384          06/05/2023           1      $240.00       $0.00
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22612824384          06/05/2023           1      $218.24       $0.00
    014267-05                104639290001 201607083  BONATESTA        JOSEPH     01   22712742972          06/29/2023           3      $127.03       $0.00
    014267-05                104639290001 201607083  BONATESTA        MELISSA    18   22712478233          06/28/2023           1       $50.00      $24.58
    014267-05                104639290001 201607083  BONATESTA        JOSEPH     01   22712644953          06/29/2023           1       $88.00      $12.42
    014267-05                104639290001 201607083  BONATESTA        JOSEPH     01   22712742972          06/29/2023           1      $557.00       $0.00
    014267-05                104639290001 201607083  BONATESTA        JOSEPH     01   22712742972          06/29/2023           1       $22.05       $0.00
    014267-05                104639290001 201607083  BONATESTA        JOSEPH     01   22712742972          06/29/2023           1      $267.00     $140.51
    014267-05                104639290001 201607083  BONATESTA        JOSEPH     01   22712742972          06/29/2023           1    $3,642.00   $2,389.37
    014267-05                104639290001 201607083  BONATESTA        MELISSA    18   22712478233          06/28/2023           1       $80.00       $8.32
    014267-05                104639290001 201607083  BONATESTA        JOSEPH     01   22712742972          06/29/2023           1       $22.05       $0.00
    014267-05                104639290001 201607083  BONATESTA        JOSEPH     01   22712794130          06/29/2023           1      $813.00     $422.34
    014267-05                104821823001 203725621  DAISLEY          BRITTENY   18   22212778358          06/30/2023           1      $691.00       $0.00
    014267-05                104821823001 203725621  HASSEN           LELAND     19   22211588698          05/09/2023           1       $85.00      $75.69
    014267-05                104821823001 203725621  DAISLEY          BRITTENY   18   22212505555          06/27/2023           1       $40.00       $0.00
    014267-05                104821823001 203725621  DAISLEY          BRITTENY   18   22212564883          06/30/2023           1       $14.00       $0.00
    014267-05                104821823001 203725621  DAISLEY          BRITTENY   18   22212505555          06/27/2023           1      $150.00      $65.10
    014267-05                104821823001 203725621  DAISLEY          BRITTENY   18   22212564883          06/30/2023           1       $65.00       $0.00
    014267-05                104821823001 203725621  HASSEN           LELAND     19   22211588697          05/04/2023           1       $85.00      $75.69
    014267-05                104821823001 203725621  DAISLEY          BRITTENY   18   22212564883          06/30/2023           1       $92.00       $0.00
    014267-05                119055015001 204700537  KERR             MARYBETH   18   22030978185          06/05/2023           1      $130.00     $110.01
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   22612829586          07/03/2023           1       $53.00      $53.00
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   22612829586          07/03/2023           1      $427.00     $427.00
    014267-05                117760647001 208602985  ABEL             DOUGLAS    01   22312750928          06/02/2023           1    $1,250.00     $159.28
    014267-05                117760647001 208602985  ABEL             DOUGLAS    01   22312750928          06/10/2023           1    $1,250.00     $165.02
    014267-05                117760647001 208602985  ABEL             DOUGLAS    01   22312750928          06/14/2023           1    $1,250.00     $165.02
    014267-05                105312745001 209560853  KUDLAWIEC        MARY       19   22512796683          06/30/2023           1       $50.00      $22.60
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112766434          07/03/2023           1      $191.00      $97.34
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112248140          06/21/2023           1      $275.00     $185.41

                                                                                                                                              PAGE:46 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112248140          06/21/2023           1      $283.00     $145.43
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112248140          06/21/2023          10       $10.00       $2.40
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112248140          06/21/2023           1       $59.00      $41.56
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112248140          06/21/2023           2       $20.00      $17.94
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112766434          07/03/2023           1      $424.00      $54.21
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112766434          07/03/2023           1       $14.00       $0.00
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112248140          06/21/2023         390      $390.00     $163.80
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112248140          06/21/2023           2       $14.00      $11.14
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112248140          06/21/2023           1       $11.00       $6.19
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112248140          06/21/2023          20        $2.00       $2.00
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112248140          06/21/2023           1      $160.00      $61.45
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112766434          07/03/2023           1       $62.00      $31.01
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112248140          06/21/2023           1       $10.00       $8.97
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112248140          06/21/2023          10       $10.00       $0.80
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112248140          06/21/2023           7       $49.00      $38.99
    014267-05                105312745001 209560853  KUDLAWIEC        MARY       19   22512796683          06/30/2023           1       $40.00      $10.45
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112766434          07/03/2023           1       $65.00      $39.89
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112565224          06/23/2023           1       $47.00      $28.55
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112248140          06/21/2023           2      $102.00      $33.98
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112248140          06/21/2023          10      $100.00      $89.70
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112248140          06/21/2023          10       $70.00      $55.70
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112248140          06/21/2023           1       $55.00      $40.16
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112248140          06/21/2023           1      $256.00     $189.14
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112248140          06/21/2023          10      $450.00      $14.70
    014267-05                105322961001 209620623  DELOSH           SHERRY     18   22212564885          06/29/2023           1      $142.00      $43.28
    014267-05                105322961001 209620623  DELOSH           SHERRY     18   22212441447          06/29/2023           1      $135.00      $64.99
    014267-05                105322961001 209620623  DELOSH           SHERRY     18   22212441447          06/29/2023           1        $7.00       $2.63
    014267-05                105322961001 209620623  DELOSH           SHERRY     18   22212564885          06/29/2023           1       $53.00      $40.38
    014267-05                105322961001 209620623  DELOSH           SHERRY     18   22212564885          06/29/2023           1       $48.00      $40.43
    014267-05                105399373001 210548948  ROCCO            SUSAN      18   22412559026          06/28/2023           1      $115.00     $105.21
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023           1      $521.00      $89.76
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023          (1)   ($329.00)   ($130.45)

