PAID CLAIMS DETAIL                                                  
                                              Product/Sub Group-8 Digit                                              

INVOICE NUMBER:     230725589774                                           PAGE:               1 of 72           
BILL ACCOUNT NUMBER:CN02401002                                             PAID CLAIMS MONTH:  July 2023         
BILL ACCOUNT NAME:  Admiral Peary                                          CLAIMS PAID THRU:   07/21/2023        
CLIENT NUMBER:      0240                                                   BILL CYCLE:         3 of 4            
CLIENT NAME:        Admiral Peary                                          PREPARED DATE:      07/25/2023        

            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                101377897001 161663518  BALDISH          EDWARD     18   404769538347002401   07/18/2023           6       $37.90       $0.00
    014267-01                101534701001 163661783  MCMAHON          KRISTINA   18   222811100012742401   07/21/2023          90       $50.33      $10.99
    014267-01                101534701001 163661783  MCMAHON          KRISTINA   18   872148468249181401   07/17/2023           1      $251.08     $197.37
    014267-01                101757430001 166620944  GLENN            ANGELA     18   208442752469771401   07/17/2023          90      $447.13       $0.00
    014267-01                102062170001 170549666  HARKER           ROSEMARI   18   2360013502911401     07/14/2023          90      $297.07       $1.52
    014267-01                113324089001 181506290  MCINTOSH         CONSTANC   18   357637992663721401   07/14/2023          16       $98.81      $28.30
    014267-01                103106368001 183468098  RABATIN          DEBORA     18   183713796555991401   07/18/2023          10       $71.70      $14.44
    014267-01                103723995001 190642553  PANEK            REBECCA    18   652974707300032401   07/20/2023           5       $47.69       $0.00
    014267-01                104231917001 196603987  HUTSKY           JOSEPH     18   649868017070131401   07/14/2023           4       $77.92       $0.00
    014267-01                104231917001 196603987  HUTSKY           JOSEPH     18   935123048806942401   07/21/2023          56    $2,235.08   $1,763.63
    014267-01                104231917001 196603987  HUTSKY           JOSEPH     18   244805620416562401   07/22/2023          56      $654.06     $494.83
    014267-01                105143186001 207564217  BAUM             SUSAN      18   9652261515341401     07/15/2023          90      $510.05       $7.34
  014267-01 Total                                                                                                                    $4,778.82   $2,518.42
  014267-03
    014267-03                100658703001 125504688  MULLIGAN         IAN        19   197723753320232401   07/20/2023          30      $314.73      $10.98
    014267-03                100658703001 125504688  MULLIGAN         IAN        19   825137702955341401   07/15/2023          30      $463.99     $226.37
    014267-03                100658703001 125504688  MULLIGAN         ANDREW     19   766498108805842401   07/21/2023          30      $135.60       $0.00
    014267-03                100658703001 125504688  MULLIGAN         ANDREA     18   34538398484052401    07/21/2023          84    $3,579.99   $2,583.12
    014267-03                101220663001 159625419  ECKENRODE        PAUL       18   58118668325691401    07/18/2023           8       $36.99       $4.46
    014267-03                101220663001 159625419  ECKENRODE        PAUL       18   673583468078032401   07/20/2023          30      $369.37      $94.73
    014267-03                101220663001 159625419  ECKENRODE        GINA       01   895159038682462401   07/22/2023          90    $1,713.99   $1,223.57
    014267-03                101220663001 159625419  ECKENRODE        GINA       01   705834627422052401   07/21/2023           5       $75.99       $5.10
    014267-03                101229346001 159686619  THOMAS           ABIGAIL    01   502594580717462401   07/22/2023          30       $85.26      $10.62
    014267-03                112172536001 159687597  KOKUS            MICHAEL    18   18208788372132401    07/20/2023          28      $838.90     $653.16
    014267-03                110652030001 161544709  ANDREWS          SHANNON    18   841255458199112401   07/19/2023          30      $112.53       $0.00

                                                                                                                                               PAGE:2 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                110652030001 161544709  ANDREWS          EDWARD     01   824793938522081401   07/17/2023          12       $23.83       $0.00
    014267-03                110652030001 161544709  ANDREWS          SHANNON    18   632417546105181401   07/17/2023          30      $490.45      $16.15
    014267-03                101369778001 161607101  LACUE            ERIN       18   884027952054441401   07/15/2023          14      $249.31       $1.14
    014267-03                101375474001 161644485  DAVIS            JAMES      01   338158188909621401   07/14/2023          90    $1,120.34     $286.48
    014267-03                101375474001 161644485  DAVIS            JAMES      01   525378937809621401   07/14/2023          90      $976.04      $48.73
    014267-03                101375474001 161644485  DAVIS            JAMES      01   414288228119621401   07/14/2023          50       $94.47       $0.84
    014267-03                101375474001 161644485  DAVIS            JAMES      01   300397736609621401   07/14/2023          90       $79.31       $1.43
    014267-03                101513840001 163540068  DUBETSKY         JACQUELI   18   753153558924922401   07/20/2023          30      $155.17       $0.00
    014267-03                101913203001 168601612  DUBREUCQ         SARAH      01   912192912102732401   07/05/2023         (30)   ($271.09)       $0.00
    014267-03                101913203001 168601612  DUBREUCQ         SARAH      01   947737573302732401   07/05/2023         (30)   ($369.12)    ($16.80)
    014267-03                102137743001 171520828  KOCHINSKY        WILLIAM    01   162719798147642401   07/21/2023          90      $437.04       $4.86
    014267-03                102137743001 171520828  KOCHINSKY        WILLIAM    01   614767377184621401   07/14/2023          84       $12.83       $0.00
    014267-03                102137743001 171520828  KOCHINSKY        WILLIAM    01   180626700284621401   07/14/2023          50      $214.68       $1.54
    014267-03                102137743001 171520828  KOCHINSKY        WILLIAM    01   23217296724542401    07/21/2023          28      $623.77     $510.87
    014267-03                114762902001 171664326  SOWERS           SAMANTHA   01   526263653125591401   07/18/2023          30      $256.46       $7.43
    014267-03                110310108001 177645121  ROPP             COLTON     19   681301187608061401   07/16/2023           7       $72.48       $2.48
    014267-03                110310108001 177645121  ROPP             COLTON     19   322815158918061401   07/16/2023          19      $270.02     $128.92
    014267-03                115784376001 178669991  PARONISH         TASHA      18   320463748455922401   07/20/2023          30      $155.97       $0.00
    014267-03                115784376001 178669991  PARONISH         NOAH       01   35154810516862401    07/22/2023          50      $882.95     $683.85
    014267-03                102813097001 179642584  MOREALLI         MICHAEL    18   368807016684112401   07/19/2023          90      $519.05      $14.12
    014267-03                102813097001 179642584  MOREALLI         JACKSON    19   507433018668362401   07/22/2023          30       $50.58      $21.95
    014267-03                102813097001 179642584  MOREALLI         JACKSON    19   563976218394052401   07/21/2023          30       $33.63      $13.67
    014267-03                102898332001 180688012  HITE             DOUGLAS    01   643593753400271401   07/17/2023          84   $21,122.79  $12,072.73
    014267-03                129507784001 181740411  PECORA           PAIGE      18   364632222690922401   07/20/2023          84      $126.02      $51.22
    014267-03                103039127001 182562529  BEACH            THERESA    18   722359848542161401   07/16/2023           7      $266.48      $11.26
    014267-03                114720476001 182663889  YAHNER           JUSTIN     01   283468488153642401   07/21/2023          90       $38.04       $4.80
    014267-03                114720476001 182663889  YAHNER           JUSTIN     01   424425318146642401   07/21/2023          90       $24.00       $6.73
    014267-03                103288637001 185583037  FARABAUGH        SYDNEY     19   888154050616612401   07/19/2023          30      $299.86      $62.95
    014267-03                103373563001 186587333  BEUNIER-SMITH    YVETTE     18   292788208530181401   07/17/2023         100    $1,042.99     $734.40
    014267-03                103373563001 186587333  BEUNIER-SMITH    YVETTE     18   723058131122331401   07/14/2023         100    $1,042.99     $734.40
    014267-03                103373563001 186587333  BEUNIER-SMITH    YVETTE     18   789871130430181401   07/15/2023        (100) ($1,042.99)   ($734.40)
    014267-03                103373563001 186587333  BEUNIER-SMITH    YVETTE     18   105332781638441401   07/15/2023         100    $1,042.99     $734.40

                                                                                                                                               PAGE:3 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                103373563001 186587333  BEUNIER-SMITH    YVETTE     18   910444862638441401   07/14/2023        (100) ($1,042.99)   ($734.40)
    014267-03                103373563001 186587333  BEUNIER-SMITH    YVETTE     18   938435670463691401   07/18/2023         100      $722.40      $68.85
    014267-03                103377064001 186607237  BRACKEN          KELLY      18   351075063243321401   07/14/2023          10       $46.30       $0.00
    014267-03                103377064001 186607237  BRACKEN          KELLY      18   421905230068391401   07/18/2023          25       $46.99      $18.61
    014267-03                103377064001 186607237  BRACKEN          KELLY      18   607706148333642401   07/21/2023          90       $41.37       $2.43
    014267-03                103379409001 186624451  LOBICK           ABIGAIL    19   438457926749922401   07/20/2023          28      $147.68      $13.70
    014267-03                103536981001 188580018  MALLOY           KAREN      18   826375440274032401   07/20/2023          25       $77.63      $54.71
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   275030794648480401   07/12/2023          90      $392.80      $87.35
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   869849528968922401   07/20/2023          30    $1,134.61     $886.82
    014267-03                103624049001 189580744  SPRENGER         KEITH      19   267693183614181401   07/13/2023           2      $499.56      $89.99
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   109605453285821401   07/14/2023          30      $250.35       $5.70
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   551225440476862401   07/22/2023           6       $16.35       $0.00
    014267-03                103624049001 189580744  SPRENGER         KEITH      19   682551747793181401   07/13/2023          (1)   ($499.56)    ($89.99)
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   522871387069702401   07/19/2023          90    $1,826.37   $1,147.93
    014267-03                111593010001 191660151  CHAPMAN          CHAD       01   507472831834841401   07/15/2023          30      $269.34       $0.00
    014267-03                103968095001 193564829  KINNEY           MELISSA    18   56775628963871401    06/19/2023         (15)   ($263.51)    ($90.43)
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   981525868388381401   07/17/2023          30       $77.66      $32.76
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   295541710388381401   07/13/2023         (30)    ($77.66)    ($32.76)
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   506684092126821401   07/13/2023         (14) ($1,076.46)    ($44.37)
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   728316000326821401   07/14/2023          14    $1,076.46      $44.37
    014267-03                115783835001 194687195  BENDER           SHANON     18   589097213937822401   07/20/2023          10       $19.12       $0.00
    014267-03                115783835001 194687195  BENDER           SHANON     18   501784477123161401   07/16/2023           6       $37.90       $2.54
    014267-03                135232407001 195780857  VENESKY          AMANDA     18   692429518041461401   07/16/2023          30      $474.43     $361.48
    014267-03                104400727001 198662868  FOX              LISA       18   440756438501591401   07/18/2023           5       $75.99       $5.10
    014267-03                117356283001 199567270  CENCE            JULIE      18   127204637162252401   07/21/2023           7       $74.53       $0.00
    014267-03                120189904001 199707914  KEENER           COREY      01   259667486892881401   07/18/2023          60      $110.99      $10.94
    014267-03                104567865001 200681648  MCCULLOUGH       KIMBERLY   18   877513193019871401   07/17/2023          10       $54.58       $5.51
    014267-03                104567865001 200681648  MCCULLOUGH       KIMBERLY   18   700229608619871401   07/17/2023          30      $324.92     $165.51
    014267-03                104567865001 200681648  MCCULLOUGH       KIMBERLY   18   772363816441312401   07/18/2023          30       $39.88       $5.76
    014267-03                104641701001 201623847  MCGINNIS         DAVID      01   954098740516521401   07/14/2023          97       $73.52      $24.45
    014267-03                104641701001 201623847  MCGINNIS         DAVID      01   360007966780621401   07/14/2023          90      $432.45      $25.42
    014267-03                110124351001 202707741  MANIFEST         ALESANDR   19   100930674051701401   07/13/2023          30    $4,131.44   $3,439.67

