PAID CLAIMS DETAIL                                                  
                                              Product/Sub Group-8 Digit                                              

INVOICE NUMBER:     230718587835                                           PAGE:               1 of 69           
BILL ACCOUNT NUMBER:CN02401002                                             PAID CLAIMS MONTH:  July 2023         
BILL ACCOUNT NAME:  Admiral Peary                                          CLAIMS PAID THRU:   07/14/2023        
CLIENT NUMBER:      0240                                                   BILL CYCLE:         2 of 4            
CLIENT NAME:        Admiral Peary                                          PREPARED DATE:      07/18/2023        

            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                101911501001 168586533  GEORGE           TERESA     18   606366300699670401   07/11/2023          30      $192.94       $2.20
    014267-01                101911501001 168586533  GEORGE           TERESA     18   934777782699670401   07/11/2023          30      $177.95       $1.28
    014267-01                101911501001 168586533  GEORGE           TERESA     18   694955393796390401   07/12/2023          30       $16.47       $0.00
    014267-01                101911501001 168586533  GEORGE           TERESA     18   357747597697390401   07/12/2023          30      $176.49       $0.00
    014267-01                103208282001 184584093  MACALUS          RHONDA     18   114866638586160401   07/10/2023          30       $22.07       $0.00
    014267-01                103723995001 190642553  PANEK            REBECCA    18   482542721046930401   07/09/2023          30      $123.13       $0.00
    014267-01                104231917001 196603987  HUTSKY           JOSEPH     18   495378421139650401   07/10/2023          25       $86.31       $1.97
    014267-01                105143186001 207564217  BAUM             SUSAN      18   288136428189290401   07/12/2023          28    $1,123.92     $871.89
  014267-01 Total                                                                                                                    $1,919.28     $877.34
  014267-03
    014267-03                101369778001 161607101  LACUE            ALBERT     01   323815573820411401   07/13/2023          30      $929.45     $595.64
    014267-03                101369778001 161607101  LACUE            ALBERT     01   449017692920411401   07/13/2023          30      $973.24     $292.07
    014267-03                113804551001 165663453  WHARTON          ANDREA     18   606134032093650401   07/10/2023          63      $115.95      $37.63
    014267-03                122684801001 165748370  POOLE            MICHAEL    01   79962221578470401    07/11/2023          21      $119.28      $10.10
    014267-03                101760095001 166629321  BLAKE            JAMES      18   761437516587690401   07/12/2023          16       $13.64       $0.00
    014267-03                101760095001 166629321  BLAKE            JAMES      18   902207012787690401   07/12/2023           1       $14.56       $0.00
    014267-03                101760095001 166629321  BLAKE            JAMES      18   951048558629801401   07/13/2023           7       $18.80       $0.00
    014267-03                101760095001 166629321  BLAKE            JAMES      18   214738727887690401   07/12/2023           4       $16.61       $0.00
    014267-03                101760095001 166629321  BLAKE            JODY       01   553484942497740401   07/09/2023          50      $140.70      $11.05
    014267-03                101760095001 166629321  BLAKE            JODY       01   553092841497740401   07/09/2023          66      $248.25       $5.54
    014267-03                101913203001 168601612  DUBREUCQ         SARAH      01   646936328752901401   07/13/2023           4       $10.63       $0.00
    014267-03                101913203001 168601612  DUBREUCQ         MARY       19   669046338814801401   07/13/2023          90      $301.88     $210.09
    014267-03                101913203001 168601612  DUBREUCQ         MARY       19   770796688224801401   07/13/2023          90    $1,336.25   $1,009.14
    014267-03                102137743001 171520828  KOCHINSKY        DARLA      18   108982511617390401   07/12/2023           2      $219.99     $160.62
    014267-03                102137743001 171520828  KOCHINSKY        WILLIAM    01   774358311018801401   07/13/2023          90      $245.26      $14.15

                                                                                                                                               PAGE:2 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                102151761001 171602272  MISLEVY          NATHAN     19   248082421791970401   07/11/2023          10       $58.59       $8.81
    014267-03                120477354001 172722160  KISS             JENNIFER   01   784177242768290401   07/12/2023          90       $53.33      $19.40
    014267-03                132856256001 172763697  VESCOVI          ISAAC      18   649357397837750401   07/10/2023          30      $181.83       $2.36
    014267-03                115600731001 173704087  FRYDRYCH         ANDREA     18   131968791936930401   07/09/2023          84       $92.56      $70.13
    014267-03                119499088001 174728328  STRASSER         ADAM       18   308978611081590401   07/12/2023           6       $82.81      $21.63
    014267-03                102486556001 175629643  HRITZ            SANDRA     18   295537367160440401   06/29/2023         (90)    ($75.18)    ($13.62)
    014267-03                102486556001 175629643  HRITZ            SANDRA     18   28627266702340401    07/09/2023          90      $241.00      $10.11
    014267-03                102732865001 178607248  NAGEL            TAMMY      01   681778660514870401   07/11/2023           7       $16.16       $0.00
    014267-03                102732865001 178607248  NAGEL            TAMMY      01   973498501500590401   07/12/2023           7       $70.72       $1.63
    014267-03                102972300001 181604543  SCHIRATO         ISABELLA   19   194579371004950401   07/10/2023          10       $19.42       $0.00
    014267-03                103039127001 182562529  BEACH            THERESA    18   891757296915650401   07/10/2023          30       $26.38       $0.00
    014267-03                103039127001 182562529  BEACH            WESLEY     01   439879071915650401   07/10/2023          30      $113.66       $4.87
    014267-03                103288637001 185583037  FARABAUGH        SYDNEY     19   576934962957950401   07/10/2023          30      $553.01      $23.54
    014267-03                126605497001 185728227  KIRSCH           RAEANNA    18   427167917582190401   07/12/2023          30        $9.00       $0.00
    014267-03                103373563001 186587333  BEUNIER-SMITH    YVETTE     18   780176120288290401   07/12/2023          30      $353.99      $12.36
    014267-03                103373563001 186587333  BEUNIER-SMITH    YVETTE     18   852318998188290401   07/07/2023         (30)   ($353.99)    ($12.36)
    014267-03                103377064001 186607237  BRACKEN          KELLY      18   349788768628260401   07/10/2023          30       $74.05       $5.42
    014267-03                103377064001 186607237  BRACKEN          KELLY      18   287238891638260401   07/10/2023          90      $810.99     $111.68
    014267-03                103377064001 186607237  BRACKEN          KELLY      18   743568678452360401   07/10/2023          25      $133.00      $11.05
    014267-03                103377064001 186607237  BRACKEN          KELLY      18   776805863443511401   07/13/2023          15      $183.21     $123.95
    014267-03                103377064001 186607237  BRACKEN          KELLY      18   367589761629350401   07/10/2023          30       $99.89       $9.60
    014267-03                103536981001 188580018  MALLOY           KAREN      18   346837647175770401   07/11/2023          42      $231.18     $166.27
    014267-03                103536981001 188580018  MALLOY           KAREN      18   107780623326240401   07/09/2023          90       $24.00      $14.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   271126238761970401   07/11/2023          20    $1,475.65       $9.06
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   180822821831850401   07/10/2023          30       $50.49       $0.54
    014267-03                103624049001 189580744  SPRENGER         KEITH      19   929628527330011401   07/13/2023           1      $499.56      $89.99
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   976310253011590401   07/08/2023          30      $678.45     $520.75
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   889908930011590401   07/08/2023         (30)   ($678.45)   ($520.75)
    014267-03                103818021001 191709419  OWENS            ALLISON    18   741602221132970401   07/11/2023          14      $150.29       $0.00
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   790519541293111401   07/13/2023          45       $24.00      $14.00
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   200378748514111401   07/13/2023          14       $38.15       $0.00
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   426934452219311401   07/13/2023          30       $77.66      $32.76

                                                                                                                                               PAGE:3 of 69
                                                                                                                                                            
            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   828158641293111401   07/13/2023          14    $1,076.46      $44.37
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   716930764460140401   07/09/2023          28      $660.58     $510.87
    014267-03                104385940001 198563222  ALBRIGHT         PAULA      18   565122731671311401   07/13/2023          30      $417.61     $200.62
    014267-03                104385940001 198563222  ALBRIGHT         PAULA      18   41289641761311401    07/13/2023           5      $193.39      $53.90
    014267-03                104385940001 198563222  ALBRIGHT         ALEXANDE   19   465478491205040401   07/09/2023          30        $7.93       $0.00
    014267-03                104385940001 198563222  ALBRIGHT         ALEXANDE   19   576496130930011401   07/13/2023          30      $135.35       $0.00
    014267-03                104400727001 198662868  FOX              LISA       18   702416400134870401   07/11/2023          90      $775.20      $17.87
    014267-03                117356283001 199567270  CENCE            WILLIAM    01   749477662076570401   07/11/2023          90       $63.56      $15.07
    014267-03                117356283001 199567270  CENCE            JULIE      18   307796610886570401   07/11/2023          90      $620.19      $12.34
    014267-03                117356283001 199567270  CENCE            JULIE      18   721490723686570401   07/11/2023          30      $681.53     $429.85
    014267-03                120189904001 199707914  KEENER           COREY      01   284610593827901401   07/13/2023          30      $173.02       $0.00
    014267-03                120189904001 199707914  KEENER           CHRISTIN   18   234378461564650401   07/10/2023          30      $158.01       $0.00
    014267-03                120189904001 199707914  KEENER           CHRISTIN   18   575919721527901401   07/13/2023          30      $169.50       $0.00
    014267-03                128918490001 204744375  MURPHY           JAMIE      18   315997552620950401   07/10/2023          90      $406.31      $18.15
    014267-03                128918490001 204744375  MURPHY           JAMIE      18   9690374420950401     07/10/2023          90      $508.50      $12.34
    014267-03                128918490001 204744375  MURPHY           JAMIE      18   118398978789850401   07/10/2023          90      $268.55      $24.01
    014267-03                104968290001 205547039  DIAMOND          ROBERT     18   335432181206450401   07/10/2023          40      $227.86      $11.55
    014267-03                104968290001 205547039  DIAMOND          ROBERT     18   932478730648950401   07/10/2023          90       $76.96       $6.61
    014267-03                104968290001 205547039  DIAMOND          ROBERT     18   857097736185590401   07/10/2023         (90)    ($76.96)     ($6.61)
    014267-03                104968290001 205547039  DIAMOND          ROBERT     18   518517216285590401   07/12/2023          90       $73.15       $6.61
    014267-03                105151459001 207608668  LEAMER           MARY       18   79598831303211401    07/13/2023          90      $578.84      $13.18
    014267-03                115784377001 208708748  THOMAS           MELODY     18   625637262004980401   07/12/2023          30      $468.56     $356.77
    014267-03                115784377001 208708748  THOMAS           MELODY     18   586962331004980401   07/12/2023          30      $384.99     $265.35
    014267-03                105412522001 210627625  KLINE            ANTHONY    18   867867592218650401   07/10/2023          10       $75.69       $3.84
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   608219121094950401   07/10/2023          10      $270.37     $154.88
  014267-03 Total                                                                                                                   $18,415.05   $5,234.78
  014267-05
    014267-05                101460852001 162709665  MARSHALL         NICHOLE    01   525285553442970401   06/29/2023         (90)   ($126.26)    ($37.62)
    014267-05                101665655001 165520467  FISANICK         LAURA      18   615738748313801401   07/13/2023          30    $1,724.99   $1,279.85
    014267-05                101665655001 165520467  FISANICK         BASIL      01   299645163643801401   07/13/2023          10      $314.69       $4.47
    014267-05                101829382001 167588314  PERUSO-LYTLE     AMY        18   720472161275011401   07/13/2023          28    $1,228.64     $965.94
    014267-05                101995157001 169643849  WENDEROTH        FRED       18   858266758635080401   06/27/2023         (30)   ($796.85)     ($7.95)

                                                                                                                                               PAGE:4 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                117497733001 169665790  DATSKO           STACY      18   168738978638650401   07/10/2023          30      $400.11      $16.15
    014267-05                112228663001 170540291  SHERRY           EMMA       19   910849461463511401   07/13/2023          84      $616.75     $476.43
    014267-05                102075179001 170640732  SHUTTY           ERIN       01   246838350742750401   07/10/2023          90       $38.00       $9.76
    014267-05                110122526001 171629572  MASTRINE         MELISSA    18   171277386902490401   07/08/2023         (30)    ($33.40)       $0.00
    014267-05                110122526001 171629572  MASTRINE         MELISSA    18   508836930050011401   04/22/2023         (30)   ($105.90)    ($96.00)
    014267-05                110122526001 171629572  MASTRINE         MELISSA    18   531407616012490401   07/12/2023          30       $39.41       $2.90
    014267-05                115391991001 174547012  JACOBS           TIMOTHY    18   346496440263650401   07/10/2023          28       $98.56      $52.09
    014267-05                102801153001 179566492  LANEY            ERIC       01   447688691532160401   07/10/2023          25      $387.31      $58.04
    014267-05                102801153001 179566492  LANEY            ERIC       01   624468127391160401   07/10/2023          50      $183.03       $5.51
    014267-05                102801153001 179566492  LANEY            ERIC       01   788417476702160401   07/10/2023          50      $137.20      $26.99
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   574359171439290401   07/12/2023          90      $693.78     $499.76
    014267-05                102864840001 180482050  PARONISH         AMY        01   517508648144470401   07/11/2023          90      $388.01       $9.96
    014267-05                102864840001 180482050  PARONISH         AMY        01   749382131208570401   07/11/2023          28      $155.12     $104.43
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   610002831810770401   07/11/2023          90      $245.26      $14.15
    014267-05                102864840001 180482050  PARONISH         AMY        01   677617052697750401   07/10/2023          25       $53.36      $22.77
    014267-05                102864840001 180482050  PARONISH         AMY        01   658848847029470401   07/10/2023         (25)    ($53.36)    ($22.77)
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   188705903400770401   07/11/2023          90      $226.14      $27.48
    014267-05                102864840001 180482050  PARONISH         AMY        01   792088817144470401   07/11/2023          90      $203.38      $12.41
    014267-05                121108476001 180665007  MOREALLI         SCOTT      18   17398958241850401    07/10/2023          30      $606.56     $450.28
    014267-05                133298619001 193702336  SMITH            BRANDON    01   351180973729801401   07/13/2023          30      $141.44       $0.00
    014267-05                104069392001 194642896  DAISLEY          CHELSEY    18   754654412782060401   07/10/2023           1        $9.99       $0.00
    014267-05                104318685001 197640477  HUDAK            JUSTICE    19   983257487142790401   07/12/2023         150      $204.86     $157.47
    014267-05                104318685001 197640477  HUDAK            JUSTICE    19   459475303002790401   07/12/2023          90      $241.25      $23.73
    014267-05                114051191001 200641754  STARUCH          ASHLEY     01   436125313637690401   07/12/2023           7       $27.77       $5.36
    014267-05                104564922001 200649293  BRADLEY          MARCY      18   633132261575850401   07/10/2023          30       $12.32       $0.00
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   777135613739350401   07/10/2023          30       $19.49       $0.26
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   465217127050311401   07/13/2023          56       $15.19       $0.00
    014267-05                104639290001 201607083  BONATESTA        JOSEPH     01   310737297965470401   07/11/2023          58      $181.21     $125.37
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   21929951388801401    07/13/2023          30       $31.57       $1.31
    014267-05                105133917001 207507140  BORN             LEA        18   496226660924950401   07/10/2023          28       $87.99      $57.34
    014267-05                112105056001 208606192  TARANTO          JESSICA    01   348630194799190401   07/12/2023          30       $34.42       $0.00
    014267-05                112105056001 208606192  TARANTO          JESSICA    01   904834042000290401   07/12/2023          30       $21.05       $0.00

                                                                                                                                               PAGE:5 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                112105056001 208606192  TARANTO          JESSICA    01   725698488402750401   07/10/2023          30       $43.75       $8.48
    014267-05                105242584001 208640494  SHERRY           JENNIFER   18   854314262002190401   07/12/2023           7       $41.38       $0.00
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   63315593532190401    07/12/2023          16    $2,015.00       $8.07
    014267-05                105312745001 209560853  KUDLAWIEC        MELISSA    18   461778138279101401   07/13/2023          30      $124.55       $0.00
    014267-05                105399373001 210548948  ROCCO            THOMAS     01   740979871302750401   07/10/2023          90      $163.19     $106.04
    014267-05                105408339001 210604721  MULLEN           THOMAS     18   564868648024870401   07/10/2023         (30)   ($482.99)   ($242.58)
    014267-05                105408339001 210604721  MULLEN           THOMAS     18   915922271024870401   07/11/2023          30      $106.20      $75.98
    014267-05                105408339001 210604721  MULLEN           THOMAS     18   25469741254801401    07/13/2023           6       $32.44       $6.89
    014267-05                105408339001 210604721  MULLEN           THOMAS     18   423949441434170401   07/11/2023          30      $288.42      $89.33
    014267-05                105408339001 210604721  MULLEN           THOMAS     18   742949971688260401   07/10/2023          30      $482.99     $242.58
    014267-05                105507489001 211702122  BASSETT          SOPHIA     19   238868038242570401   07/11/2023          60       $76.27      $10.62
    014267-05                105507489001 211702122  BASSETT          KIMBER     19   567088511137870401   07/11/2023          30      $170.69       $0.00
    014267-05                105507489001 211702122  BASSETT          SOPHIA     19   370508251504570401   07/11/2023          16       $75.02      $33.30
    014267-05                105507594001 211703743  TENEROWICZ       JUDE       01   605817047700101401   07/05/2023        (125)     ($2.94)       $0.00
  014267-05 Total                                                                                                                   $10,787.05   $4,584.58
  014267-06
    014267-06                101267523001 160429168  PETRISKO         MICHAEL    01   573788828688501401   07/13/2023          90      $254.20     $106.04
    014267-06                101267523001 160429168  PETRISKO         MICHAEL    01   715367836639350401   07/10/2023          50      $213.69       $5.40
    014267-06                114965976001 167642610  DOLANSKY         SEAN       01   862615413098501401   07/13/2023          30      $484.99     $234.51
    014267-06                114965976001 167642610  DOLANSKY         SEAN       01   60388977033901401    07/13/2023          30       $46.25       $1.90
    014267-06                114965976001 167642610  DOLANSKY         SEAN       01   639769101098501401   07/13/2023          30       $71.29       $0.00
    014267-06                101904370001 168545436  BORING           BETTY      18   303097676861340401   07/09/2023           7       $56.17       $0.00
    014267-06                101904370001 168545436  BORING           BETTY      18   254022311561340401   07/09/2023          15       $11.11       $0.00
    014267-06                102234268001 172609097  SMITH            KERRY      18   299102491367870401   07/11/2023          90       $10.00       $0.00
    014267-06                103211068001 184601686  LEFFERTS         TAYLOR     19   122108091592901401   07/13/2023          90      $277.90      $12.97
    014267-06                103272483001 185482246  MOSCHGAT         CONNIE     01   813250084902750401   07/10/2023          30       $88.54      $32.76
    014267-06                103272483001 185482246  DUMM             RALPH      18   424307887781750401   07/10/2023          50    $1,187.60     $933.00
    014267-06                103272483001 185482246  DUMM             RALPH      18   830066370966190401   07/12/2023          50    $1,187.60     $933.00
    014267-06                103272483001 185482246  MOSCHGAT         CONNIE     01   416368218462901401   07/13/2023          30      $329.60     $244.45
    014267-06                103272483001 185482246  MOSCHGAT         CONNIE     01   26148298733260401    07/10/2023          30      $152.87      $38.70
    014267-06                103272483001 185482246  DUMM             RALPH      18   18312901653870401    07/10/2023         (50) ($1,187.60)   ($933.00)
    014267-06                103272483001 185482246  MOSCHGAT         CONNIE     01   945040413694011401   07/13/2023          30      $155.17       $0.00

                                                                                                                                               PAGE:6 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   490405633884160401   07/10/2023           7       $11.50       $0.00
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   981358541423411401   07/13/2023          30       $55.76       $1.27
    014267-06                126568873001 188582035  MYERS            ELIZABET   18   482897942561311401   07/13/2023           9       $20.68       $0.00
    014267-06                126568873001 188582035  MYERS            KEVIN      01   951327647023540401   07/09/2023          30       $51.99       $0.00
    014267-06                104212846001 196485949  DAISLEY          LAUREN     19   420777036163060401   07/10/2023          30       $76.27      $10.62
    014267-06                104212846001 196485949  DAISLEY          TODD       18   500287176182790401   07/12/2023          90      $365.28       $4.93
  014267-06 Total                                                                                                                    $3,920.86   $1,626.55
  014267-07
    014267-07                101429258001 162485516  HARVEY           JOHN       01   585488507922790401   07/12/2023          30      $117.33       $5.21
    014267-07                101605583001 164627824  SALEME           HANNAH     19   627030404851190401   07/10/2023         (84)   ($217.99)    ($43.88)
    014267-07                101605583001 164627824  SALEME           HANNAH     19   552087522951190401   07/12/2023          28       $76.36      $15.13
    014267-07                101605583001 164627824  SALEME           HANNAH     19   327438557084160401   07/10/2023          84      $217.99      $43.88
    014267-07                101762054001 166645996  MCCAULLEY        MELISSA    01   913090584542150401   07/10/2023          30       $41.68       $0.00
    014267-07                110592948001 171640757  GRASSI           BRIDGET    01   767090833406901401   07/13/2023          90       $32.30       $0.00
    014267-07                102160098001 171649555  BAKER            MARK       01   522218501491211401   07/13/2023          10       $13.04       $0.00
    014267-07                102222699001 172543654  SCHREYER         RENEE      18   851750354674011401   07/13/2023          30      $184.41       $0.00
    014267-07                102468339001 175523583  NIEBAUER         TONYA      18   990460834501670401   07/11/2023          30    $1,181.79     $918.33
    014267-07                102970458001 181589405  BROWN            THOMAS     01   592098078765290401   07/12/2023          90      $476.79       $8.18
    014267-07                122806756001 181726437  MARRA            BRITTANY   01   635418500397260401   06/26/2023         (15)   ($242.56)    ($53.23)
    014267-07                117714302001 185620255  DISHONG          SHAWN      18   883048140626190401   07/12/2023          30       $81.30      $37.31
    014267-07                103879349001 192529999  WATT             LISA       01   87904252695190401    07/12/2023          50      $527.71      $10.67
    014267-07                103879349001 192529999  WATT             KEVIN      18   279278048550040401   07/09/2023          50       $49.32       $5.39
    014267-07                103879349001 192529999  WATT             KEVIN      18   353867136638801401   07/13/2023         100      $113.04       $1.43
    014267-07                104804112001 203580135  SMITH            ROBERT     01   50637857158870401    07/11/2023          90       $58.87       $6.43
    014267-07                135952257001 204760740  MYERS            KATELYN    18   733568228484650401   07/10/2023          84      $118.96      $34.27
    014267-07                104976759001 205602810  CARRIZALES       MONICA     01   97127896743950401    07/10/2023          90      $245.26       $1.73
    014267-07                105133870001 207507048  PRZYBYS          BRADEN     19   903957336341040401   07/09/2023           6       $20.16       $0.00
    014267-07                121862944001 207724279  DODSON           ADRIENNE   18   594192201566370401   07/11/2023          10    $1,210.00       $0.00
    014267-07                121862944001 207724279  DODSON           ADRIENNE   18   386987836391670401   07/11/2023          28      $493.24     $260.05
    014267-07                105235875001 208589040  EVANS            ALEXANDE   19   346160503496060401   07/10/2023          30      $444.18     $326.40
    014267-07                105484472001 211540040  WALTERS          RONALD     18   240676988794440401   07/07/2023         (50)    ($11.11)       $0.00
    014267-07                105484472001 211540040  WALTERS          RONALD     18   877468021894440401   07/09/2023          50       $11.11       $0.00

                                                                                                                                               PAGE:7 of 69
                                                                                                                                                            
            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          LAUREN     19   679568448548801401   07/13/2023          30       $15.00       $0.00
    014267-07                113092711001 214135088  HAJNOSZ          LAUREN     19   428820844548801401   07/13/2023          30       $15.00       $0.00
  014267-07 Total                                                                                                                    $5,273.18   $1,577.30
  014267-08
    014267-08                101747063001 166560149  KRUISE           EDWARD     01   801758088255010401   07/07/2023          90       $76.00       $0.00
    014267-08                101747063001 166560149  KRUISE           EDWARD     01   965476171255010401   07/07/2023          90      $384.70      $15.37
    014267-08                101747063001 166560149  KRUISE           EDWARD     01   874998670314010401   07/07/2023          90      $279.56       $5.99
    014267-08                101747063001 166560149  KRUISE           EDWARD     01   637422678255010401   07/07/2023          90       $68.80       $7.68
    014267-08                117058404001 167564751  STASKO           KEVIN      01   353426128490011401   07/13/2023          30      $124.14       $4.35
    014267-08                117058404001 167564751  STASKO           KEVIN      01   18469261590011401    07/13/2023          25      $218.84     $120.42
    014267-08                117058404001 167564751  STASKO           LORI       18   468548521221011401   07/13/2023          50       $19.47       $0.00
    014267-08                116193139001 168527313  CYMBOR           PATRICIA   18   553772731609801401   07/13/2023          84       $24.41       $2.82
    014267-08                116193139001 168527313  CYMBOR           PATRICIA   18   752790834709801401   07/13/2023          30       $71.50       $0.00
    014267-08                116193139001 168527313  CYMBOR           PATRICIA   18   384206920998311401   07/13/2023          30      $156.60       $2.36
    014267-08                132465085001 175547949  VENESKY          KIM        18   427637017081160401   07/10/2023          30      $454.92     $356.77
    014267-08                103031088001 182508904  ZUNGALI          PHILIP     18   64900864375670401    07/11/2023          90      $468.70      $99.24
    014267-08                103031088001 182508904  ZUNGALI          PHILIP     18   645344542806670401   07/11/2023          10       $20.34       $0.00
    014267-08                103036754001 182545346  DELOZIER         JOSEPH     18   469016888036880401   07/12/2023          50      $276.99      $17.07
    014267-08                103036754001 182545346  DELOZIER         JOSEPH     18   326714602199160401   07/10/2023          30      $391.99     $109.92
    014267-08                103537183001 188580574  HEBERT           LINDA      18   711177252243140401   07/09/2023          30      $200.64       $8.08
    014267-08                104393562001 198605554  MCBREEN          KEVIN      18   436044322883260401   07/10/2023          90      $126.10       $7.66
    014267-08                110998339001 200645662  FEES             JOHN       01   962130703269590401   07/12/2023          90      $785.47     $122.88
    014267-08                105133504001 207506202  LITZINGER        PATRICK    18   674107997628501401   07/13/2023          90       $24.00       $6.96
  014267-08 Total                                                                                                                    $4,173.17     $887.57
  014267-12
    014267-12                101592912001 164561540  KIVISTO          MARY       18   93408031766930401    07/09/2023          30      $130.96       $0.00
    014267-12                101592912001 164561540  KIVISTO          MARY       18   700340454766930401   07/09/2023          30        $9.92       $0.00
  014267-12 Total                                                                                                                      $140.88       $0.00
  014267-13
    014267-13                103527331001 188520159  MONTANARO        RITA       18   649166140580401401   07/13/2023          90      $394.94       $9.76
    014267-13                104707411001 202484824  POMPA            LOUISE     18   64124852504801401    07/13/2023          30       $92.29       $0.00
  014267-13 Total                                                                                                                      $487.23       $9.76