                                                                                                                                              PAGE:47 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023          (1)   ($108.00)    ($62.39)
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023           1      $424.00      $38.62
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023          (1)    ($65.00)    ($38.88)
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023           1      $125.00      $56.65
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023          (1)    ($44.00)    ($22.61)
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023           1       $14.00       $0.00
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023          (1)   ($108.00)    ($62.39)
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023          (1)   ($424.00)    ($52.84)
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023          (1)    ($14.00)       $0.00
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023           1      $108.00      $45.60
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023           1      $132.00      $62.28
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023          (1)   ($132.00)    ($85.21)
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023           1      $132.00      $62.28
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023          (1)   ($125.00)    ($77.51)
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023          (1)   ($125.00)    ($77.51)
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023           1      $108.00      $45.60
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023           1       $24.00      $18.42
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023          (2)    ($13.28)       $0.00
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023          (1)    ($24.00)    ($25.21)
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023          (1)   ($521.00)   ($178.04)
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023          (1)    ($24.00)    ($25.21)
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023           1      $125.00      $56.65
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023          (1)   ($132.00)    ($85.21)
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023           1       $65.00      $28.41
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023          (1)   ($252.00)    ($40.63)
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023           1       $44.00      $16.52
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023           2       $13.28       $0.00
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023           1      $329.00      $95.34
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023           1      $252.00      $29.75
    014267-05                105507489001 211702122  BASSETT          KEVIN      01   22308047875          03/06/2023           1       $24.00      $18.42
  014267-05 Total                                                                                                                   $52,536.97  $21,551.86
  014267-06

                                                                                                                                              PAGE:48 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-06                110058092001 179504663  MCGOUGH          GERALD     18   22812782582          06/27/2023           1      $700.00       $0.00
    014267-06                110058092001 179504663  MCGOUGH          GERALD     18   22812767010          06/27/2023           1      $109.00       $0.00
    014267-06                110058092001 179504663  MCGOUGH          GERALD     18   22812767010          06/27/2023           1      $126.00       $0.00
    014267-06                110058092001 179504663  MCGOUGH          GERALD     18   22812782582          06/27/2023           1      $630.00     $264.28
    014267-06                110058092001 179504663  MCGOUGH          GERALD     18   22812782582          06/27/2023           1      $460.00     $211.90
    014267-06                110058092001 179504663  MCGOUGH          GERALD     18   22812782582          06/27/2023           1      $450.00       $0.00
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   22212778327          07/03/2023           1       $65.00      $39.89
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   22212778327          07/03/2023           1       $92.00      $86.25
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   22212700168          07/03/2023           1       $25.00      $19.08
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   22212778327          07/03/2023           1       $37.00      $13.86
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   22212778327          07/03/2023           1      $132.00      $87.42
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   22212778327          07/03/2023           1       $76.00      $26.59
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   22212700168          07/03/2023           1      $135.00      $69.99
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   22212778327          07/03/2023           1       $14.00       $0.00
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   22212778327          07/03/2023           1      $132.00      $87.42
    014267-06                126568873001 188582035  MYERS            KEVIN      01   22112725819          06/28/2023           1       $33.00      $11.97
    014267-06                126568873001 188582035  MYERS            KEVIN      01   22112421404          06/28/2023           1      $125.00      $65.70
    014267-06                119289043001 201600245  KRUMENACKER      MARTIN     19   22112430213          06/29/2023           1      $135.00      $69.99
    014267-06                119289043001 201600245  KRUMENACKER      MARTIN     19   22112430213          06/29/2023           1       $25.00      $19.08
  014267-06 Total                                                                                                                    $3,501.00   $1,073.42
  014267-07
    014267-07                121106664001 159703665  KANE             CLARA      19   22031226492          06/23/2023           1      $118.00     $107.84
    014267-07                121106664001 159703665  KANE             CLARA      19   22031226492          06/23/2023           1      $152.00     $152.00
    014267-07                121106664001 159703665  KANE             CLARA      19   22031226492          06/23/2023           1       $92.00      $46.26
    014267-07                121106664001 159703665  KANE             ALANNAH    19   22031226493          06/23/2023           1      $250.00     $216.12
    014267-07                121106664001 159703665  KANE             ALANNAH    19   22031226493          06/23/2023           1       $25.00      $25.00
    014267-07                121106664001 159703665  KANE             CLARA      19   22031226492          06/23/2023           1       $29.00      $17.97
    014267-07                121106664001 159703665  KANE             CLARA      19   22031226492          06/23/2023           2       $50.00      $50.00
    014267-07                121106664001 159703665  KANE             CLARA      19   22031226492          06/23/2023           3       $54.00      $36.96
    014267-07                121106664001 159703665  KANE             ALANNAH    19   22031226493          06/23/2023           1       $29.00      $17.97
    014267-07                121106664001 159703665  KANE             ALANNAH    19   22031226493          06/23/2023           1      $118.00     $107.84
    014267-07                121106664001 159703665  KANE             SHANE      19   22031425331          07/05/2023           1      $420.00       $0.00