                                                                                                                                               PAGE:4 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                128918490001 204744375  MURPHY           JAMIE      18   392847773753871401   07/17/2023          28    $1,952.57   $1,279.85
    014267-03                105161905001 207722715  BERZONSKY        ALYSSA     18   571035318963162401   07/22/2023          30      $128.17       $0.00
    014267-03                105399036001 210547835  MCEVOY           REBECCA    18   33325758809771401    07/17/2023          30      $365.83       $1.02
    014267-03                105399036001 210547835  MCEVOY           REBECCA    18   225914367909771401   07/17/2023          30       $39.58       $4.54
    014267-03                105399036001 210547835  MCEVOY           REBECCA    18   725601250978871401   07/17/2023          28      $886.43     $691.31
    014267-03                105412522001 210627625  KLINE            ANTHONY    18   525016270680921401   07/14/2023          30       $85.26      $10.62
    014267-03                105412522001 210627625  KLINE            ANTHONY    18   174188900180921401   07/14/2023           7       $70.72       $1.63
    014267-03                105412522001 210627625  KLINE            ANTHONY    18   958185783880921401   07/14/2023           5        $2.04       $0.00
    014267-03                105481344001 211520772  STRASSER         JANINE     01   990547242865821401   07/14/2023          90      $976.05      $20.11
    014267-03                123539693001 211720533  STILES-KRUG      EMILY      01   656613448381591401   07/18/2023          90      $425.37       $9.76
  014267-03 Total                                                                                                                   $52,216.14  $27,744.75
  014267-05
    014267-05                101460852001 162709665  MARSHALL         DUSTIN     18   314557506493462401   07/22/2023          50      $267.81      $10.24
    014267-05                101460852001 162709665  MARSHALL         NICHOLE    01   130995138633212401   07/19/2023          30      $227.19       $7.20
    014267-05                101460852001 162709665  MARSHALL         NICHOLE    01   634976168333212401   07/19/2023          30      $155.26       $0.00
    014267-05                101665655001 165520467  FISANICK         BASIL      01   843557983593871401   07/17/2023          30       $16.99       $0.00
    014267-05                101665655001 165520467  FISANICK         BASIL      01   86662322891771401    07/17/2023          12      $133.00      $11.05
    014267-05                101665655001 165520467  FISANICK         BASIL      01   665901370207902401   07/19/2023          30       $46.48       $9.77
    014267-05                101665655001 165520467  FISANICK         BASIL      01   331439848251442401   07/21/2023          50      $213.69       $5.40
    014267-05                101665655001 165520467  FISANICK         BASIL      01   169664567057181401   07/17/2023          30      $126.41       $0.00
    014267-05                101825625001 167566948  BROWN            JIM        01   446923168715891401   07/05/2023          (1)   ($276.99)   ($197.37)
    014267-05                101829382001 167588314  LYTLE            ELLA       19   645053053651742401   07/21/2023          30       $22.67       $0.00
    014267-05                101829382001 167588314  LYTLE            ELLA       19   143798878990742401   07/21/2023          30       $82.42       $0.00
    014267-05                101829382001 167588314  LYTLE            ELLA       19   539089048061742401   07/21/2023          30      $964.27       $2.47
    014267-05                101995157001 169643849  WENDEROTH        FRED       18   764239548904271401   07/17/2023          45      $147.78      $12.62
    014267-05                133049535001 169741183  NORMAN           MICHAEL    01   911781460906642401   07/21/2023          90      $263.89       $6.03
    014267-05                112228663001 170540291  SHERRY           MELINDA    18   357765998937281401   07/17/2023          30       $73.24      $46.74
    014267-05                112228663001 170540291  SHERRY           MELINDA    18   126265120668512401   07/17/2023         (30)    ($81.04)       $0.00
    014267-05                112228663001 170540291  SHERRY           MELINDA    18   240525920668512401   07/17/2023          30       $81.04       $0.00
    014267-05                112228663001 170540291  SHERRY           MELINDA    18   331971430357281401   07/17/2023          30       $81.04       $0.00
    014267-05                112228663001 170540291  SHERRY           MELINDA    18   603397063142812401   07/17/2023         (30)    ($73.24)    ($46.74)
    014267-05                112228663001 170540291  SHERRY           MELINDA    18   449197563142812401   07/17/2023          30       $73.24      $46.74

                                                                                                                                               PAGE:5 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                110122526001 171629572  MASTRINE         MELISSA    18   989061930845612401   07/19/2023          84       $45.39      $37.63
    014267-05                102653549001 177643765  KUDLAWIEC        ANGELA     01   911817326406341401   07/15/2023          90       $60.28      $20.92
    014267-05                102794894001 179527800  MCMULLEN         PATRICK    01   696833046795591401   07/18/2023          30      $126.41       $0.00
    014267-05                102801153001 179566492  LANEY            KAREN      18   749566618349591401   07/17/2023          90      $447.93      $13.18
    014267-05                102801153001 179566492  LANEY            KAREN      18   58221597249591401    07/17/2023         (90)   ($578.84)    ($13.18)
    014267-05                102801153001 179566492  LANEY            KAREN      18   541397653091081401   07/17/2023          90      $578.84      $13.18
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   460698908261742401   07/21/2023          84       $25.90       $0.86
    014267-05                102864840001 180482050  PARONISH         ROLAND     18   843857883639922401   07/20/2023          50    $1,085.91     $851.40
    014267-05                102864840001 180482050  PARONISH         AMY        01   816691657639922401   07/20/2023          50    $1,487.45   $1,173.63
    014267-05                102971934001 181603444  NELSON           JULIE      01   600227472119821401   07/02/2023         (90)   ($180.99)   ($106.09)
    014267-05                102971934001 181603444  NELSON           JULIE      01   817326378078441401   07/15/2023          90      $508.50      $12.34
    014267-05                102971934001 181603444  NELSON           JULIE      01   496137836033871401   07/17/2023          30       $50.58      $21.95
    014267-05                102971934001 181603444  NELSON           JULIE      01   727060174078441401   07/15/2023          90      $180.99     $106.09
    014267-05                103035711001 182542331  ZAZVRSKEY        LISA       18   527518997470131401   07/14/2023          90    $1,016.59     $286.48
    014267-05                103035711001 182542331  ZAZVRSKEY        LISA       18   244683263076862401   07/22/2023          30      $737.02     $165.51
    014267-05                103380060001 186626373  SCALESE          TRACY      18   999111537134922401   07/20/2023          90      $156.64       $0.39
    014267-05                104144215001 195582778  DUMM             JENNIFER   18   943984680190152401   07/21/2023           7       $20.69       $0.00
    014267-05                104144215001 195582778  DUMM             SCOTT      01   307884007686281401   07/17/2023          30       $72.42       $5.70
    014267-05                104144215001 195582778  DUMM             CAMRYN     19   283302672223661401   07/16/2023          10       $57.45       $6.29
    014267-05                104318685001 197640477  HUDAK            JUSTICE    19   581040654535741401   07/15/2023          90      $373.89      $23.73
    014267-05                104318685001 197640477  HUDAK            JUSTICE    19   298238318255341401   07/15/2023         150      $204.86     $157.47
    014267-05                104318685001 197640477  HUDAK            MICHELLE   18   792221660488922401   07/20/2023          30       $36.21       $0.00
    014267-05                104318685001 197640477  HUDAK            JUSTICE    19   491303353034712401   07/15/2023         (90)   ($373.89)    ($23.73)
    014267-05                104318685001 197640477  HUDAK            JUSTICE    19   827408281155341401   07/12/2023        (150)   ($204.86)   ($157.47)
    014267-05                104318685001 197640477  HUDAK            JUSTICE    19   401800634134741401   07/12/2023         (90)   ($241.25)    ($23.73)
    014267-05                104318685001 197640477  HUDAK            JUSTICE    19   678789038984712401   07/19/2023          30      $124.63       $1.74
    014267-05                104318685001 197640477  HUDAK            MICHELLE   18   133325368488922401   07/20/2023          30       $28.56      $18.56
    014267-05                126331099001 197728059  MCKEE            MARIA      01   509872192752161401   07/16/2023           5       $54.99       $0.00
    014267-05                126331099001 197728059  MCKEE            MARIA      01   396861370572161401   07/16/2023           5       $75.99       $5.10
    014267-05                126331099001 197728059  MCKEE            MARIA      01   352249968162161401   07/16/2023           1       $14.30       $0.00
    014267-05                110289777001 198665728  SLAVIK           ROBERT     01   922947577448321401   07/14/2023          84   $24,921.42  $19,555.78
    014267-05                110289777001 198665728  SLAVIK           LORETTA    18   405934302209521401   07/14/2023          90      $442.85       $6.12