                                                                                                                                               PAGE:8 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  014267-15
    014267-15                101825051001 167565230  PARONISH         THOMAS     18   674528741508570401   07/11/2023          90    $1,332.25   $1,009.14
    014267-15                101825051001 167565230  PARONISH         THOMAS     18   869332541658290401   07/12/2023          90      $276.60      $27.87
    014267-15                101825051001 167565230  PARONISH         THOMAS     18   744550864027190401   07/12/2023          28    $1,228.64     $965.94
    014267-15                102304935001 173545673  PARONISH         REBECCA    01   100947122294980401   07/12/2023           7       $27.59       $0.00
    014267-15                102312278001 173587932  PALMISANO        LEONARD    18   718180153955040401   07/09/2023          25      $341.99      $58.04
    014267-15                102564657001 176602616  FRONTINO         DEBORAH    18   281316808333140401   07/09/2023          90      $806.05       $7.87
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   121597987499590401   07/12/2023          14      $138.77       $9.05
    014267-15                103212512001 184605964  KIMMEL           RICHARD    18   363652681437411401   07/13/2023          90       $38.00       $9.96
    014267-15                104466514001 199567150  KIRSCH           DANIEL     01   675087532812190401   07/12/2023          90        $7.15       $0.00
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   228337816248080401   07/10/2023          90      $807.78      $19.33
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   52769311248080401    07/10/2023         (90)   ($807.78)    ($19.33)
    014267-15                104714087001 202525913  JUBAS            GARY       01   236300563182750401   07/10/2023          90      $987.46     $741.63
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   504246420782750401   07/10/2023          90      $807.78      $19.33
    014267-15                104714087001 202525913  JUBAS            GARY       01   172408491448080401   07/10/2023         (90)   ($987.46)   ($741.63)
    014267-15                104714087001 202525913  JUBAS            GARY       01   854258007548080401   07/10/2023          90      $987.46     $741.63
  014267-15 Total                                                                                                                    $5,992.28   $2,848.83
  014267-22
    014267-22                104709255001 202500368  KLEZEK           JANA       18   51099921225850401    07/10/2023          10      $115.55       $3.75
    014267-22                104709255001 202500368  KLEZEK           JANA       18   167667146092750401   07/10/2023          15       $49.03       $1.65
  014267-22 Total                                                                                                                      $164.58       $5.40
  014267-26
    014267-26                102716636001 178509898  THOMAS           BRUCE      18   524107362728470401   07/11/2023          90      $416.20     $113.21
    014267-26                103601183001 189447557  SETTLE           SUSAN      18   454098918945190401   07/12/2023          28       $19.03       $1.99
    014267-26                103601183001 189447557  SETTLE           SUSAN      18   339328328945190401   07/12/2023          34       $39.64       $0.00
    014267-26                103619172001 189545507  DRISKEL          DONNA      01   659728657935260401   07/10/2023          30       $23.97       $0.00
    014267-26                103619172001 189545507  DRISKEL          DONNA      01   359520514108470401   07/11/2023          30       $53.67       $0.00
    014267-26                103865487001 192460825  WHITESELL        EDWARD     18   377626010309550401   07/10/2023          30      $324.92     $165.51
    014267-26                103865487001 192460825  WHITESELL        EDWARD     18   946507346172570401   07/10/2023          90      $397.30      $30.87
    014267-26                103865487001 192460825  WHITESELL        EDWARD     18   47348968859101401    07/13/2023          90      $685.60       $3.90
  014267-26 Total                                                                                                                    $1,960.33     $315.48
  014267-36

                                                                                                                                               PAGE:9 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-36                109914485001 163626883  SHROYER          ROY        01   902067777724170401   07/11/2023          30       $38.07       $6.88
    014267-36                109914485001 163626883  SHROYER          WENDY      18   992867416920090401   07/12/2023          30      $121.43       $0.00
    014267-36                101597846001 164585882  BECQUET          DAWN       18   513428470741290401   07/12/2023           6       $20.68       $0.00
    014267-36                101609657001 164662147  BYRNE            JUSTIN     18   949968047458501401   07/13/2023          34      $179.08       $0.00
    014267-36                101742475001 166526179  CLAYCOMB         DYLAN      19   453637492807390401   07/12/2023          28       $28.66      $14.19
    014267-36                132201566001 182642148  REVESZ           KATHLEEN   01   419867287246930401   07/09/2023          30       $82.42       $0.00
    014267-36                132201566001 182642148  REVESZ           KATHLEEN   01   69118177887750401    07/10/2023          30      $259.54      $13.98
    014267-36                132201566001 182642148  REVESZ           STACEY     19   850157086345160401   07/10/2023          34       $17.00       $1.10
    014267-36                120713080001 187605431  CONRAD           CHRISTIN   18   971989151295850401   07/10/2023          28       $25.78       $0.00
    014267-36                120713080001 187605431  CONRAD           CHRISTIN   18   585525583785850401   07/10/2023          30       $86.72       $5.35
    014267-36                120713080001 187605431  CONRAD           CHRISTIN   18   242957696695850401   07/10/2023          28       $27.80       $4.24
    014267-36                117835248001 194706672  COMMONS          DAVID      18   175297807791670401   07/11/2023          30       $49.99       $0.00
    014267-36                117835248001 194706672  COMMONS          MADALYNN   19   586739711406211401   07/13/2023          14       $34.06       $8.81
    014267-36                105326129001 209640969  WURM             JACQUELI   18   322786710765770401   07/11/2023          30      $112.63       $0.00
    014267-36                105326129001 209640969  WURM             JACQUELI   18   253124682565770401   07/11/2023          30      $659.85      $19.90
  014267-36 Total                                                                                                                    $1,743.71      $74.45
  014267-37
    014267-37                134922147001 178526604  DILLON           LISA       18   717504222320260401   07/10/2023          90      $366.40      $53.04
    014267-37                134922147001 178526604  DILLON           LISA       18   193704672020260401   07/10/2023          90        $2.27       $0.00
    014267-37                134922147001 178526604  DILLON           LISA       18   43632071910260401    07/10/2023          84      $171.07      $28.64
    014267-37                134922147001 178526604  DILLON           LISA       18   509528957810260401   07/10/2023          90      $256.35       $1.03
    014267-37                134922147001 178526604  DILLON           LISA       18   431596770120260401   07/10/2023          90      $363.89       $0.00
    014267-37                103459963001 187600390  BRYAN            KAREN      18   682034722374890401   07/12/2023         360        $8.99       $0.00
    014267-37                103459963001 187600390  BRYAN            KAREN      18   190120994804801401   07/13/2023          30      $180.21      $46.78
    014267-37                103459963001 187600390  BRYAN            KAREN      18   851378191205470401   07/11/2023          30      $129.90       $0.00
  014267-37 Total                                                                                                                    $1,479.08     $129.49
  014267- Total                                                                                                                     $56,456.68  $18,171.53
Drug Total                                                                                                                          $56,456.68  $18,171.53
                                                                                                                                                            
HDHP PPO
  014267-54
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22712995609          07/06/2023           1       $50.00      $10.45

                                                                                                                                              PAGE:10 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22713358132          07/13/2023           1       $50.00      $10.45
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22712995609          07/06/2023           1       $80.00      $22.60
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22713180425          07/11/2023           2      $168.00      $49.16
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22713180425          07/11/2023           1       $80.00      $22.60
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22713358132          07/13/2023           2      $168.00      $49.16
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22712995609          07/06/2023           2      $168.00      $49.16
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22713180425          07/11/2023           1       $50.00      $10.45
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22713358132          07/13/2023           1       $80.00      $22.60
    014267-54                101290691001 160589924  BORLIE           MARGARET   18   22212954462          06/30/2023           1      $225.00       $0.00
    014267-54                101290691001 160589924  BORLIE           MARGARET   18   22212954462          06/30/2023           1      $137.00     $211.05
    014267-54                101290691001 160589924  BORLIE           MARGARET   18   22212954462          06/30/2023           1       $75.00      $44.01
    014267-54                101290691001 160589924  BORLIE           MARGARET   18   22212960774          06/30/2023           1       $85.00      $62.82
    014267-54                101290691001 160589924  BORLIE           MARGARET   18   22212954462          06/30/2023           1      $200.00     $160.18
    014267-54                101299088001 160644992  MARTINAZZI       BRANDON    18   22212993001          07/06/2023           1      $175.00       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   254077102088650401   07/10/2023          30       $70.50       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   22813008935          07/04/2023           1      $269.00       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   22813008935          07/04/2023           1       $23.15       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   313902121978650401   07/10/2023          30      $148.61       $7.92
    014267-54                101363408001 161569102  COOK             SCOTT      18   22813008935          07/04/2023           1       $56.00       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   22813008935          07/04/2023           1       $87.00       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   203628260978650401   07/10/2023          30       $46.00       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   22813008935          07/04/2023           1       $61.00       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   22813008935          07/04/2023           1      $102.00       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   173017512356750401   07/10/2023          30      $127.03       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   22813008935          07/04/2023           1       $27.78       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   22813008935          07/04/2023           1       $23.00       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   382260334878650401   07/10/2023          30       $37.84       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   22813008935          07/04/2023           1      $116.00       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   22813008935          07/04/2023           1       $67.00       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   346228977878650401   07/10/2023          30       $44.26       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   166668337411470401   07/11/2023          30      $211.23       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   22813008935          07/04/2023           1      $107.00       $0.00

                                                                                                                                              PAGE:11 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                101363408001 161569102  COOK             SCOTT      18   22813008935          07/04/2023           1    $1,121.00       $0.00
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043347          06/30/2023           3      $430.00       $0.00
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043281          06/01/2023           1      $148.00     $104.76
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22112831771          06/26/2023           1       $83.00      $19.85
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043347          06/30/2023           1       $27.00       $0.00
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043281          06/01/2023           1        $4.00       $0.00
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043347          06/30/2023           1       $89.00       $0.00
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22112831771          06/26/2023           1       $89.00      $15.43
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043281          06/01/2023           1        $4.00       $0.00
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22112943856          06/30/2023           1      $205.00      $76.59
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22112831771          06/26/2023           1      $150.00      $26.97
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043347          06/30/2023           1       $83.00       $0.00
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043281          06/01/2023          60   $10,500.00   $7,128.00
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043347          06/30/2023           1      $360.00     $298.82
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043281          06/01/2023           1      $610.00     $510.76
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043347          06/30/2023           1      $150.00       $0.00
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043281          06/01/2023           1      $360.00     $298.82
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   22513177629          07/03/2023           1       $44.00      $20.80
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22611203220          06/02/2023           1      $259.34     $120.81
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22513103767          07/11/2023           1       $20.00       $0.00
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   286278290075190401   07/12/2023          30      $163.84      $10.94
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22513103767          07/11/2023           1       $33.00      $16.68
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22513080478          07/10/2023           1       $20.00       $0.00
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   496887406286930401   07/09/2023          10       $34.42       $5.20
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   22513177629          07/03/2023           1      $168.00      $22.19
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22513080478          07/10/2023           1       $33.00      $16.68
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22513103767          07/11/2023           4      $144.00      $98.32
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22610482932          10/21/2022           1      $760.27     $760.27
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22610482932          10/21/2022           1    $6,690.35     $872.28
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   22513177629          07/03/2023           1       $87.00      $22.27
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   727568208721670401   07/11/2023          30      $172.93       $8.54
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   22513177629          07/03/2023           1      $184.00      $10.99

                                                                                                                                              PAGE:12 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22513080478          07/10/2023           4      $144.00      $98.32
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   72228958765190401    07/12/2023          30       $38.83      $10.57
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   22513177629          07/03/2023           1       $80.00      $14.98
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22608958845          10/18/2022           1      $729.86     $729.86
    014267-54                101682663001 165620949  GIBSON           BRIAN      18   22613212209          07/06/2023           1      $557.00       $0.00
    014267-54                101682663001 165620949  GIBSON           BRIAN      18   22612905000          07/06/2023           1      $621.00     $220.73
    014267-54                101682663001 165620949  GIBSON           BRIAN      18   22613212209          07/06/2023           1    $1,456.00       $0.00
    014267-54                101682663001 165620949  GIBSON           BRIAN      18   22613212209          07/06/2023           2      $360.00       $0.00
    014267-54                101682663001 165620949  GIBSON           BRIAN      18   22613212209          07/06/2023           1       $22.05       $0.00
    014267-54                101682663001 165620949  GIBSON           BRIAN      18   22613212209          07/06/2023           1       $27.78       $0.00
    014267-54                101682663001 165620949  GIBSON           BRIAN      18   22613212209          07/06/2023          45       $30.01       $0.00
    014267-54                131732377001 167623544  MARSH            RAYMOND    01   470708388073411401   07/13/2023          28      $114.40      $17.02
    014267-54                131732377001 167623544  MARSH            SHELLY     18   22713119171          06/27/2023           1       $21.00      $18.50
    014267-54                131732377001 167623544  MARSH            SHELLY     18   22713119171          06/27/2023           1       $95.00      $85.70
    014267-54                131732377001 167623544  MARSH            SHELLY     18   22713023010          03/02/2023           1      $107.00     $106.66
    014267-54                131732377001 167623544  MARSH            SHELLY     18   22713119171          06/27/2023           1       $21.00      $18.17
    014267-54                131732377001 167623544  MARSH            SHELLY     18   22713023010          03/02/2023           1       $75.00      $46.15
    014267-54                131732377001 167623544  MARSH            SHELLY     18   454587692599590401   06/27/2023         (30)   ($170.68)    ($10.14)
    014267-54                131732377001 167623544  MARSH            SHELLY     18   22713023010          03/02/2023           1      $512.00     $173.73
    014267-54                131732377001 167623544  MARSH            SHELLY     18   22713119171          06/27/2023           1      $205.00     $118.88
    014267-54                101835217001 167625474  BEZEK            JENNIFER   18   22113310740          07/11/2023           1      $715.00      $38.56
    014267-54                123673326001 167720876  MEHALKO          MELISSA    18   388325313735340401   07/09/2023          90      $139.45       $0.00
    014267-54                114826745001 169628242  SOKIRA           LISA       18   533518788732240401   07/09/2023           7       $50.49      $20.84
    014267-54                114826745001 169628242  SOKIRA           LISA       18   22213161694          07/09/2023           1       $61.00      $20.78
    014267-54                102080764001 170683398  STRAZISAR        ETHAN      19   22112944321          07/05/2023           1      $222.00     $102.70
    014267-54                102159846001 171648736  PALKO            JONAH      19   721718728473750401   07/10/2023          30      $149.04      $85.85
    014267-54                102159846001 171648736  PALKO            JONAH      19   22031736525          07/10/2023           1      $160.00     $126.85
    014267-54                102159846001 171648736  PALKO            JONAH      19   754856900172670401   07/11/2023          25      $246.45     $197.72
    014267-54                102223852001 172547027  ALBRIGHT         TERRY      18   22713029423          07/10/2023           1       $95.00       $0.00
    014267-54                102327601001 173704369  GREGORY          MARILYN    18   22412894396          07/06/2023           1      $185.00     $124.83
    014267-54                102327601001 173704369  GREGORY          MARILYN    18   22412894396          07/06/2023           1       $25.00      $19.08
    014267-54                112685074001 175662935  KOLARIK          BROOKE     19   22713297564          07/05/2023           1      $125.00       $0.00

                                                                                                                                              PAGE:13 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                112244092001 175669827  YODER            BRIANNA    18   289200964611470401   07/11/2023          30        $9.00       $0.00
    014267-54                112244092001 175669827  YODER            BRIANNA    18   546686760611470401   07/11/2023          30      $202.06       $0.00
    014267-54                117041830001 177705872  GALLAGHER        EMILY      19   22713247890          06/07/2023           1      $290.00       $0.00
    014267-54                117041830001 177705872  GALLAGHER        MATTHEW    01   378784152352970401   07/11/2023           7       $92.26       $0.00
    014267-54                103127832001 183589717  EDWARDS          AMY        18   22031786633          06/26/2023           1       $95.00       $0.00
    014267-54                116625941001 183628434  LITZINGER        BROOKE     19   22813095263          07/10/2023           1       $30.00      $24.58
    014267-54                116625941001 183628434  LITZINGER        LYDIA      19   22813072760          07/10/2023           1      $195.00      $74.94
    014267-54                116625941001 183628434  LITZINGER        BROOKE     19   22813095263          07/10/2023           1       $50.00      $33.32
    014267-54                116625941001 183628434  LITZINGER        LYDIA      19   173518527772211401   07/13/2023          30      $146.57      $38.92
    014267-54                116625941001 183628434  LITZINGER        BROOKE     19   42307882766511401    06/29/2023         (30)   ($141.44)    ($12.79)
    014267-54                116625941001 183628434  LITZINGER        BROOKE     19   22813095263          07/10/2023           1       $25.00      $11.87
    014267-54                116625941001 183628434  LITZINGER        JENNIFER   18   72887376935590401    07/12/2023          30      $277.96      $28.80
    014267-54                121194993001 185622463  WENDEROTH        AVA        19   22313194228          07/12/2023           1      $195.00       $0.00
    014267-54                121194993001 185622463  WENDEROTH        ALISHA     18   39587467078650401    07/10/2023          30      $142.46       $0.00
    014267-54                121194993001 185622463  WENDEROTH        ALISHA     18   22313065058          07/10/2023           1       $90.00       $0.00
    014267-54                121194993001 185622463  WENDEROTH        ALISHA     18   22313065058          07/10/2023           1       $97.00       $0.00
    014267-54                121194993001 185622463  BEAMER           HAYLEE     19   993428358067211401   07/13/2023          30      $142.45       $0.00
    014267-54                121194993001 185622463  WENDEROTH        ALISHA     18   22313065058          07/10/2023           1      $144.00       $0.00
    014267-54                103303874001 185683958  GEISER           RANDY      01   22213056298          07/06/2023           1       $50.00      $20.58
    014267-54                103303874001 185683958  GEISER           RANDY      01   22213056298          07/06/2023           1       $45.00      $15.14
    014267-54                103303874001 185683958  GEISER           RANDY      01   22213056298          07/06/2023           1       $25.00       $8.32
    014267-54                103303874001 185683958  GEISER           RANDY      01   22213056298          07/06/2023           1       $16.00       $0.00
    014267-54                103303874001 185683958  GEISER           RANDY      01   22213056298          07/06/2023           1       $78.00      $10.09
    014267-54                103379738001 186625394  RHINE            HARVEY     01   22512992365          07/05/2023           1      $132.00      $87.42
    014267-54                103379738001 186625394  RHINE            HARVEY     01   22512992365          07/05/2023           1       $65.00      $39.89
    014267-54                103379738001 186625394  RHINE            HEATHER    18   22513260413          07/10/2023           1      $142.00      $72.85
    014267-54                103379738001 186625394  RHINE            HARVEY     01   22512992365          07/05/2023           1      $132.00      $87.42
    014267-54                103379738001 186625394  RHINE            HARVEY     01   22512998328          07/05/2023           1       $38.00      $10.06
    014267-54                103379738001 186625394  RHINE            HARVEY     01   22512992365          07/05/2023           1      $252.00      $30.80
    014267-54                103379738001 186625394  RHINE            HARVEY     01   22512992366          07/06/2023           1       $14.00       $0.00
    014267-54                103379738001 186625394  RHINE            HARVEY     01   22512992365          07/05/2023           1       $14.00       $0.00
    014267-54                103379738001 186625394  RHINE            HEATHER    18   22513281218          07/12/2023           2      $112.00      $49.16

                                                                                                                                              PAGE:14 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                103379738001 186625394  RHINE            HEATHER    18   22513281218          07/12/2023           2      $160.00      $45.20
    014267-54                103379738001 186625394  RHINE            HARVEY     01   22512992366          07/06/2023           1       $65.00      $35.01
    014267-54                103379738001 186625394  RHINE            HARVEY     01   921275503758570401   07/07/2023         (30)   ($317.02)    ($15.70)
    014267-54                114634138001 186666547  PERACCHINO       BETHANY    18   22412969619          07/05/2023           1      $200.00     $102.00
    014267-54                114634138001 186666547  PERACCHINO       BETHANY    18   22412969619          07/05/2023           1       $25.00       $4.01
    014267-54                114634138001 186666547  PERACCHINO       BETHANY    18   22813273270          07/07/2023           1    $1,855.16       $0.00
    014267-54                104054990001 194546961  KANICH           CHRISTIA   19   22513099074          06/26/2023           1      $277.00     $329.99
    014267-54                104054990001 194546961  KANICH           CHRISTIA   19   22512869565          06/26/2023           1      $142.00      $40.64
    014267-54                104054990001 194546961  KANICH           AMY        01   22512998432          06/29/2023           1      $242.00     $157.86
    014267-54                104054990001 194546961  KANICH           CHRISTIA   19   22512869565          06/26/2023           1      $328.00      $41.39
    014267-54                104054990001 194546961  KANICH           CHRISTIA   19   22513099074          06/26/2023           1      $344.00     $150.61
    014267-54                104054990001 194546961  KANICH           CHRISTIA   19   22512869565          06/26/2023           1      $204.00      $37.63
    014267-54                104054990001 194546961  KANICH           CHRISTIA   19   22513099074          06/26/2023           1    $1,024.00     $634.57
    014267-54                104241017001 196668222  BORING           MALAYNA    19   22213299012          06/21/2023           1       $14.00       $0.00
    014267-54                104241017001 196668222  BORING           MALAYNA    19   22213299012          06/21/2023           1       $60.00       $0.00
    014267-54                104322714001 197666714  ZAMBONI          KATE       01   334417576123111401   07/13/2023          25      $303.94       $0.00
    014267-54                104322714001 197666714  ZAMBONI          KATE       01   765164762198590401   07/12/2023          25      $303.94       $0.00
    014267-54                104322714001 197666714  ZAMBONI          KATE       01   553457387913111401   07/12/2023         (25)   ($303.94)       $0.00
    014267-54                104402015001 198667995  KOSS             SUMMER     19   43462391758570401    07/11/2023          10      $100.82      $13.84
    014267-54                104402015001 198667995  KOSS             SUMMER     19   399128998458570401   07/11/2023          30      $112.30      $20.62
    014267-54                104402015001 198667995  KOSS             SERENA     19   944558251538111401   07/13/2023          28       $54.29      $10.86
    014267-54                104402015001 198667995  KOSS             SUMMER     19   22612960131          06/28/2023           1       $53.00       $0.00
    014267-54                104402015001 198667995  KOSS             SUMMER     19   22612960131          06/28/2023           1       $50.00       $0.00
    014267-54                104402015001 198667995  KOSS             SHANNON    18   22813015861          07/05/2023           1       $66.00      $11.87
    014267-54                104402015001 198667995  KOSS             SUMMER     19   261107156280670401   07/11/2023           7       $12.31       $2.30
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041612          06/20/2023           1      $332.00     $126.93
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041609          06/06/2023           1      $579.00     $326.02
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041612          06/20/2023           2      $634.00     $155.55
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041609          06/06/2023           5    $1,160.00   $1,302.59
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041609          06/06/2023           6      $193.50     $493.68
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041610          06/07/2023          12   $21,852.00   $7,634.32
    014267-54                104472618001 199605677  RHOADES          SHERRIE    01   114078460676160401   06/27/2023         (30)    ($38.83)    ($11.89)

                                                                                                                                              PAGE:15 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                104472618001 199605677  RHOADES          SHERRIE    01   22613172965          07/11/2023           1      $150.00      $85.00
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041612          06/20/2023          10       $10.00      $42.48
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041609          06/06/2023           1      $156.00     $104.07
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041611          06/19/2023           1       $29.50       $0.00
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041612          06/20/2023           1      $579.00     $665.33
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041612          06/20/2023           1       $32.25      $82.28
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041612          06/20/2023         130      $845.00     $513.56
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041611          06/19/2023           1       $94.50      $29.86
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041609          06/06/2023           1       $32.25      $82.28
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041613          06/21/2023          12   $21,852.00   $7,634.32
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041608          06/05/2023           1       $50.50      $15.88
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041608          06/05/2023           1       $94.50      $29.86
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041612          06/20/2023           1      $317.00     $165.03
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041609          06/06/2023          10       $10.00      $42.48
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041609          06/06/2023          10    $1,200.00     $657.98
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041609          06/06/2023          10      $942.50   $1,372.89
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041609          06/06/2023         130      $845.00     $513.56
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041612          06/20/2023           1      $532.00     $273.77
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041611          06/19/2023           1       $50.50      $15.88
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041612          06/20/2023          10    $1,200.00     $657.98
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041610          06/07/2023           1      $235.00      $73.66
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041609          06/06/2023           1      $532.00     $273.77
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041612          06/20/2023           1      $579.00     $326.02
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041609          06/06/2023           1      $317.00      $77.78
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041612          06/20/2023           5    $1,160.00   $1,302.59
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041612          06/20/2023           6      $193.50     $493.68
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041612          06/20/2023           1       $10.50      $30.07
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041609          06/06/2023           1      $579.00     $665.33
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041609          06/06/2023           1       $10.50      $30.07
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041612          06/20/2023          10      $942.50   $1,372.89
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041613          06/21/2023           1      $235.00      $73.66
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041608          06/05/2023           1       $29.50       $0.00

                                                                                                                                              PAGE:16 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                104472618001 199605677  RHOADES          SHERRIE    01   22613172965          07/11/2023           1       $25.00       $4.01
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041609          06/06/2023           1      $317.00     $165.03
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613041612          06/20/2023           1      $156.00     $104.07
    014267-54                104717677001 202546801  CHUHRAN          STACIE     18   884016590975901401   07/13/2023          30       $21.99       $2.01
    014267-54                104738058001 202684807  REPINE           MARCY      18   392368811454080401   07/11/2023          30      $249.09      $13.56
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           1      $184.22       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           2      $391.88       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           8        $2.44       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           1      $140.00       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           1        $2.99       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           1       $56.71       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           2        $2.20       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           1        $0.94       $0.00
    014267-54                104738058001 202684807  REPINE           MARK       01   22031766851          07/06/2023           1       $86.00      $24.58
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           1       $77.00       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           2       $84.44       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           1      $296.19       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031824208          07/03/2023           1      $100.00      $30.99
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           1        $5.82       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           1    $1,145.00       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           1   $11,704.00  $11,626.73
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           4        $2.44       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           1      $697.00       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           1       $95.00       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           2      $147.70       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           7    $1,471.15       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023         100       $21.24       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023          56    $2,797.00       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           1       $36.38       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023          20       $67.65       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031824208          07/03/2023           1      $140.00      $38.56
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023          50        $8.01       $0.00