                                                                                                                                              PAGE:49 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-07                121106664001 159703665  KANE             ALANNAH    19   22031073023          06/26/2023           1      $895.00       $0.00
    014267-07                121106664001 159703665  KANE             ALANNAH    19   22031352585          06/26/2023           1       $20.00       $0.00
    014267-07                101762054001 166645996  FOCHLER          NANCY      18   22812697765          06/29/2023           1      $220.00      $94.89
    014267-07                102080665001 170683038  MICHINA          BRIDGET    18   22112385049          06/26/2023           1       $75.00      $46.15
    014267-07                102080665001 170683038  MICHINA          BRIDGET    18   22112385049          06/26/2023           1      $512.00     $173.73
    014267-07                102160098001 171649555  BAKER            MARK       01   22031377802          06/29/2023           1      $207.00      $65.00
    014267-07                102160098001 171649555  BAKER            MARK       01   22031377802          06/29/2023           1      $225.00      $66.99
    014267-07                102160098001 171649555  BAKER            MARK       01   22031377802          06/29/2023           1       $29.50       $0.00
    014267-07                102404201001 174648572  DAVISON          SEAN       18   22512800749          06/27/2023           1       $44.00       $0.00
    014267-07                102404201001 174648572  DAVISON          SEAN       18   22512800749          06/27/2023           1       $44.00       $0.00
    014267-07                102406412001 174667290  O'NEILL          NOAH       19   22212474371          05/11/2023           3      $211.50      $73.74
    014267-07                102406412001 174667290  O'NEILL          NOAH       19   22212474370          05/18/2023           3      $211.50      $73.74
    014267-07                102406412001 174667290  O'NEILL          NOAH       19   22212474369          05/10/2023           4      $282.00      $98.32
    014267-07                102489118001 175647993  ODONNELL         SHANNON    18   22712700510          06/28/2023           1       $55.00      $37.00
    014267-07                102489118001 175647993  ODONNELL         SHANNON    18   22712723200          06/28/2023           1       $75.00      $46.15
    014267-07                102489118001 175647993  ODONNELL         SHANNON    18   22712700510          06/28/2023           1       $50.00      $31.00
    014267-07                102489118001 175647993  ODONNELL         SHANNON    18   22712723200          06/28/2023           1      $512.00     $173.73
    014267-07                129427228001 175749560  HANNOLD          SUZAN      18   22112435829          06/29/2023           1      $175.18      $65.70
    014267-07                129427228001 175749560  HANNOLD          SUZAN      18   22112435829          06/29/2023           1      $195.74     $100.17
    014267-07                129427228001 175749560  HANNOLD          SUZAN      18   22112679880          06/30/2023           1       $29.50       $0.00
    014267-07                129427228001 175749560  HANNOLD          SUZAN      18   22112679880          06/30/2023           1       $84.25      $21.87
    014267-07                102562858001 176587306  GIBBONS          SYDNEY     19   22112658351          06/29/2023           1      $118.00     $118.00
    014267-07                102562858001 176587306  GIBBONS          ANGELA     18   22112723098          07/03/2023           1      $175.00      $82.69
    014267-07                102562858001 176587306  GIBBONS          ANGELA     18   22112723098          07/03/2023           1       $30.00       $0.00
    014267-07                102967311001 181580382  BLACK            BRAD       01   22312588939          06/28/2023           1      $991.00     $343.52
    014267-07                102967311001 181580382  BLACK            BRAD       01   22312735734          06/28/2023           1      $250.00      $78.26
    014267-07                102970458001 181589405  BROWN            LISA       18   22031352818          06/29/2023           1      $220.00      $94.89
    014267-07                102970458001 181589405  BROWN            LISA       18   22031352818          06/29/2023           1       $20.00       $5.91
    014267-07                102970458001 181589405  BROWN            THOMAS     01   22031111694          06/29/2023           2      $138.00      $45.20
    014267-07                102970458001 181589405  BROWN            TAYLOR     19   22031426357          06/30/2023           1      $103.48      $33.50
    014267-07                102970458001 181589405  BROWN            LISA       18   22031352584          06/27/2023           1       $55.00      $37.00
    014267-07                102970458001 181589405  BROWN            TAYLOR     19   22031426357          06/30/2023           1      $137.50      $33.50