                                                                                                                                               PAGE:6 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                104458297001 199522163  NICHOL           HAILEY     19   886613983898871401   07/17/2023          30      $213.18       $0.25
    014267-05                104478830001 199648158  KLINE            AMELIA     19   852893638408462401   07/22/2023           7       $52.25       $8.81
    014267-05                114051191001 200641754  STARUCH          ASHLEY     01   208092301667721401   07/14/2023           7       $98.53      $16.40
    014267-05                114051191001 200641754  STARUCH          ASHLEY     01   505324702422821401   07/14/2023           7       $45.54      $24.86
    014267-05                114051191001 200641754  STARUCH          ASHLEY     01   715349608192462401   07/22/2023          60       $31.57       $1.31
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   995961430302771401   07/17/2023          30      $172.99      $26.24
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   675537377829621401   07/13/2023         (56)    ($15.19)       $0.00
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   187150994829621401   07/14/2023          56       $65.55       $0.00
    014267-05                104639290001 201607083  BONATESTA        JOSEPH     01   940604017144632401   07/20/2023          30       $32.25      $14.43
    014267-05                104821823001 203725621  HASSEN           LELAND     19   557133518229052401   07/21/2023          30      $444.18     $336.40
    014267-05                104821823001 203725621  HASSEN           LILLIAN    19   824424427646771401   07/17/2023           7      $203.50      $18.89
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   914051690350532401   07/14/2023         (30)   ($230.98)    ($12.04)
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   873368637376331401   07/14/2023          30      $230.98      $12.04
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   528114307250532401   07/17/2023         (90) ($1,679.86) ($1,277.67)
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   785558558568871401   07/17/2023          90    $1,679.86   $1,277.67
    014267-05                105133917001 207507140  BORN             LIZA       19   329744597767791401   07/18/2023           7       $21.42       $0.00
    014267-05                105133917001 207507140  BORN             LIZA       19   379215180474691401   07/18/2023           7       $17.79       $3.14
    014267-05                117760647001 208602985  ABEL             DOUGLAS    01   93311237555132401    07/20/2023          30       $29.80       $0.00
    014267-05                117760647001 208602985  ABEL             HANNAH     19   138354367605712401   07/19/2023          10      $102.28       $7.50
    014267-05                117760647001 208602985  ABEL             HANNAH     19   801833248405712401   07/19/2023          12       $14.99       $0.00
    014267-05                117760647001 208602985  ABEL             DOUGLAS    01   988674072546341401   07/15/2023          30       $34.30       $0.00
    014267-05                117760647001 208602985  ABEL             HANNAH     19   65017076015712401    07/19/2023          30       $85.26      $10.62
    014267-05                112105056001 208606192  TARANTO          PAUL       18   647703958248412401   07/19/2023          30       $14.11       $1.28
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   810687217555041401   07/15/2023          12       $59.99      $15.10
    014267-05                105312745001 209560853  KUDLAWIEC        MARY       19   961231800624902401   07/19/2023          30        $9.99       $0.00
    014267-05                105399373001 210548948  ROCCO            THOMAS     01   441953213081562401   07/10/2023         (90)   ($163.19)   ($106.04)
    014267-05                105399373001 210548948  ROCCO            SAMANTHA   19   732705078224842401   07/21/2023          84      $489.34      $43.88
    014267-05                105408339001 210604721  MULLEN           THOMAS     18   241476848759341401   07/15/2023          30       $24.68       $0.00
    014267-05                127479959001 210721282  DOUGHERTY        BRANDON    01   235965453299521401   07/14/2023          20      $272.03      $43.37
    014267-05                105507489001 211702122  BASSETT          SOPHIA     19   389482671834921401   07/14/2023          90      $510.10      $16.12
  014267-05 Total                                                                                                                   $36,769.25  $22,556.56
  014267-06

                                                                                                                                               PAGE:7 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-06                101267523001 160429168  PETRISKO         MICHAEL    01   444175818034902401   07/19/2023          90      $519.05      $14.12
    014267-06                114965976001 167642610  DOLANSKY         SEAN       01   976523708702312401   07/19/2023          16       $91.99      $33.30
    014267-06                110058092001 179504663  MCGOUGH          GERALD     18   538375913589231401   07/14/2023          30      $126.41       $0.00
    014267-06                103211068001 184601686  LEFFERTS         SARA       19   92214017201991401    07/08/2023         (30)    ($25.51)     ($0.44)
    014267-06                103211068001 184601686  LEFFERTS         SARA       19   265232462001991401   07/06/2023         (84)   ($441.04)    ($39.59)
    014267-06                103272483001 185482246  MOSCHGAT         CONNIE     01   34627197253621401    07/14/2023          30      $317.02       $5.70
    014267-06                103272483001 185482246  MOSCHGAT         CONNIE     01   235583998139922401   07/20/2023          90       $38.77       $0.29
    014267-06                103272483001 185482246  MOSCHGAT         CONNIE     01   528339178139922401   07/20/2023          90      $101.83       $4.86
    014267-06                103272483001 185482246  MOSCHGAT         CONNIE     01   667401530139922401   07/20/2023          90      $380.64      $16.87
    014267-06                103272483001 185482246  DUMM             RALPH      18   550485628869922401   07/20/2023           1        $4.45       $0.00
    014267-06                103371598001 186582068  SEDLOCK          KAREN      18   618927627726521401   07/14/2023          30       $19.13       $0.00
    014267-06                103371598001 186582068  SEDLOCK          JOHN       01   4316298812742401     07/21/2023          90      $665.58      $14.65
    014267-06                103371598001 186582068  SEDLOCK          JOHN       01   865945718742132401   07/20/2023          50       $33.19       $0.14
    014267-06                103371598001 186582068  SEDLOCK          KAREN      18   791215290291771401   07/17/2023          30       $78.99      $14.04
    014267-06                103371598001 186582068  SEDLOCK          JOHN       01   651463843551442401   07/21/2023          90        $6.99       $2.09
    014267-06                104212846001 196485949  DAISLEY          LAUREN     19   694427246606922401   07/20/2023          50      $105.24      $28.92
    014267-06                104212846001 196485949  DAISLEY          THERESA    01   261544950447942401   07/21/2023          30       $63.02       $1.62
    014267-06                104212846001 196485949  DAISLEY          THERESA    01   308996118399312401   07/19/2023          20       $88.77      $10.74
    014267-06                104212846001 196485949  DAISLEY          LAUREN     19   499561550076791401   07/18/2023          50      $139.23      $46.54
    014267-06                104212846001 196485949  DAISLEY          LAUREN     19   946815588546912401   07/18/2023         (50)   ($139.23)    ($46.54)
    014267-06                112723490001 199583547  WEILAND          DANIEL     18   235288678368991401   07/18/2023           1        $8.88       $0.00
    014267-06                135706193001 201604382  SODMONT          MICHELLE   18   338123473941442401   07/21/2023          90      $436.00       $4.86
    014267-06                105148829001 207601138  MESSINA          AUSTIN     19   468507453291232401   07/07/2023         (30)   ($150.85)       $0.00
  014267-06 Total                                                                                                                    $2,468.55     $112.17
  014267-07
    014267-07                121106664001 159703665  KANE             ALANNAH    19   505779678169771401   07/17/2023          10       $26.91       $0.00
    014267-07                101308695001 160783275  SHERRY           KENDRA     18   452273873987691401   07/18/2023          28       $57.18      $11.92
    014267-07                101308695001 160783275  SHERRY           KENDRA     18   514423968197691401   07/18/2023          30       $75.45       $1.78
    014267-07                101429258001 162485516  HARVEY           EMILY      19   184565448777491401   07/18/2023          84      $121.34      $25.80
    014267-07                101762054001 166645996  MCCAULLEY        MELISSA    01   227989668764532401   07/20/2023          28      $215.99      $46.28
    014267-07                102222699001 172543654  SCHREYER         RENEE      18   89687953223812401    07/13/2023         (30)   ($184.41)       $0.00
    014267-07                102222699001 172543654  SCHREYER         MORGAN     19   468077233624512401   07/19/2023          90      $317.92       $1.03

                                                                                                                                               PAGE:8 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-07                102406412001 174667290  O'NEILL          CARRIE     18   146791440995052401   07/21/2023           6       $46.00       $0.00
    014267-07                102406412001 174667290  O'NEILL          CARRIE     18   376793918195052401   07/21/2023          10       $49.28       $0.00
    014267-07                102468339001 175523583  NIEBAUER         TODD       01   298421150291732401   07/20/2023           5       $36.35       $0.10
    014267-07                102654899001 177648345  MARSHALL         WILLIAM    18   126585040186642401   07/21/2023          30      $125.10      $10.73
    014267-07                102807156001 179604238  RABATIN          ADRIENNE   18   25181360093412401    07/19/2023          28    $1,483.17     $955.94
    014267-07                102807156001 179604238  RABATIN          TAYLOR     19   897298738257791401   07/18/2023          84      $538.05      $39.59
    014267-07                102970458001 181589405  BROWN            THOMAS     01   181497746175132401   07/20/2023          30       $15.63       $0.00
    014267-07                102970458001 181589405  BROWN            THOMAS     01   562087586075132401   07/19/2023         (30)    ($15.63)       $0.00
    014267-07                102970458001 181589405  BROWN            THOMAS     01   496592512135912401   07/19/2023          30       $15.63       $0.00
    014267-07                122806756001 181726437  MARRA            BRYAN      18   980951517028791401   07/18/2023           5       $16.01       $0.00
    014267-07                122806756001 181726437  MARRA            KENNEDY    19   644443768798922401   07/20/2023           5       $35.88       $0.00
    014267-07                122806756001 181726437  MARRA            BRITTANY   01   190054027482132401   07/20/2023          15      $242.56      $57.95
    014267-07                122806756001 181726437  MARRA            BRYAN      18   516055110618791401   07/18/2023           5       $47.69       $0.00
    014267-07                124239642001 182745822  LINK             DYLAN      18   430313286199112401   07/19/2023           9       $28.02       $0.00
    014267-07                124239642001 182745822  LINK             MARIA      01   141847786247491401   07/18/2023           7      $509.20       $0.00
    014267-07                124239642001 182745822  LINK             MARIA      01   884203608801742401   07/21/2023          90      $218.96       $0.00
    014267-07                117714302001 185620255  DISHONG          SHAWN      18   101731310129922401   07/20/2023           7        $6.88       $0.00
    014267-07                117714302001 185620255  DISHONG          SHAWN      18   727661877991252401   07/12/2023         (30)    ($81.30)    ($37.31)
    014267-07                103537202001 188580615  DAVIS            ROBERT     01   184227356563462401   07/22/2023          90       $74.59       $0.00
    014267-07                103537202001 188580615  DAVIS            ROBERT     01   831699308563462401   07/22/2023          90      $365.28      $14.93
    014267-07                103553330001 188685116  MENTO            BETH       18   857025518750232401   07/20/2023          30      $213.63       $0.00
    014267-07                103698349001 190486201  KERFONTA         HEATHER    18   766417396711742401   07/21/2023          90      $525.33     $375.80
    014267-07                103879349001 192529999  WATT             HAYLEE     19   553807893571591401   07/18/2023         100      $278.97       $6.87
    014267-07                103879349001 192529999  WATT             HAYLEE     19   304759938571591401   07/18/2023         100       $50.60      $12.77
    014267-07                135720029001 196765983  MYERS            MARISSA    18   689722132317161401   07/16/2023          16       $14.87       $0.00
    014267-07                112923331001 201725616  SEMANCHIK-BARTO  KIRSTIE    18   991115960960232401   07/20/2023          50      $482.84     $354.12
    014267-07                104804112001 203580135  SMITH            MICHELE    18   511097897690921401   07/14/2023          10       $21.71       $0.00
    014267-07                104804112001 203580135  SMITH            MICHELE    18   96567562390921401    07/14/2023          15       $86.11       $0.00
    014267-07                133550618001 207723892  GALEBACH         NOAH       19   443863558515922401   07/18/2023         (30)   ($233.97)    ($64.70)
    014267-07                133550618001 207723892  GALEBACH         NOAH       19   786854280635922401   07/20/2023          30      $360.29      $64.70
    014267-07                133550618001 207723892  GALEBACH         NOAH       19   667631490461102401   07/18/2023          30      $233.97      $64.70
    014267-07                105235875001 208589040  EVANS            CRISTIAN   18   529156108359891401   07/18/2023          90      $510.05       $7.34