                                                                                                                                              PAGE:17 of 69
                                                                                                                                                            
            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   22031766851          07/06/2023           1       $69.00      $10.45
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023          10       $36.58       $0.00
    014267-54                104738058001 202684807  REPINE           MARK       01   22031766851          07/06/2023           1       $66.00      $11.87
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           1      $302.71       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           1       $19.67       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           3        $7.53       $0.00
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032002938          06/27/2023           1       $46.00       $4.89
    014267-54                104738058001 202684807  REPINE           MARCY      18   22031536623          06/12/2023           3       $21.48       $0.00
    014267-54                104788273001 203482794  PALKO            DANIEL     18   22413251443          07/12/2023           1       $45.00       $0.00
    014267-54                126258506001 207609840  KIRSCH           SHELLEY    18   22812873659          06/26/2023           1      $302.71       $0.00
    014267-54                126258506001 207609840  KIRSCH           SHELLEY    18   22812873659          06/26/2023           1      $110.00      $34.20
    014267-54                126258506001 207609840  KIRSCH           SHELLEY    18   22812873659          06/26/2023           1       $27.00       $0.00
    014267-54                105155289001 207641433  DUGAS            CHRISTOP   01   22031593705          07/08/2023           1      $225.00       $0.00
    014267-54                105312729001 209560824  LAUER            MARIA      18   22312831796          06/27/2023           1       $60.00      $19.52
    014267-54                105312729001 209560824  LAUER            JEFFREY    01   22313221257          07/11/2023           1       $68.00      $25.97
    014267-54                105312729001 209560824  LAUER            JEFFREY    01   22312962075          07/06/2023           1      $209.00     $120.81
    014267-54                105312729001 209560824  LAUER            JEFFREY    01   22313221257          07/11/2023           1       $60.00      $17.31
    014267-54                105312729001 209560824  LAUER            JEFFREY    01   22312962075          07/06/2023           1        $7.00       $2.50
    014267-54                120307645001 210683109  MCCORMICK        SARAH      18   22112950994          07/05/2023           1      $358.00      $30.99
    014267-54                120307645001 210683109  MCCORMICK        SARAH      18   629287266690460401   07/10/2023          30      $211.85       $0.00
    014267-54                120307645001 210683109  MCCORMICK        SARAH      18   22112964291          07/05/2023           1       $48.00      $58.59
    014267-54                120307645001 210683109  MCCORMICK        SARAH      18   22112950994          07/05/2023           1      $715.00      $38.56
    014267-54                120307645001 210683109  MCCORMICK        SARAH      18   931008080478650401   07/10/2023          30      $572.31       $0.00
    014267-54                120307645001 210683109  MCCORMICK        SARAH      18   22112964291          07/05/2023           1      $497.00     $225.44
    014267-54                122643511001 211720938  CONRAD           SAMANTHA   18   22713180706          07/06/2023           1      $218.00       $0.00
    014267-54                122643511001 211720938  CONRAD           SAMANTHA   18   22713115064          07/06/2023           1      $662.00       $0.00
    014267-54                122643511001 211720938  CONRAD           SAMANTHA   18   22713364593          07/10/2023           1      $209.00       $0.00
    014267-54                105508252001 211723306  FARABAUGH        VERA       19   22113286075          07/13/2023           4      $224.00     $110.92
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22513077358          07/10/2023           1       $80.00      $22.60
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22513077358          07/10/2023           1       $55.00      $11.87
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22512978974          07/07/2023           1       $80.00      $22.60
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22512978974          07/07/2023           1       $84.00      $24.58

                                                                                                                                              PAGE:18 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22513077358          07/10/2023           1       $84.00      $24.58
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22512978974          07/07/2023           1       $50.00      $14.41
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22513077358          07/10/2023           1       $50.00      $14.41
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22512978974          07/07/2023           1       $55.00      $11.87
  014267-54 Total                                                                                                                  $127,461.34  $56,438.68
  014267- Total                                                                                                                    $127,461.34  $56,438.68
  017697-00
    017697-00                101289752001 160587191  KARGO            KRISTEN    18   22813249430          06/07/2023           1      $290.00     $157.86
    017697-00                113918356001 162669421  ROSSMAN          PAUL       01   838777016638801401   07/13/2023          30      $269.33       $7.20
    017697-00                113918356001 162669421  ROSSMAN          PAUL       01   55287757538801401    07/13/2023          30       $47.20      $11.90
    017697-00                113918356001 162669421  ROSSMAN          PAUL       01   22113159917          07/07/2023           1       $30.00      $22.60
    017697-00                113918356001 162669421  ROSSMAN          PAUL       01   22113159917          07/07/2023           1       $35.00      $24.58
    017697-00                113918356001 162669421  ROSSMAN          PAUL       01   22113159917          07/07/2023           1       $50.00      $33.32
    017697-00                113918356001 162669421  ROSSMAN          PAUL       01   157047486538801401   07/13/2023          30        $3.37       $2.55
    017697-00                116893538001 164669255  WALTERS          AMY        18   22813247246          07/10/2023           1      $220.00     $109.89
    017697-00                116893538001 164669255  WALTERS          AMY        18   272029351717870401   07/11/2023           5       $13.21       $4.61
    017697-00                116893538001 164669255  WALTERS          AMY        18   102147297517870401   07/11/2023          14       $53.96       $8.46
    017697-00                128881676001 164765283  LEAHEY           ALIZA      19   22213082765          05/28/2023           1       $78.00      $16.72
    017697-00                101684237001 165626002  EDGELL           JOHN       18   22512625257          06/20/2023           1      $160.00      $61.80
    017697-00                101684237001 165626002  EDGELL           JOHN       18   22512625257          06/20/2023           1      $215.00      $85.70
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031550147          01/05/2023           1    $1,300.00     $450.00
    017697-00                102000987001 169688887  VAN CASTER       TARA       18   22031550147          01/05/2023          22      $358.70     $243.50
    017697-00                102072716001 170622250  MCCOMBIE         JARROD     18   22813024247          07/07/2023           1       $50.00       $0.00
    017697-00                102072716001 170622250  MCCOMBIE         JARROD     18   22813024247          07/07/2023           1       $80.00       $0.00
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22212956034          06/30/2023           1       $88.00      $43.13
    017697-00                102300718001 173523551  MYERS            MATTHEW    01   22413189261          04/19/2023           1      $205.00     $101.05
    017697-00                102300718001 173523551  MYERS            MATTHEW    01   22413189261          04/19/2023           1       $21.00      $15.45
    017697-00                102300718001 173523551  MYERS            MATTHEW    01   22413189261          04/19/2023           1       $21.00      $15.73
    017697-00                102742521001 178682192  WHEELER          KAMRYN     19   59477487189370401    07/11/2023          28      $117.44      $18.28
    017697-00                102742521001 178682192  WHEELER          KAMRYN     19   22613034658          07/06/2023           1      $230.00     $116.03
    017697-00                102884338001 180600186  KIRSCH           BRIDGET    18   22113223629          07/05/2023           1      $178.00       $0.00
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22209504814          05/18/2023           1      $185.00     $119.36

                                                                                                                                              PAGE:19 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22209504814          05/18/2023          (1)   ($135.00)   ($124.04)
    017697-00                115794029001 180664146  KUDLAWIEC        BRYAN      01   613735873566490401   07/12/2023          30       $13.05       $2.55
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22209504814          05/18/2023          (2)    ($80.00)    ($32.03)
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22209504814          05/18/2023           2       $80.00      $32.03
    017697-00                115794029001 180664146  KUDLAWIEC        BRYAN      01   380237056589590401   07/12/2023          30       $72.33       $3.96
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22209504814          05/18/2023           1      $275.00     $221.58
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22209504814          05/18/2023           1       $85.00      $48.14
    017697-00                115794029001 180664146  KUDLAWIEC        BRYAN      01   22213213804          07/12/2023           2      $108.00      $55.46
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22209504814          05/18/2023          (1)   ($220.00)   ($220.00)
    017697-00                115794029001 180664146  KUDLAWIEC        BRYAN      01   721037557412011401   07/12/2023         (30)    ($13.05)     ($2.55)
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22209504814          05/18/2023          (1)   ($185.00)   ($119.36)
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22209504814          05/18/2023           1      $135.00     $124.04
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22209504814          05/18/2023          (1)    ($50.00)    ($36.91)
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22209504814          05/18/2023           4      $160.00      $84.84
    017697-00                115794029001 180664146  KUDLAWIEC        LAUREN     18   647960084631590401   07/12/2023          10      $100.82      $13.84
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22209504814          05/18/2023          (1)    ($85.00)    ($48.14)
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22209504814          05/18/2023          (4)   ($160.00)    ($84.84)
    017697-00                115794029001 180664146  KUDLAWIEC        BRYAN      01   975550673412011401   07/12/2023          30       $67.16       $2.55
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22209504814          05/18/2023           1       $50.00      $36.91
    017697-00                103299423001 185646090  NILESKI          STEPHEN    01   51500874540040401    07/09/2023          30      $349.48      $23.83
    017697-00                103299423001 185646090  NILESKI          KERRY      18   22612936376          07/07/2023           2      $141.00      $49.16
    017697-00                103299423001 185646090  NILESKI          STEPHEN    01   499085623474850401   07/10/2023          30       $85.68      $12.86
    017697-00                103468306001 187645700  GERGELY          APRIL      18   22413304284          07/10/2023           1      $170.00       $0.00
    017697-00                103468306001 187645700  GERGELY          APRIL      18   22413304284          07/10/2023           1      $882.00       $0.00
    017697-00                103468306001 187645700  GERGELY          APRIL      18   22413304284          07/10/2023           1      $384.00       $0.00
    017697-00                115603314001 187702712  MARINO           HENRY      19   22612933094          07/05/2023           1      $125.00      $84.93
    017697-00                115603314001 187702712  MARINO           AMANDA     18   22613172650          05/30/2023           1       $25.00      $10.06
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22313047084          07/11/2023           1       $15.00      $11.87
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22312825895          07/06/2023           2      $141.00      $49.16
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22312825895          07/06/2023           1       $69.00      $28.53
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22313039271          07/10/2023           1       $69.00      $28.53
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22313039271          07/10/2023           2      $141.00      $49.16

                                                                                                                                              PAGE:20 of 69
                                                                                                                                                            
            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             JESSICA    18   22313039271          07/10/2023           1       $60.00      $12.84
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22313047084          07/11/2023           1       $42.00      $33.32
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22313047084          07/11/2023           1       $15.00      $10.45
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22312825895          07/06/2023           1       $60.00      $12.84
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22313039271          07/10/2023           1       $69.00      $22.60
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22313047084          07/11/2023           1       $27.00      $24.58
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22312825895          07/06/2023           1       $69.00      $22.60
    017697-00                122764620001 194708330  MONTAG           JENNA      18   22313130235          07/07/2023           1      $200.00     $100.00
    017697-00                117751540001 195663631  BARLICK          SARAH      18   22413070985          07/06/2023           1      $135.00      $37.33
    017697-00                117751540001 195663631  BARLICK          SARAH      18   22413070985          07/06/2023           1       $31.00       $0.00
    017697-00                117751540001 195663631  BARLICK          SARAH      18   22413070985          07/06/2023           1       $91.50      $24.86
    017697-00                117751540001 195663631  BARLICK          SARAH      18   22413070985          07/06/2023           1      $236.00      $69.76
    017697-00                117751540001 195663631  BARLICK          SARAH      18   22413070985          07/06/2023           1       $88.50      $17.05
    017697-00                104228854001 196584813  FARREN           HEATHER    18   153467716978590401   07/12/2023           3       $58.30      $46.73
    017697-00                104228854001 196584813  FARREN           HEATHER    18   778167097233690401   07/12/2023          30       $29.65      $11.69
    017697-00                104228854001 196584813  FARREN           HEATHER    18   579878077627870401   07/11/2023          14       $12.45       $9.94
    017697-00                104228854001 196584813  FARREN           ANTHONY    01   22712913981          06/28/2023           1      $681.00     $512.43
    017697-00                104228854001 196584813  FARREN           HEATHER    18   180787647143690401   07/12/2023          30       $19.24      $10.05
    017697-00                104565684001 200662396  WEAKLAND         TAMMY      18   22313212776          07/10/2023           1      $800.00     $294.00
    017697-00                104565684001 200662396  WEAKLAND         TAMMY      18   22313212776          07/10/2023           1      $150.00      $11.68
    017697-00                104565684001 200662396  WEAKLAND         TAMMY      18   22313212776          07/10/2023           1      $400.00     $102.54
    017697-00                116895622001 200707458  CLEVENGER        HANNAH     01   600150204272190401   07/12/2023           6       $46.00       $0.00
    017697-00                104728902001 202620444  DAMIN            JENNY      18   22613312337          06/08/2023           1      $205.00     $101.05
    017697-00                104728902001 202620444  DAMIN            JENNY      18   22613312337          06/08/2023           1       $95.00       $0.00
    017697-00                104810347001 203609555  HALE             LEWIS      18   22113022911          07/05/2023           1       $45.00      $33.32
    017697-00                104816797001 203661805  ORAVEC           NICOLE     01   22713332549          07/05/2023           1      $115.00     $110.01
    017697-00                104816797001 203661805  ORAVEC           ISAAC      19   22712989655          07/07/2023           2       $69.34      $69.34
    017697-00                118583174001 206701815  BURLINGAME       CHRISTOP   01   22213057946          07/05/2023           1      $129.00       $0.00
    017697-00                105299927001 209482347  DELANEY          WILLIAM    18   22813369026          07/12/2023           5      $280.00     $115.00
    017697-00                105299927001 209482347  DELANEY          WILLIAM    18   22813369026          07/12/2023           1       $60.00       $0.00
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   22513135199          07/07/2023           1      $220.00     $109.89
  017697-00 Total                                                                                                                   $11,653.66   $3,901.74

                                                                                                                                              PAGE:21 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  017697-01
    017697-01                101899087001 168489808  DUNMYER          WILLIAM    18   648226720023111401   07/13/2023          30       $25.72       $6.97
    017697-01                101899087001 168489808  DUNMYER          WILLIAM    18   772237066762211401   07/13/2023          30       $88.55      $13.71
    017697-01                101979949001 169547153  PROSSER          NATALIE    18   22413187820          07/07/2023           1       $47.00      $33.32
    017697-01                102056797001 170523784  NOLL             VERONICA   18   563959111305801401   07/13/2023          30       $58.29       $6.84
    017697-01                110205080001 172527634  HELDIBRIDLE      LORI       18   254718430366901401   07/05/2023          90      $718.96       $0.00
    017697-01                102730783001 178600938  STASIK           MELANIE    19   22413177348          07/07/2023           1      $145.00     $110.01
    017697-01                102730783001 178600938  STASIK           ROBERT     01   914437527875770401   06/27/2023         (30)   ($140.96)     ($8.71)
    017697-01                103056572001 182667400  MORELAND         MELISSA    18   22213204745          06/28/2023           1      $129.00      $35.85
    017697-01                103056572001 182667400  MORELAND         MELISSA    18   22213204745          06/28/2023           1      $145.00      $40.64
    017697-01                103056572001 182667400  MORELAND         MELISSA    18   22213204745          06/28/2023           1      $123.00      $29.90
    017697-01                103056572001 182667400  MORELAND         WYATT      19   22213126617          07/11/2023           1      $140.00      $89.99
    017697-01                103056572001 182667400  MORELAND         WYATT      19   673167547141670401   07/11/2023          10       $61.29      $17.73
    017697-01                135065199001 186686490  THOMAS           CRYSTAL    18   22313276866          07/06/2023           1      $127.00     $126.32
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   22512979525          07/06/2023           1       $35.00      $22.10
    017697-01                103625384001 189584284  STOY             KAMRYN     19   22513228663          07/10/2023           1      $145.00      $74.97
    017697-01                103625384001 189584284  STOY             KAMRYN     19   22513074173          06/26/2023           1      $261.00      $42.44
    017697-01                103625384001 189584284  STOY             KAMRYN     19   22513074173          06/26/2023           1      $218.00      $92.56
    017697-01                103625384001 189584284  STOY             KAMRYN     19   22513074173          06/26/2023           1      $235.00     $102.26
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   22512979525          07/06/2023           1       $47.00      $33.32
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   350758757857650401   07/10/2023          30      $260.67       $8.50
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   22512979525          07/06/2023           1       $34.00      $24.58
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   22512979525          07/06/2023           1       $22.00       $0.00
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   22512979525          07/06/2023           1       $17.00       $0.00
    017697-01                104882005001 204526094  BEM              REGINA     18   22613255645          06/27/2023           1      $390.00       $0.00
    017697-01                104882005001 204526094  BEM              REGINA     18   22613255645          06/27/2023           1      $207.00       $0.00
    017697-01                104882005001 204526094  BEM              REGINA     18   22613255645          06/27/2023           1      $156.00       $0.00
    017697-01                104882005001 204526094  BEM              REGINA     18   22613255645          06/27/2023           1      $129.00       $0.00
    017697-01                105064449001 206608212  TREXLER          CHRISTIN   18   22613083636          06/27/2023           1      $220.00       $0.00
  017697-01 Total                                                                                                                    $4,044.52     $903.30
  017697-10
    017697-10                101522332001 163584304  BAIRD            JEFFREY    18   115207532516190401   07/12/2023          30      $240.64     $157.72

                                                                                                                                              PAGE:22 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-10                101522332001 163584304  BAIRD            JEFFREY    18   375308530845190401   07/12/2023          30       $28.70      $10.76
    017697-10                101522332001 163584304  BAIRD            JEFFREY    18   592608680845190401   07/12/2023          30       $94.92      $11.53
    017697-10                101522332001 163584304  BAIRD            JEFFREY    18   62898708775190401    07/12/2023          30      $122.42       $5.48
    017697-10                101522332001 163584304  BAIRD            JEFFREY    18   378897956845190401   07/12/2023          30      $121.24      $20.16
    017697-10                104387032001 198566408  FABBRI           JEANETTE   18   273766280842190401   07/12/2023          30       $45.00       $5.43
    017697-10                104387032001 198566408  FABBRI           CARL       01   42277132842190401    07/12/2023          30       $36.82       $5.62
    017697-10                104387032001 198566408  FABBRI           JEANETTE   18   948464232942190401   07/12/2023          30       $25.27       $6.22
    017697-10                104387032001 198566408  FABBRI           JEANETTE   18   983504482942190401   07/12/2023          30       $74.89      $13.31
    017697-10                104387032001 198566408  FABBRI           CARL       01   317756170742190401   07/12/2023          30      $125.73       $7.83
    017697-10                104387032001 198566408  FABBRI           JEANETTE   18   13996300811290401    07/12/2023          30      $332.01       $6.46
  017697-10 Total                                                                                                                    $1,247.64     $250.52
  017697-70
    017697-70                102057668001 170526421  LENZ             SALLY      18   22813325934          07/10/2023           1    $2,213.00   $1,081.57
  017697-70 Total                                                                                                                    $2,213.00   $1,081.57
  017697- Total                                                                                                                     $19,158.82   $6,137.13
  017728-00
    017728-00                102646677001 177602042  HOCKENBERRY      ALLEN      01   22312926312          07/05/2023           1       $83.79       $0.00
    017728-00                102646677001 177602042  HOCKENBERRY      ALLEN      01   22312926312          07/05/2023           1       $26.46       $0.00
    017728-00                110124768001 177620071  KUHN             MARK       01   22312821038          07/03/2023           1       $31.00       $0.00
    017728-00                110124768001 177620071  KUHN             MARK       01   22312821038          07/03/2023           1      $164.00       $0.00
    017728-00                110124768001 177620071  KUHN             MARK       01   22312821038          07/03/2023           1      $135.00       $0.00
    017728-00                110124768001 177620071  KUHN             MARK       01   73056638795850401    07/10/2023          30      $208.83       $0.00
    017728-00                110124768001 177620071  KUHN             MARK       01   22312821038          07/03/2023           1       $82.50       $0.00
    017728-00                110124768001 177620071  KUHN             MARK       01   22312821038          07/03/2023           1      $129.00       $0.00
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1      $263.00     $189.94
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           4       $33.34       $9.00
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1    $3,409.00   $1,120.24
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1       $37.00      $13.52
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1)   ($126.00)    ($51.64)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           2       $22.05       $4.10
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/10/2023          (4)    ($28.02)     ($2.48)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023          14      $135.98       $0.00

                                                                                                                                              PAGE:23 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/10/2023           1       $65.00      $33.53
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1       $76.00      $25.92
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1      $102.00      $57.90
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/10/2023           1      $163.00      $42.33
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1       $48.00      $21.47
    017728-00                113594013001 180509497  TEETER           PAULA      01   820824032550560401   07/10/2023          30        $9.00       $3.96
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1)   ($263.00)   ($189.94)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/10/2023          (1)    ($37.00)    ($13.52)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1       $97.00      $34.48
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/11/2023           1       $65.00      $38.88
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/11/2023           1      $163.00      $42.33
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023          96      $267.14      $34.56
    017728-00                113594013001 180509497  TEETER           PAULA      01   793700143599470401   07/11/2023          30       $18.00      $16.35
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (3)    ($83.34)    ($17.97)
    017728-00                113594013001 180509497  TEETER           PAULA      01   599050134399470401   07/11/2023          30        $9.00       $3.96
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/10/2023          (1)   ($163.00)    ($42.33)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1)    ($14.00)       $0.00
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/11/2023           9      $302.19      $30.78
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1)    ($92.00)    ($30.07)
    017728-00                113594013001 180509497  TEETER           PAULA      01   423612831000570401   07/11/2023          30       $60.22      $17.66
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1)    ($76.00)    ($25.92)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023         (14)   ($135.98)       $0.00
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1)    ($65.00)    ($38.88)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1)    ($97.00)    ($65.35)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1)    ($38.00)    ($15.86)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (6)   ($201.46)    ($20.52)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/10/2023           1       $65.00      $38.88
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/11/2023          (1)   ($163.00)    ($42.33)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1)    ($37.00)    ($13.52)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1)    ($92.00)    ($84.06)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/11/2023          (1)    ($37.00)    ($13.52)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           6      $201.46      $20.52

                                                                                                                                              PAGE:24 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/10/2023           1       $76.00      $25.92
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1)   ($102.00)    ($57.90)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/11/2023          (1)    ($14.00)       $0.00
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1)   ($126.00)    ($45.14)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1       $97.00      $65.35
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1    $1,134.00     $875.70
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1)   ($126.00)    ($51.64)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/10/2023          (1)    ($76.00)    ($25.92)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1) ($3,409.00) ($1,120.24)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1)    ($97.00)    ($34.48)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (4)    ($33.34)     ($9.00)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/10/2023           4       $28.02       $2.48
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/10/2023          12      $402.92      $41.04
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/11/2023          (1)    ($65.00)    ($38.88)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/10/2023           4       $22.05       $0.76
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/10/2023          (4)    ($33.34)     ($9.00)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1)   ($123.00)    ($79.01)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/10/2023         (19)   ($179.29)       $0.00
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1)    ($48.00)    ($21.47)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/10/2023         (12)   ($402.92)    ($41.04)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1) ($1,134.00)   ($875.70)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           4       $22.05       $0.76
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/11/2023           1       $14.00       $0.00
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (2)    ($22.05)     ($4.10)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/10/2023          (1)    ($65.00)    ($33.53)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1      $424.00      $52.84
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1      $126.00      $51.64
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/10/2023           4       $33.34       $9.00
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/11/2023           1       $37.00      $13.52
    017728-00                113594013001 180509497  TEETER           PAULA      01   985966720550560401   07/10/2023          30       $60.22      $17.66
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/11/2023          (1)    ($76.00)    ($25.92)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/10/2023           1       $37.00      $13.52

                                                                                                                                              PAGE:25 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/10/2023           1       $14.00       $0.00
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023          48    $9,129.08   $3,564.25
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           3      $315.92     $222.77
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/10/2023          (4)    ($22.05)     ($0.76)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1)    ($91.00)    ($32.43)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1      $126.00      $45.14
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1       $22.05       $1.21
    017728-00                113594013001 180509497  TEETER           PAULA      01   483294792299470401   07/10/2023         (30)     ($9.00)     ($3.96)
    017728-00                113594013001 180509497  TEETER           PAULA      01   260012501000570401   07/10/2023         (30)    ($60.22)    ($17.66)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1      $126.00      $51.64
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           3       $83.34      $17.97
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1       $65.00      $38.88
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (1)   ($424.00)    ($52.84)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023         (96)   ($267.14)    ($34.56)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/11/2023          (1)    ($65.00)    ($33.53)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/11/2023           1       $65.00      $33.53
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1       $91.00      $32.43
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/11/2023          (9)   ($112.08)       $0.00
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/10/2023          (1)    ($14.00)       $0.00
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1       $92.00      $84.06
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/10/2023           1       $27.78       $5.99
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/10/2023          19      $179.29       $0.00
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1       $38.00      $15.86
    017728-00                113594013001 180509497  TEETER           PAULA      01   464547527550560401   07/10/2023          30       $18.00      $16.35
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023          (4)    ($22.05)     ($0.76)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/11/2023           9      $112.08       $0.00
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/11/2023          (9)   ($302.19)    ($30.78)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/10/2023          (1)    ($65.00)    ($38.88)
    017728-00                113594013001 180509497  TEETER           PAULA      01   870787607599470401   07/10/2023         (30)    ($18.00)    ($16.35)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/09/2023         (51) ($9,445.00) ($3,564.24)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1       $92.00      $30.07
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/11/2023           1       $76.00      $25.92