                                                                                                                                              PAGE:50 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-07                102970458001 181589405  BROWN            TAYLOR     19   22031426357          06/30/2023           1      $137.50      $33.50
    014267-07                102970458001 181589405  BROWN            THOMAS     01   22031111694          06/29/2023           3      $211.50      $73.74
    014267-07                102970458001 181589405  BROWN            TAYLOR     19   22031426357          06/30/2023           1      $173.23      $33.50
    014267-07                102970458001 181589405  BROWN            TAYLOR     19   22031426357          06/30/2023           1      $103.49      $33.50
    014267-07                102970458001 181589405  BROWN            THOMAS     01   22031111694          06/29/2023           1       $60.00      $12.84
    014267-07                102970458001 181589405  BROWN            TAYLOR     19   22031426442          06/30/2023           1      $331.15     $123.00
    014267-07                102970458001 181589405  BROWN            TAYLOR     19   22031234291          06/30/2023           1      $190.00     $100.81
    014267-07                102970458001 181589405  BROWN            LISA       18   22031248910          06/27/2023           1      $512.00     $173.73
    014267-07                103024367001 182466226  WARNER           DAVID      01   22812718167          06/22/2023           1      $254.00     $110.48
    014267-07                117714302001 185620255  DISHONG          SHAWN      18   22812695382          06/28/2023           1      $190.00     $142.86
    014267-07                117714302001 185620255  DISHONG          SHAWN      18   22812695382          06/28/2023           1       $65.00      $17.61
    014267-07                117714302001 185620255  DISHONG          SHAWN      18   22812460205          06/29/2023           2      $138.00      $45.20
    014267-07                117714302001 185620255  DISHONG          SHAWN      18   22812460205          06/29/2023           1       $60.00      $12.84
    014267-07                117714302001 185620255  DISHONG          SHAWN      18   22812460205          06/29/2023           1       $69.00      $28.53
    014267-07                117714302001 185620255  DISHONG          SHAWN      18   22812460205          06/29/2023           3      $211.50      $73.74
    014267-07                117714302001 185620255  DISHONG          SHAWN      18   22812460205          06/29/2023           1       $55.50      $11.87
    014267-07                136429345001 186687603  WYLAND           FREDERIC   01   22112683098          06/30/2023           1       $47.00      $13.32
    014267-07                103879349001 192529999  WATT             LISA       01   22812434329          06/26/2023           1      $335.00     $148.43
    014267-07                103879349001 192529999  WATT             HAYLEE     19   22812720505          06/30/2023           1      $343.00     $137.71
    014267-07                103879349001 192529999  WATT             LISA       01   22812572468          06/28/2023           1      $192.68       $0.00
    014267-07                103879349001 192529999  WATT             LISA       01   22812572468          06/28/2023           1      $116.02       $0.00
    014267-07                121100051001 196644672  SMEARMAN         OSCAR      19   22212441449          06/29/2023           1      $153.00     $119.36
    014267-07                135720029001 196765983  MYERS            MARISSA    18   22212716453          06/29/2023           1      $225.00     $174.95
    014267-07                135720029001 196765983  MYERS            MARISSA    18   22212509601          06/26/2023         111    $1,665.00   $1,174.67
    014267-07                104630583001 201560699  BAKER            DEBORAH    18   22310463139          06/01/2023           4      $282.00      $98.32
    014267-07                104630583001 201560699  BAKER            DEBORAH    18   22310463139          06/01/2023           2      $138.00      $45.20
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22712578164          06/24/2023           1      $323.00     $179.73
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22712578167          06/22/2023           1      $323.00     $179.73
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22712578165          06/26/2023           1      $311.00     $190.00
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22712766880          06/30/2023           1      $311.00     $190.00
    014267-07                112923331001 201725616  BARTO            COHEN      19   22712536554          06/30/2023           1       $96.00      $74.99
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22712766878          06/28/2023           1      $311.00     $190.00

                                                                                                                                              PAGE:51 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22712766881          07/01/2023           1      $311.00     $190.00
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22712766896          06/27/2023           1       $38.00      $10.00
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22712578169          06/23/2023           1      $323.00     $179.73
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22712578168          06/25/2023           1      $323.00     $179.73
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22712578166          06/27/2023           1      $311.00     $190.00
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22712766879          06/29/2023           1      $311.00     $190.00
    014267-07                112923331001 201725616  BARTO            REECE      19   22712636960          06/13/2023           1      $545.00     $527.99
    014267-07                104976759001 205602810  CARRIZALES       MONICA     01   22312684650          07/03/2023           1       $39.00       $0.00
    014267-07                104976759001 205602810  SPEICHER         ROBERT     18   22312730472          06/19/2023           1      $172.00       $0.00
    014267-07                104976759001 205602810  SPEICHER         ROBERT     18   22312730472          06/19/2023           1      $156.00       $0.00
    014267-07                104976759001 205602810  SPEICHER         ROBERT     18   22312730472          06/19/2023           1      $225.00       $0.00
    014267-07                104976759001 205602810  SPEICHER         ROBERT     18   22312730472          06/19/2023           1      $207.00      $65.00
    014267-07                104976759001 205602810  SPEICHER         ROBERT     18   22312730472          06/19/2023           1      $123.00       $0.00
    014267-07                104976759001 205602810  SPEICHER         ROBERT     18   22312730472          06/19/2023           1      $150.00       $0.00
    014267-07                104976759001 205602810  SPEICHER         ROBERT     18   22312730472          06/19/2023           1      $129.00       $0.00
    014267-07                121862944001 207724279  DODSON           ADRIENNE   18   22112681374          06/22/2023           1      $140.00      $20.62
    014267-07                121862944001 207724279  DODSON           ADRIENNE   18   22112681374          06/22/2023           1       $60.00       $8.09
    014267-07                136097486001 207760396  KELLY            ABBY       18   22812720440          06/30/2023           1      $175.00       $0.00
    014267-07                136097486001 207760396  KELLY            ABBY       18   22812720440          06/30/2023           1      $181.00       $0.00
    014267-07                136097486001 207760396  KELLY            ABBY       18   22812720440          06/30/2023           1       $29.50       $0.00
    014267-07                136097486001 207760396  KELLY            ABBY       18   22812723742          06/28/2023           1       $47.00      $13.32
    014267-07                105308353001 209527301  HABERKORN        TIMOTHY    01   22112598201          07/03/2023           2      $168.00      $49.16
    014267-07                105308353001 209527301  HABERKORN        TIMOTHY    01   22112465764          06/26/2023           1      $222.00     $193.83
    014267-07                105308353001 209527301  HABERKORN        TIMOTHY    01   22112598201          07/03/2023           1      $115.00      $83.63
    014267-07                105308353001 209527301  HABERKORN        KIMBERLY   18   22112675235          06/29/2023           1      $140.00     $124.83
    014267-07                105308353001 209527301  HABERKORN        TIMOTHY    01   22112598201          07/03/2023           1       $80.00      $22.60
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22711298650          05/30/2023           1      $120.00      $22.60
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22711298651          05/31/2023           1      $120.00      $22.60
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22710626574          05/15/2023           2      $120.00       $8.78
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22710626574          05/15/2023           2      $120.00      $57.06
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22709851732          05/10/2023          (2)   ($120.00)    ($22.60)
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22709851733          05/08/2023          (2)   ($120.00)    ($22.60)