                                                                                                                                               PAGE:9 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-07                105235875001 208589040  EVANS            CRISTIAN   18   119603838199891401   07/18/2023           7       $30.16       $0.00
    014267-07                105235875001 208589040  EVANS            CRISTIAN   18   381046998829891401   07/18/2023          90      $243.17       $0.92
    014267-07                105413169001 210629784  HARROLD          GAVIN      19   496153323928152401   07/07/2023         (18)    ($85.26)    ($25.66)
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   240907063852971401   07/17/2023          30       $36.21       $0.00
    014267-07                113092711001 214135088  HAJNOSZ          CAROLEE    18   659369758852971401   07/17/2023          30        $9.00       $0.00
  014267-07 Total                                                                                                                    $7,165.41   $1,925.60
  014267-08
    014267-08                101267755001 160429635  FLORA            MARK       18   920071417194591401   07/18/2023          90       $96.40       $7.66
    014267-08                127928506001 162602138  TREON            TINA       18   432188388800621401   07/14/2023          28      $281.50      $12.04
    014267-08                127928506001 162602138  TREON            TINA       18   625476448900771401   07/17/2023          30      $101.06       $8.70
    014267-08                127928506001 162602138  TREON            TINA       18   91120323700621401    07/14/2023          30      $104.12       $0.00
    014267-08                127928506001 162602138  TREON            TINA       18   303727606800621401   07/14/2023          30      $153.71       $9.02
    014267-08                127928506001 162602138  TREON            TINA       18   77666340600621401    07/14/2023          30      $181.83       $2.36
    014267-08                101747063001 166560149  KRUISE           EDWARD     01   802888458908010401   07/07/2023          28    $1,141.09     $815.00
    014267-08                101747063001 166560149  KRUISE           EDWARD     01   476864292618010401   07/07/2023          43      $630.12     $416.06
    014267-08                117058404001 167564751  STASKO           KEVIN      01   492855188487462401   07/22/2023          30      $864.34     $552.10
    014267-08                117058404001 167564751  STASKO           KEVIN      01   13073883287462401    07/22/2023          30      $797.96     $507.70
    014267-08                116871611001 173605841  MURPHY           JANELL     18   8191097790691401     07/18/2023          28    $1,952.57   $1,279.85
    014267-08                132465085001 175547949  VENESKY          KIM        18   83504337372212401    07/19/2023          30      $145.35       $0.00
    014267-08                103031088001 182508904  ZUNGALI          ROBIN      01   103532272798232401   07/20/2023          30      $871.91     $557.16
    014267-08                103031088001 182508904  ZUNGALI          PHILIP     18   690534587418691401   07/18/2023          30      $579.31     $361.48
    014267-08                103036754001 182545346  DELOZIER         JOSEPH     18   691387036691771401   07/17/2023          28      $171.99     $104.43
    014267-08                103036754001 182545346  DELOZIER         JOSEPH     18   441203923247281401   07/17/2023          84    $3,579.99   $2,583.12
    014267-08                103036754001 182545346  DELOZIER         JOSEPH     18   272193836063162401   07/22/2023          50      $145.33       $5.51
    014267-08                103043271001 182585206  FINET            THERESA    18   983485988791771401   07/17/2023          28    $1,198.99     $881.89
    014267-08                103046886001 182605120  HENDRICK         JILL       18   740586158019291401   07/18/2023          90      $100.30       $0.00
    014267-08                103537183001 188580574  BERTRAM          GRACE      19   173117123803161401   07/16/2023          91      $268.55      $24.01
    014267-08                103537183001 188580574  HEBERT           JEFFERY    01   423134077210662401   07/22/2023          30      $169.99       $6.54
    014267-08                103537183001 188580574  HEBERT           LINDA      18   842265708189891401   07/18/2023          90       $98.99      $30.00
    014267-08                103711350001 190563467  PASSONETTI       DAVID      01   28927693106281401    07/17/2023          30      $112.30      $10.62
    014267-08                104305401001 197548896  KUNTZMAN         AMY        18   350343356537642401   07/21/2023          50       $39.09       $0.14
    014267-08                104393562001 198605554  MCBREEN          AMBER      19   118607816383002401   07/18/2023          28      $102.01      $19.48

                                                                                                                                              PAGE:10 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-08                104393562001 198605554  MCBREEN          KEVIN      18   142364230444771401   07/17/2023          30      $213.63       $0.00
    014267-08                110998339001 200645662  FEES             JENNY      18   338373448787332401   07/20/2023          90      $230.64       $5.92
    014267-08                110998339001 200645662  FEES             JENNY      18   442013428008332401   07/20/2023          45       $73.40       $3.37
    014267-08                110998339001 200645662  FEES             JENNY      18   430633608967642401   07/21/2023          90       $92.29      $12.97
    014267-08                110998339001 200645662  FEES             JENNY      18   357277596587332401   07/20/2023          30      $316.03       $5.70
    014267-08                110998339001 200645662  FEES             JENNY      18   743245488687332401   07/20/2023          30       $27.45       $2.35
    014267-08                105133504001 207506202  LITZINGER        SUSAN      01   632917066880261401   07/16/2023          30      $536.28     $411.11
  014267-08 Total                                                                                                                   $15,378.52   $8,636.29
  014267-12
    014267-12                101592912001 164561540  KIVISTO          DAVID      01   325703953094081401   07/17/2023          28    $1,118.04     $877.19
    014267-12                101592912001 164561540  KIVISTO          DAVID      01   81903278408991401    07/18/2023          30      $284.10     $207.94
    014267-12                101592912001 164561540  KIVISTO          DAVID      01   371655728214871401   07/17/2023          30      $712.96     $552.10
    014267-12                101592912001 164561540  KIVISTO          DAVID      01   966923468307061401   07/16/2023          30        $6.65       $0.00
    014267-12                102304578001 173544751  MARCINKO         MICHELE    18   484702901208201401   07/13/2023          84      $121.42       $4.92
    014267-12                104217337001 196509986  KLEZEK           REBECCA    18   696354657174352401   07/21/2023          30      $123.13       $2.45
  014267-12 Total                                                                                                                    $2,366.30   $1,644.60
  014267-13
    014267-13                102118780001 171382795  ORR              GEMAINE    18   541049918075922401   07/20/2023          30       $31.05       $0.00
    014267-13                102552483001 176526359  CALDWELL         DAVID      18   753314037682312401   07/19/2023          30      $672.90     $520.75
    014267-13                102552483001 176526359  CALDWELL         DAVID      18   986271370823871401   07/17/2023          30       $88.61       $3.88
    014267-13                102552483001 176526359  CALDWELL         DAVID      18   960161100582312401   07/19/2023          30       $38.40       $4.54
    014267-13                104707411001 202484824  POMPA            LOUISE     18   606389438058481401   07/17/2023          30      $221.86       $0.00
  014267-13 Total                                                                                                                    $1,052.82     $529.17
  014267-15
    014267-15                101825051001 167565230  PARONISH         THOMAS     18   387373188736462401   07/22/2023          28    $1,123.92     $881.89
    014267-15                101825051001 167565230  PARONISH         THOMAS     18   498013373621161401   07/16/2023          30      $426.46     $322.18
    014267-15                101825051001 167565230  PARONISH         THOMAS     18   610325740763991401   07/06/2023         (50)   ($297.88)   ($219.00)
    014267-15                101825051001 167565230  PARONISH         THOMAS     18   410637567959921401   07/12/2023         (90)   ($276.60)    ($27.87)
    014267-15                101825051001 167565230  PARONISH         THOMAS     18   886550173959921401   07/12/2023          90      $276.60      $27.87
    014267-15                102312278001 173587932  PALMISANO        LEONARD    18   100136978862312401   07/19/2023          30       $49.49       $3.40
    014267-15                103115531001 183523270  SHEA             EDWARD     18   655491577353162401   07/22/2023          90      $379.22      $16.87
    014267-15                103115531001 183523270  SHEA             EDWARD     18   209285658994871401   07/17/2023          60       $85.26      $10.62

                                                                                                                                              PAGE:11 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-15                103212512001 184605964  KIMMEL           RICHARD    18   109364577785562401   07/22/2023          90      $269.57      $39.95
    014267-15                103212512001 184605964  KIMMEL           RICHARD    18   722521190256771401   07/17/2023          30      $105.40      $15.24
    014267-15                104458562001 199522908  SERAFIN          SANDRA     18   300258337420921401   07/14/2023           6       $36.71       $2.54
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   352051947402002401   07/06/2023          30      $145.59      $30.73
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   8499998216432401     07/20/2023          20       $14.44       $0.00
  014267-15 Total                                                                                                                    $2,338.18   $1,104.42
  014267-19
    014267-19                105488365001 211561553  MCDERMOTT        KIMBERLY   18   867112652318991401   07/18/2023          30       $47.27       $2.90
  014267-19 Total                                                                                                                       $47.27       $2.90
  014267-22
    014267-22                104709255001 202500368  KLEZEK           JANA       18   840167133240742401   07/21/2023          30      $148.56       $0.00
  014267-22 Total                                                                                                                      $148.56       $0.00
  014267-26
    014267-26                103601183001 189447557  SETTLE           SUSAN      18   535956288484771401   07/17/2023          30       $67.65       $0.00
    014267-26                103601183001 189447557  SETTLE           SUSAN      18   359205770768561401   07/16/2023          30       $67.65       $0.00
    014267-26                103601183001 189447557  SETTLE           SUSAN      18   798297056484771401   07/16/2023         (30)    ($67.65)       $0.00
    014267-26                103865487001 192460825  WHITESELL        EDWARD     18   361653096027512401   07/19/2023          90      $407.20       $0.00
    014267-26                103945030001 193422246  BROWN            JOHN       18   823033198566491401   07/18/2023          90      $261.40       $3.40
    014267-26                104456115001 199505432  VESCOVI          TIMOTHY    18   464834467661951401   07/16/2023          90      $125.50       $1.66
    014267-26                104456115001 199505432  VESCOVI          TIMOTHY    18   617517166661951401   07/16/2023          90      $175.69       $0.00
    014267-26                105050264001 206525459  MCCOY            ROBERT     18   584454682135911401   07/14/2023          90       $71.50       $7.68
    014267-26                105050264001 206525459  MCCOY            ROBERT     18   21857987135911401    07/14/2023          90      $169.60       $0.00
  014267-26 Total                                                                                                                    $1,278.54      $12.74
  014267-36
    014267-36                109914485001 163626883  SHROYER          ROY        01   910498147255041401   07/15/2023          34      $196.08       $0.00
    014267-36                109914485001 163626883  SHROYER          WENDY      18   944597313754561401   07/16/2023          28       $81.95       $1.99
    014267-36                109914485001 163626883  SHROYER          ROY        01   806073183943871401   07/17/2023          34       $81.99       $8.47
    014267-36                109914485001 163626883  SHROYER          ROY        01   249243696845561401   07/16/2023          34       $41.97       $0.96
    014267-36                109914485001 163626883  SHROYER          ROY        01   679857856113791401   07/18/2023          34       $41.97       $0.96
    014267-36                109914485001 163626883  SHROYER          ROY        01   997937553903791401   07/16/2023         (34)    ($41.97)     ($0.96)
    014267-36                101597846001 164585882  BECQUET          DAWN       18   659107753381771401   07/17/2023           6       $20.68       $0.00
    014267-36                101609657001 164662147  BYRNE            VANESSA    01   904558551170321401   07/14/2023          34      $131.72      $10.08