                                                                                                                                              PAGE:26 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017728-00                113594013001 180509497  TEETER           PAULA      01   22027944859          05/10/2023          (1)    ($27.78)     ($5.99)
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1      $123.00      $79.01
    017728-00                113594013001 180509497  TEETER           PAULA      01   22030049154          05/09/2023           1       $14.00       $0.00
    017728-00                114875891001 204664917  LUTHER           RENEE      01   22812867802          07/06/2023           1      $150.00       $0.00
    017728-00                114875891001 204664917  LUTHER           JOSEPH     18   22813073433          07/07/2023           1       $88.07       $0.00
    017728-00                114875891001 204664917  LUTHER           JOSEPH     18   22813073433          07/07/2023           1      $148.10       $0.00
    017728-00                114875891001 204664917  LUTHER           JOSEPH     18   22813098416          07/07/2023           1       $13.00       $0.00
    017728-00                114875891001 204664917  LUTHER           JOSEPH     18   22813073433          07/07/2023           1       $33.67       $0.00
    017728-00                114875891001 204664917  LUTHER           RENEE      01   22813098414          07/07/2023           1       $73.00       $0.00
    017728-00                114875891001 204664917  LUTHER           RENEE      01   567743856529700401   07/07/2023          90      $261.40       $0.00
    017728-00                115593107001 208604479  HARR             CHRISTIN   01   567747327003140401   07/09/2023          30      $271.13      $40.94
    017728-00                115593107001 208604479  HARR             CHRISTIN   01   503337137735590401   07/12/2023          30       $76.14      $14.17
    017728-00                115593107001 208604479  HARR             MATTHEW    18   623717786804470401   07/11/2023          30       $13.50      $12.45
    017728-00                115941556001 210707006  LOWMASTER        TIMOTHY    01   894290033353801401   07/13/2023          30      $230.72       $0.00
  017728-00 Total                                                                                                                    $2,328.58     $329.52
  017728- Total                                                                                                                      $2,328.58     $329.52
  104272-02
    104272-02                101295757001 160624529  HOOVER           MILEY      19   524306628397390401   07/12/2023          30      $378.39       $0.00
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22031547819          07/06/2023           1       $25.00       $2.69
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22031547819          07/06/2023           1      $138.00     $107.03
    104272-02                101437249001 162546576  CARBONARA        THERESA    18   22413003887          06/05/2023           1      $332.00     $126.93
    104272-02                101451955001 162628734  NIEBAUER         HEATHER    18   486079121975380401   07/11/2023          30       $39.41       $0.00
    104272-02                101451955001 162628734  NIEBAUER         HEATHER    18   112594672414390401   07/11/2023         (30)    ($39.41)       $0.00
    104272-02                101451955001 162628734  NIEBAUER         HEATHER    18   55588017514390401    07/12/2023          30       $39.41       $0.00
    104272-02                101451955001 162628734  NIEBAUER         ANNALIES   19   220497947442060401   07/10/2023          30      $114.31       $0.00
    104272-02                101451955001 162628734  NIEBAUER         ANNALIES   19   160414532822060401   07/10/2023          30       $42.00       $0.00
    104272-02                101451955001 162628734  NIEBAUER         ANNALIES   19   199667396370160401   07/10/2023          15       $41.59       $0.00
    104272-02                121084549001 162722491  GEORGE           JARED      18   22713186811          07/06/2023           1      $106.00      $22.60
    104272-02                121084549001 162722491  GEORGE           JARED      18   22712887141          07/03/2023           1       $79.00      $31.08
    104272-02                121084549001 162722491  GEORGE           JARED      18   22712887141          07/03/2023           1      $106.00      $22.60
    104272-02                121084549001 162722491  GEORGE           JARED      18   22713186811          07/06/2023           1       $79.00      $31.08
    104272-02                121084549001 162722491  GEORGE           JARED      18   22713186811          07/06/2023           1       $86.00      $24.58

                                                                                                                                              PAGE:27 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                101607826001 164645212  STOHON           NATHAN     18   455557896870290401   07/12/2023           8      $244.01       $0.00
    104272-02                101607826001 164645212  STOHON           GRACE      19   567728368471490401   07/12/2023          10       $24.97       $0.00
    104272-02                101613845001 164701873  MULDOON          JACK       19   22212990037          06/23/2023           1      $644.00       $0.00
    104272-02                118716153001 165649170  CONWAY           KAYLEE     19   22613283680          07/13/2023           1      $130.00       $0.00
    104272-02                118716153001 165649170  CONWAY           KAYLEE     19   22613283680          07/13/2023           1       $37.00       $0.00
    104272-02                118716153001 165649170  CONWAY           KAYLEE     19   22613283680          07/13/2023           1       $45.00       $0.00
    104272-02                135710323001 165723208  RANCK            REAGAN     19   22713367708          07/07/2023           1       $40.00      $38.33
    104272-02                135710323001 165723208  RANCK            REAGAN     19   22713367708          07/07/2023           1      $130.00     $125.27
    104272-02                135710323001 165723208  RANCK            REAGAN     19   22713367708          07/07/2023           1       $15.00      $15.00
    104272-02                135710323001 165723208  RANCK            REAGAN     19   22713367708          07/07/2023           1       $27.00      $21.21
    104272-02                135710323001 165723208  RANCK            LANDON     19   22713367707          07/07/2023           1      $129.00     $126.85
    104272-02                135710323001 165723208  RANCK            REAGAN     19   22713367708          07/07/2023           1      $105.00     $105.00
    104272-02                101903657001 168543440  WEILAND          JAMES      18   117574782560260401   07/10/2023          30      $192.32      $13.94
    104272-02                101918329001 168627615  MCCOMBIE         BLAZE      19   22712771611          06/01/2023           1      $200.00     $120.81
    104272-02                101918329001 168627615  MCCOMBIE         BLAZE      18   22713247946          07/07/2023           1       $60.00      $60.00
    104272-02                101918329001 168627615  MCCOMBIE         BLAZE      18   22713247946          07/07/2023           2       $94.00      $45.20
    104272-02                101918329001 168627615  MCCOMBIE         KIMBERLY   01   22713247947          07/07/2023           2       $94.00      $45.20
    104272-02                101918329001 168627615  MCCOMBIE         BLAZE      19   22712771611          06/01/2023           1       $90.00       $8.50
    104272-02                101918329001 168627615  MCCOMBIE         BLAZE      19   22712771611          06/01/2023           1       $47.00      $10.50
    104272-02                101918329001 168627615  MCCOMBIE         KIMBERLY   01   22713247947          07/07/2023           1       $60.00      $60.00
    104272-02                101918329001 168627615  MCCOMBIE         BLAZE      18   626189481918650401   07/10/2023          10       $76.69      $13.84
    104272-02                101918687001 168628770  STEVENS          DOMINIC    19   22512872636          07/03/2023           1       $27.00       $0.00
    104272-02                101918687001 168628770  STEVENS          SAMUEL     01   22513254265          07/10/2023           1      $215.00       $0.00
    104272-02                101918687001 168628770  STEVENS          DOMINIC    19   22512872636          07/03/2023           1        $5.00       $0.00
    104272-02                101918687001 168628770  STEVENS          DOMINIC    19   22512872636          07/03/2023           1      $129.00       $0.00
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   792396780028260401   07/10/2023          30      $496.80       $0.00
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1      $328.00       $0.00
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           3      $153.00       $0.00
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1       $44.00      $16.66
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1      $322.00       $3.01
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1      $125.00      $30.84
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1       $38.00       $6.95

                                                                                                                                              PAGE:28 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   117907862383260401   07/07/2023         (30)     ($8.28)       $0.00
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   109398758235970401   07/10/2023         (30)   ($496.80)       $0.00
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1       $68.00      $24.30
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   484929341831080401   07/11/2023          21      $347.76       $0.00
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1       $23.00       $0.00
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713184395          07/07/2023           1      $254.00      $55.01
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1      $125.00      $35.58
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1       $61.00      $17.20
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1      $108.00      $27.19
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1       $69.00      $41.37
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1       $67.00      $13.34
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1      $466.00       $0.00
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1       $51.00      $24.30
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           2      $138.00       $0.00
    104272-02                101993438001 169628033  BALL             SETH       19   22213118695          07/10/2023           1      $225.00       $0.00
    104272-02                101993438001 169628033  BALL             SETH       19   779054362661670401   07/11/2023          20       $49.15       $0.00
    104272-02                101993438001 169628033  BALL             SETH       19   737692121015670401   07/11/2023           7       $84.03       $0.00
    104272-02                113905772001 169663596  WAGNER           WILLIAM    18   332047266023930401   07/09/2023          30      $129.90       $0.00
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   22031958192          07/10/2023           1       $55.00      $50.51
    104272-02                102055671001 170520271  GIBSON           HAILEY     19   225288538708801401   07/13/2023          21      $155.11     $124.43
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   22031958192          07/10/2023           1       $25.00      $18.31
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   22031958192          07/10/2023           1       $90.00      $85.70
    104272-02                102159375001 171647155  NIKOLISHEN       JEANNINE   18   962280183685850401   07/10/2023          30       $48.40      $20.62
    104272-02                102243890001 172685116  KUKLA            LOGAN      19   906628041457060401   07/10/2023          30      $322.14      $74.06
    104272-02                102243890001 172685116  KUKLA            MADISON    19   986288218146930401   07/09/2023          30      $170.69       $9.21
    104272-02                135851965001 172764065  LOCHER           MARISA     18   22713147716          07/07/2023           1       $95.00       $0.00
    104272-02                135851965001 172764065  LOCHER           MARISA     18   803060713942780401   07/12/2023          30      $127.95       $0.00
    104272-02                110157934001 173649775  OSTINOWSKY       SARA       18   22413135412          07/10/2023           1      $150.00      $85.00
    104272-02                110157934001 173649775  OSTINOWSKY       SARA       18   22413135412          07/10/2023           1       $25.00       $4.01
    104272-02                110157934001 173649775  OSTINOWSKY       SARA       18   567857076821850401   07/10/2023          28       $54.29      $10.86
    104272-02                102327164001 173700970  FORCELLINI       AMY        18   442357932558501401   07/13/2023          30      $158.01       $8.23
    104272-02                102327164001 173700970  FORCELLINI       CANNON     19   173637646268870401   07/11/2023          30      $305.99      $79.70

                                                                                                                                              PAGE:29 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                102327164001 173700970  FORCELLINI       CANNON     19   859542241558501401   07/13/2023          30      $150.85       $9.21
    104272-02                102327164001 173700970  FORCELLINI       CANNON     19   22813159583          07/11/2023           1      $140.00      $89.99
    104272-02                102403638001 174646831  GERNEY           DAWNA      18   22031767061          07/10/2023           1       $10.00       $0.00
    104272-02                102403638001 174646831  GERNEY           DAWNA      18   22031767061          07/10/2023           1        $5.00       $0.00
    104272-02                102403638001 174646831  GERNEY           DAWNA      18   22031767061          07/10/2023           1       $95.00       $0.00
    104272-02                122695741001 174663939  BEDNAR           CHELSEA    19   22112961873          07/03/2023           4      $140.00      $98.32
    104272-02                122695741001 174663939  BEDNAR           CHELSEA    19   22113317483          06/07/2023           1      $158.00     $110.01
    104272-02                122695741001 174663939  BEDNAR           KIMBERLY   18   22113063389          07/09/2023           2       $79.08      $58.16
    104272-02                122695741001 174663939  BEDNAR           KIMBERLY   18   22113063389          07/09/2023           1        $9.25       $3.30
    104272-02                102484817001 175624053  DEMI             THERESA    18   493435823914470401   07/11/2023          30      $122.42       $5.48
    104272-02                102484817001 175624053  DEMI             THERESA    18   22812912769          07/05/2023           1      $190.00     $120.81
    104272-02                102484817001 175624053  DEMI             THERESA    18   826398811801770401   07/11/2023          30       $82.00       $8.76
    104272-02                102484817001 175624053  DEMI             THERESA    18   377797277814470401   07/11/2023          30       $15.88       $8.86
    104272-02                102484817001 175624053  DEMI             THERESA    18   719798448065670401   07/11/2023          30      $321.18      $16.49
    104272-02                102484817001 175624053  DEMI             THERESA    18   590350203914470401   07/11/2023          30       $19.10       $4.15
    104272-02                102484817001 175624053  DEMI             WILLIAM    19   22812912767          07/03/2023           1      $190.00     $120.81
    104272-02                102567140001 176620059  GIRONDA          SHANNON    18   22813015746          07/05/2023           1      $246.00     $106.11
    104272-02                102636302001 177540502  GILLEN           NATHANIE   19   220237132224411401   07/13/2023          14       $37.86       $8.08
    104272-02                102636302001 177540502  GILLEN           NATHANIE   19   81650664304411401    07/13/2023          20      $286.96      $28.80
    104272-02                102636302001 177540502  GILLEN           NATHANIE   19   22513283470          07/13/2023           1      $262.77      $72.85
    104272-02                102655122001 177649243  MOORE            DAVID      18   960247336879850401   07/10/2023          28       $73.37       $4.35
    104272-02                102655122001 177649243  MOORE            DAVID      18   22613027870          07/05/2023           1      $630.00     $542.81
    104272-02                102655122001 177649243  MOORE            DAVID      18   700637337910950401   07/10/2023          28    $1,357.49     $901.89
    104272-02                102655122001 177649243  MOORE            DAVID      18   274998948800950401   07/10/2023          30       $82.82      $34.60
    104272-02                102655122001 177649243  MOORE            DAVID      18   22612905010          07/05/2023           1      $142.00      $85.70
    104272-02                102655122001 177649243  MOORE            DAVID      18   590520143835340401   07/09/2023           7      $100.10      $26.40
    104272-02                102655122001 177649243  MOORE            DAVID      18   284258107500950401   07/10/2023          10       $62.31      $11.98
    104272-02                102655122001 177649243  MOORE            DAVID      18   741498317116190401   07/12/2023           7       $25.26       $4.49
    104272-02                114861273001 177704151  GRUDZIEN         CARRIE     18   639997196762750401   07/10/2023          30      $127.50      $44.22
    104272-02                102717987001 178523742  LEWIS            TINA       18   796484652323750401   07/10/2023           6       $46.00      $12.54
    104272-02                102736259001 178627674  ELDERS           SUZETTE    18   22813073229          07/06/2023           1       $88.07      $10.00
    104272-02                114581870001 178644516  COPOSKY          JENNIFER   18   22812878020          07/06/2023           5      $412.50     $155.40

                                                                                                                                              PAGE:30 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                114581870001 178644516  COPOSKY          JENNIFER   18   22812878011          07/05/2023           5      $412.50     $155.40
    104272-02                114581870001 178644516  COPOSKY          JENNIFER   18   22813094664          07/10/2023           6      $495.00     $186.48
    104272-02                114581870001 178644516  COPOSKY          JENNIFER   18   22813065459          07/05/2023           1       $29.00      $19.51
    104272-02                114821237001 178664294  RAKAR            DARCY      18   22212976492          06/26/2023           1      $211.00      $66.80
    104272-02                114821237001 178664294  RAKAR            DARCY      18   22212976492          06/26/2023           1      $251.00      $88.49
    104272-02                118208355001 179643695  NILESKI          KARLEE     19   853057446128690401   07/12/2023          30       $34.51      $19.60
    104272-02                118208355001 179643695  NILESKI          KARLEE     19   232354522147930401   07/09/2023          28       $18.27      $16.53
    104272-02                118208355001 179643695  NILESKI          KARLEE     19   606314572352790401   07/12/2023          30       $34.98       $7.95
    104272-02                117984805001 180681319  WARNER           BROOKE     18   442828937937930401   07/09/2023          30        $9.00       $0.00
    104272-02                117984805001 180681319  WARNER           BROOKE     18   477777257845290401   07/12/2023          30        $6.33       $0.00
    104272-02                118477767001 180707184  TEMPLETON        DREW       19   22313181149          07/06/2023           1      $317.00      $98.74
    104272-02                102971874001 181603269  STEPHAN          ADAM       18   22312834869          06/29/2023           1       $90.00      $89.99
    104272-02                110617661001 182683831  GOCHNOUR         CLINTON    18   22212856192          07/05/2023           1      $129.00     $126.85
    104272-02                110617661001 182683831  GOCHNOUR         JULIE      01   22213334022          07/06/2023           1       $27.00      $15.94
    104272-02                110617661001 182683831  GOCHNOUR         PYPER      19   22212976243          07/05/2023           1       $50.00      $50.00
    104272-02                110617661001 182683831  GOCHNOUR         PYPER      19   22212856193          07/05/2023           1      $129.00     $126.85
    104272-02                110617661001 182683831  GOCHNOUR         JULIE      01   22213334022          07/06/2023           1        $4.00       $0.16
    104272-02                110617661001 182683831  GOCHNOUR         PYPER      19   22212856193          07/05/2023           1        $7.00       $6.07
    104272-02                124119460001 183588004  BELL             SHAWN      18   22113285361          07/12/2023           1      $200.00     $118.88
    104272-02                124119460001 183588004  BELL             SHAWN      18   22113149343          07/11/2023           1       $65.00       $8.00
    104272-02                124119460001 183588004  BELL             SHAWN      18   22113149343          07/11/2023           1       $75.00       $8.00
    104272-02                124119460001 183588004  BELL             SHAWN      18   22112977644          06/29/2023           1       $29.50       $0.00
    104272-02                124119460001 183588004  BELL             SHAWN      18   22112977643          06/08/2023           1       $29.50       $0.00
    104272-02                124119460001 183588004  BELL             SHAWN      18   22113149343          07/11/2023           1      $125.00      $11.64
    104272-02                124119460001 183588004  BELL             SHAWN      18   22112977644          06/29/2023           1      $375.00       $0.00
    104272-02                124119460001 183588004  BELL             SHAWN      18   22112874259          06/29/2023           1      $400.00       $0.00
    104272-02                124119460001 183588004  BELL             SHAWN      18   22112977643          06/08/2023           1      $129.00       $0.00
    104272-02                124119460001 183588004  BELL             SHAWN      18   22112977644          06/29/2023           1      $332.00       $0.00
    104272-02                124119460001 183588004  BELL             SHAWN      18   22112977643          06/08/2023           1      $375.00       $0.00
    104272-02                124119460001 183588004  BELL             SHAWN      18   22112977644          06/29/2023           1      $129.00       $0.00
    104272-02                124119460001 183588004  BELL             SHAWN      18   22113149343          07/11/2023           1       $75.00       $7.50
    104272-02                103223419001 184685904  DUMM             MADELINE   19   22713247931          06/07/2023           1      $150.00      $85.70

                                                                                                                                              PAGE:31 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                103223419001 184685904  DUMM             MADELINE   19   22712889783          07/07/2023           1       $24.00      $12.84
    104272-02                120874357001 185584906  KEMOCK           THERESA    18   840018857703870401   07/11/2023          25      $114.41      $70.58
    104272-02                103293323001 185606084  MORRISON         ERIN       18   22513189686          07/12/2023           1       $45.00      $24.58
    104272-02                103293323001 185606084  MORRISON         ERIN       18   22812865085          07/05/2023           1      $150.00     $110.01
    104272-02                103293323001 185606084  MORRISON         ERIN       18   22513189686          07/12/2023           1       $40.00      $23.27
    104272-02                115775315001 187704817  SIPE             GABRIEL    19   22813279498          07/10/2023           2       $50.00      $32.03
    104272-02                115775315001 187704817  SIPE             GABRIEL    19   22813279498          07/10/2023           1       $49.00      $21.21
    104272-02                115775315001 187704817  SIPE             GABRIEL    19   22813279498          07/10/2023           1       $95.00      $46.07
    104272-02                115775315001 187704817  SIPE             GABRIEL    19   22813279498          07/10/2023           1       $49.00      $21.21
    104272-02                115775315001 187704817  SIPE             GABRIEL    19   22813279498          07/10/2023           1      $210.00     $101.13
    104272-02                115775315001 187704817  SIPE             SCOTT      01   712797052665190401   07/12/2023          30    $1,295.24   $1,022.30
    104272-02                115775315001 187704817  SIPE             GABRIEL    19   22813279498          07/10/2023           1      $373.00     $216.20
    104272-02                115775315001 187704817  SIPE             GABRIEL    19   552986420005850401   07/10/2023          20       $42.00      $42.00
    104272-02                115775315001 187704817  SIPE             SAMUEL     19   22813279499          07/10/2023           1      $210.00     $101.13
    104272-02                103551054001 188665731  KIM              MIKALAH    19   22613311305          07/10/2023           1       $39.00      $14.18
    104272-02                103551054001 188665731  KIM              MIKALAH    19   22613311305          07/10/2023           1       $23.00       $0.00
    104272-02                103551054001 188665731  KIM              MEKENNA    19   22613205991          06/21/2023           1      $150.00      $80.66
    104272-02                103553425001 188685513  KIRSCH           EMMA       19   22113111739          07/11/2023           1       $40.00      $12.84
    104272-02                103553425001 188685513  KIRSCH           EMMA       19   22112948395          07/07/2023           1       $40.00      $12.84
    104272-02                103553425001 188685513  KIRSCH           EMMA       19   22113288983          07/13/2023           1       $40.00      $12.84
    104272-02                103625291001 189584046  WESTRICK         STEPHEN    18   890276640667801401   07/13/2023          30       $29.99      $12.53
    104272-02                103625291001 189584046  WESTRICK         STEPHEN    18   36898907848411401    07/13/2023          30       $29.80       $5.43
    104272-02                111045735001 189641841  MILLER           ASHLEY     18   22031863479          07/05/2023           1      $107.00      $21.03
    104272-02                111045735001 189641841  MILLER           BRENNAN    19   22031761179          07/10/2023           1       $50.00      $33.32
    104272-02                111045735001 189641841  MILLER           JOHN       01   964536380124650401   07/10/2023          30      $146.34       $5.45
    104272-02                111045735001 189641841  MILLER           JOHN       01   335987397494470401   07/11/2023          10      $270.02     $138.92
    104272-02                111045735001 189641841  MILLER           MYAH       19   22031761180          07/10/2023           1       $50.00      $33.32
    104272-02                111045735001 189641841  MILLER           BRENNAN    19   22031761179          07/10/2023           1       $25.00      $11.87
    104272-02                111045735001 189641841  MILLER           ASHLEY     18   22031761178          07/10/2023           1       $20.00      $12.15
    104272-02                111045735001 189641841  MILLER           MYAH       19   22031761180          07/10/2023           2       $60.00      $49.16
    104272-02                111045735001 189641841  MILLER           ASHLEY     18   22031786635          07/05/2023           1        $8.00       $3.25
    104272-02                111045735001 189641841  MILLER           JOHN       01   167787914140401      07/09/2023           7       $10.80       $4.60

                                                                                                                                              PAGE:32 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                111045735001 189641841  MILLER           ASHLEY     18   22031863479          07/05/2023           1       $67.00      $34.47
    104272-02                111045735001 189641841  MILLER           JOHN       01   696037976522750401   07/10/2023          30      $159.01       $8.23
    104272-02                111045735001 189641841  MILLER           ASHLEY     18   22031761178          07/10/2023           1       $25.00      $24.58
    104272-02                111045735001 189641841  MILLER           ASHLEY     18   22031761178          07/10/2023           1       $40.00      $33.32
    104272-02                111045735001 189641841  MILLER           BRENNAN    19   22031875792          07/10/2023           1      $130.00      $89.99
    104272-02                111045735001 189641841  MILLER           ASHLEY     18   22031761178          07/10/2023           1       $15.00      $11.87
    104272-02                111045735001 189641841  MILLER           JOHN       01   285598338622750401   07/10/2023          30       $76.04      $12.99
    104272-02                111045735001 189641841  MILLER           BRENNAN    19   678795333383360401   07/10/2023          17       $75.02      $43.30
    104272-02                111045735001 189641841  MILLER           BRENNAN    19   956338541483360401   07/10/2023          14       $86.50      $17.73
    104272-02                111045735001 189641841  MILLER           MYAH       19   22031761180          07/10/2023           1       $30.00      $22.41
    104272-02                111045735001 189641841  MILLER           BRENNAN    19   22031761179          07/10/2023           1       $30.00      $24.58
    104272-02                111045735001 189641841  MILLER           MYAH       19   22031761180          07/10/2023           1       $25.00      $11.87
    104272-02                122351577001 189724811  KOPCZYK          STACY      18   22613372190          07/03/2023           1      $158.00      $41.87
    104272-02                122351577001 189724811  KOPCZYK          STACY      18   22613034583          07/06/2023           1      $313.00      $44.06
    104272-02                122351577001 189724811  KOPCZYK          STACY      18   22613169804          07/07/2023           1      $100.00      $41.08
    104272-02                122351577001 189724811  KOPCZYK          STACY      18   22613034583          07/06/2023           1      $355.00     $103.91
    104272-02                122351577001 189724811  KOPCZYK          STACY      18   22613372190          07/03/2023           1      $137.00      $22.48
    104272-02                122351577001 189724811  KOPCZYK          STACY      18   22613133456          07/06/2023           1      $827.00     $542.81
    104272-02                122351577001 189724811  KOPCZYK          STACY      18   22613169804          07/07/2023           1      $220.00     $109.89
    104272-02                122351577001 189724811  KOPCZYK          STACY      18   22613133456          07/06/2023           1      $423.00     $248.43
    104272-02                103643051001 189746790  VANFOSSEN        ALESHA     18   22513049234          06/27/2023           1      $149.00      $71.89
    104272-02                103699741001 190489435  SMITH            DORIS      18   14730854534170401    07/11/2023          30       $21.48       $0.00
    104272-02                103699741001 190489435  SMITH            DORIS      18   382218397530590401   07/11/2023         (30)    ($21.48)       $0.00
    104272-02                103699741001 190489435  SMITH            DORIS      18   800306478925370401   07/11/2023          30        $9.99       $0.00
    104272-02                103699741001 190489435  SMITH            DORIS      18   389557616630590401   07/12/2023          30       $21.48       $0.00
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22312834868          07/07/2023           1       $10.00       $9.62
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313060497          07/06/2023           1       $76.00      $38.82
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313060497          07/06/2023           1       $23.00       $0.00
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313060497          07/06/2023           1       $86.00      $23.22
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   193730464699290401   07/12/2023           5        $9.99       $2.43
    104272-02                103713375001 190569811  SCHWEITZER       EMMA       19   570687816465850401   07/10/2023          10      $111.51      $12.49
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313060497          07/06/2023           1       $81.00      $40.96