                                                                                                                                              PAGE:52 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22709851733          05/08/2023           2      $120.00      $45.20
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22709851732          05/10/2023          (1)   ($120.00)    ($28.53)
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22711298651          05/31/2023           1      $120.00      $28.53
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22711298651          05/31/2023           1      $120.00      $24.58
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22710626574          05/15/2023          (1)   ($120.00)    ($24.58)
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22711298650          05/30/2023           1      $120.00      $28.53
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22711298650          05/30/2023           1      $120.00      $24.58
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22709851733          05/08/2023           1      $120.00      $24.58
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22709851733          05/08/2023           1      $120.00      $28.53
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22709851733          05/08/2023          (1)   ($120.00)    ($24.58)
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22709851732          05/10/2023           2      $120.00      $49.16
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22709851733          05/08/2023          (1)   ($120.00)    ($28.53)
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22709851732          05/10/2023           2      $120.00       $8.78
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22712701362          06/28/2023           1      $220.00      $89.89
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22710626574          05/15/2023           2      $120.00      $49.16
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22709851732          05/10/2023           2      $120.00      $57.06
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22710626574          05/15/2023          (2)   ($120.00)    ($22.60)
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22709851732          05/10/2023          (1)   ($120.00)    ($24.58)
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22710626574          05/15/2023          (1)   ($120.00)    ($28.53)
    014267-07                131402363001 230555409  MCMAHON          ADDALYN    19   22512426940          06/29/2023           1       $35.00      $16.70
    014267-07                131402363001 230555409  MCMAHON          ADDALYN    19   22512426940          06/29/2023           1       $40.00       $2.99
    014267-07                131402363001 230555409  MCMAHON          ADDALYN    19   22512426940          06/29/2023           1      $185.00     $118.97
  014267-07 Total                                                                                                                   $21,582.22   $9,292.45
  014267-08
    014267-08                114847328001 071624700  PRODORUTTI       THERESA    19   22212576215          06/26/2023           1        $7.00       $2.10
    014267-08                114847328001 071624700  RENNINGER        JAMES      01   22212441448          06/29/2023           1      $195.00     $106.85
    014267-08                114847328001 071624700  PRODORUTTI       THERESA    19   22212576215          06/26/2023           1      $142.00      $56.50
    014267-08                114847328001 071624700  RENNINGER        JAMES      01   22212441448          06/29/2023           1       $25.00       $0.00
    014267-08                101267755001 160429635  FLORA            MARK       18   22712514525          06/27/2023           1       $14.00       $0.00
    014267-08                101267755001 160429635  FLORA            MARK       18   22712596952          06/30/2023           1    $1,251.00     $854.59
    014267-08                101267755001 160429635  FLORA            CLARISSA   01   22712644962          06/28/2023           1      $200.00     $100.00
    014267-08                101267755001 160429635  FLORA            MARK       18   22712596952          06/30/2023         100      $278.27      $36.00