                                                                                                                                              PAGE:12 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-36                101609657001 164662147  BYRNE            VANESSA    01   583917976170321401   07/14/2023          34       $87.13       $0.00
    014267-36                101609657001 164662147  BYRNE            JUSTIN     18   351814700903161401   07/16/2023          34      $153.68       $1.10
    014267-36                101609657001 164662147  BYRNE            JUSTIN     18   717048588803161401   07/16/2023          34       $60.82       $0.00
    014267-36                101609657001 164662147  BYRNE            JUSTIN     18   258458970528621401   07/14/2023          30       $12.32       $0.00
    014267-36                120850202001 164728456  BRODISH          TORIE      18   585157676679112401   07/19/2023          30      $142.45       $0.00
    014267-36                120850202001 164728456  BRODISH          TORIE      18   433517477999521401   07/14/2023          30       $82.99       $0.00
    014267-36                101742475001 166526179  CLAYCOMB         DAVID      18   517245080983791401   07/18/2023           6      $398.78       $0.00
    014267-36                101742475001 166526179  CLAYCOMB         MORGAN     19   632135768972791401   07/18/2023          28       $89.54      $18.28
    014267-36                101742475001 166526179  CLAYCOMB         DAVID      18   472553648338791401   07/18/2023          30      $173.02       $0.00
    014267-36                115426142001 168701689  ZERNICK          REBECCA    18   704011050631591401   07/18/2023          30      $474.43     $361.48
    014267-36                115426142001 168701689  ZERNICK          REBECCA    18   135276848631591401   07/18/2023          30       $14.03       $0.00
    014267-36                115426142001 168701689  ZERNICK          REBECCA    18   95953833173791401    07/18/2023          28        $9.00       $9.00
    014267-36                135324608001 174628856  WILLIAMSON       ROSS       18   706637046007061401   07/16/2023          30       $51.16       $0.00
    014267-36                135324608001 174628856  WILLIAMSON       ROSS       18   977764087996061401   07/16/2023          30       $81.72       $0.00
    014267-36                102792037001 179509577  WAGSTAFF         RICHARD    18   832979438261712401   07/19/2023          30      $170.90       $6.35
    014267-36                102792037001 179509577  WAGSTAFF         RICHARD    18   38943276361712401    07/19/2023          30       $25.00      $10.81
    014267-36                102792037001 179509577  WAGSTAFF         RICHARD    18   23237303361712401    07/19/2023          30       $22.35       $0.00
    014267-36                132201566001 182642148  REVESZ           STACEY     19   746965758285142401   07/21/2023          30       $34.98      $14.86
    014267-36                132201566001 182642148  REVESZ           MEGAN      19   920092701662031401   07/14/2023          30      $104.32       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   410942141670621401   07/14/2023           3       $42.06       $0.00
    014267-36                132201566001 182642148  REVESZ           STACEY     19   371002552359712401   07/10/2023         (34)    ($17.00)     ($1.10)
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   843681120755081401   07/14/2023          30      $651.95     $503.14
    014267-36                104067536001 194626051  BURKHARDT        JASON      18   157109038968871401   07/17/2023          30      $475.43     $361.48
    014267-36                104073548001 194669857  RUDDEK           ELIZABET   01   676498831837721401   07/14/2023          34       $95.62       $0.00
    014267-36                117835248001 194706672  COMMONS          MADALYNN   19   866166280852721401   07/14/2023          30    $2,913.52   $1,914.45
    014267-36                104564544001 200647718  DIEHL            DARRELL    18   791817347271131401   07/14/2023          30       $62.72       $3.39
    014267-36                118690744001 203684634  BEHORY           JUSTIN     18   712281042948310401   07/07/2023          90    $2,327.48   $1,684.84
    014267-36                112032810001 208608905  WARGO            KENNETH    18   307622052466642401   07/21/2023          28       $27.60       $1.78
    014267-36                112032810001 208608905  WARGO            BRANDI     01   672977353591461401   07/16/2023          30      $170.68       $0.00
    014267-36                112032810001 208608905  WARGO            BRANDI     01   509253756721161401   07/16/2023          30       $15.88       $0.00
    014267-36                112032810001 208608905  WARGO            BRANDI     01   866461160937642401   07/21/2023          30       $93.29       $0.00
    014267-36                112032810001 208608905  WARGO            KENNETH    18   63777466680562401    07/22/2023          28       $95.99      $53.34

                                                                                                                                              PAGE:13 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  014267-36 Total                                                                                                                    $9,698.23   $4,964.70
  014267-37
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   437867037106521401   07/14/2023          30       $92.76       $5.62
    014267-37                102139943001 171527840  TARWATER         PATRICIA   18   232114357434632401   07/07/2023         (25)    ($86.15)       $0.00
    014267-37                103035623001 182542100  TOMASELLI        ANTHONY    18   58073818052612401    07/19/2023          30      $965.27     $346.13
    014267-37                103035623001 182542100  TOMASELLI        ANTHONY    18   129765970632591401   07/18/2023          30       $79.11       $6.43
    014267-37                103035623001 182542100  TOMASELLI        ANTHONY    18   47435138832591401    07/18/2023          90      $541.41       $1.12
    014267-37                103459963001 187600390  BRYAN            KAREN      18   600216558897212401   07/19/2023          10       $99.71       $0.00
    014267-37                103459963001 187600390  BRYAN            KAREN      18   795493726756971401   07/17/2023          30      $305.93       $0.00
    014267-37                103459963001 187600390  BRYAN            KAREN      18   522883446279591401   07/18/2023          30      $280.90       $3.08
    014267-37                103619466001 189546549  RODGERS          RAMONA     18   521964160760232401   07/20/2023          10       $45.45       $0.00
    014267-37                103619466001 189546549  RODGERS          RAMONA     18   783284507819771401   07/17/2023          90       $55.84       $2.17
    014267-37                103881647001 192546893  TRANQUILLO       VALARIE    18   741777243055691401   07/18/2023          90       $63.56      $10.07
    014267-37                103881647001 192546893  TRANQUILLO       VALARIE    18   145665970745691401   07/18/2023          30      $213.63       $0.00
    014267-37                104379611001 198524891  PACIFICO         ANTHONY    01   861779668187642401   07/21/2023          90      $131.12      $15.23
    014267-37                104379611001 198524891  PACIFICO         ANTHONY    01   830311097087642401   07/21/2023          90       $96.82      $15.79
    014267-37                104379611001 198524891  PACIFICO         ANTHONY    01   447133648687642401   07/21/2023          90      $104.28       $0.00
    014267-37                104379611001 198524891  PACIFICO         ANTHONY    01   187171737787642401   07/21/2023          90    $1,032.45     $281.48
  014267-37 Total                                                                                                                    $4,022.09     $687.12
  014267- Total                                                                                                                    $139,728.68  $72,439.44
Drug Total                                                                                                                         $139,728.68  $72,439.44
                                                                                                                                                            
Facility
  053264-01
    053264-01                107311465001 363488272  DONGELL          EDWARD     01   22113585060          07/13/2023           1      $130.00      $51.19
    053264-01                107311465001 363488272  DONGELL          EDWARD     01   22113585060          07/13/2023           1      $129.00      $31.97
    053264-01                107311465001 363488272  DONGELL          EDWARD     01   22113585060          07/13/2023           1      $410.00     $142.21
    053264-01                107311465001 363488272  DONGELL          EDWARD     01   22113585060          07/13/2023           1       $31.00       $0.00
    053264-01                107311465001 363488272  DONGELL          EDWARD     01   22113585060          07/13/2023           1      $150.00     $121.37
    053264-01                107311465001 363488272  DONGELL          EDWARD     01   22113585060          07/13/2023           1      $236.00      $69.76
    053264-01                107311465001 363488272  DONGELL          EDWARD     01   22113585060          07/13/2023           1      $217.00      $67.68
    053264-01                107311465001 363488272  DONGELL          EDWARD     01   22113585060          07/13/2023           1      $164.00      $72.40

                                                                                                                                              PAGE:14 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  053264-01 Total                                                                                                                    $1,467.00     $556.58
  053264- Total                                                                                                                      $1,467.00     $556.58
Facility Total                                                                                                                       $1,467.00     $556.58
                                                                                                                                                            
HDHP PPO
  014267-54
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22713678504          07/18/2023           1       $50.00      $10.45
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22713678504          07/18/2023           1       $80.00      $22.60
    014267-54                101206582001 159544984  DUNCHUCK         MARYANN    01   22713678504          07/18/2023           2      $168.00      $49.16
    014267-54                101290691001 160589924  BORLIE           MARGARET   18   462497062814631401   07/15/2023          60       $92.70      $19.87
    014267-54                101290691001 160589924  BORLIE           MARGARET   18   22213684442          07/07/2023           1       $35.00      $24.58
    014267-54                101290691001 160589924  BORLIE           MARGARET   18   22213684442          07/07/2023           1       $45.00      $33.32
    014267-54                101299088001 160644992  MARTINAZZI       BRANDON    18   948175418161912401   07/06/2023         (30)    ($25.45)       $0.00
    014267-54                101299088001 160644992  MARTINAZZI       BRANDON    18   132223018851912401   07/06/2023         (30)    ($28.97)       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   96103868801991401    07/11/2023         (30)   ($211.23)       $0.00
    014267-54                101363408001 161569102  COOK             SCOTT      18   22813763744          07/04/2023           1      $235.00       $0.00
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043347          06/30/2023          (1)   ($360.00)   ($298.82)
    014267-54                101514808001 163542690  FULLER           KIMBERLY   18   22113437541          07/17/2023           1       $50.00      $33.32
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043347          06/30/2023           1       $83.00       $0.00
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043347          06/30/2023           1      $150.00       $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   22113043347          06/30/2023          (3)   ($430.00)       $0.00
    014267-54                101514808001 163542690  FULLER           KEVIN      01   380827653764871401   07/17/2023          90      $366.25     $230.09
    014267-54                101514808001 163542690  FULLER           KIMBERLY   18   22113438592          07/17/2023           1       $86.00      $50.00
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043347          06/30/2023           1       $27.00       $0.00
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043347          06/30/2023           1      $148.00     $104.76
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043347          06/30/2023          (1)    ($83.00)       $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   22113043347          06/30/2023           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   22113043347          06/30/2023          (1)    ($27.00)       $0.00
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043347          06/30/2023           1      $360.00     $298.82