                                                                                                                                              PAGE:33 of 69
                                                                                                                                                            
            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   22313060497          07/06/2023           1       $69.00      $33.34
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313060497          07/06/2023           1       $42.00      $15.81
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313060497          07/06/2023           1       $96.00      $43.25
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313060497          07/06/2023           1       $67.00      $13.34
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   998448847154390401   07/12/2023          30      $235.55       $9.29
    104272-02                103713375001 190569811  SCHWEITZER       AMELIA     19   558808710802490401   07/12/2023          30      $150.85       $9.21
    104272-02                103713375001 190569811  SCHWEITZER       EMMA       19   142229871650950401   07/10/2023           7       $17.03       $9.78
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313060497          07/06/2023           1       $37.00      $31.02
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313060497          07/06/2023           1      $104.00      $16.66
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313060497          07/06/2023           1       $65.00      $35.09
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313060497          07/06/2023           1       $87.00      $37.46
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313060497          07/06/2023           1      $190.00      $32.85
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   385686810100390401   07/12/2023          30      $788.90     $142.32
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313060497          07/06/2023           1      $108.00      $27.19
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313060497          07/06/2023           1      $172.00      $43.84
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22312834868          07/07/2023           1       $27.00      $15.94
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313060497          07/06/2023           1       $67.00      $20.00
    104272-02                103713375001 190569811  SCHWEITZER       AMELIA     19   22312832118          07/06/2023           1      $158.00     $110.01
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   468997426665490401   07/12/2023          30       $62.99      $27.75
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313060497          07/06/2023           5      $535.00     $230.79
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313060497          07/06/2023           1       $87.00      $37.84
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313060497          07/06/2023           1       $38.00       $6.95
    104272-02                103717291001 190600652  KUPCHELLA        GREGORY    01   22413166123          07/11/2023           1      $209.00       $0.00
    104272-02                103717291001 190600652  KUPCHELLA        GREGORY    01   22413272875          07/10/2023           1      $102.00       $0.00
    104272-02                103717291001 190600652  KUPCHELLA        GREGORY    01   22413272875          07/10/2023           1       $23.00       $0.00
    104272-02                115278421001 190668800  DUGAN            BRADLEY    01   322010873530111401   07/13/2023          30      $384.54       $0.00
    104272-02                103812819001 191649655  PROKOP           LAKKIN     19   22613311306          07/10/2023           1       $86.00      $23.22
    104272-02                103812819001 191649655  PROKOP           LAKKIN     19   22613311306          07/10/2023           1       $44.00      $16.66
    104272-02                103812819001 191649655  PROKOP           BOBBI      18   761207957166550401   07/10/2023          90      $434.20      $22.43
    104272-02                103812819001 191649655  PROKOP           BOBBI      18   22613259308          07/11/2023           1      $186.09     $120.81
    104272-02                103812819001 191649655  PROKOP           LAKKIN     19   22613311306          07/10/2023           1       $96.00      $43.25
    104272-02                103812819001 191649655  PROKOP           LAKKIN     19   718908341751670401   07/11/2023          30      $165.87       $7.09

                                                                                                                                              PAGE:34 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                103812819001 191649655  PROKOP           LAKKIN     19   22613311306          07/10/2023           1       $23.00       $0.00
    104272-02                103812819001 191649655  PROKOP           LAKKIN     19   22613311306          07/10/2023           1      $102.00      $21.78
    104272-02                103812819001 191649655  PROKOP           BOBBI      18   658447742687870401   07/11/2023          30      $165.87       $7.09
    104272-02                103814953001 191669673  LAMARK           ANTHONY    19   226218227699770401   07/11/2023          30      $478.99     $356.40
    104272-02                103814953001 191669673  LAMARK           TAWNYA     01   125524982067790401   07/12/2023          21       $40.99      $14.19
    104272-02                103814953001 191669673  LAMARK           TAWNYA     01   529830864371811401   07/13/2023          30       $46.79      $12.90
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22213087148          06/26/2023           1       $95.00      $85.70
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22213059928          07/07/2023           2       $70.00      $49.16
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22212974057          07/03/2023           3      $105.00      $73.74
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22213215143          07/11/2023           2       $94.00      $45.20
    104272-02                103958453001 193504313  SHAFFER          GREGORY    18   677736920910730401   07/09/2023          33      $191.50     $130.10
    104272-02                103958453001 193504313  SHAFFER          GREGORY    18   22213215142          07/11/2023           1       $60.00      $60.00
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22213059928          07/07/2023           1       $90.00      $11.87
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22213059928          07/07/2023           1       $70.00      $10.45
    104272-02                103958453001 193504313  SHAFFER          GREGORY    18   373569642063598301   07/01/2023          60      $752.13     $547.27
    104272-02                103958453001 193504313  SHAFFER          GREGORY    18   22213215142          07/11/2023           2       $94.00      $45.20
    104272-02                103958453001 193504313  SHAFFER          GREGORY    18   443508527910730401   07/09/2023          33       $27.50       $7.36
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22213215143          07/11/2023           1       $60.00      $60.00
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22212974057          07/03/2023           1       $70.00      $10.45
    104272-02                103960961001 193522698  PAGANO           KAREN      18   22812916119          07/03/2023           1      $312.00      $44.85
    104272-02                103960961001 193522698  PAGANO           ALBERT     01   632155363585670401   07/11/2023          30        $4.00       $4.00
    104272-02                103960961001 193522698  PAGANO           KAREN      18   22812926487          07/03/2023           1      $642.00     $248.43
    104272-02                116900492001 193709853  MAZZARELLA       JAMIE      18   22513148899          07/07/2023           1       $31.00       $0.00
    104272-02                116900492001 193709853  MAZZARELLA       JAMIE      18   22513148899          07/07/2023           1      $236.00      $53.92
    104272-02                116900492001 193709853  MAZZARELLA       JAMIE      18   22513148898          07/05/2023           1       $31.00       $0.00
    104272-02                116900492001 193709853  MAZZARELLA       JAMIE      18   22513148899          07/07/2023           1      $273.00      $64.45
    104272-02                116900492001 193709853  MAZZARELLA       JAMIE      18   22513148898          07/05/2023           1      $273.00      $64.45
    104272-02                135291530001 196767240  FARABAUGH        DOMINIC    18   22213299647          07/10/2023           1      $145.00      $74.97
    104272-02                135291530001 196767240  FARABAUGH        DOMINIC    18   235718091108750401   07/10/2023           6       $35.64      $12.54
    104272-02                110735193001 198603232  DAVIS            JUSTIN     01   919838787933950401   07/10/2023          25       $87.02      $70.58
    104272-02                133177478001 198763668  FOUST            CASIDY     18   22513048850          06/30/2023           1      $295.00       $0.00
    104272-02                104473668001 199609100  MCHUGH           SANDRA     01   22312934635          07/05/2023           1      $300.00     $138.65

                                                                                                                                              PAGE:35 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                104473668001 199609100  MCHUGH           SANDRA     01   631868688706880401   07/12/2023          30       $85.26      $20.62
    104272-02                104561618001 200626571  MYERS            JULIA      19   22513315487          07/11/2023           1      $145.00       $0.00
    104272-02                104561618001 200626571  MYERS            JACQUELI   18   22512869823          07/06/2023           1      $246.00     $124.83
    104272-02                121483612001 200709933  KMETZ            CAMDEN     19   21179253994          03/04/2022           1      $369.00     $214.05
    104272-02                111760051001 200724515  BARTO            REBECCA    18   22412996943          07/06/2023           1      $200.00     $100.00
    104272-02                104739733001 202709413  SEMELSBERGER     SUSANNA    18   22113068923          07/07/2023           1       $67.00       $0.00
    104272-02                131156919001 202748584  MCCABE           JEMMA      19   22031856911          07/11/2023           1      $150.00     $146.09
    104272-02                131156919001 202748584  MCCABE           JEMMA      19   22031856911          07/11/2023           2       $70.00      $40.40
    104272-02                131156919001 202748584  MCCABE           JEMMA      19   22031856911          07/11/2023           1      $120.00      $45.84
    104272-02                131156919001 202748584  MCCABE           JEMMA      19   22031856911          07/11/2023           4       $80.00      $61.00
    104272-02                131156919001 202748584  MCCABE           JEMMA      19   22031856911          07/11/2023           1      $153.00     $113.67
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   22413010417          07/10/2023           1      $125.00      $85.70
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   886658070169011401   07/13/2023          30       $31.48       $3.93
    104272-02                104795329001 203523973  CORRENTE         TRISTAN    19   280317116839590401   07/12/2023          14      $173.11      $16.30
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   828376880353950401   07/10/2023          12       $32.56       $8.80
    104272-02                104795329001 203523973  CORRENTE         WILLIAM    18   22412890851          07/06/2023           1      $302.58     $120.81
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   589679451459011401   07/13/2023          30      $153.79       $9.54
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   863008377759011401   07/13/2023          30      $137.80      $13.12
    104272-02                104795329001 203523973  CORRENTE         WILLIAM    18   22412890851          07/06/2023           1       $60.00      $17.61
    104272-02                104801669001 203563037  JENKINS          EDWARD     01   22813248604          07/01/2023           1      $100.00      $39.40
    104272-02                104801669001 203563037  JENKINS          EDWARD     01   279052953207510401   07/08/2023          90      $135.40      $76.60
    104272-02                104801669001 203563037  JENKINS          DAWN       18   22812842641          06/15/2023           1      $226.70     $135.36
    104272-02                104801669001 203563037  JENKINS          DAWN       18   22812842641          06/15/2023           1        $9.25       $3.30
    104272-02                104801669001 203563037  JENKINS          EDWARD     01   22813248604          07/01/2023           1       $50.00      $28.93
    104272-02                104801669001 203563037  JENKINS          EDWARD     01   249897567304650401   07/10/2023          90      $146.00      $18.16
    104272-02                104811837001 203624160  DORSCH           SHAWN      01   22613289900          07/12/2023           1       $30.00      $14.69
    104272-02                104811837001 203624160  DORSCH           SHAWN      01   22613312338          06/14/2023           1      $205.00     $101.05
    104272-02                104811837001 203624160  DORSCH           SHAWN      01   22613289900          07/12/2023           1       $45.00      $33.32
    104272-02                104811837001 203624160  DORSCH           SHAWN      01   22613312338          06/14/2023           1       $21.00      $15.45
    104272-02                104811837001 203624160  DORSCH           SHAWN      01   22613289900          07/12/2023           1       $21.00      $11.87
    104272-02                104811837001 203624160  DORSCH           SHAWN      01   22613312338          06/14/2023           1       $21.00      $15.73
    104272-02                104821551001 203720987  YESENOSKY        HADLEY     19   22031549798          06/29/2023           1       $90.00      $89.99

                                                                                                                                              PAGE:36 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                104821606001 203721732  SHANER           NATALIE    19   22112948407          07/07/2023           1       $40.00      $21.21
    104272-02                104821606001 203721732  SHANER           NATALIE    19   22112948407          07/07/2023           1       $40.00      $10.96
    104272-02                104821606001 203721732  SHANER           LOGAN      19   22112948406          07/07/2023           1      $180.00      $81.62
    104272-02                104821606001 203721732  SHANER           NATALIE    19   22112948407          07/07/2023           1       $85.00      $48.14
    104272-02                104821606001 203721732  SHANER           LOGAN      19   22112948406          07/07/2023           1      $185.00     $119.36
    104272-02                104821606001 203721732  SHANER           LOGAN      19   22112948406          07/07/2023           1      $400.00     $362.95
    104272-02                104821606001 203721732  SHANER           LOGAN      19   22112948406          07/07/2023           1       $40.00       $2.99
    104272-02                104821606001 203721732  SHANER           LOGAN      19   22112948406          07/07/2023           2       $80.00      $42.42
    104272-02                104821606001 203721732  SHANER           NATALIE    19   22112948407          07/07/2023           1       $40.00      $10.96
    104272-02                104821606001 203721732  SHANER           LOGAN      19   22112948406          07/07/2023           1       $35.00      $16.70
    104272-02                104821606001 203721732  SHANER           NATALIE    19   22112948407          07/07/2023           1      $185.00     $119.36
    104272-02                104821606001 203721732  SHANER           LOGAN      19   22112948406          07/07/2023           6      $240.00      $96.08
    104272-02                119571853001 205587218  GWIZDAK          LORI       18   22413049787          07/08/2023           1       $40.00      $11.87
    104272-02                119571853001 205587218  GWIZDAK          LORI       18   22413049787          07/08/2023           1       $50.00      $33.32
    104272-02                119571853001 205587218  GWIZDAK          LORI       18   22413049787          07/08/2023           1       $60.00      $22.41
    104272-02                119571853001 205587218  GWIZDAK          THOMAS     01   22413049789          07/07/2023           1       $50.00      $33.32
    104272-02                119571853001 205587218  GWIZDAK          THOMAS     01   22413049789          07/07/2023           1       $40.00      $10.45
    104272-02                119571853001 205587218  GWIZDAK          THOMAS     01   22413049789          07/07/2023           1       $40.00      $11.87
    104272-02                119571853001 205587218  GWIZDAK          LORI       18   22413049787          07/08/2023           1       $40.00      $10.45
    104272-02                119571853001 205587218  GWIZDAK          THOMAS     01   797750133724170401   07/11/2023          30       $71.29       $4.94
    104272-02                119571853001 205587218  GWIZDAK          THOMAS     01   22413049789          07/07/2023           1       $60.00      $22.41
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22513294086          07/06/2023           1       $42.00      $18.05
    104272-02                105057437001 206567193  GILKEY           KEITH      18   692777482849650401   07/10/2023          90      $243.10      $59.62
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22513294086          07/06/2023           1       $75.00      $26.36
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22513294086          07/06/2023           1       $56.00      $22.62
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22513294086          07/06/2023           1      $101.00      $42.95
    104272-02                105057437001 206567193  GILKEY           COOPER     19   824757187390160401   07/10/2023          10       $16.23       $7.01
    104272-02                105057437001 206567193  GILKEY           KEITH      18   8487097744260401     07/10/2023          90      $541.80     $298.91
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22513112370          07/06/2023           1      $190.00     $133.50
    104272-02                105057437001 206567193  GILKEY           KEITH      18   970216803639220401   07/08/2023          90      $412.60      $23.37
    104272-02                105057437001 206567193  GILKEY           COOPER     19   585357886690160401   07/10/2023          30      $228.35      $24.44
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22513294086          07/06/2023           1       $89.00      $31.52

                                                                                                                                              PAGE:37 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                105057437001 206567193  GILKEY           COOPER     19   282386230352760401   07/11/2023          30      $156.65       $8.62
    104272-02                105057437001 206567193  GILKEY           KEITH      18   127716413639220401   07/08/2023          90       $19.30       $0.61
    104272-02                105057437001 206567193  GILKEY           KEITH      18   838428110639220401   07/08/2023          90       $64.75      $12.55
    104272-02                105070575001 206649577  RIBARICH         ROBIN      18   22313130145          07/07/2023           1      $209.00       $0.00
    104272-02                105133377001 207505950  VICINI           TIMOTHY    18   357622811298701401   07/13/2023          30       $18.58       $0.00
    104272-02                105133377001 207505950  VICINI           TIMOTHY    18   998262661551890401   07/12/2023          30       $18.58       $0.00
    104272-02                105133377001 207505950  VICINI           TIMOTHY    18   25778760209801401    07/12/2023         (30)     ($4.00)       $0.00
    104272-02                105133377001 207505950  VICINI           TIMOTHY    18   275158370741890401   07/12/2023          30       $36.21       $0.00
    104272-02                105133377001 207505950  VICINI           TIMOTHY    18   704678750898801401   07/13/2023          30       $36.21       $0.00
    104272-02                105133377001 207505950  VICINI           TIMOTHY    18   470276998209801401   07/13/2023          30        $4.00       $0.00
    104272-02                105133377001 207505950  VICINI           TIMOTHY    18   30207687198701401    07/12/2023         (30)    ($18.58)       $0.00
    104272-02                105133377001 207505950  VICINI           TIMOTHY    18   505274172741890401   07/12/2023          30        $4.00       $0.00
    104272-02                105133377001 207505950  VICINI           TIMOTHY    18   708686328898801401   07/12/2023         (30)    ($36.21)       $0.00
    104272-02                105313170001 209561991  MAGULICK         RICHARD    18   616799981321470401   07/06/2023          30       $17.78       $0.00
    104272-02                105313170001 209561991  MAGULICK         RICHARD    18   22313137980          07/06/2023          20       $22.05       $2.60
    104272-02                105313170001 209561991  MAGULICK         RICHARD    18   22313137980          07/06/2023           1       $22.05       $0.00
    104272-02                105313170001 209561991  MAGULICK         RICHARD    18   22313137980          07/06/2023           1    $1,456.00   $1,689.99
    104272-02                105313170001 209561991  MAGULICK         RICHARD    18   22313137980          07/06/2023           1       $27.78      $10.52
    104272-02                105313170001 209561991  MAGULICK         RICHARD    18   22312831798          07/06/2023           1      $621.00     $220.73
    104272-02                105313170001 209561991  MAGULICK         RICHARD    18   22313137980          07/06/2023           1      $180.00       $0.00
    104272-02                105313170001 209561991  MAGULICK         RICHARD    18   22313137980          07/06/2023           1      $557.00       $0.00
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212310328          06/24/2023           1       $73.25      $28.58
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212310328          06/24/2023           1      $429.00     $397.21
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212310328          06/24/2023           1      $825.00     $503.89
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212310328          06/24/2023           1      $573.00     $490.93
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212310328          06/24/2023           1      $108.00      $34.06
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212310328          06/24/2023           1       $73.25      $28.58
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212310328          06/24/2023           1      $121.00     $138.59
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212310328          06/24/2023           1      $108.00      $34.06
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212310328          06/24/2023           1      $202.00     $185.43
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212310328          06/24/2023           1      $151.00      $29.28
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212310328          06/24/2023           1      $224.00      $27.62

                                                                                                                                              PAGE:38 of 69
                                                                                                                                                            
            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   665496060153650401   07/10/2023          10        $4.00       $4.00
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212310328          06/24/2023           1    $1,455.00      $53.41
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212310328          06/24/2023           1       $17.00       $0.00
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212310328          06/24/2023           1      $131.00      $49.35
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212956374          06/24/2023           1      $184.00      $61.62
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212310328          06/24/2023           1      $113.00      $15.99
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212310328          06/24/2023         100      $100.00      $60.55
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212956374          06/24/2023           1      $140.00      $58.54
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212310328          06/24/2023           1       $17.00       $0.00
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212310328          06/24/2023           1    $1,712.00     $578.10
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22212310328          06/24/2023           4      $217.00      $94.46
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22312825574          07/03/2023           1      $358.00      $30.99
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22313191208          07/11/2023           1      $175.00     $102.69
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   163525833736701401   07/13/2023          30       $27.63      $26.12
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22312825574          07/03/2023           1      $715.00      $38.56
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22313191208          07/11/2023           1       $30.00       $2.00
    104272-02                118612138001 220230729  EDMISTON         LAUREL     19   22413052703          07/10/2023           1       $18.00       $2.83
    104272-02                118612138001 220230729  EDMISTON         LAUREL     19   22413052703          07/10/2023           1      $185.00     $112.39
    104272-02                118612138001 220230729  EDMISTON         KIMBERLY   18   894246498343870401   07/11/2023          30       $58.88      $15.76
    104272-02                118612138001 220230729  EDMISTON         KIMBERLY   18   22413135373          07/11/2023           1      $125.00      $85.70
    104272-02                107536593001 391923055  SHAFFER          IAN        19   22313017848          07/10/2023           1       $70.00      $26.58
    104272-02                107536593001 391923055  SHAFFER          NICHOLAS   18   22312721214          06/27/2023           1      $118.50      $74.18
    104272-02                114286162001 394927245  SHAFFER          RENEE      18   22413100083          06/30/2023           1       $75.00      $42.60
    104272-02                114286162001 394927245  SHAFFER          RENEE      18   22413100083          06/30/2023           1      $160.00       $0.00
    104272-02                114286162001 394927245  SHAFFER          RENEE      18   22413100083          06/30/2023           1       $30.00      $20.20
  104272-02 Total                                                                                                                   $58,255.74  $22,480.19
  104272-09
    104272-09                101226816001 159666231  STIFFLER         AYDEN      19   22031703239          06/21/2023           1      $100.00      $85.70
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713090618          06/15/2023           1      $225.00      $66.99
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713090618          06/15/2023           1       $88.75      $21.83
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713090618          06/15/2023           1      $252.00      $67.48
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713090619          06/23/2023           1      $207.00      $65.00

                                                                                                                                              PAGE:39 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713090619          06/23/2023           1       $88.75      $21.83
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713090618          06/15/2023           1      $207.00      $65.00
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713090619          06/23/2023           1      $123.00      $30.70
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713090618          06/15/2023           1      $123.00      $30.70
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22712789947          07/02/2023          23      $396.54     $253.23
    104272-09                122665066001 163589264  KASCHALK         MARY       18   768308211010390401   07/12/2023          14       $78.12       $2.66
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713297374          07/07/2023           5      $321.00      $37.85
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713297374          07/07/2023           5    $1,430.00   $1,215.00
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713249362          06/30/2023           1      $193.00      $62.82
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713090619          06/23/2023           1      $225.00      $66.99
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22712789947          07/02/2023           5    $1,430.00   $1,215.00
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22712789947          07/02/2023           5      $321.00      $37.85
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713335095          07/12/2023           1      $527.00     $170.43
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713297374          07/07/2023          23      $396.54     $253.23
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713090619          06/23/2023           1      $252.00      $67.48
    104272-09                112895895001 171602746  MESORAS          JENNIFER   18   519160013109830401   07/09/2023          30      $158.01       $8.23
    104272-09                112895895001 171602746  MESORAS          JENNIFER   18   303376968009830401   07/09/2023          20       $85.45       $5.84
    104272-09                112895895001 171602746  MESORAS          JENNIFER   18   171906448663750401   07/10/2023          30      $143.04      $16.71
    104272-09                118503729001 181720719  SANTINI          EMILY      01   984107117075670401   07/11/2023          30    $1,042.69     $836.71
    104272-09                113645111001 199688428  STRITTMATTER     HADLEIGH   19   22513232537          07/12/2023           1       $40.00       $2.99
    104272-09                113645111001 199688428  STRITTMATTER     HADLEIGH   19   22513232537          07/12/2023           1       $40.00       $4.95
    104272-09                113645111001 199688428  STRITTMATTER     HADLEIGH   19   22513232537          07/12/2023           1       $40.00      $21.21
    104272-09                113645111001 199688428  STRITTMATTER     HADLEIGH   19   22513232537          07/12/2023           1       $35.00      $16.70
    104272-09                113645111001 199688428  STRITTMATTER     HADLEIGH   19   22513232537          07/12/2023           1      $450.00     $372.36
    104272-09                113645111001 199688428  STRITTMATTER     HADLEIGH   19   22513232537          07/12/2023           1      $185.00     $130.20
    104272-09                113645111001 199688428  STRITTMATTER     ALISHA     01   22513229047          07/06/2023           1      $163.00     $102.70
  104272-09 Total                                                                                                                    $9,366.89   $5,356.37
  104272-12
    104272-12                135039874001 183502743  MAZZARELLA       MARY       18   22413018710          07/10/2023           1      $135.00       $0.00
    104272-12                135039874001 183502743  MAZZARELLA       MARY       18   22413018710          07/10/2023           1       $50.00       $0.00
    104272-12                104623467001 201509415  PERSIO           MARIA      18   22613264280          03/01/2023           1      $369.00       $0.00
    104272-12                104623467001 201509415  PERSIO           MARIA      18   662576028506011401   07/13/2023          30       $39.45       $0.00

                                                                                                                                              PAGE:40 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  104272-12 Total                                                                                                                      $593.45       $0.00
  104272- Total                                                                                                                     $68,216.08  $27,836.56
HDHP PPO Total                                                                                                                     $217,164.82  $90,741.89
                                                                                                                                                            
Major Medical
  053264-01
    053264-01                107311465001 363488272  DONGELL          LINDA      18   38180730907          06/21/2023           1        $6.00       $4.80
    053264-01                107311465001 363488272  DONGELL          LINDA      18   38180730907          06/21/2023           1        $6.00       $4.80
    053264-01                107311465001 363488272  DONGELL          LINDA      18   38180730907          06/26/2023           1        $9.49       $7.59
    053264-01                107311465001 363488272  DONGELL          LINDA      18   38180730907          06/21/2023           1        $6.00       $4.80
  053264-01 Total                                                                                                                       $27.49      $21.99
  053264- Total                                                                                                                         $27.49      $21.99
Major Medical Total                                                                                                                     $27.49      $21.99
                                                                                                                                                            
PPO
  014267-01
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/23/2023          18    $2,232.00   $1,764.94
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/22/2023           2       $59.00       $0.00
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/22/2023           1      $240.00     $222.92
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/22/2023           1      $194.00      $55.50
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/23/2023           7      $108.00       $0.00
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/22/2023           1        $4.50       $4.38
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/23/2023           1       $34.25      $16.86
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/22/2023           1      $120.00      $18.33
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/22/2023           1      $214.00      $56.25
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/23/2023           1      $156.00      $53.64
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/23/2023           1       $40.00      $10.87
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/22/2023           1       $34.25      $16.86
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/23/2023           2       $59.00       $0.00
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/22/2023           3       $56.25       $0.00
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/22/2023          18    $2,232.00   $1,614.94
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/22/2023           4      $331.00     $220.77

                                                                                                                                              PAGE:41 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/23/2023           1      $181.00      $77.51
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/23/2023           1      $203.00       $0.00
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/22/2023           1    $2,086.00     $619.24
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/22/2023           8      $228.00     $180.79
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/22/2023           1      $229.00     $217.44
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/23/2023           1    $2,108.00   $1,136.14
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/23/2023           1       $34.25      $16.86
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/23/2023           1      $123.00      $30.70
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/22/2023           1      $156.00      $53.64
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/22/2023           1       $34.25      $16.86
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712988639          06/23/2023           1      $105.00      $77.03
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22712875788          06/22/2023           1      $129.00      $35.85
    014267-01                101534701001 163661783  MCMAHON          KRISTINA   18   22412970042          07/05/2023           1      $220.00      $94.89
    014267-01                101534701001 163661783  MCMAHON          KRISTINA   18   22412970042          07/05/2023           1       $20.00       $5.91
    014267-01                101911501001 168586533  GEORGE           TERESA     18   22113285831          07/11/2023           1      $127.00     $126.32
    014267-01                101911501001 168586533  GEORGE           TERESA     18   22112946687          07/06/2023           1      $190.00     $100.00
    014267-01                101911501001 168586533  GEORGE           TERESA     18   22113285831          07/11/2023           1       $20.00       $0.00
    014267-01                113324089001 181506290  MCINTOSH         CONSTANC   18   22413132174          06/29/2023           1       $20.00      $12.84
    014267-01                113324089001 181506290  MCINTOSH         CONSTANC   18   22413132174          06/29/2023           1       $20.00      $12.84
    014267-01                102962866001 181546596  DURKAY           STEPHEN    18   22413217577          07/08/2023           1      $135.00      $37.33
    014267-01                102962866001 181546596  DURKAY           STEPHEN    18   22413217577          07/08/2023           1      $228.00      $65.42
    014267-01                102962866001 181546596  DURKAY           STEPHEN    18   22413217577          07/08/2023           1       $31.00       $0.00
    014267-01                102962866001 181546596  DURKAY           STEPHEN    18   22413217577          07/08/2023           1      $129.00      $31.14
    014267-01                102962866001 181546596  DURKAY           STEPHEN    18   22413217577          07/08/2023           1      $152.00      $42.32
    014267-01                103208282001 184584093  MACALUS          RHONDA     18   22813158849          07/06/2023           1       $88.07       $0.00
    014267-01                103208282001 184584093  MACALUS          RHONDA     18   22813158849          07/06/2023           1      $148.10      $13.00
    014267-01                103208282001 184584093  MACALUS          RHONDA     18   22813153243          07/06/2023           1      $220.00      $94.89
    014267-01                103208282001 184584093  MACALUS          RHONDA     18   22813158849          07/06/2023           1      $130.49       $0.00
    014267-01                103208282001 184584093  MACALUS          RHONDA     18   22813153243          07/06/2023           1       $20.00       $0.00
    014267-01                104231917001 196603987  HUTSKY           JOSEPH     18   22112842059          07/05/2023           1      $209.00     $100.81
  014267-01 Total                                                                                                                   $13,838.41   $7,256.03
  014267-03