                                                                                                                                              PAGE:53 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-08                101267755001 160429635  FLORA            MARK       18   22712514525          06/27/2023           1       $25.00      $23.99
    014267-08                101747063001 166560149  KRUISE           FRANCES    18   22212669278          06/29/2023           1      $220.00      $89.89
    014267-08                101747063001 166560149  KRUISE           FRANCES    18   22212609766          07/03/2023           3      $252.00       $0.00
    014267-08                101747063001 166560149  KRUISE           FRANCES    18   22212609766          07/03/2023           1       $75.00       $0.00
    014267-08                116871611001 173605841  MURPHY           DAVID      01   22512561895          06/30/2023           1        $9.25       $3.30
    014267-08                116871611001 173605841  MURPHY           JANELL     18   22512708002          06/27/2023           1       $42.57      $25.42
    014267-08                116871611001 173605841  MURPHY           JANELL     18   22512708002          06/27/2023           1       $18.40      $11.00
    014267-08                116871611001 173605841  MURPHY           JANELL     18   22512708002          06/27/2023           1       $75.00      $47.93
    014267-08                116871611001 173605841  MURPHY           DAVID      01   22512768085          06/23/2023           1      $330.00     $264.28
    014267-08                116871611001 173605841  MURPHY           DAVID      01   22512561895          06/30/2023           1       $83.85      $50.07
    014267-08                116871611001 173605841  MURPHY           JANELL     18   22512708002          06/27/2023           1       $83.85      $50.07
    014267-08                132465085001 175547949  VENESKY          JOHN       01   22712458712          06/20/2023           1      $110.00       $0.00
    014267-08                132465085001 175547949  VENESKY          JOHN       01   22712458712          06/20/2023           1      $150.00       $0.00
    014267-08                132465085001 175547949  VENESKY          JOHN       01   22712458712          06/20/2023           1      $150.00       $0.00
    014267-08                132465085001 175547949  VENESKY          JOHN       01   22712458712          06/20/2023           1       $83.00       $0.00
    014267-08                132465085001 175547949  VENESKY          JOHN       01   22712458712          06/20/2023           1       $65.00       $0.00
    014267-08                132465085001 175547949  VENESKY          JOHN       01   22712458712          06/20/2023           1      $175.00       $0.00
    014267-08                102490553001 175663819  TAYLOR           JEANETTE   18   22212576117          06/29/2023           1      $200.00     $100.00
    014267-08                103031088001 182508904  ZUNGALI          PHILIP     18   22612647337          07/03/2023           2        $4.00       $0.00
    014267-08                103031088001 182508904  ZUNGALI          PHILIP     18   22612647337          07/03/2023           1       $30.00       $0.00
    014267-08                103031088001 182508904  ZUNGALI          ROBIN      01   22612554683          06/21/2023           1       $75.00      $36.28
    014267-08                103031088001 182508904  ZUNGALI          ROBIN      01   22612554683          06/21/2023           1      $170.00      $33.50
    014267-08                103036754001 182545346  DELOZIER         BARBARA    01   22212754679          07/03/2023           1      $250.00       $0.00
    014267-08                103043271001 182585206  FINET            THERESA    18   22312421877          06/08/2023           1      $350.00      $90.81
    014267-08                103043271001 182585206  FINET            THERESA    18   22312421877          06/08/2023           1      $200.00      $36.87
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023           1       $83.00      $53.74
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023          (1)   ($173.00)    ($80.96)
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023           1       $63.00      $43.73
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023           1       $86.00      $62.00
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023          (1)    ($83.00)    ($53.74)
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023          (1)   ($300.00)    ($40.88)
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023           1      $173.00      $80.96

                                                                                                                                              PAGE:54 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023          (1)    ($65.00)    ($32.37)
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023          (1)    ($63.00)    ($43.73)
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023           1       $69.00      $86.41
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023          (1)    ($14.00)       $0.00
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22412107242          06/19/2023           1      $354.00     $238.32
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023           1       $62.00      $30.22
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023          (1)    ($65.00)    ($62.10)
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023          (1)    ($86.00)    ($62.00)
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023           1      $116.00      $68.20
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023           1       $65.00      $48.58
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023          (1)   ($108.00)    ($53.74)
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023           1      $300.00      $40.88
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023           1      $501.00     $294.46
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023           1       $14.00       $0.00
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023          (1)   ($116.00)    ($68.20)
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023          (1)   ($501.00)   ($294.46)
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023           1      $108.00      $53.74
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023           1       $65.00      $62.10
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22412107242          06/19/2023           1       $14.00       $0.00
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023          (1)    ($65.00)    ($48.58)
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023           1       $65.00      $32.37
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22411892793          06/19/2023          (1)    ($62.00)    ($30.22)
    014267-08                121090722001 192600296  PACKARD          STACIE     18   22612596185          06/28/2023           1      $145.00      $54.97
    014267-08                119463514001 194744937  WHOLAVER         KENDRA     18   22712427606          06/15/2023           1      $559.00      $87.67
    014267-08                119463514001 194744937  WHOLAVER         KENDRA     18   22712427606          06/15/2023           1      $181.00      $77.51
    014267-08                119463514001 194744937  WHOLAVER         KENDRA     18   22712427606          06/15/2023           1      $169.00      $42.59
    014267-08                119463514001 194744937  WHOLAVER         KENDRA     18   22712427606          06/15/2023           1      $175.00      $41.62
    014267-08                119463514001 194744937  WHOLAVER         KENDRA     18   22712427606          06/15/2023           1      $555.00      $78.17
    014267-08                105065403001 206621146  BAKER            LINDA      18   22612660183          06/28/2023          10       $27.00       $1.50
    014267-08                105065403001 206621146  BAKER            LINDA      18   22612660183          06/28/2023           4       $36.00       $2.20
    014267-08                105065403001 206621146  BAKER            LINDA      18   22612660183          06/28/2023           8       $31.35       $6.96
    014267-08                105065403001 206621146  BAKER            LINDA      18   22612660183          06/28/2023           2      $450.00     $141.00