                                                                                                                                              PAGE:15 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                101514808001 163542690  FULLER           KIMBERLY   18   22113437541          07/17/2023           1       $40.00      $22.10
    014267-54                101514808001 163542690  FULLER           KIMBERLY   18   22113437541          07/17/2023           1       $35.00      $24.58
    014267-54                101514808001 163542690  FULLER           KEVIN      01   22113043347          06/30/2023           1       $89.00       $0.00
    014267-54                101589732001 164542342  ROBERTS          DAVID      01   22032407356          06/22/2023           1       $75.00       $0.00
    014267-54                101589732001 164542342  ROBERTS          DAVID      01   22032407356          06/22/2023           1       $75.00       $0.00
    014267-54                101589732001 164542342  ROBERTS          DAVID      01   22032407356          06/22/2023           1      $290.00       $0.00
    014267-54                101589732001 164542342  ROBERTS          DAVID      01   22032407471          06/23/2023           1       $20.00       $0.00
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22513756854          07/20/2023           1       $33.00      $16.68
    014267-54                101679413001 165601158  SIMMONS          ABIGAIL    19   311923938496061401   07/16/2023          30       $77.77      $15.35
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   22513731580          07/10/2023           1       $47.00      $33.32
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22513756854          07/20/2023           4      $144.00      $98.32
    014267-54                101679413001 165601158  SIMMONS          ABIGAIL    19   108057013496061401   07/16/2023          30       $25.53       $4.94
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   583291357160742401   07/21/2023          30       $69.11      $21.49
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22513731566          07/19/2023           1       $20.00       $0.00
    014267-54                101679413001 165601158  SIMMONS          ABIGAIL    19   128651630160771401   07/17/2023          30       $68.45       $7.97
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22513756854          07/20/2023           1       $20.00       $0.00
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   665521570160742401   07/21/2023          30       $68.45       $7.97
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22513731566          07/19/2023           4      $144.00      $98.32
    014267-54                101679413001 165601158  SIMMONS          CYNTHIA    18   527301427753942401   07/21/2023          28    $1,123.92     $901.89
    014267-54                101679413001 165601158  SIMMONS          JACOB      19   380353386221591401   07/18/2023          30      $686.35     $138.31
    014267-54                101679413001 165601158  SIMMONS          GERALD     01   22513731566          07/19/2023           1       $33.00      $16.68
    014267-54                131732377001 167623544  MARSH            RAYMOND    01   651947766269621401   07/14/2023           4        $9.65       $6.73
    014267-54                131732377001 167623544  MARSH            SHELLY     18   102053033455412401   07/19/2023           5       $10.00       $1.92
    014267-54                131732377001 167623544  MARSH            RAYMOND    01   22713576915          07/14/2023           1      $702.52     $702.52
    014267-54                131732377001 167623544  MARSH            SHELLY     18   540149988985642401   07/21/2023           5       $47.69       $6.85
    014267-54                101835217001 167625474  BEZEK            JENNIFER   18   22113363349          07/11/2023           1      $497.00     $225.44
    014267-54                101835217001 167625474  BEZEK            JENNIFER   18   22113363349          07/11/2023           1       $48.00      $58.59
    014267-54                123673326001 167720876  MEHALKO          NOLAN      19   22611221894          06/12/2023          (1)   ($185.00)   ($112.39)
    014267-54                123673326001 167720876  MEHALKO          NOLAN      19   22611221894          06/12/2023          (3)   ($120.00)    ($63.63)
    014267-54                123673326001 167720876  MEHALKO          MELISSA    18   22613594038          07/14/2023           1      $188.00       $0.00
    014267-54                123673326001 167720876  MEHALKO          MELISSA    18   141198960729521401   07/14/2023           7       $50.49       $0.00
    014267-54                123673326001 167720876  MEHALKO          MELISSA    18   22613506710          07/13/2023           1       $23.00       $0.00

                                                                                                                                              PAGE:16 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                123673326001 167720876  MEHALKO          NOLAN      19   22611221894          06/12/2023          (1)   ($325.00)   ($292.66)
    014267-54                123673326001 167720876  MEHALKO          MELISSA    18   22613506710          07/13/2023           1      $102.00       $0.00
    014267-54                123673326001 167720876  MEHALKO          NOLAN      19   22611221894          06/12/2023           5      $200.00      $80.07
    014267-54                123673326001 167720876  MEHALKO          MELISSA    18   22613506710          07/13/2023           1       $87.00       $0.00
    014267-54                123673326001 167720876  MEHALKO          MELISSA    18   22613506710          07/13/2023           1       $98.00       $0.00
    014267-54                123673326001 167720876  MEHALKO          MELISSA    18   22613506710          07/13/2023           1       $56.00       $0.00
    014267-54                123673326001 167720876  MEHALKO          MELISSA    18   22613506710          07/13/2023           1      $119.00       $0.00
    014267-54                123673326001 167720876  MEHALKO          MELISSA    18   22613506710          07/13/2023           1      $188.00       $0.00
    014267-54                123673326001 167720876  MEHALKO          NOLAN      19   22611221894          06/12/2023          (1)   ($200.00)   ($200.00)
    014267-54                123673326001 167720876  MEHALKO          NOLAN      19   22611221894          06/12/2023          (5)   ($200.00)    ($80.07)
    014267-54                123673326001 167720876  MEHALKO          NOLAN      19   22611221894          06/12/2023           3      $120.00      $63.63
    014267-54                123673326001 167720876  MEHALKO          NOLAN      19   22611221894          06/12/2023           1      $250.00     $202.14
    014267-54                123673326001 167720876  MEHALKO          MELISSA    18   22613506710          07/13/2023           1       $61.00       $0.00
    014267-54                123673326001 167720876  MEHALKO          MELISSA    18   22613506710          07/13/2023           1       $96.00       $0.00
    014267-54                123673326001 167720876  MEHALKO          MELISSA    18   22613506710          07/13/2023           1       $96.00       $0.00
    014267-54                123673326001 167720876  MEHALKO          NOLAN      19   22611221894          06/12/2023           1      $195.00     $125.27
    014267-54                123673326001 167720876  MEHALKO          NOLAN      19   22611221894          06/12/2023          (1)   ($195.00)   ($125.27)
    014267-54                123673326001 167720876  MEHALKO          NOLAN      19   22611221894          06/12/2023           1      $325.00     $292.66
    014267-54                123673326001 167720876  MEHALKO          MELISSA    18   22613506710          07/13/2023           1      $128.00       $0.00
    014267-54                123673326001 167720876  MEHALKO          NOLAN      19   22611221894          06/12/2023           1      $185.00     $112.39
    014267-54                101899822001 168521561  BENDER           STEPHEN    18   384727607601341401   07/15/2023          30      $159.01       $0.00
    014267-54                101899822001 168521561  BENDER           STEPHEN    18   763266620601341401   07/15/2023          30       $38.83       $0.00
    014267-54                101979530001 169545952  KOKOSKI          KENNEDY    19   22813540725          06/12/2023           1      $150.00       $0.00
    014267-54                101979530001 169545952  KOKOSKI          KENNEDY    19   22813540725          06/12/2023           1      $170.00       $0.00
    014267-54                114826745001 169628242  SOKIRA           LISA       18   430593413566432401   07/20/2023          30      $199.61       $8.16
    014267-54                114826745001 169628242  SOKIRA           LISA       18   279609598566432401   07/20/2023          30      $279.52      $80.56
    014267-54                114826745001 169628242  SOKIRA           LISA       18   9793818233722401     07/20/2023          30    $5,520.60   $4,432.95
    014267-54                102080764001 170683398  STRAZISAR        ROBERT     01   667392592782462401   07/22/2023          30       $72.19       $4.94
    014267-54                114763003001 171621966  MARHEFKA         KAREN      18   553198258240771401   07/17/2023          17       $24.00       $0.00
    014267-54                122307690001 171640335  WIEGAND          AARON      18   577014597504422401   07/20/2023          30       $29.52       $0.00
    014267-54                122307690001 171640335  WIEGAND          AARON      18   579213568804422401   07/20/2023          30      $211.28       $0.00
    014267-54                122307690001 171640335  WIEGAND          AARON      18   737479208347132401   07/20/2023          30       $37.15       $0.00

                                                                                                                                              PAGE:17 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                122307690001 171640335  WIEGAND          AARON      18   674234057604422401   07/20/2023          30      $127.95       $0.00
    014267-54                102159846001 171648736  PALKO            MONICA     18   342211707896891401   07/18/2023           7       $11.19       $7.31
    014267-54                112685074001 175662935  KOLARIK          ZACHARY    19   538423273530332401   07/20/2023          30      $288.70       $0.00
    014267-54                112685074001 175662935  KOLARIK          ZACHARY    19   22713753178          07/19/2023           1      $185.00     $118.97
    014267-54                112685074001 175662935  KOLARIK          ZACHARY    19   22713753178          07/19/2023           1      $220.00     $216.20
    014267-54                112685074001 175662935  KOLARIK          ZACHARY    19   580126928320332401   07/19/2023         (30)   ($322.68)       $0.00
    014267-54                112685074001 175662935  KOLARIK          ZACHARY    19   22713753178          07/19/2023           1       $85.00      $46.07
    014267-54                112685074001 175662935  KOLARIK          PAYTON     19   398939988884842401   07/21/2023           5        $4.49       $0.00
    014267-54                112685074001 175662935  KOLARIK          ZACHARY    19   879867786951312401   07/19/2023          30      $359.39       $0.00
    014267-54                112685074001 175662935  KOLARIK          ZACHARY    19   803643558171312401   07/19/2023          30      $322.68       $0.00
    014267-54                112685074001 175662935  KOLARIK          PAYTON     19   676609228294842401   07/21/2023           1        $5.19       $0.00
    014267-54                112685074001 175662935  KOLARIK          ZACHARY    19   22713753178          07/19/2023           2       $80.00      $42.42
    014267-54                112685074001 175662935  KOLARIK          ZACHARY    19   22713753178          07/19/2023           1       $35.00      $16.70
    014267-54                112685074001 175662935  KOLARIK          ZACHARY    19   22713753178          07/19/2023           2       $80.00      $32.03
    014267-54                117041830001 177705872  GALLAGHER        EMILY      19   22713783881          07/19/2023           1       $75.00      $10.96
    014267-54                117041830001 177705872  GALLAGHER        EMILY      19   22713783881          07/19/2023           1       $75.00      $10.96
    014267-54                117041830001 177705872  GALLAGHER        MARLEE     19   22713539851          06/11/2023           1      $150.00      $19.32
    014267-54                117041830001 177705872  GALLAGHER        MARLEE     19   22713539851          06/11/2023           1       $47.00      $10.50
    014267-54                117041830001 177705872  GALLAGHER        EMILY      19   22713783881          07/19/2023           1      $175.00     $119.36
    014267-54                116625941001 183628434  LITZINGER        LYDIA      19   22813553818          07/17/2023          15      $330.00     $248.10
    014267-54                116625941001 183628434  LITZINGER        BRIANNA    19   22813827719          07/20/2023           2       $80.00      $42.42
    014267-54                116625941001 183628434  LITZINGER        LYDIA      19   22813582240          07/18/2023          30      $660.00     $496.20
    014267-54                116625941001 183628434  LITZINGER        LYDIA      19   22813635691          07/17/2023           1      $160.00     $126.85
    014267-54                116625941001 183628434  LITZINGER        BRIANNA    19   22813827719          07/20/2023           1       $40.00       $4.95
    014267-54                116625941001 183628434  LITZINGER        BRIANNA    19   22813827719          07/20/2023           1      $385.00     $292.72
    014267-54                116625941001 183628434  LITZINGER        BRIANNA    19   22813827719          07/20/2023           1      $220.00     $216.20
    014267-54                116625941001 183628434  LITZINGER        LYDIA      19   22813582240          07/18/2023          15      $330.00     $248.10
    014267-54                116625941001 183628434  LITZINGER        BRIAN      01   148897623686642401   07/21/2023          30       $10.29       $4.47
    014267-54                116625941001 183628434  LITZINGER        LYDIA      19   22813827720          07/20/2023           1       $40.00       $2.99
    014267-54                116625941001 183628434  LITZINGER        LYDIA      19   22813827720          07/20/2023           1       $40.00       $4.95
    014267-54                116625941001 183628434  LITZINGER        JENNIFER   18   912660503392341401   07/15/2023          30      $144.81      $12.31
    014267-54                116625941001 183628434  LITZINGER        VIVIAN     19   151615648037432401   07/20/2023          30      $104.65      $31.35