                                                                                                                                              PAGE:42 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                100658703001 125504688  MULLIGAN         ANDREA     18   22312889651          07/05/2023           1      $160.00       $0.00
    014267-03                101229215001 159686054  HITE             ALLISON    18   22513077452          10/18/2022           1       $45.00      $27.40
    014267-03                101229215001 159686054  HITE             ALLISON    18   22513077452          10/18/2022           1       $35.00      $10.45
    014267-03                101229215001 159686054  HITE             ALLISON    18   22513077452          10/18/2022           1      $125.00      $84.19
    014267-03                101229215001 159686054  HITE             ALLISON    18   22513077452          10/18/2022           2       $94.00      $49.16
    014267-03                101229215001 159686054  HITE             ALLISON    18   22513077451          11/22/2022           3      $141.00      $73.74
    014267-03                101229215001 159686054  HITE             ALLISON    18   22513077451          11/22/2022           1       $35.00      $10.45
    014267-03                101229346001 159686619  THOMAS           HANNAH     19   22113048040          07/06/2023           3      $288.00       $0.00
    014267-03                110652030001 161544709  ANDREWS          SHANNON    18   22031572283          06/30/2023           1       $72.00      $42.60
    014267-03                110652030001 161544709  ANDREWS          SHANNON    18   22031572283          06/30/2023           1      $240.00     $148.53
    014267-03                110652030001 161544709  ANDREWS          SHANNON    18   22031572283          06/30/2023           1       $46.00      $20.20
    014267-03                110652030001 161544709  ANDREWS          SHANNON    18   22031649916          07/03/2023           1      $175.00     $100.81
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613027562          07/06/2023           1      $213.00       $0.00
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613027562          07/06/2023           1      $203.00       $0.00
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613027562          07/06/2023           1       $76.00       $0.00
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613350852          07/10/2023           1       $55.00      $37.00
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613027562          07/06/2023           1       $14.00       $0.00
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613027562          07/06/2023           1      $141.00       $0.00
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613027562          07/06/2023           1      $114.00       $0.00
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613027562          07/06/2023           1       $97.00       $0.00
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613027562          07/06/2023           1      $124.00       $0.00
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613027562          07/06/2023           1       $97.00      $68.74
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613027562          07/06/2023           1      $259.00       $0.00
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613027562          07/06/2023           1      $282.00       $0.00
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613027562          07/06/2023           1       $92.00       $0.00
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613027562          07/06/2023           1      $424.00       $0.00
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613350852          07/10/2023           1       $50.00      $31.00
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613027562          07/06/2023           1       $65.00       $0.00
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613027562          07/06/2023           1      $300.00       $0.00
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613027562          07/06/2023           1      $114.00       $0.00
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613027562          07/06/2023           1      $126.00       $0.00
    014267-03                101375474001 161644485  DAVIS            DANA       18   22511611669          06/14/2023           1    $1,579.90   $1,164.50

                                                                                                                                              PAGE:43 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                101375474001 161644485  DAVIS            DANA       18   22511611669          06/14/2023           1       $92.00      $69.66
    014267-03                101375474001 161644485  DAVIS            DANA       18   22511611669          06/14/2023          (1)    ($92.00)    ($69.66)
    014267-03                101593218001 164562405  HOOVER           KELLY      18   22312955574          07/06/2023           1       $48.00      $58.59
    014267-03                101593218001 164562405  HOOVER           KELLY      18   22313039382          07/06/2023           1      $358.00      $30.99
    014267-03                101593218001 164562405  HOOVER           KELLY      18   22312955574          07/06/2023           1      $497.00     $225.44
    014267-03                101593218001 164562405  HOOVER           KELLY      18   22313039382          07/06/2023           1      $715.00      $38.56
    014267-03                122684801001 165748370  POOLE            ELLIOT     19   22512891214          07/05/2023           1      $176.00     $160.70
    014267-03                122684801001 165748370  POOLE            BENSON     19   22512891213          07/05/2023           4      $148.00      $67.10
    014267-03                122684801001 165748370  POOLE            ELLIOT     19   22512891214          07/05/2023           4      $148.00      $67.10
    014267-03                122684801001 165748370  POOLE            BENSON     19   22512891213          07/05/2023           1      $176.00     $160.70
    014267-03                122684801001 165748370  POOLE            ELLIOT     19   22512891214          07/05/2023           1      $211.00     $125.04
    014267-03                122684801001 165748370  POOLE            ELLIOT     19   22512891214          07/05/2023           1       $54.00      $22.22
    014267-03                122684801001 165748370  POOLE            BENSON     19   22512891213          07/05/2023           1      $211.00     $125.04
    014267-03                122684801001 165748370  POOLE            BENSON     19   22512891213          07/05/2023           1       $54.00      $22.22
    014267-03                101995873001 169646253  MANACK           BRANDON    01   22712427757          06/23/2023           1    $6,837.00   $1,509.73
    014267-03                101995873001 169646253  MANACK           BRANDON    01   22712427757          06/23/2023         100      $675.00     $403.23
    014267-03                101995873001 169646253  MANACK           BRANDON    01   22712427757          06/23/2023           1       $88.00      $18.82
    014267-03                101995873001 169646253  MANACK           BRANDON    01   22712427757          06/23/2023           1      $528.00      $26.90
    014267-03                102151761001 171602272  MISLEVY          NATHAN     19   22613205856          07/11/2023           1       $96.00      $65.70
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22613198537          07/11/2023           1       $50.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22613198537          07/11/2023           2      $160.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          NATHAN     19   22613198536          07/11/2023           2      $150.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22613198537          07/11/2023           1       $84.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22613111970          07/05/2023           1       $50.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22613111970          07/05/2023           1       $80.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22613111970          07/05/2023           2      $168.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          NATHAN     19   22613198536          07/11/2023           1       $80.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22613198537          07/11/2023           1       $50.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22613111970          07/05/2023           1       $50.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          NATHAN     19   22613198536          07/11/2023           1       $84.00       $0.00
    014267-03                102486556001 175629643  HRITZ            DARREN     01   22113022657          06/20/2023           2       $11.11       $6.60
    014267-03                102486556001 175629643  HRITZ            DARREN     01   22113022369          07/05/2023           1       $65.00       $0.00

                                                                                                                                              PAGE:44 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                102486556001 175629643  HRITZ            DARREN     01   22113022657          06/20/2023           1       $84.56      $50.07
    014267-03                102486556001 175629643  HRITZ            DARREN     01   22113022657          06/20/2023           1       $62.00      $28.14
    014267-03                102486556001 175629643  HRITZ            DARREN     01   22113022657          06/20/2023           1       $57.00      $25.42
    014267-03                102486556001 175629643  HRITZ            DARREN     01   22113022657          06/20/2023           1       $17.84      $14.00
    014267-03                102486556001 175629643  HRITZ            DARREN     01   22113022369          07/05/2023           1      $150.00     $100.81
    014267-03                102486556001 175629643  HRITZ            DARREN     01   22113022657          06/20/2023           1      $228.63     $135.36
    014267-03                102486556001 175629643  HRITZ            DARREN     01   22113022657          06/20/2023           1       $18.58      $11.00
    014267-03                102732865001 178607248  NAGEL            ERIC       18   22713180649          07/07/2023           1       $55.00       $0.00
    014267-03                102732865001 178607248  NAGEL            ERIC       18   22713180649          07/07/2023           1      $196.00       $0.00
    014267-03                102741496001 178667598  KOSS             SUMMER     19   22713115070          06/28/2023           1       $78.00      $16.72
    014267-03                102741496001 178667598  KOSS             SERENA     19   22713207107          07/07/2023           1       $47.00       $3.32
    014267-03                102741496001 178667598  KOSS             JEFFREY    18   22713101271          07/10/2023           1      $160.00       $0.00
    014267-03                102741496001 178667598  KOSS             JEFFREY    18   22713101271          07/10/2023           1       $97.00      $33.48
    014267-03                102741496001 178667598  KOSS             SUMMER     19   22713015739          07/06/2023           1      $209.00       $0.00
    014267-03                102741496001 178667598  KOSS             JEFFREY    18   22713154872          07/02/2023           1      $151.50       $0.00
    014267-03                102741496001 178667598  KOSS             JEFFREY    18   22713327587          07/10/2023           1      $186.90       $0.00
    014267-03                102741496001 178667598  KOSS             JEFFREY    18   22713068730          06/26/2023           1       $84.56      $50.07
    014267-03                113722774001 180661551  DUCLO            ALLISON    18   22712427536          06/26/2023           1    $2,680.00   $1,406.92
    014267-03                113722774001 180661551  DUCLO            ALLISON    18   22712427536          06/26/2023          30       $60.00       $0.00
    014267-03                113722774001 180661551  DUCLO            ALLISON    18   22712427536          06/26/2023         100      $675.00     $641.89
    014267-03                102898332001 180688012  HITE             DOUGLAS    01   22031880986          06/29/2023           1       $56.00       $0.00
    014267-03                102898332001 180688012  HITE             DOUGLAS    01   22031880986          06/29/2023           1      $183.00      $90.81
    014267-03                102898332001 180688012  HITE             DOUGLAS    01   22031880986          06/29/2023           1       $44.00       $0.00
    014267-03                102898332001 180688012  HITE             DOUGLAS    01   22031880986          06/29/2023           1      $158.00       $0.00
    014267-03                102898332001 180688012  HITE             DOUGLAS    01   22031880986          06/29/2023           1       $80.00       $0.00
    014267-03                102898332001 180688012  HITE             DOUGLAS    01   22031880986          06/29/2023           1       $42.00       $0.00
    014267-03                102898332001 180688012  HITE             DOUGLAS    01   22031880986          06/29/2023           1       $44.00       $0.00
    014267-03                102898332001 180688012  HITE             DOUGLAS    01   22031880986          06/29/2023           1       $44.00       $0.00
    014267-03                102898332001 180688012  HITE             DOUGLAS    01   22031880986          06/29/2023           1       $70.00       $0.00
    014267-03                102972300001 181604543  SCHIRATO         MARIA      18   22612904802          07/06/2023           4       $16.00       $0.00
    014267-03                102972300001 181604543  SCHIRATO         MARIA      18   22612904802          07/05/2023           1       $99.00       $0.00
    014267-03                102986121001 181726473  SMITH            LAKEN      18   22312860076          07/06/2023           1        $7.00       $0.00

                                                                                                                                              PAGE:45 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                102986121001 181726473  SMITH            LAKEN      18   22312860076          07/06/2023           1      $135.00      $69.99
    014267-03                103288637001 185583037  NEFF             PAMELA     01   22211598974          06/15/2023          (1)   ($132.00)    ($85.21)
    014267-03                103288637001 185583037  NEFF             PAMELA     01   22211598974          06/15/2023           1      $132.00      $85.21
    014267-03                103288637001 185583037  NEFF             PAMELA     01   22211598974          06/15/2023          (1)    ($14.00)       $0.00
    014267-03                103288637001 185583037  NEFF             PAMELA     01   22211598974          06/15/2023           1       $14.00       $0.00
    014267-03                103288637001 185583037  NEFF             PAMELA     01   22211598974          06/15/2023           1      $125.00      $77.51
    014267-03                103288637001 185583037  NEFF             PAMELA     01   22211598974          06/15/2023           1      $132.00      $85.21
    014267-03                103288637001 185583037  NEFF             PAMELA     01   22211598974          06/15/2023           1      $125.00      $77.51
    014267-03                103288637001 185583037  NEFF             PAMELA     01   22211598974          06/15/2023          (1)   ($132.00)    ($85.21)
    014267-03                103305848001 185705093  LANE             APRIL      18   22512992367          07/05/2023           1      $868.00       $0.00
    014267-03                103305848001 185705093  LANE             APRIL      18   22512979140          07/05/2023           1      $336.00       $0.00
    014267-03                126605497001 185728227  KIRSCH           HUNTER     19   22413228066          06/05/2023           1       $47.00       $0.00
    014267-03                126605497001 185728227  KIRSCH           RAEANNA    18   22413267782          07/11/2023           1      $175.00       $0.00
    014267-03                126605497001 185728227  KIRSCH           HUNTER     19   22413228066          06/05/2023           1      $200.00     $100.81
    014267-03                103377064001 186607237  BRACKEN          KELLY      18   22412869048          06/30/2023           1      $129.00     $106.85
    014267-03                114686704001 186607919  TERZA            ISABELL    19   22112802621          07/06/2023           2       $80.00      $42.42
    014267-03                114686704001 186607919  TERZA            ISABELL    19   22112802621          07/06/2023           1      $220.00     $216.20
    014267-03                114686704001 186607919  TERZA            ISABELL    19   22112802621          07/06/2023           1       $40.00       $2.99
    014267-03                114686704001 186607919  TERZA            ISABELL    19   22112802621          07/06/2023           1      $385.00     $292.72
    014267-03                114686704001 186607919  TERZA            ISABELL    19   22112802621          07/06/2023           1       $40.00       $4.95
    014267-03                114686704001 186607919  TERZA            ISABELL    19   22112802621          07/06/2023           1       $35.00      $16.70
    014267-03                114686704001 186607919  TERZA            ISABELL    19   22112802621          07/06/2023           1      $185.00     $130.20
    014267-03                103529602001 188526813  VENESKY          CHRIS      01   22113055291          06/30/2023           1       $87.00      $35.03
    014267-03                103529602001 188526813  VENESKY          CHRIS      01   22112943816          02/20/2023           1      $339.00     $178.76
    014267-03                103529602001 188526813  VENESKY          CHRIS      01   22113055291          06/30/2023           1       $76.00      $44.79
    014267-03                103529602001 188526813  VENESKY          CHRIS      01   22113055291          06/30/2023           1      $103.00      $41.10
    014267-03                103536981001 188580018  MALLOY           KAREN      18   22031569558          07/06/2023           1      $600.00     $140.08
    014267-03                103536981001 188580018  MALLOY           KAREN      18   22031569558          07/06/2023           2    $2,150.00     $558.14
    014267-03                103536981001 188580018  MALLOY           KAREN      18   22031569558          07/06/2023           1       $74.00      $50.51
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023           1      $236.00     $166.81
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023          25        $6.25       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023          (1)    ($83.00)       $0.00

                                                                                                                                              PAGE:46 of 69
                                                                                                                                                            
            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   22211107476          05/17/2023          (1) ($1,159.00)   ($822.44)
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023           1       $17.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023           1       $17.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023           1      $148.00     $104.76
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023          10      $120.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213074501          06/09/2023           1      $405.00     $287.09
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023           2       $26.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023          (2)    ($26.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023           2       $26.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023           7       $91.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023           4       $52.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023          36       $72.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023           1       $76.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023           1      $236.00     $166.81
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023          (1)    ($76.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023         200      $400.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023           1    $1,159.00     $822.44
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023         (30)    ($60.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023          (4)    ($52.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023          25        $6.25       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023          (1)   ($236.00)   ($166.81)
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023          (2)    ($24.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023           1      $405.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056789          06/16/2023          12   $17,220.00   $4,327.69
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023         (25)     ($6.25)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023         130    $1,170.00     $599.46
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023          (1) ($1,159.00)   ($822.44)
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023         164      $328.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023           1      $360.00     $298.82
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023        (130) ($1,170.00)   ($599.46)
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023          (1)   ($360.00)   ($298.82)
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023           1       $17.00       $0.00

                                                                                                                                              PAGE:47 of 69
                                                                                                                                                            
            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   22211107357          05/31/2023          25        $6.25       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023           1      $145.00     $104.76
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023           2       $24.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194107          05/03/2023           1      $240.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023          (7)    ($91.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023          10        $4.50       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023         (25)     ($6.25)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023           1      $145.00     $104.76
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194107          05/03/2023         100      $200.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023          (1)   ($240.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023           7       $91.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023         100      $200.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213061222          07/02/2023           4      $756.00     $354.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194107          05/03/2023         130    $1,170.00     $599.46
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023          (2)    ($24.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023          (1)   ($405.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023           1      $240.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194107          05/03/2023          10      $120.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213152797          06/07/2023           1       $79.00      $45.29
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056811          06/21/2023           1      $150.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213074501          06/09/2023           1      $150.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213143634          06/30/2023           1      $236.00     $166.81
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056789          06/16/2023           1      $236.00     $166.81
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023          10        $4.50       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023           2       $24.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213074501          06/09/2023           1      $135.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023           2       $26.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023         (10)   ($120.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023           1      $240.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213291283          06/18/2023           1      $220.00     $155.60
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023         (36)    ($72.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194107          05/03/2023           1      $190.00     $166.81

                                                                                                                                              PAGE:48 of 69
                                                                                                                                                            
            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   22213056830          06/28/2023          10      $120.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023           1      $405.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213291283          06/23/2023           1      $220.00     $155.60
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023           2       $24.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023           1      $236.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023           2       $24.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194107          05/03/2023          28       $56.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194107          05/03/2023           2       $26.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194107          05/03/2023         172      $344.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056811          06/21/2023           1      $135.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023           7       $91.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023           4       $52.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023           1      $236.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023           1    $1,159.00     $822.44
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023          10        $4.50       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023          (2)   ($296.00)   ($209.54)
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023           1      $236.00     $166.81
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023         (10)     ($4.50)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023          10      $900.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023           1      $236.00     $166.81
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213300522          05/19/2023           1    $1,602.30     $262.51
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023           1      $236.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023           1    $1,159.00     $822.44
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023          (1)   ($236.00)   ($166.81)
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023           1      $145.00     $104.76
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213061222          07/02/2023           4       $70.92       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194107          05/03/2023           1      $188.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023        (164)   ($328.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023         (10)     ($4.50)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023          (4)    ($52.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023          (1)   ($236.00)   ($166.81)
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023           4       $52.00       $0.00

                                                                                                                                              PAGE:49 of 69
                                                                                                                                                            
            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   22211194107          05/03/2023           7       $91.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107411          05/05/2023          (1)   ($188.00)   ($166.81)
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194107          05/03/2023           1      $188.00     $166.81
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194107          05/03/2023          10      $900.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023          10      $900.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107411          05/05/2023           1      $188.00     $166.81
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194107          05/03/2023           1      $188.00     $166.81
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056835          06/02/2023           1      $236.00     $166.81
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023          (1)   ($236.00)   ($166.81)
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194107          05/03/2023          25        $6.25       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194107          05/03/2023          10        $4.50       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194107          05/03/2023           2       $24.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023        (130) ($1,170.00)   ($599.46)
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023           1      $405.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023         100      $200.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023          36       $72.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023           1      $360.00     $298.82
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023          10        $4.50       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023           1      $145.00     $104.76
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023          (1)   ($236.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023          (1)   ($145.00)   ($104.76)
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213058900          07/05/2023           1      $263.00      $55.70
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023           1    $1,159.00     $822.44
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023           1      $236.00     $166.81
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023         170      $340.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023          25        $6.25       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023           1      $236.00     $166.81
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023           1       $76.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023         164      $328.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023        (100)   ($200.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056811          06/21/2023           1      $340.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023          (1)   ($145.00)   ($104.76)

                                                                                                                                              PAGE:50 of 69
                                                                                                                                                            
            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   22211107357          05/31/2023           2       $26.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023           1      $405.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023           1      $236.00     $166.81
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023          (1)   ($240.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023        (170)   ($340.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023          10      $120.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213291283          06/07/2023           1      $220.00     $155.60
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023           1       $83.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023           1      $236.00     $166.81
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023           1       $76.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023           2      $296.00     $209.54
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056811          06/21/2023           1      $405.00     $287.09
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023           1      $360.00     $298.82
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023           7       $91.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056835          06/02/2023          12   $17,220.00   $4,327.69
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194107          05/03/2023           1      $145.00     $104.76
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194107          05/03/2023           1      $960.00     $822.44
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023           1      $240.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023          10      $900.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023          30       $60.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023         130    $1,170.00     $599.46
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023        (100)   ($200.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023          (7)    ($91.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213074501          06/09/2023           1      $340.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023          (1)   ($405.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023          (1)   ($236.00)   ($166.81)
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023           1      $236.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023           2      $472.00     $333.64
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023         (10)   ($120.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023           1      $236.00     $166.81
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023           4       $52.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056799          06/14/2023          10      $120.00       $0.00

                                                                                                                                              PAGE:51 of 69
                                                                                                                                                            
            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   22211107411          05/05/2023          12   $17,220.00   $4,327.69
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023          10      $900.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023          (1)   ($236.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023         130    $1,170.00     $599.46
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211194107          05/03/2023           4       $52.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023          (1)    ($17.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023          (2)    ($26.00)       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023         100      $200.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107357          05/31/2023           1      $240.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22211107476          05/17/2023           1      $236.00     $166.81
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213056830          06/28/2023         130    $1,170.00     $599.46
    014267-03                128323370001 189744510  TOTH             BRIANNA    18   22213213327          07/07/2023           1      $220.00      $89.89
    014267-03                103710443001 190560450  BOGUS            CODY       19   22512992668          06/23/2023           6      $127.54       $0.00
    014267-03                103710443001 190560450  BOGUS            CODY       19   22512992668          06/23/2023           8       $44.10       $0.00
    014267-03                103710443001 190560450  BOGUS            CODY       19   22512992668          06/23/2023           1      $251.00       $0.00
    014267-03                103710443001 190560450  BOGUS            CODY       19   22512992668          06/23/2023           2      $240.00       $0.00
    014267-03                103710443001 190560450  BOGUS            CODY       19   22512992668          06/23/2023           5      $298.71       $0.00
    014267-03                103710443001 190560450  BOGUS            CODY       19   22512992668          06/23/2023           1       $44.10       $0.00
    014267-03                103710443001 190560450  SHEARMAN         WILLIAM    01   22513263253          07/07/2023           1      $109.30      $23.48
    014267-03                103710443001 190560450  BOGUS            CODY       19   22512992668          06/23/2023           1       $27.78       $0.00
    014267-03                103710443001 190560450  BOGUS            CODY       19   22512999197          06/23/2023           1      $320.00     $111.67
    014267-03                103710443001 190560450  BOGUS            CODY       19   22512992668          06/23/2023           1      $277.00       $0.00
    014267-03                103710443001 190560450  BOGUS            CODY       19   22512992668          06/23/2023          12    $1,728.00       $0.00
    014267-03                103710443001 190560450  SHEARMAN         JOAN       18   22513166749          07/11/2023           1      $205.00      $90.81
    014267-03                103710443001 190560450  BOGUS            CODY       19   22512992668          06/23/2023          30       $33.08       $0.00
    014267-03                103710443001 190560450  BOGUS            CODY       19   22512992668          06/23/2023           4       $33.86       $0.00
    014267-03                103710443001 190560450  BOGUS            CODY       19   22512992668          06/23/2023           4       $22.05       $0.00
    014267-03                103710443001 190560450  BOGUS            CODY       19   22512992668          06/23/2023           1    $5,849.00   $1,477.70
    014267-03                103710443001 190560450  BOGUS            CODY       19   22512992668          06/23/2023           2       $22.05       $0.00
    014267-03                103710443001 190560450  BOGUS            CODY       19   22512992668          06/23/2023           1       $22.05       $0.00
    014267-03                103710443001 190560450  BOGUS            CODY       19   22512992668          06/23/2023           3    $1,420.00       $0.00
    014267-03                103710443001 190560450  SHEARMAN         JOAN       18   22513166749          07/11/2023           1      $410.00       $0.00

                                                                                                                                              PAGE:52 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                103710443001 190560450  BOGUS            CODY       19   22512992668          06/23/2023           3      $564.00       $0.00
    014267-03                103817438001 191700343  BROWN            MATTHEW    18   22813069178          06/20/2023           1       $42.45      $42.45
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22513007751          07/10/2023           1       $25.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22513007751          07/10/2023           1       $50.00       $3.32
    014267-03                103817438001 191700343  BROWN            MATTHEW    18   22813069178          06/20/2023           1       $10.00      $10.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22513178399          07/12/2023           1       $25.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22513178399          07/12/2023           1       $25.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22513178399          07/12/2023           1       $50.00       $3.32
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22513007751          07/10/2023           1       $25.00       $0.00
    014267-03                103968095001 193564829  KINNEY           EVAN       19   22513096460          07/11/2023           1      $240.00     $148.53
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22812884025          06/30/2023           1      $515.00     $157.52
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813287284          06/05/2023           1       $35.00      $15.18
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813094640          07/07/2023           1    $1,370.00     $101.10
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813287284          06/05/2023           4       $12.00       $4.76
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813094643          06/28/2023           1      $400.00      $56.40
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813273083          07/09/2023           1    $1,370.00     $101.10
    014267-03                110383851001 194682923  WARGO            JOHN       01   22313151639          07/03/2023           1       $47.00       $3.32
    014267-03                104217524001 196520554  FORD             LAURA      18   22813334158          06/21/2023           1      $140.00     $100.81
    014267-03                120189904001 199707914  FETSKO           ELOWYN     19   22713071764          07/10/2023           1      $140.00      $69.99
    014267-03                104641701001 201623847  MCGINNIS         DAVID      01   21694589039          10/18/2022           1      $760.27      $38.55
    014267-03                104641701001 201623847  MCGINNIS         DAVID      01   21694589039          10/18/2022           1    $6,690.35   $6,690.35
    014267-03                104641701001 201623847  MCGINNIS         DAVID      01   21694589039          10/18/2022          (1)   ($760.27)   ($760.27)
    014267-03                104641701001 201623847  MCGINNIS         DAVID      01   21694589039          10/18/2022          (1) ($6,690.35) ($6,690.35)
    014267-03                104697984001 202442564  MEIDINGER        JEFFREY    18   22313189624          07/05/2023           1       $70.00       $0.00
    014267-03                104697984001 202442564  MEIDINGER        JEFFREY    18   22313109768          07/05/2023           1      $282.00       $0.00
    014267-03                105154214001 207627750  KLINE            ETHAN      19   22513055596          07/10/2023           1      $140.00      $69.99
    014267-03                112953016001 207643714  LEWIS            BLAKE      19   22112950666          06/08/2023           1      $300.00     $117.00
    014267-03                112953016001 207643714  LEWIS            BLAKE      19   22112950666          06/08/2023           1      $150.00      $58.50
    014267-03                105481344001 211520772  STRASSER         JANINE     01   22313046859          04/11/2023           1      $239.00     $106.85
    014267-03                105481344001 211520772  STRASSER         JANINE     01   22312824989          06/28/2023           1      $550.00     $140.08
    014267-03                105481344001 211520772  STRASSER         JANINE     01   22312824989          06/28/2023           1      $260.00      $79.37
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   22031948728          07/03/2023           1    $2,065.00       $0.00