                                                                                                                                              PAGE:55 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-08                105065403001 206621146  BAKER            LINDA      18   22612787506          06/27/2023           1    $1,484.00     $784.70
    014267-08                105065403001 206621146  BAKER            LINDA      18   22612481048          06/27/2023           1    $6,500.00   $1,561.42
    014267-08                105065403001 206621146  BAKER            LINDA      18   22612386067          06/27/2023           1   $20,000.00  $14,666.97
    014267-08                105065403001 206621146  BAKER            LINDA      18   22612787506          06/27/2023           1      $742.00      $59.80
  014267-08 Total                                                                                                                   $36,830.54  $19,951.26
  014267-13
    014267-13                103271646001 185480430  GOODERHAM-KRUG   BARBARA    18   22312558780          06/30/2023           1      $109.30      $23.48
    014267-13                103527331001 188520159  MONTANARO        RITA       18   22712458706          06/21/2023           1      $625.00       $0.00
    014267-13                128297384001 201589800  LIEB             LAURA      18   22812460705          06/28/2023           1      $125.00      $65.70
    014267-13                128297384001 201589800  LIEB             LAURA      18   22812808643          07/03/2023           1       $53.00      $53.00
    014267-13                128297384001 201589800  LIEB             LAURA      18   22812808643          07/03/2023           1      $427.00     $427.00
    014267-13                105133450001 207506102  VESCOVI          MARY       18   22412824615          07/05/2023           1      $193.00     $127.86
  014267-13 Total                                                                                                                    $1,532.30     $697.04
  014267-15
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22212781192          06/29/2023           1       $40.00      $10.45
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22212781193          07/03/2023           1       $50.00      $22.60
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22212781194          06/27/2023           1       $50.00      $22.60
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22212781194          06/27/2023           3      $120.00      $73.74
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22212781193          07/03/2023           3      $120.00      $73.74
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22212781194          06/27/2023           1       $40.00      $10.45
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22212781193          07/03/2023           1       $40.00      $10.45
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22212781192          06/29/2023           3      $120.00      $73.74
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22212781192          06/29/2023           1       $50.00      $22.60
    014267-15                102057315001 170525384  LEAHEY           BRADY      18   22612785857          06/30/2023           1      $145.00      $49.97
    014267-15                103115531001 183523270  SHEA             EDWARD     18   22212678401          07/05/2023           1       $35.00      $23.27
    014267-15                103115531001 183523270  SHEA             EDWARD     18   22212678401          07/05/2023           1       $42.00       $0.00
    014267-15                103115531001 183523270  SHEA             EDWARD     18   22212678401          07/05/2023           1      $110.00      $80.99
    014267-15                103115531001 183523270  SHEA             EDWARD     18   22212678401          07/05/2023           1       $30.00       $0.00
    014267-15                104458562001 199522908  SERAFIN          SANDRA     18   22812604944          06/27/2023           1       $25.00      $12.84
    014267-15                104466514001 199567150  KIRSCH           DANIEL     01   22412790682          07/03/2023           1       $65.00       $0.00
    014267-15                104466514001 199567150  KIRSCH           DANIEL     01   22412790682          07/03/2023           1       $97.00       $0.00
    014267-15                104466514001 199567150  KIRSCH           DANIEL     01   22412790682          07/03/2023           1      $163.00       $0.00

                                                                                                                                              PAGE:56 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-15                104466514001 199567150  KIRSCH           DANIEL     01   22412790682          07/03/2023           1       $14.00       $0.00
    014267-15                104466514001 199567150  KIRSCH           DANIEL     01   22412790682          07/03/2023           1      $300.00       $0.00
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22512796684          06/28/2023           3      $120.00      $73.74
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22512796684          06/28/2023           1       $50.00      $12.73
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22512796685          06/26/2023           1       $40.00       $0.00
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22512796684          06/28/2023           1       $40.00       $0.00
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22512796685          06/26/2023           3      $120.00      $73.74
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22512796685          06/26/2023           1       $50.00      $12.73
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22512796685          06/26/2023           1       $45.00      $28.53
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22512796684          06/28/2023           1       $45.00      $28.53
  014267-15 Total                                                                                                                    $2,166.00     $717.44
  014267-26
    014267-26                101590378001 164544186  NATCHER          LYNNE      18   22712474399          06/29/2023           1       $35.00      $24.58
    014267-26                101590378001 164544186  NATCHER          LYNNE      18   22712474399          06/29/2023           1       $45.00      $14.41
    014267-26                101590378001 164544186  NATCHER          LYNNE      18   22712474399          06/29/2023           1       $70.00      $10.45
    014267-26                101590378001 164544186  NATCHER          LYNNE      18   22712474399          06/29/2023           1       $90.00      $11.87
    014267-26                103945030001 193422246  BROWN            JOHN       18   22712632064          06/28/2023           1       $75.00      $38.48
    014267-26                104456115001 199505432  VESCOVI          TIMOTHY    18   22031227592          06/27/2023           6       $30.00      $19.80
    014267-26                104456115001 199505432  VESCOVI          TIMOTHY    18   22031227592          06/27/2023           2      $160.00     $100.14
    014267-26                104456115001 199505432  VESCOVI          TIMOTHY    18   22031227592          06/27/2023           1       $70.00      $47.93
    014267-26                104456115001 199505432  VESCOVI          TIMOTHY    18   22031227592          06/27/2023           1      $160.00     $135.36
    014267-26                104456115001 199505432  VESCOVI          TIMOTHY    18   22031227592          06/27/2023           1       $15.00      $11.00
    014267-26                104456115001 199505432  VESCOVI          TIMOTHY    18   22031227592          06/27/2023           1       $20.00      $14.00
    014267-26                104456115001 199505432  VESCOVI          TIMOTHY    18   22031227592          06/27/2023           1       $36.50      $25.42
    014267-26                105050264001 206525459  MCCOY            ROBERT     18   22512590876          06/29/2023           1      $209.00     $111.85
  014267-26 Total                                                                                                                    $1,015.50     $565.29
  014267-36
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023           1      $132.00      $87.42
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023           1       $65.00      $39.89
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023           1      $132.00      $87.42
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023           1      $424.00      $54.21
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023           1      $201.00       $0.00