                                                                                                                                              PAGE:18 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                116625941001 183628434  LITZINGER        LYDIA      19   22813827720          07/20/2023           1       $35.00      $16.70
    014267-54                116625941001 183628434  LITZINGER        LYDIA      19   22813553818          07/17/2023          30      $660.00     $496.20
    014267-54                116625941001 183628434  LITZINGER        LYDIA      19   22813570890          07/17/2023           1      $195.00      $74.94
    014267-54                116625941001 183628434  LITZINGER        VIVIAN     19   724104387792732401   07/20/2023          30      $256.14      $61.69
    014267-54                116625941001 183628434  LITZINGER        BRIANNA    19   22813827719          07/20/2023           1       $35.00      $16.70
    014267-54                116625941001 183628434  LITZINGER        BRIANNA    19   22813827719          07/20/2023           1      $185.00     $130.20
    014267-54                116625941001 183628434  LITZINGER        JENNIFER   18   22813571175          07/12/2023           1      $263.00      $85.70
    014267-54                116625941001 183628434  LITZINGER        BRIANNA    19   22813827719          07/20/2023           1       $40.00       $2.99
    014267-54                116625941001 183628434  LITZINGER        LYDIA      19   22813827720          07/20/2023           1      $185.00     $130.20
    014267-54                116625941001 183628434  LITZINGER        JENNIFER   18   786941590924991401   07/18/2023          30      $101.54      $36.40
    014267-54                103206930001 184580132  NEDRICH          MELANIE    18   785391237215591401   07/18/2023          30      $762.94       $0.00
    014267-54                103206930001 184580132  NEDRICH          MELANIE    18   123691520715591401   07/18/2023          30       $47.99       $0.00
    014267-54                121194993001 185622463  WENDEROTH        HANNAH     19   22313762495          07/19/2023           1      $225.00       $0.00
    014267-54                121194993001 185622463  WENDEROTH        ALISHA     18   715813048679112401   07/19/2023          30       $47.27       $0.00
    014267-54                121194993001 185622463  WENDEROTH        HANNAH     19   246281680509712401   07/19/2023          30        $2.26       $0.00
    014267-54                103303874001 185683958  GEISER           RANDY      01   22213543485          07/17/2023           1      $210.00      $93.40
    014267-54                103303874001 185683958  GEISER           RANDY      01   22213543485          07/17/2023           1      $194.00     $120.81
    014267-54                103303874001 185683958  GEISER           RANDY      01   22213543485          07/17/2023         300   $12,000.00   $4,995.00
    014267-54                103303874001 185683958  GEISER           HOPE       18   27527217338031401    07/14/2023          30      $298.11      $38.55
    014267-54                103303874001 185683958  GEISER           HOPE       18   118843123137061401   07/16/2023          30        $5.91       $4.47
    014267-54                103379738001 186625394  RHINE            HARVEY     01   22512992366          07/06/2023          (1)    ($14.00)       $0.00
    014267-54                103379738001 186625394  RHINE            HARVEY     01   22512992366          07/06/2023           1      $110.00      $62.22
    014267-54                103379738001 186625394  RHINE            HARVEY     01   22512992366          07/06/2023           2      $164.00     $127.21
    014267-54                103379738001 186625394  RHINE            HANNAH     19   764297853319412401   07/19/2023           5       $47.69       $6.85
    014267-54                103379738001 186625394  RHINE            HEATHER    18   22513393064          07/11/2023           1       $67.00      $20.00
    014267-54                103379738001 186625394  RHINE            HEATHER    18   22513393064          07/11/2023           1       $86.00      $23.22
    014267-54                103379738001 186625394  RHINE            HEATHER    18   22513393064          07/11/2023           1      $108.00      $27.19
    014267-54                103379738001 186625394  RHINE            HEATHER    18   22513393064          07/11/2023           1       $23.00       $0.00
    014267-54                103379738001 186625394  RHINE            HANNAH     19   22513761147          02/09/2023           1      $211.00      $66.80
    014267-54                103379738001 186625394  RHINE            HARVEY     01   67297307041770401    07/11/2023          90      $850.90      $44.86
    014267-54                103379738001 186625394  RHINE            HARVEY     01   22512992366          07/06/2023           4      $812.00     $209.05
    014267-54                103379738001 186625394  RHINE            HEATHER    18   22513393064          07/11/2023           1       $96.00      $43.25

                                                                                                                                              PAGE:19 of 72
                                                                                                                                                            
            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            HARVEY     01   22512992366          07/06/2023          (1)    ($65.00)    ($35.01)
    014267-54                103379738001 186625394  RHINE            HARVEY     01   22512992366          07/06/2023           1      $115.00     $180.14
    014267-54                103379738001 186625394  RHINE            HARVEY     01   22512992366          07/06/2023           1       $65.00      $39.89
    014267-54                103379738001 186625394  RHINE            HEATHER    18   505864062292190401   07/12/2023          84    $4,217.40   $3,630.20
    014267-54                103379738001 186625394  RHINE            HARVEY     01   22512992366          07/06/2023           1       $14.00       $0.00
    014267-54                114634138001 186666547  PERACCHINO       BETHANY    18   22413614949          07/05/2023           1      $130.87      $33.50
    014267-54                114634138001 186666547  PERACCHINO       BETHANY    18   22413380343          07/05/2023           1      $119.53      $36.28
    014267-54                103471827001 187681175  SHAFTIC          STEPHANI   18   161711870149112401   07/19/2023          30      $220.72       $0.00
    014267-54                103884128001 192564580  ALEXANDER        EMMA       19   22812727452          05/22/2023          (1)   ($187.00)    ($67.86)
    014267-54                103884128001 192564580  ALEXANDER        EMMA       19   22812727452          05/22/2023           1      $187.00      $67.86
    014267-54                103884128001 192564580  ALEXANDER        EMMA       19   22812727452          05/22/2023          (1)   ($125.00)    ($39.17)
    014267-54                103884128001 192564580  ALEXANDER        EMMA       19   22812727452          05/22/2023          (1)   ($165.00)    ($67.86)
    014267-54                103884128001 192564580  ALEXANDER        EMMA       19   22812727452          05/22/2023           1      $210.00      $39.17
    014267-54                103884128001 192564580  ALEXANDER        EMMA       19   498528028615621401   07/14/2023          28       $29.93      $14.54
    014267-54                103884128001 192564580  ALEXANDER        EMMA       19   22812727452          05/22/2023           1      $168.00      $67.86
    014267-54                103884128001 192564580  ALEXANDER        EMMA       19   22812727452          05/22/2023           1      $165.00      $67.86
    014267-54                103884128001 192564580  ALEXANDER        EMMA       19   22812727452          05/22/2023          (1)   ($168.00)    ($67.86)
    014267-54                104054990001 194546961  KANICH           WILLIAM    18   22513393040          07/11/2023           1      $424.00      $54.21
    014267-54                104054990001 194546961  KANICH           WILLIAM    18   22513393040          07/11/2023           1       $65.00      $39.89
    014267-54                104054990001 194546961  KANICH           AMY        01   29645288092462401    07/22/2023          30      $236.55      $53.85
    014267-54                104054990001 194546961  KANICH           WILLIAM    18   950695393917721401   07/14/2023          30      $112.30      $20.62
    014267-54                104054990001 194546961  KANICH           CHRISTIA   19   648093133540261401   07/03/2023         (30)    ($82.99)     ($7.97)
    014267-54                104054990001 194546961  KANICH           CHRISTIA   19   236088008915591401   07/18/2023          30       $82.99       $7.97
    014267-54                104054990001 194546961  KANICH           WILLIAM    18   237578590408621401   07/14/2023           5       $16.00       $2.43
    014267-54                104054990001 194546961  KANICH           WILLIAM    18   22513393040          07/11/2023           1       $97.00      $68.74
    014267-54                104054990001 194546961  KANICH           CHRISTIA   19   168783033145412401   07/19/2023          22       $27.99      $12.11
    014267-54                104241017001 196668222  BORING           KAYLA      19   121051860104462401   07/22/2023          28       $60.98      $12.49
    014267-54                117170403001 197701125  BARELICH         NICOLE     18   89161297125591401    07/18/2023          30       $22.38       $8.92
    014267-54                117170403001 197701125  BARELICH         NICOLE     18   505159168508691401   07/18/2023          30       $52.88       $3.96
    014267-54                117170403001 197701125  BARELICH         NICOLE     18   522264140125591401   07/18/2023          30       $68.45       $7.97
    014267-54                117170403001 197701125  BARELICH         NICOLE     18   901687633225591401   07/18/2023          30      $205.33      $62.96
    014267-54                104384687001 198549351  KOTELNICKI       JAMES      18   221418177822341401   07/15/2023          30      $211.29      $13.91