                                                                                                                                              PAGE:53 of 69
                                                                                                                                                            
            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            GEORGE     01   22031546717          07/03/2023           1      $589.00       $0.00
    014267-03                114739500001 211701060  FEES             KENNEDY    19   22312934901          07/05/2023           1      $149.00      $41.89
    014267-03                114739500001 211701060  FEES             KENNEDY    19   22313219730          07/12/2023          30      $258.90       $0.00
    014267-03                114739500001 211701060  FEES             KENNEDY    19   22313181125          07/05/2023           1      $619.00       $0.00
    014267-03                114739500001 211701060  FEES             KENNEDY    19   22313189721          07/05/2023           1       $24.00       $0.00
    014267-03                114739500001 211701060  FEES             EASTON     19   22312934902          07/05/2023           1      $149.00      $41.89
    014267-03                114739500001 211701060  FEES             EASTON     19   22313181124          07/05/2023           1      $317.00       $0.00
    014267-03                114739500001 211701060  FEES             KENNEDY    19   22313219730          07/12/2023          30    $1,857.00       $0.00
    014267-03                114739500001 211701060  FEES             EASTON     19   22313189722          07/05/2023           1       $23.00       $0.00
  014267-03 Total                                                                                                                  $133,127.02  $34,536.40
  014267-05
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22812086764          06/15/2023           1      $640.00     $152.01
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22813152852          06/30/2023           1      $239.00      $90.74
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22812987620          06/15/2023           1       $67.00      $16.50
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22813152852          06/30/2023           1      $220.00      $96.02
    014267-05                101665655001 165520467  FISANICK         LAURA      18   22813008694          06/27/2023           1      $360.00     $298.82
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22812995376          07/05/2023           1      $125.00      $47.85
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22812987620          06/15/2023           1       $32.00      $12.32
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22812086764          06/15/2023           1    $1,078.00      $88.16
    014267-05                135605376001 165742483  WHALEN           BRITTANY   18   22031952487          07/12/2023           1      $190.00     $100.00
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22713237345          06/29/2023           2       $22.00      $70.00
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22713237345          06/29/2023           1   $18,045.00   $2,493.55
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22713237345          06/29/2023           7    $3,528.00       $0.00
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22713237345          06/29/2023           2        $2.50      $12.66
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22713237345          06/29/2023           1       $20.75       $3.99
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22713237345          06/29/2023           4       $82.00      $24.30
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22713237345          06/29/2023           1      $671.00       $4.38
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22712988998          06/29/2023           1      $891.00     $313.19
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22713237345          06/29/2023           1        $8.00       $4.38
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22713237345          06/29/2023           8        $8.00      $33.98
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22713237345          06/29/2023           2      $350.00       $0.00
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22713237345          06/29/2023           1       $26.50      $16.65

                                                                                                                                              PAGE:54 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22713237345          06/29/2023         150      $150.00      $57.35
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22713237345          06/29/2023           3       $40.50      $13.13
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22713237345          06/29/2023           2    $1,886.00       $0.00
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22712988971          06/29/2023           1      $451.00     $313.19
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22713237345          06/29/2023           1        $8.00       $4.38
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22713237345          06/29/2023         100      $100.00      $33.98
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22713237345          06/29/2023           1        $1.00       $0.00
    014267-05                109938670001 166680558  SHUTTY           PARKER     19   22713237345          06/29/2023           4      $135.00     $103.48
    014267-05                101995157001 169643849  WENDEROTH        FRED       18   22213299127          07/12/2023           1      $275.00      $95.81
    014267-05                101995157001 169643849  WENDEROTH        FRED       18   22213332350          06/26/2023           1      $114.91      $73.36
    014267-05                101995157001 169643849  WENDEROTH        FRED       18   22213299127          07/12/2023           1       $50.00      $17.61
    014267-05                112228663001 170540291  SHERRY           TAYLOR     19   22413093469          07/05/2023           1      $120.00     $110.01
    014267-05                102075179001 170640732  SHUTTY           ERIN       01   22513277073          07/10/2023           1       $95.00      $60.70
    014267-05                129935534001 172742640  CAMPBELL         KENNETH    01   22512973056          07/07/2023           1       $45.00       $8.32
    014267-05                115823363001 173706254  RUDDOCK          ALIVIA     19   22512998427          06/30/2023           1      $163.00      $80.99
    014267-05                115823363001 173706254  RUDDOCK          GIANA      19   22512998426          06/30/2023           1      $163.00      $80.99
    014267-05                102801153001 179566492  LANEY            ERIC       01   22313126025          07/10/2023           1      $224.00     $109.19
    014267-05                102801153001 179566492  LANEY            KAREN      18   22313064514          06/27/2023           1      $160.00      $95.81
    014267-05                102892610001 180645375  PARONISH         CAMDEN     19   22213120598          07/10/2023           1        $8.00       $5.00
    014267-05                102892610001 180645375  PARONISH         CAMDEN     19   22213120598          07/10/2023           1      $141.00     $112.97
    014267-05                102892610001 180645375  PARONISH         CAMDEN     19   22213120598          07/10/2023           1       $30.00      $26.70
    014267-05                102892610001 180645375  PARONISH         CAMDEN     19   22213120598          07/10/2023           1       $15.00       $2.57
    014267-05                102892610001 180645375  PARONISH         CAMDEN     19   22213120598          07/10/2023           1        $8.00       $5.50
    014267-05                102971934001 181603444  NELSON           JULIE      01   22713119596          06/28/2023           2       $80.00      $46.68
    014267-05                102971934001 181603444  NELSON           JULIE      01   22713119596          06/28/2023           1       $30.00       $0.00
    014267-05                102971934001 181603444  NELSON           JULIE      01   22713119596          06/28/2023           1       $50.00       $8.32
    014267-05                115392593001 189764421  FOX              JENNIFER   18   22213163552          07/11/2023           1      $120.00     $110.01
    014267-05                115392593001 189764421  FOX              JENNIFER   18   22212853878          07/05/2023           1      $120.00     $110.01
    014267-05                133298619001 193702336  SMITH            LAUREN     18   22613194059          07/05/2023           1      $158.00       $0.00
    014267-05                133298619001 193702336  SMITH            BRANDON    01   22613175377          07/05/2023           1       $39.00      $12.36
    014267-05                133298619001 193702336  SMITH            LAUREN     18   22613194059          07/05/2023           1    $2,241.00     $770.69
    014267-05                133298619001 193702336  SMITH            BRANDON    01   22613203096          07/05/2023           1      $242.00     $132.86

                                                                                                                                              PAGE:55 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                133298619001 193702336  SMITH            LAUREN     18   22613194059          07/05/2023           1       $88.00       $0.00
    014267-05                133298619001 193702336  SMITH            LAUREN     18   22613194059          07/05/2023           1       $80.00       $0.00
    014267-05                133298619001 193702336  SMITH            LAUREN     18   22613194059          07/05/2023           1      $116.00       $0.00
    014267-05                133298619001 193702336  SMITH            LAUREN     18   22613194059          07/05/2023           1    $1,176.00     $257.88
    014267-05                133298619001 193702336  SMITH            LAUREN     18   22613194059          07/05/2023           1      $200.00       $0.00
    014267-05                104078368001 194767581  BRADY            CHELSEA    18   22613265862          05/10/2023           1       $47.00       $0.00
    014267-05                104078368001 194767581  BRADY            CHELSEA    18   22613265862          05/10/2023           1      $290.00     $132.86
    014267-05                104213378001 196487222  MICCO            GARY       01   22213082759          07/06/2023           1      $499.00     $213.28
    014267-05                104241138001 196668859  MCCRACKEN        KIMBERLY   18   22613204256          06/29/2023           1       $64.00      $24.46
    014267-05                104318685001 197640477  HUDAK            JUSTICE    19   22031920715          07/12/2023           1      $130.00      $95.81
    014267-05                126331099001 197728059  MCKEE            LILIANA    19   22712927776          07/02/2023           1      $260.00     $110.00
    014267-05                126331099001 197728059  MCKEE            LILIANA    19   22712886687          07/02/2023           1      $361.00     $132.35
    014267-05                126331099001 197728059  MCKEE            LILIANA    19   22712927776          07/02/2023           1      $255.00     $255.00
    014267-05                104458297001 199522163  NICHOL           BRENNA     18   22413272840          07/10/2023           1      $259.00     $151.96
    014267-05                104458297001 199522163  NICHOL           BRENNA     18   22413272840          07/10/2023           1       $14.00       $0.00
    014267-05                104458297001 199522163  NICHOL           BRENNA     18   22413077599          07/07/2023           1      $158.00     $101.05
    014267-05                104458297001 199522163  NICHOL           BRENNA     18   22413272840          07/10/2023           1      $424.00      $54.21
    014267-05                104458297001 199522163  NICHOL           BRENNA     18   22413272840          07/10/2023           1       $97.00      $68.74
    014267-05                104458297001 199522163  NICHOL           BRENNA     18   22413272840          07/10/2023           1       $65.00      $39.89
    014267-05                104458297001 199522163  NICHOL           BRENNA     18   22413272840          07/10/2023           1       $92.00      $86.25
    014267-05                114051191001 200641754  STARUCH          KEVIN      18   22512992698          07/07/2023           1      $108.00      $13.64
    014267-05                114051191001 200641754  STARUCH          KEVIN      18   22512992698          07/07/2023           1       $53.00      $13.18
    014267-05                114051191001 200641754  STARUCH          KEVIN      18   22512992698          07/07/2023           2      $296.00       $0.00
    014267-05                114051191001 200641754  STARUCH          KEVIN      18   22512992698          07/07/2023           1      $226.00       $0.00
    014267-05                114051191001 200641754  STARUCH          KEVIN      18   22512992698          07/07/2023           1       $91.00      $13.34
    014267-05                114051191001 200641754  STARUCH          KEVIN      18   22512992698          07/07/2023           1       $86.00       $2.25
    014267-05                114051191001 200641754  STARUCH          KEVIN      18   22512992698          07/07/2023           1       $38.00       $6.95
    014267-05                114051191001 200641754  STARUCH          KEVIN      18   22512992698          07/07/2023           1       $32.00       $5.79
    014267-05                114051191001 200641754  STARUCH          JOHN       19   22513055602          07/10/2023           1      $140.00      $64.99
    014267-05                114051191001 200641754  STARUCH          ASHLEY     01   22513228684          07/07/2023           1       $30.00      $15.41
    014267-05                114051191001 200641754  STARUCH          KEVIN      18   22512992698          07/07/2023           1       $67.00      $20.00
    014267-05                114051191001 200641754  STARUCH          KEVIN      18   22512992698          07/07/2023           1      $107.00       $0.00

                                                                                                                                              PAGE:56 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                114051191001 200641754  STARUCH          KEVIN      18   22512992698          07/07/2023           1       $96.00       $0.00
    014267-05                114051191001 200641754  STARUCH          KEVIN      18   22512992698          07/07/2023           1       $23.00       $0.00
    014267-05                114051191001 200641754  STARUCH          KEVIN      18   22512992698          07/07/2023           1       $67.00      $13.34
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613170136          06/30/2023           1      $340.00     $133.51
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613351149          07/03/2023           1      $330.00     $141.73
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613170187          06/30/2023           2      $284.00      $99.62
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613263671          07/03/2023           1       $38.00      $10.00
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22612861154          06/27/2023           1      $301.00      $90.38
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613170187          06/30/2023           1      $147.00      $67.78
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613170187          06/30/2023           1      $161.00      $66.76
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613170211          06/30/2023           1       $45.00      $13.86
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613170187          06/30/2023          11      $968.00     $280.50
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613083523          06/30/2023           1    $1,271.00     $904.44
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613170187          06/30/2023           1      $161.00      $49.81
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613083299          07/06/2023           1    $1,784.00     $543.80
    014267-05                104639290001 201607083  BONATESTA        JOSEPH     01   22713024278          07/07/2023           1       $80.00       $8.32
    014267-05                104639290001 201607083  BONATESTA        JOSEPH     01   22713024278          07/07/2023           1       $50.00      $24.58
    014267-05                104821823001 203725621  DAISLEY          BRITTENY   18   22213214559          07/12/2023           1      $150.00      $85.00
    014267-05                104821823001 203725621  DAISLEY          BRITTENY   18   22213214559          07/12/2023           1       $30.00       $0.00
    014267-05                104821823001 203725621  DAISLEY          BRITTENY   18   22213214559          07/12/2023           1       $25.00       $4.01
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   22612898857          07/03/2023           1      $715.00      $38.56
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   22612898857          07/03/2023           1      $358.00      $30.99
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   22613044513          07/06/2023           1      $175.00     $120.81
    014267-05                105133917001 207507140  BORN             LEA        18   22312962059          07/05/2023           1      $142.00      $60.70
    014267-05                112105056001 208606192  TARANTO          JESSICA    01   22313060455          07/08/2023           1      $102.00       $0.00
    014267-05                112105056001 208606192  TARANTO          JESSICA    01   22313060455          07/08/2023           1       $65.00       $0.00
    014267-05                112105056001 208606192  TARANTO          JESSICA    01   22313060455          07/08/2023           1       $14.00       $0.00
    014267-05                112105056001 208606192  TARANTO          JESSICA    01   22313060455          07/08/2023           1      $424.00       $0.00
    014267-05                112105056001 208606192  TARANTO          JESSICA    01   22313060455          07/08/2023           1       $65.00       $0.00
    014267-05                112105056001 208606192  TARANTO          JESSICA    01   22313060455          07/08/2023           1       $97.00      $68.74
    014267-05                112105056001 208606192  TARANTO          JESSICA    01   22313060455          07/08/2023           1      $198.00       $0.00
    014267-05                112105056001 208606192  TARANTO          JESSICA    01   22313060455          07/08/2023           1       $92.00       $0.00

                                                                                                                                              PAGE:57 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                112105056001 208606192  TARANTO          JESSICA    01   22313060455          07/08/2023           1      $177.00       $0.00
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970824          07/05/2023           1       $45.00      $21.36
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22113230076          07/07/2023           1       $47.00      $28.55
    014267-05                105312745001 209560853  KUDLAWIEC        MARY       19   22113108026          07/11/2023           1       $40.00       $6.00
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970824          07/05/2023           1       $10.00       $7.88
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22113138949          04/19/2023           1      $201.00      $93.75
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970824          07/05/2023           1       $89.00      $44.10
    014267-05                105312745001 209560853  KUDLAWIEC        MARY       19   22113108026          07/11/2023           1       $55.00      $15.18
    014267-05                105322961001 209620623  DELOSH           ALYSSA     19   22213164466          07/11/2023           1      $175.00     $116.03
    014267-05                105399373001 210548948  ROCCO            THOMAS     01   22413272839          07/07/2023           1      $372.00     $318.35
    014267-05                105399373001 210548948  ROCCO            THOMAS     01   22413272839          07/07/2023           1       $80.00       $0.00
    014267-05                105399373001 210548948  ROCCO            THOMAS     01   22413272839          07/07/2023           1      $219.40      $31.91
    014267-05                105399373001 210548948  ROCCO            THOMAS     01   22413272839          07/07/2023           1      $260.00     $211.61
    014267-05                105399373001 210548948  ROCCO            SAMANTHA   19   22413174247          07/09/2023           1       $14.00      $14.00
    014267-05                105399373001 210548948  ROCCO            THOMAS     01   22413272839          07/07/2023           1       $65.00      $99.34
    014267-05                105399373001 210548948  ROCCO            THOMAS     01   22413166395          07/07/2023           1      $184.00      $43.68
    014267-05                105408339001 210604721  MULLEN           THOMAS     18   22613091581          07/10/2023           1       $80.00       $8.32
    014267-05                105408339001 210604721  MULLEN           THOMAS     18   22613091581          07/10/2023           2      $100.00      $49.16
    014267-05                127479959001 210721282  DOUGHERTY        BRANDON    01   22813104759          07/07/2023           1      $132.00      $92.12
    014267-05                105507489001 211702122  BASSETT          SOPHIA     19   22313241396          07/11/2023           1      $221.00     $124.63
    014267-05                105507489001 211702122  BASSETT          SOPHIA     19   22313241396          07/11/2023           1       $35.00       $3.13
    014267-05                105507489001 211702122  BASSETT          SOPHIA     19   22313241396          07/11/2023           1       $36.00      $17.49
    014267-05                105507489001 211702122  BASSETT          CLARA      19   22313131739          07/11/2023           1      $125.00      $28.48
    014267-05                105507594001 211703743  TENEROWICZ       BANE       19   22031855307          07/05/2023           1      $124.00      $85.54
    014267-05                105507594001 211703743  TENEROWICZ       BANE       19   22031782597          07/05/2023           1      $260.00      $61.61
  014267-05 Total                                                                                                                   $51,962.56  $12,740.22
  014267-06
    014267-06                102234268001 172609097  SMITH            BRIANA     19   22112945546          07/05/2023           1      $120.00     $110.01
    014267-06                110058092001 179504663  MCGOUGH          PATRICIA   01   22812995047          07/06/2023           1      $358.00      $30.99
    014267-06                110058092001 179504663  MCGOUGH          PATRICIA   01   22812995047          07/06/2023           1      $715.00      $38.56
    014267-06                110058092001 179504663  MCGOUGH          PATRICIA   01   22813008619          07/06/2023           1      $427.00     $427.00
    014267-06                110058092001 179504663  MCGOUGH          PATRICIA   01   22813008619          07/06/2023           1       $53.00      $53.00

                                                                                                                                              PAGE:58 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   22213122539          07/10/2023           1      $135.00      $69.99
    014267-06                126568873001 188582035  MYERS            KEVIN      01   22113043321          06/28/2023           1      $302.71     $193.33
    014267-06                126568873001 188582035  MYERS            KEVIN      01   22112772081          07/05/2023           1    $1,500.00     $561.50
    014267-06                104212846001 196485949  DAISLEY          LAUREN     19   22113285764          07/11/2023           1      $222.00      $85.78
  014267-06 Total                                                                                                                    $3,832.71   $1,570.16
  014267-07
    014267-07                110529124001 124685815  RICUPERO         ROCCO      19   22713278466          07/12/2023           1       $25.00       $4.71
    014267-07                110529124001 124685815  RICUPERO         ROCCO      19   22713278466          07/12/2023           1       $35.00      $20.20
    014267-07                110529124001 124685815  RICUPERO         VINCENZO   19   22713278469          07/12/2023           1      $160.00     $124.00
    014267-07                110529124001 124685815  RICUPERO         ROCCO      19   22713278466          07/12/2023           1      $350.00     $350.00
    014267-07                110529124001 124685815  RICUPERO         GIA        19   22713278468          07/12/2023           1       $35.00      $20.20
    014267-07                110529124001 124685815  RICUPERO         GIA        19   22713278468          07/12/2023           1      $350.00     $350.00
    014267-07                110529124001 124685815  RICUPERO         GIA        19   22713278468          07/12/2023           1       $25.00       $4.71
    014267-07                110529124001 124685815  RICUPERO         VINCENZO   19   22713278469          07/12/2023           1       $25.00       $4.71
    014267-07                110529124001 124685815  RICUPERO         ROCCO      19   22713278466          07/12/2023           1      $160.00     $124.00
    014267-07                110529124001 124685815  RICUPERO         VINCENZO   19   22713278469          07/12/2023           1       $35.00      $20.20
    014267-07                110529124001 124685815  RICUPERO         GIA        19   22713278468          07/12/2023           1      $160.00     $124.00
    014267-07                110529124001 124685815  RICUPERO         VINCENZO   19   22713278469          07/12/2023           1      $350.00     $350.00
    014267-07                121106664001 159703665  KANE             CLARA      19   22032003838          07/11/2023           1       $41.00      $33.01
    014267-07                121106664001 159703665  KANE             CLARA      19   22032003838          07/11/2023           1       $30.00      $25.68
    014267-07                121106664001 159703665  KANE             MELISSA    18   22031920704          07/11/2023           1      $200.00     $102.00
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513173650          07/03/2023           1      $300.00     $188.76
    014267-07                113678744001 162669503  MICHAEL          KAYLA      18   22512972494          07/05/2023           1      $145.00      $59.97
    014267-07                101605583001 164627824  SALEME           AVA        19   22213299830          07/11/2023           1      $141.00     $112.97
    014267-07                101605583001 164627824  SALEME           AVA        19   22213299830          07/11/2023           1       $32.00      $23.03
    014267-07                101605583001 164627824  SALEME           AVA        19   22213299830          07/11/2023           1       $30.00      $26.70
    014267-07                101605583001 164627824  SALEME           CARSON     19   22213299831          07/11/2023           1       $24.00      $22.20
    014267-07                101605583001 164627824  SALEME           CARSON     19   22213299831          07/11/2023           1      $124.00     $102.70
    014267-07                101605583001 164627824  SALEME           AVA        19   22213299830          07/11/2023           1        $8.00       $5.00
    014267-07                101605583001 164627824  SALEME           AVA        19   22213299830          07/11/2023           1        $8.00       $5.50
    014267-07                101605583001 164627824  SALEME           CARSON     19   22213299831          07/11/2023           1       $30.00      $26.70
    014267-07                101605583001 164627824  SALEME           AVA        19   22213299830          07/11/2023           1      $200.00     $196.13

                                                                                                                                              PAGE:59 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-07                102080665001 170683038  MICHINA          BRIDGET    18   22113137005          07/07/2023           1      $143.00      $21.31
    014267-07                110592948001 171640757  GRASSI           BRIDGET    01   22313224713          07/13/2023           1      $263.60     $118.88
    014267-07                102404201001 174648572  MANNING          MANDIE     01   22513320694          07/10/2023           1      $190.00     $100.00
    014267-07                102807156001 179604238  RABATIN          ADRIENNE   18   22313191671          06/06/2023           1      $290.00     $142.86
    014267-07                102807156001 179604238  RABATIN          ADRIENNE   18   22313191671          06/06/2023           1       $47.00       $0.00
    014267-07                102967311001 181580382  BLACK            BRAD       01   22313015612          06/28/2023           1      $530.00     $277.30
    014267-07                102970458001 181589405  BROWN            TAYLOR     19   22031688351          06/29/2023           1       $69.25      $20.05
    014267-07                102970458001 181589405  BROWN            TAYLOR     19   22031688351          06/29/2023           1       $29.50       $0.04
    014267-07                102970458001 181589405  BROWN            THOMAS     01   22031540415          07/06/2023           2      $141.00      $49.16
    014267-07                102970458001 181589405  BROWN            THOMAS     01   22031540415          07/06/2023           1       $69.00      $22.60
    014267-07                102970458001 181589405  BROWN            TAYLOR     19   22031688351          06/29/2023           1      $149.00      $36.74
    014267-07                102970458001 181589405  BROWN            THOMAS     01   22031760411          07/10/2023           1       $60.00      $12.84
    014267-07                102970458001 181589405  BROWN            THOMAS     01   22031760411          07/10/2023           3      $211.50      $73.74
    014267-07                102970458001 181589405  BROWN            THOMAS     01   22031760411          07/10/2023           1       $69.00      $22.60
    014267-07                102970458001 181589405  BROWN            THOMAS     01   22031540415          07/06/2023           1       $60.00      $12.84
    014267-07                124239642001 182745822  LINK             MARIA      01   22613342361          07/10/2023           1       $88.50      $22.78
    014267-07                124239642001 182745822  LINK             MARIA      01   22613342361          07/10/2023           1       $67.25      $50.91
    014267-07                124239642001 182745822  LINK             MARIA      01   22613342361          07/10/2023           1      $184.00      $87.64
    014267-07                124239642001 182745822  LINK             MARIA      01   22613342361          07/10/2023           1       $46.50      $14.32
    014267-07                124239642001 182745822  LINK             MARIA      01   22613342361          07/10/2023           1      $107.00      $22.41
    014267-07                124239642001 182745822  LINK             DOMINIC    19   22613267842          07/12/2023           1       $40.00      $10.96
    014267-07                124239642001 182745822  LINK             DOMINIC    19   22613267842          07/12/2023           1      $185.00     $119.36
    014267-07                124239642001 182745822  LINK             DOMINIC    19   22613267842          07/12/2023           1       $40.00      $10.96
    014267-07                113012253001 183647983  WATT             NATALIE    01   22031942287          07/06/2023           1      $178.00      $58.67
    014267-07                103553330001 188685116  MENTO            BETH       18   22512974779          07/06/2023           2        $4.00       $0.00
    014267-07                103553330001 188685116  MENTO            BETH       18   22512974779          07/06/2023           1       $30.00       $0.00
    014267-07                103723690001 190641355  GLASS            ROBERT     01   22413053613          07/07/2023           1      $148.10       $0.00
    014267-07                103723690001 190641355  GLASS            ROBERT     01   22413053613          07/07/2023           1      $264.06       $0.00
    014267-07                103723690001 190641355  GLASS            ROBERT     01   22413226275          07/07/2023           1       $20.00       $0.00
    014267-07                103723690001 190641355  GLASS            ROBERT     01   22413226275          07/07/2023           1      $127.00     $126.32
    014267-07                103879349001 192529999  WATT             LISA       01   22812873175          06/28/2023           1    $3,654.00     $753.30
    014267-07                103879349001 192529999  WATT             LISA       01   22812873175          06/28/2023           2       $50.00      $25.00