                                                                                                                                              PAGE:57 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023           1       $37.00      $13.86
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023           1      $201.00       $0.00
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023           1      $201.00       $0.00
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612595957          06/28/2023           1      $154.00     $154.00
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023           1      $201.00     $113.56
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023           1       $14.00       $0.00
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023           1      $201.00      $10.08
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023           1       $97.00      $68.74
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023           1       $76.00      $62.07
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023           1      $201.00       $0.00
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023           1       $57.00      $31.52
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023           1      $132.00      $99.13
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512625041          06/24/2023          13      $193.50     $148.87
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512455488          06/26/2023           1      $347.00     $209.59
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512725511          06/27/2023           1      $248.94      $95.36
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512777151          06/26/2023           1      $362.76     $184.60
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512725512          06/28/2023           1      $248.94      $95.36
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512777152          06/29/2023           1      $248.94      $95.36
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512625041          06/24/2023           1    $1,500.00     $296.28
    014267-36                101597846001 164585882  BECQUET          DAWN       18   22512561055          06/14/2023           1       $55.00      $37.00
    014267-36                101597846001 164585882  BECQUET          DAWN       18   22512561055          06/14/2023           1       $50.00      $31.00
    014267-36                101694701001 165742506  STRAPLE          KOTY       18   22212499106          10/31/2022           1       $23.00       $0.00
    014267-36                101694701001 165742506  STRAPLE          KOTY       18   22212499106          10/31/2022           1       $44.00       $0.00
    014267-36                101694701001 165742506  STRAPLE          KOTY       18   22212501734          11/01/2022           1      $209.00      $59.86
    014267-36                101694701001 165742506  STRAPLE          KOTY       18   22212499106          10/31/2022           1      $108.00       $0.00
    014267-36                101694701001 165742506  STRAPLE          KOTY       18   22212499106          10/31/2022           1       $67.00       $0.00
    014267-36                101694701001 165742506  STRAPLE          KOTY       18   22212499106          10/31/2022           1       $96.00       $0.00
    014267-36                101694701001 165742506  STRAPLE          KOTY       18   22212499106          10/31/2022           1       $67.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023           1       $67.00      $24.49
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023           1       $56.00       $7.99
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023           1       $67.00      $19.59
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023           1       $53.00      $10.82

                                                                                                                                              PAGE:58 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023           1      $168.00      $21.74
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023           1       $30.00       $9.96
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023           1       $53.00      $12.91
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023           1      $116.00      $17.68
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812511378          06/27/2023           1       $23.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22812814475          06/27/2023           1       $52.00      $10.06
    014267-36                103290047001 185586721  FARABAUGH        MARIA      19   22812424215          06/15/2023           1      $313.00     $215.18
    014267-36                103290047001 185586721  FARABAUGH        MARIA      19   22812424215          06/15/2023           1      $316.00     $215.18
    014267-36                103290047001 185586721  FARABAUGH        MARIA      19   22812424215          06/15/2023           1      $170.00     $169.35
    014267-36                103555014001 188707325  BATEMAN          EMERSON    19   22612619012          05/18/2023           1    $1,341.00     $184.60
    014267-36                103555014001 188707325  BATEMAN          EMERSON    19   22612619012          05/20/2023           1      $523.00      $67.01
    014267-36                103555014001 188707325  BATEMAN          EMERSON    19   22612619012          05/19/2023           1      $545.00      $66.37
    014267-36                103945030001 193422246  BROWN            JOHN       18   22712604946          03/16/2023           1       $35.00      $10.06
    014267-36                104073548001 194669857  RUDDEK           ELIZABET   01   22512625004          06/30/2023           1    $1,900.00   $1,040.00
    014267-36                104073548001 194669857  RUDDEK           ELIZABET   01   22512625004          06/30/2023         100       $80.00      $38.00
    014267-36                105326129001 209640969  WURM             JACQUELI   18   22212576121          06/26/2023           1      $322.00     $137.86
  014267-36 Total                                                                                                                   $12,625.08   $4,354.03
  014267-37
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   22112536225          06/23/2023           1      $369.00     $254.65
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   22112657949          06/23/2023           1      $400.00     $151.67
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   22112658251          06/23/2023           1       $55.00      $20.54
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   22112536257          06/23/2023           1      $729.00     $254.65
    014267-37                134922147001 178526604  DILLON           LISA       18   22612490379          06/30/2023           1      $239.00     $111.85
    014267-37                134922147001 178526604  DILLON           LISA       18   22612614781          06/30/2023           1      $239.00       $0.00
    014267-37                103881647001 192546893  TRANQUILLO       VALARIE    18   22212433423          06/27/2023           1       $24.00       $0.00
    014267-37                104382358001 198542829  EVANS            SANDRA     18   22712503697          06/23/2023           1      $130.87      $33.50
    014267-37                104382358001 198542829  EVANS            SANDRA     18   22712503697          06/23/2023           1      $119.53      $36.28
  014267-37 Total                                                                                                                    $2,305.40     $863.14
  014267- Total                                                                                                                    $232,342.52  $82,710.89
PPO Total                                                                                                                          $232,342.52  $82,710.89
                                                                                                                                                            
Professional

                                                                                                                                              PAGE:59 of 59
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  053264-01
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22112658868          06/29/2023           1      $485.00     $183.66
  053264-01 Total                                                                                                                      $485.00     $183.66
  053264- Total                                                                                                                        $485.00     $183.66
Professional Total                                                                                                                     $485.00     $183.66
Paid Claims Detail Total                                                                                                                       $262,460.18