                                                                                                                                              PAGE:60 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-07                103879349001 192529999  WATT             LISA       01   22812873175          06/28/2023           2    $1,286.00   $1,033.91
    014267-07                103879349001 192529999  WATT             HAYLEE     19   22812987664          06/30/2023           1       $72.00      $16.43
    014267-07                103879349001 192529999  WATT             LISA       01   22813065582          06/28/2023           1      $330.00     $127.35
    014267-07                103879349001 192529999  WATT             LISA       01   22813065582          06/28/2023           4      $300.00     $277.52
    014267-07                103879349001 192529999  WATT             LISA       01   22813065582          06/28/2023           1      $200.00      $96.54
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22713151630          07/04/2023           1      $311.00     $190.00
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22713151629          07/05/2023           1      $311.00     $190.00
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22713151628          07/03/2023           1      $311.00     $190.00
    014267-07                113562031001 202707640  MULLEN           PARKER     19   22413231900          07/12/2023           1       $30.00       $0.00
    014267-07                113562031001 202707640  MULLEN           PARKER     19   22413231900          07/12/2023           2        $4.00       $0.00
    014267-07                104804112001 203580135  SMITH            MICHELE    18   22313113239          07/12/2023           1       $95.00      $65.70
    014267-07                104804112001 203580135  SMITH            MICHELE    18   22313296086          07/14/2023           1       $95.00      $65.70
    014267-07                135952257001 204760740  MYERS            KALI       19   22313143082          05/27/2023           1      $225.00      $53.17
    014267-07                135952257001 204760740  MYERS            KALI       19   22313143082          05/27/2023           1      $105.00      $67.01
    014267-07                104976759001 205602810  CARRIZALES       MONICA     01   22313062726          07/10/2023           1       $39.00       $0.00
    014267-07                105133870001 207507048  PRZYBYS          ALAYNA     19   22112943824          07/06/2023           1      $150.00      $70.10
    014267-07                133550618001 207723892  GALEBACH         NOAH       19   22512828369          07/05/2023           1      $150.00     $110.01
    014267-07                121862944001 207724279  LEARY            VANESSA    19   22112948403          07/07/2023           1       $32.00       $0.00
    014267-07                121862944001 207724279  LEARY            VANESSA    19   22112948403          07/07/2023           1      $140.00      $74.99
    014267-07                121862944001 207724279  DODSON           ADRIENNE   18   22112964305          07/05/2023           1    $1,661.00     $159.97
    014267-07                136097486001 207760396  KELLY            ABBY       18   22813334641          06/30/2023           1      $145.00      $54.97
    014267-07                105308353001 209527301  HABERKORN        TIMOTHY    01   22112835846          07/06/2023           1       $80.00      $22.60
    014267-07                105308353001 209527301  HABERKORN        TIMOTHY    01   22113133261          07/11/2023           1       $80.00      $22.60
    014267-07                105308353001 209527301  HABERKORN        TIMOTHY    01   22113133261          07/11/2023           2      $168.00      $49.16
    014267-07                105308353001 209527301  HABERKORN        TIMOTHY    01   22112835846          07/06/2023           3      $252.00      $73.74
    014267-07                105413169001 210629784  HARROLD          GARRETT    19   22312891368          07/07/2023           1      $160.00     $110.50
    014267-07                105413169001 210629784  HARROLD          GAVIN      19   22312891365          07/07/2023           1       $25.00       $4.71
    014267-07                105413169001 210629784  HARROLD          GAVIN      19   22312891365          07/07/2023           1       $35.00      $20.20
    014267-07                105413169001 210629784  HARROLD          GARRETT    19   22312891368          07/07/2023           1       $25.00       $4.71
    014267-07                105413169001 210629784  HARROLD          GAVIN      19   22312891365          07/07/2023           1      $210.00     $205.90
    014267-07                105413169001 210629784  HARROLD          GAVIN      19   22312891365          07/07/2023           1      $160.00     $124.00
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22709851733          05/08/2023          (2)   ($120.00)    ($45.20)

                                                                                                                                              PAGE:61 of 69
                                                                                                                                                            
            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          (1)   ($120.00)    ($28.53)
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22711298650          05/30/2023           2      $120.00      $49.16
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22713247167          07/11/2023           1      $150.00     $110.01
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22711298651          05/31/2023          (1)   ($120.00)    ($28.53)
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22709851733          05/08/2023           2      $120.00      $37.31
    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   22711298651          05/31/2023           2      $120.00      $49.16
    014267-07                113092711001 214135088  HAJNOSZ          JACKLYN    19   22713217769          06/21/2023           1       $30.00      $20.12
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22711298651          05/31/2023          (2)   ($120.00)    ($22.60)
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22711298650          05/30/2023          (2)   ($120.00)    ($22.60)
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22711298650          05/30/2023           2      $120.00       $8.78
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22711298650          05/30/2023          (1)   ($120.00)    ($24.58)
    014267-07                113092711001 214135088  HAJNOSZ          JACKLYN    19   22713217769          06/21/2023           1      $335.00     $154.65
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22711298651          05/31/2023           2      $120.00       $8.78
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22711298651          05/31/2023          (1)   ($120.00)    ($24.58)
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22711298651          05/31/2023           2      $120.00      $57.06
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22711298650          05/30/2023           2      $120.00      $57.06
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22709851733          05/08/2023           2      $120.00      $49.16
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   22711298650          05/30/2023          (1)   ($120.00)    ($28.53)
  014267-07 Total                                                                                                                   $18,280.26   $8,502.21
  014267-08
    014267-08                101376666001 161648458  THOMAS           DREW       18   22032003298          06/22/2023           1      $140.00     $100.81
    014267-08                101747063001 166560149  KRUISE           FRANCES    18   22213148156          07/06/2023           3      $252.00       $0.00
    014267-08                101747063001 166560149  KRUISE           FRANCES    18   22213148156          07/06/2023           1       $65.00       $0.00
    014267-08                101747063001 166560149  KRUISE           FRANCES    18   22213148156          07/06/2023           1       $75.00       $0.00
    014267-08                116871611001 173605841  MURPHY           JANELL     18   22513252547          06/14/2023           1      $110.00      $34.20
    014267-08                116871611001 173605841  MURPHY           JANELL     18   22513252547          06/14/2023           1      $150.00      $42.92
    014267-08                116871611001 173605841  MURPHY           JANELL     18   22513252547          06/14/2023           1       $64.00      $17.11
    014267-08                116871611001 173605841  MURPHY           JANELL     18   22512971642          06/27/2023           1      $226.70     $135.36
    014267-08                116871611001 173605841  MURPHY           JANELL     18   22512971613          06/27/2023           1        $9.25       $3.30
    014267-08                116871611001 173605841  MURPHY           JANELL     18   22513252547          06/14/2023           1       $83.00      $19.85

                                                                                                                                              PAGE:62 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-08                116871611001 173605841  MURPHY           JANELL     18   22513252547          06/14/2023           1       $65.00      $24.80
    014267-08                116871611001 173605841  MURPHY           JANELL     18   22513252547          06/14/2023           1      $150.00      $26.97
    014267-08                116871611001 173605841  MURPHY           JANELL     18   22513252547          06/14/2023           1       $64.00      $13.23
    014267-08                116871611001 173605841  MURPHY           JANELL     18   22513252547          06/14/2023           1       $64.00      $14.76
    014267-08                132465085001 175547949  VENESKY          JOHN       01   22713332525          06/30/2023           1      $140.00     $100.81
    014267-08                132465085001 175547949  VENESKY          KIM        18   22713024279          07/07/2023           1       $66.00       $0.00
    014267-08                132465085001 175547949  VENESKY          KIM        18   22713024279          07/07/2023           2      $100.00       $0.00
    014267-08                102490553001 175663819  TAYLOR           JEANETTE   18   22212884478          06/19/2023           1    $1,520.00      $37.77
    014267-08                102490553001 175663819  TAYLOR           JEANETTE   18   22213214410          07/10/2023           1      $175.00      $75.99
    014267-08                103036754001 182545346  DELOZIER         BARBARA    01   22213299497          07/05/2023           1      $142.00       $0.00
    014267-08                103043271001 182585206  FINET            THERESA    18   22312969078          06/06/2023           1      $332.00     $126.93
    014267-08                103537183001 188580574  HEBERT           JEFFERY    01   22413100075          05/22/2023           1        $8.00       $3.25
    014267-08                103537183001 188580574  HEBERT           JEFFERY    01   22413273901          06/08/2023           1      $160.00      $82.69
    014267-08                103711350001 190563467  PASSONETTI       ANGELA     18   22313195505          07/11/2023           1      $190.00     $100.00
    014267-08                104393562001 198605554  MCBREEN          KEVIN      18   22613183649          07/07/2023           1      $561.00       $0.00
    014267-08                104393562001 198605554  MCBREEN          KEVIN      18   22613183649          07/07/2023           1      $217.00       $0.00
    014267-08                104393562001 198605554  MCBREEN          KEVIN      18   22613183649          07/07/2023           1       $31.00       $0.00
    014267-08                105065403001 206621146  BAKER            LINDA      18   22612896274          06/30/2023           1      $185.00     $154.17
    014267-08                105065403001 206621146  BAKER            LINDA      18   22612899070          06/27/2023           1    $1,170.00     $212.35
    014267-08                105065403001 206621146  BAKER            LINDA      18   22613109303          07/07/2023           1      $185.00       $0.00
    014267-08                105065403001 206621146  BAKER            LINDA      18   22613109303          07/04/2023           1      $165.00       $0.00
    014267-08                105065403001 206621146  BAKER            LINDA      18   22613109303          07/05/2023           1      $185.00       $0.00
    014267-08                105065403001 206621146  BAKER            LINDA      18   22612896274          06/28/2023           1      $185.00     $154.17
    014267-08                105065403001 206621146  BAKER            LINDA      18   22613109303          07/03/2023           1      $185.00       $0.00
  014267-08 Total                                                                                                                    $7,419.95   $1,481.44
  014267-12
    014267-12                103337724001 186380155  LASOTA           KATHLEEN   18   22313013935          07/05/2023           1      $175.00     $110.01
    014267-12                104217337001 196509986  KLEZEK           REBECCA    18   22112951043          07/05/2023           1      $150.00      $69.75
    014267-12                104217337001 196509986  KLEZEK           REBECCA    18   22112951044          07/05/2023           1      $120.00      $42.10
    014267-12                104217337001 196509986  KLEZEK           REBECCA    18   22112951044          07/05/2023           1        $3.00       $0.15
    014267-12                104217337001 196509986  KLEZEK           REBECCA    18   22112951044          07/05/2023           1      $484.00     $137.86
    014267-12                104217337001 196509986  KLEZEK           REBECCA    18   22112951044          07/05/2023           1      $630.00      $99.90

                                                                                                                                              PAGE:63 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-12                104217337001 196509986  KLEZEK           REBECCA    18   22113073099          06/28/2023           1       $95.00      $65.70
  014267-12 Total                                                                                                                    $1,657.00     $525.47
  014267-13
    014267-13                102552483001 176526359  CALDWELL         DAVID      18   22313035890          07/05/2023           1      $207.00       $0.00
    014267-13                102552483001 176526359  CALDWELL         DAVID      18   22313035890          07/05/2023           1      $141.00       $0.00
    014267-13                102552483001 176526359  CALDWELL         DAVID      18   22313035890          07/05/2023           1       $31.00       $0.00
    014267-13                102552483001 176526359  CALDWELL         DAVID      18   22313035890          07/05/2023           1      $217.00       $0.00
    014267-13                128297384001 201589800  LIEB             LAURA      18   22812877676          07/03/2023           1      $715.00      $38.56
    014267-13                128297384001 201589800  LIEB             LAURA      18   22812877676          07/03/2023           1      $358.00      $30.99
  014267-13 Total                                                                                                                    $1,669.00      $69.55
  014267-15
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22213157636          07/11/2023           3      $120.00      $73.74
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22212974254          07/06/2023           1       $40.00      $10.45
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22212974254          07/06/2023           1       $50.00      $22.60
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22213306649          07/13/2023           1       $40.00      $10.45
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22212974254          07/06/2023           3      $120.00      $73.74
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22213157636          07/11/2023           1       $40.00      $10.45
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22213306649          07/13/2023           1       $50.00      $22.60
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22213157636          07/11/2023           1       $50.00      $22.60
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22213306649          07/13/2023           3      $120.00      $73.74
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413267789          07/12/2023           1       $25.00      $19.08
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413267789          07/12/2023           1      $165.00      $86.29
    014267-15                103115531001 183523270  SHEA             EDWARD     18   22212976219          07/07/2023           1      $132.00       $0.00
    014267-15                103115531001 183523270  SHEA             EDWARD     18   22212976219          07/07/2023           1       $14.00       $0.00
    014267-15                103115531001 183523270  SHEA             EDWARD     18   22212976219          07/07/2023           1      $100.00       $0.00
    014267-15                104466514001 199567150  KIRSCH           JENNIFER   18   22412998124          07/05/2023           2      $100.00      $49.16
    014267-15                104466514001 199567150  KIRSCH           JENNIFER   18   22413335388          07/12/2023           2      $100.00      $49.16
    014267-15                104466514001 199567150  KIRSCH           DANIEL     01   22413267787          07/12/2023           1      $195.00     $101.85
    014267-15                104466514001 199567150  KIRSCH           JENNIFER   18   22413267788          07/12/2023           1       $17.00      $12.84
    014267-15                104466514001 199567150  KIRSCH           DANIEL     01   22413267787          07/12/2023           1       $25.00      $19.08
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22512829142          07/03/2023           1       $45.00      $28.53
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22512829144          07/05/2023           1       $50.00      $12.73

                                                                                                                                              PAGE:64 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22512829142          07/03/2023           1       $40.00       $0.00
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22512829142          07/03/2023           3      $120.00      $58.84
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22513086697          07/10/2023           1       $50.00      $12.73
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22513086697          07/10/2023           3      $120.00      $73.74
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22513086697          07/10/2023           1       $40.00       $0.00
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22513086697          07/10/2023           1       $45.00      $28.53
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22512829142          07/03/2023           1       $50.00       $0.00
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22512829144          07/05/2023           1       $40.00       $0.00
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22512829142          07/03/2023           1       $80.00      $57.63
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22512829144          07/05/2023           3      $120.00      $73.74
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22512829144          07/05/2023           1       $45.00      $28.53
  014267-15 Total                                                                                                                    $2,348.00   $1,032.83
  014267-22
    014267-22                104709255001 202500368  KLEZEK           JANA       18   22613311255          07/10/2023           1       $53.00      $53.00
    014267-22                104709255001 202500368  KLEZEK           JANA       18   22613311255          07/10/2023           1       $50.00      $50.00
  014267-22 Total                                                                                                                      $103.00     $103.00
  014267-26
    014267-26                101590378001 164544186  NATCHER          LYNNE      18   22713006767          07/05/2023           1       $35.00      $24.58
    014267-26                101590378001 164544186  NATCHER          LYNNE      18   22713006767          07/05/2023           1       $70.00      $10.45
    014267-26                101590378001 164544186  NATCHER          LYNNE      18   22713006767          07/05/2023           1       $90.00      $11.87
    014267-26                101590378001 164544186  NATCHER          LYNNE      18   22713006767          07/05/2023           1       $45.00      $14.41
    014267-26                101653527001 165421783  DIANTONIIS       RICHARD    18   22313276125          07/12/2023           1      $175.00     $105.81
    014267-26                103601183001 189447557  SETTLE           SUSAN      18   22512992699          07/05/2023           1      $107.00      $21.03
    014267-26                103601183001 189447557  SETTLE           SUSAN      18   22512992699          07/05/2023           1       $67.00      $20.00
    014267-26                103601183001 189447557  SETTLE           SUSAN      18   22512992699          07/05/2023           1       $96.00      $43.25
    014267-26                103601183001 189447557  SETTLE           SUSAN      18   22512999278          07/06/2023           1      $246.00      $91.11
    014267-26                103601183001 189447557  SETTLE           SUSAN      18   22512992699          07/05/2023           1      $167.00      $76.20
    014267-26                103601183001 189447557  SETTLE           SUSAN      18   22512992699          07/05/2023           1       $67.00      $34.47
    014267-26                103601183001 189447557  SETTLE           SUSAN      18   22512992699          07/05/2023           1       $23.00       $0.00
    014267-26                103601183001 189447557  SETTLE           SUSAN      18   22512992699          07/05/2023           1      $102.00      $21.78
    014267-26                103865487001 192460825  WHITESELL        EDWARD     18   22613208494          07/10/2023           1       $90.00      $65.70
    014267-26                103945030001 193422246  BROWN            JOHN       18   22713247329          07/12/2023           1       $74.94      $74.94

                                                                                                                                              PAGE:65 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  014267-26 Total                                                                                                                    $1,454.94     $615.60
  014267-36
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613027568          07/03/2023           1       $57.00      $31.52
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613027568          07/03/2023           1      $132.00      $87.42
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023          (1)   ($132.00)    ($99.13)
    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)   ($424.00)    ($54.21)
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613027568          07/03/2023           1      $201.00       $0.00
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613027568          07/03/2023           1       $76.00      $62.07
    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)   ($201.00)       $0.00
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613027568          07/03/2023           1      $115.00       $0.00
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613027568          07/03/2023           1      $201.00     $113.56
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613027568          07/03/2023           1       $37.00      $13.86
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023          (1)    ($14.00)       $0.00
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613027568          07/03/2023           1      $201.00     $120.07
    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)    ($76.00)    ($62.07)
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613014658          07/03/2023           1      $150.00       $0.00
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613014658          07/03/2023           1      $150.00       $0.00
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613027568          07/03/2023           1       $65.00      $39.89
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613027568          07/03/2023           1      $132.00      $99.13
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613027568          07/03/2023           1       $14.00       $0.00
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613027568          07/03/2023           1      $424.00      $54.21
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613027568          07/03/2023           2      $164.00      $18.57
    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)    ($10.08)
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613014658          07/03/2023           1      $150.00       $0.00
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613014658          07/03/2023           1      $150.00       $0.00
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613014658          07/03/2023           1      $150.00       $0.00
    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)   ($201.00)       $0.00

                                                                                                                                              PAGE:66 of 69
                                                                                                                                                            
            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)    ($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   22613027568          07/03/2023           1      $132.00      $87.42
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613027568          07/03/2023           1      $201.00     $113.56
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023          (1)   ($201.00)       $0.00
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613027568          07/03/2023           1      $201.00       $0.00
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22612829589          07/03/2023          (1)   ($132.00)    ($87.42)
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613027568          07/03/2023           1       $97.00      $68.74
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613027568          07/03/2023           1      $201.00     $120.07
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613014658          07/03/2023           1      $150.00       $0.00
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512911070          06/26/2023           2       $54.00      $30.28
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512911070          06/26/2023           8      $744.00     $417.27
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512911070          06/26/2023           1    $1,051.00     $589.45
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512911070          06/26/2023           6    $1,023.00     $573.74
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512911070          06/26/2023           1      $499.00     $279.86
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512911070          06/26/2023          60    $4,623.00   $2,592.79
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512911070          06/26/2023         362      $694.62     $389.57
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512911070          06/26/2023         157      $916.03     $513.83
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512869999          06/30/2023           1      $240.20      $97.94
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512911070          06/26/2023           1    $1,701.00     $954.00
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512911070          06/26/2023           1    $3,731.00   $2,092.52
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512911070          06/26/2023           7      $831.00     $466.06
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513170340          07/06/2023           1      $209.00     $111.85
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512911070          06/26/2023           2      $538.00     $301.73
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512992689          07/07/2023           1      $108.00      $27.19
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512992689          07/07/2023           1       $23.00       $0.00
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512911070          06/26/2023           3    $3,153.00   $1,768.35
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512992689          07/07/2023           1       $67.00      $34.47
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512992689          07/07/2023           1       $67.00      $20.00
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512992689          07/07/2023           1       $61.00      $16.76
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512911070          06/26/2023           1       $22.05      $12.36
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512911070          06/26/2023           1      $386.00     $216.48

                                                                                                                                              PAGE:67 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-36                109914485001 163626883  SHROYER          ROY        01   22512911070          06/26/2023           1      $354.00     $198.53
    014267-36                101742475001 166526179  CLAYCOMB         PAMALA     01   22413304275          07/10/2023           1      $866.00     $136.13
    014267-36                101742475001 166526179  CLAYCOMB         MORGAN     19   22412943067          07/02/2023           1       $49.00       $6.56
    014267-36                115426142001 168701689  ZERNICK          RYAN       01   22813249452          06/07/2023           1      $200.00     $105.81
    014267-36                115426142001 168701689  ZERNICK          RYAN       01   22813249452          06/07/2023           1      $125.00       $0.00
    014267-36                102792037001 179509577  WAGSTAFF         RICHARD    18   22412970639          06/19/2023           1       $57.00       $0.00
    014267-36                102792037001 179509577  WAGSTAFF         RICHARD    18   22412970639          06/19/2023           2       $11.11       $0.00
    014267-36                102792037001 179509577  WAGSTAFF         RICHARD    18   22412970639          06/19/2023           1      $228.63       $0.00
    014267-36                102792037001 179509577  WAGSTAFF         RICHARD    18   22412970639          06/19/2023           1       $62.00       $0.00
    014267-36                102792037001 179509577  WAGSTAFF         RICHARD    18   22412970639          06/19/2023           1      $151.50       $0.00
    014267-36                102792037001 179509577  WAGSTAFF         RICHARD    18   22412970639          06/19/2023           1      $353.50       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1       $53.00      $11.04
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1      $107.00      $21.03
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1       $67.00      $20.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           3      $432.00      $71.83
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1       $23.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813187370          07/06/2023           1       $30.00      $19.94
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813187370          07/06/2023           1       $61.00      $19.94
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1       $87.00      $37.84
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1      $133.00      $31.12
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1       $96.00      $15.47
    014267-36                132201566001 182642148  REVESZ           STACEY     19   22813295656          07/10/2023           1       $95.00      $70.70
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1       $76.00      $38.82
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1       $42.00      $15.81
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1      $127.00      $15.55
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1       $98.00      $36.74
    014267-36                120713080001 187605431  CONRAD           CHRISTIN   18   22413070990          07/06/2023           1      $236.00       $0.00
    014267-36                120713080001 187605431  CONRAD           CHRISTIN   18   22413070990          07/06/2023           1      $164.00       $0.00
    014267-36                120713080001 187605431  CONRAD           CHRISTIN   18   22413070990          07/06/2023           1      $190.00       $0.00
    014267-36                120713080001 187605431  CONRAD           CHRISTIN   18   22413070990          07/06/2023           1       $31.00       $0.00
    014267-36                104073548001 194669857  RUDDEK           ELIZABET   01   22513234482          07/12/2023           1       $30.00      $12.22
    014267-36                104073548001 194669857  RUDDEK           LARRY      18   22513234483          07/12/2023           2        $4.00       $0.80

                                                                                                                                              PAGE:68 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-36                104073548001 194669857  RUDDEK           ELIZABET   01   22513234482          07/12/2023           2        $4.00       $0.80
    014267-36                104073548001 194669857  RUDDEK           LARRY      18   22513234483          07/12/2023           1      $130.00     $100.81
    014267-36                104073548001 194669857  RUDDEK           LARRY      18   22513234483          07/12/2023           1       $30.00      $12.22
    014267-36                117835248001 194706672  COMMONS          MADALYNN   19   22313196261          07/12/2023           1      $175.18      $65.70
    014267-36                117835248001 194706672  COMMONS          MADALYNN   19   22313279951          07/13/2023           1      $140.00      $74.99
    014267-36                117835248001 194706672  COMMONS          NATALIE    19   22311245349          06/10/2023          (1)   ($346.00)   ($139.19)
    014267-36                117835248001 194706672  COMMONS          NATALIE    19   22311245349          06/09/2023           1      $346.00     $139.19
    014267-36                118690744001 203684634  BEHORY           JUSTIN     18   22412969613          05/25/2023           1      $179.00     $100.81
    014267-36                118690744001 203684634  BEHORY           JUSTIN     18   22412969613          05/25/2023           1       $65.00      $36.87
    014267-36                105244529001 208648921  REYNOLDS         RYAN       19   22512830709          07/06/2023           1      $185.00     $118.97
    014267-36                105244529001 208648921  REYNOLDS         RYAN       19   22512830709          07/06/2023           1       $40.00       $2.99
    014267-36                105244529001 208648921  REYNOLDS         MARCIA     18   22513127025          07/14/2022           1      $117.00      $12.42
    014267-36                105244529001 208648921  REYNOLDS         RYAN       19   22512830709          07/06/2023           1       $35.00      $16.70
    014267-36                105244529001 208648921  REYNOLDS         MARCIA     18   22513276010          07/07/2023           1      $678.00     $201.96
    014267-36                105244529001 208648921  REYNOLDS         RYAN       19   22512830709          07/06/2023           2       $80.00      $32.03
    014267-36                105244529001 208648921  REYNOLDS         RYAN       19   22512830709          07/06/2023           2       $80.00      $42.42
    014267-36                105244529001 208648921  REYNOLDS         RYAN       19   22512830709          07/06/2023           1       $85.00      $44.73
    014267-36                105244529001 208648921  REYNOLDS         MARCIA     18   22513127025          07/14/2022           1      $128.00      $13.55
    014267-36                105244529001 208648921  REYNOLDS         RYAN       19   22512830709          07/06/2023           1      $220.00     $216.20
    014267-36                105326129001 209640969  WURM             JACQUELI   18   22213161688          07/07/2023           1    $4,327.00     $856.40
    014267-36                105326129001 209640969  WURM             JACQUELI   18   22213161688          07/07/2023          12      $378.31       $0.00
    014267-36                105326129001 209640969  WURM             JACQUELI   18   22213161688          07/07/2023           1       $22.05       $0.00
    014267-36                129022752001 211720568  BAKER            JESSICA    18   22313103857          07/10/2023           1      $190.00     $100.00
  014267-36 Total                                                                                                                   $33,849.18  $14,805.14
  014267-37
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   22112831271          06/23/2023           1        $4.75       $5.10
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   22112831271          06/23/2023           2        $2.50      $12.66
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   22112831271          06/23/2023           1      $214.00      $48.32
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   22112831271          06/23/2023         100      $100.00      $33.98
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   22112831271          06/23/2023           5    $2,520.00       $0.00
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   22112831271          06/23/2023           1    $9,050.00   $2,194.01
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   22112831271          06/23/2023           1       $20.75       $3.99

                                                                                                                                              PAGE:69 of 69
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   22112831271          06/23/2023           6    $1,229.00       $0.00
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   22112831271          06/23/2023           1       $31.50      $30.07
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   22112831271          06/23/2023           1       $26.50      $16.65
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   22112831271          06/23/2023           2       $55.00      $51.65
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   22112831271          06/23/2023           1        $4.50       $0.00
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   22112831271          06/23/2023           1        $8.00       $4.38
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   22112831271          06/23/2023           4      $135.00     $103.48
    014267-37                134922147001 178526604  DILLON           LISA       18   22613112093          06/30/2023           1      $150.00       $0.00
    014267-37                103619466001 189546549  RODGERS          RAMONA     18   22031729881          06/13/2023           1      $145.00      $59.97
  014267-37 Total                                                                                                                   $13,696.50   $2,564.26
  014267- Total                                                                                                                    $283,238.53  $85,802.31
PPO Total                                                                                                                          $283,238.53  $85,802.31
                                                                                                                                                            
Professional
  053264-01
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22112940216          06/29/2023           1      $664.20     $327.45
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22112940222          06/29/2023           1      $719.55     $327.45
  053264-01 Total                                                                                                                    $1,383.75     $654.90
  053264- Total                                                                                                                      $1,383.75     $654.90
Professional Total                                                                                                                   $1,383.75     $654.90
Paid Claims Detail Total                                                                                                                       $195,392.62