                                                                                                                                              PAGE:20 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-54                104384687001 198549351  KOTELNICKI       JAMES      18   785068057822341401   07/15/2023          30      $159.12      $19.25
    014267-54                104384687001 198549351  KOTELNICKI       JAMES      18   490340254690641401   07/15/2023          30      $175.95       $8.54
    014267-54                104402015001 198667995  KOSS             SERENA     19   229162022494412401   07/19/2023          28      $186.01      $13.70
    014267-54                104402015001 198667995  KOSS             SAMANTHA   19   22612054345          06/16/2023           1      $142.00      $30.00
    014267-54                104402015001 198667995  KOSS             SUMMER     19   22613442600          06/28/2023           1       $78.00       $0.00
    014267-54                104472618001 199605677  SMEAK            BAILIE     19   22613752981          07/17/2023           1       $88.07      $10.00
    014267-54                104536194001 200467259  MULATO           ANDREW     18   545993916570181401   07/17/2023          30      $475.43     $381.48
    014267-54                104536194001 200467259  MULATO           ANDREW     18   22613506709          07/13/2023           1       $23.00       $0.00
    014267-54                104536194001 200467259  MULATO           JUDITH     01   22613752496          07/14/2023           1      $145.00      $74.97
    014267-54                104536194001 200467259  MULATO           ANDREW     18   22613506709          07/13/2023           1       $67.00      $34.47
    014267-54                104536194001 200467259  MULATO           JUDITH     01   796188811687621401   07/14/2023          30      $269.34       $6.46
    014267-54                104536194001 200467259  MULATO           ANDREW     18   22613766959          07/10/2023           1       $47.00      $33.32
    014267-54                104536194001 200467259  MULATO           JUDITH     01   948905798498362401   07/22/2023          28      $144.90      $60.59
    014267-54                104536194001 200467259  MULATO           ANDREW     18   22613506709          07/13/2023           1      $108.00      $27.19
    014267-54                104536194001 200467259  MULATO           ANDREW     18   44430933752341401    07/15/2023          30       $32.91       $6.39
    014267-54                104557985001 200604757  RUDNIK           ELI        19   598093868215261401   07/16/2023           5        $4.09       $0.00
    014267-54                104565994001 200663669  SIMMONS          COREY      19   166062742886462401   07/22/2023          15      $146.22     $138.92
    014267-54                104565994001 200663669  SIMMONS          COREY      19   204055168576462401   07/22/2023          10       $20.16      $17.50
    014267-54                104565994001 200663669  GERGELY          NICK       01   22713823980          06/30/2023           1       $36.00      $21.60
    014267-54                104565994001 200663669  GERGELY          JANEL      18   616497833838922401   07/20/2023          30       $20.76      $10.81
    014267-54                104565994001 200663669  GERGELY          NICK       01   22713823980          06/30/2023           1      $120.00      $73.34
    014267-54                136297710001 201586211  GARVER           CAROL      18   374756840458480401   07/12/2023          90      $125.50       $0.00
    014267-54                136297710001 201586211  GARVER           CAROL      18   313806540458480401   07/12/2023          90      $393.64       $0.00
    014267-54                136297710001 201586211  GARVER           CAROL      18   398068140458480401   07/12/2023          90      $227.20      $12.44
    014267-54                136297710001 201586211  GARVER           CAROL      18   604872731458480401   07/12/2023          90       $56.20       $0.00
    014267-54                104717677001 202546801  CHUHRAN          STACIE     18   884093128683061401   07/16/2023          28        $9.99       $5.84
    014267-54                104717677001 202546801  CHUHRAN          STACIE     18   112557257303331401   07/14/2023          30       $12.50       $9.96
    014267-54                104717677001 202546801  CHUHRAN          STACIE     18   87405038352971401    07/17/2023          30       $11.12       $4.47
    014267-54                104717677001 202546801  CHUHRAN          COLE       19   862195848111922401   07/20/2023          30      $664.60     $430.49
    014267-54                104717677001 202546801  CHUHRAN          BREANA     19   486199158920332401   07/20/2023          30       $76.90       $5.54
    014267-54                104717677001 202546801  CHUHRAN          BREANA     19   22413805335          07/20/2023           1      $160.00     $126.85
    014267-54                104738058001 202684807  REPINE           MARK       01   22032251691          07/13/2023           1       $69.00      $10.45

                                                                                                                                              PAGE:21 of 72
                                                                                                                                                            
            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           MARCY      18   22032026610          07/03/2023           1      $116.00      $33.37
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032026610          07/03/2023           1      $158.00      $41.87
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032026610          07/03/2023           1      $436.00     $218.29
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032026610          07/03/2023           1      $105.00      $16.13
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032397787          07/11/2023           1      $115.00      $83.63
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032026610          07/03/2023           1       $80.00      $16.13
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032397878          07/11/2023           1      $186.00     $120.81
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032026610          07/03/2023           1       $53.00      $56.73
    014267-54                104738058001 202684807  REPINE           MARK       01   22032251691          07/13/2023           1       $86.00      $24.58
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032026610          07/03/2023           1      $121.00      $33.97
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032026610          07/03/2023           1      $153.00     $115.54
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032026610          07/03/2023           1      $116.00      $21.78
    014267-54                104738058001 202684807  REPINE           MARK       01   22032251691          07/13/2023           1       $66.00      $11.87
    014267-54                104738058001 202684807  REPINE           MARCY      18   22032026610          07/03/2023           1      $158.00      $26.32
    014267-54                104788273001 203482794  PALKO            DANIEL     18   142424430673212401   07/19/2023          30       $87.52       $0.00
    014267-54                104788273001 203482794  PALKO            DANIEL     18   492164110673212401   07/19/2023          30      $122.42       $5.48
    014267-54                105312729001 209560824  LAUER            JEFFREY    01   22313431743          07/11/2023           1      $306.00     $306.00
    014267-54                120307645001 210683109  MCCORMICK        SARAH      18   673737362910021401   07/14/2023          90    $4,058.42     $151.65
    014267-54                120307645001 210683109  MCCORMICK        SARAH      18   22113640678          07/06/2023           1      $142.00     $112.37
    014267-54                120307645001 210683109  MCCORMICK        SARAH      18   22113530740          07/13/2023           1       $84.00      $53.48
    014267-54                122643511001 211720938  CONRAD           SAMANTHA   18   22713490651          07/10/2023           1      $174.00       $0.00
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22513553986          07/17/2023           1       $80.00      $22.60
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22513497113          07/14/2023           1       $50.00      $14.41
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22513497113          07/14/2023           1       $55.00      $11.87
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22513553986          07/17/2023           1       $50.00      $14.41
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22513553986          07/17/2023           1       $55.00      $11.87
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22513497113          07/14/2023           1       $80.00      $22.60
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22513553986          07/17/2023           2      $168.00      $49.16
    014267-54                105508252001 211723306  FARABAUGH        DENNIS     01   22513497113          07/14/2023           1       $84.00      $24.58
  014267-54 Total                                                                                                                   $55,577.92  $24,802.31
  014267- Total                                                                                                                     $55,577.92  $24,802.31
  017697-00

                                                                                                                                              PAGE:22 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-00                116971091001 085705608  TOMASELLI        PETER      19   22813616333          07/11/2023           1      $492.00       $4.42
    017697-00                116971091001 085705608  TOMASELLI        PETER      19   22813616333          07/11/2023           1      $283.00       $3.71
    017697-00                116971091001 085705608  TOMASELLI        PETER      19   22813616333          07/11/2023           1       $43.04       $2.90
    017697-00                116971091001 085705608  TOMASELLI        PETER      19   22813616333          07/11/2023           1        $3.00       $2.75
    017697-00                116971091001 085705608  TOMASELLI        PETER      19   22813701234          07/11/2023           1      $196.00       $8.68
    017697-00                101289752001 160587191  CLAAR            KENDALL    19   22813540719          06/11/2023           1       $60.00      $15.18
    017697-00                101289752001 160587191  CLAAR            KENDALL    19   22813540719          06/11/2023           1       $20.00       $1.28
    017697-00                101289752001 160587191  CLAAR            KENDALL    19   22813540719          06/11/2023           1      $290.00     $157.86
    017697-00                101289752001 160587191  KARGO            KRISTEN    18   340919728171912401   07/19/2023           6       $35.64      $12.54
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22113640682          07/13/2023           1       $96.00      $43.25
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22113640682          07/13/2023           1      $167.00      $76.20
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22113640682          07/13/2023           1      $104.00      $17.25
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22113640682          07/13/2023           1       $23.00       $0.00
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22113640682          07/13/2023           1       $67.00      $20.00
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22113640682          07/13/2023           1      $107.00      $21.03
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22113640682          07/13/2023           1      $102.00      $21.78
    017697-00                113918356001 162669421  ROSSMAN          PAUL       01   921694107940361401   07/13/2023         (30)    ($47.20)    ($11.90)
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22113640682          07/13/2023           1       $67.00      $25.00
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   874700793660621401   07/14/2023          30      $170.68       $7.95
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22113640682          07/13/2023           1       $67.00      $34.47
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22113640682          07/13/2023           1       $86.00      $23.22
    017697-00                113918356001 162669421  ROSSMAN          STEPHANI   18   22113640682          07/13/2023           1       $91.00      $12.20
    017697-00                113918356001 162669421  ROSSMAN          PAUL       01   332834607940361401   07/13/2023          30       $47.71      $11.90
    017697-00                128881676001 164765283  LEAHEY           AMIYAH     19   22210688342          06/05/2023           1      $185.00     $112.39
    017697-00                128881676001 164765283  LEAHEY           AMIYAH     19   22210688342          06/05/2023          (1)   ($200.00)   ($200.00)
    017697-00                128881676001 164765283  LEAHEY           AMIYAH     19   22210688342          06/05/2023          (1)   ($325.00)   ($292.66)
    017697-00                128881676001 164765283  LEAHEY           AMIYAH     19   22210688342          06/05/2023           3      $120.00      $63.63
    017697-00                128881676001 164765283  LEAHEY           AMIYAH     19   22210688342          06/05/2023          (1)   ($185.00)   ($112.39)
    017697-00                128881676001 164765283  LEAHEY           AMIYAH     19   22210688342          06/05/2023           5      $200.00      $80.07
    017697-00                128881676001 164765283  LEAHEY           AMIYAH     19   22210688342          06/05/2023           1      $325.00     $292.66
    017697-00                128881676001 164765283  LEAHEY           AMIYAH     19   22210688342          06/05/2023           1      $195.00     $125.27
    017697-00                128881676001 164765283  LEAHEY           AMIYAH     19   22210688342          06/05/2023          (3)   ($120.00)    ($63.63)

                                                                                                                                              PAGE:23 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-00                128881676001 164765283  LEAHEY           AMIYAH     19   22210688342          06/05/2023          (1)   ($195.00)   ($125.27)
    017697-00                128881676001 164765283  LEAHEY           AMIYAH     19   22210688342          06/05/2023           1      $250.00     $202.14
    017697-00                128881676001 164765283  LEAHEY           AMIYAH     19   22210688342          06/05/2023          (5)   ($200.00)    ($80.07)
    017697-00                101684237001 165626002  EDGELL           CAMERON    19   106624140962132401   07/20/2023          30      $282.49      $36.95
    017697-00                101684237001 165626002  EDGELL           CAMERON    19   599465620093991401   07/18/2023          30      $212.49      $36.95
    017697-00                101684237001 165626002  EDGELL           CAMERON    19   113868908284712401   07/18/2023         (30)   ($212.49)    ($36.95)
    017697-00                101684237001 165626002  EDGELL           CAMERON    19   22513643010          07/12/2023           1      $220.00     $109.89
    017697-00                102000987001 169688887  VAN CASTER       MARK       01   22032212118          06/13/2023           1      $150.00      $85.70
    017697-00                102072716001 170622250  MCCOMBIE         NICOLE     19   22813478422          07/14/2023           1       $96.00       $0.00
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22213429591          06/14/2023           1       $15.50       $4.38
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22213429591          06/14/2023           1    $1,178.50     $851.95
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22213429591          06/14/2023           1    $1,357.00     $365.96
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22213429591          06/14/2023           1      $169.00      $84.50
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22213429591          06/14/2023           2      $398.00     $403.11
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22213429591          06/14/2023           1    $1,178.50      $83.07
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22213429591          06/14/2023           1      $149.00      $36.74
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22213429591          06/14/2023           1      $123.00      $39.89
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22213429591          06/14/2023           1       $69.25      $40.68
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22213429591          06/14/2023          10       $62.50      $48.42
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22213320367          06/14/2023           1      $211.00     $165.02
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22213429591          06/14/2023           1    $1,457.00     $504.67
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22213429591          06/14/2023           1      $235.00      $73.66
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22213429591          06/14/2023           1      $671.00     $254.81
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22213429591          06/14/2023           4      $536.00     $401.67
    017697-00                102135251001 171483865  PODRASKY         ANTHONY    01   22213429591          06/14/2023           1       $69.25      $20.05
    017697-00                102300718001 173523551  MYERS            CASSIDY    19   672547032772121401   07/14/2023          28       $34.49      $14.54
    017697-00                102742521001 178682192  WHEELER          HAYLEY     19   623601747707702401   07/19/2023          28       $34.21      $14.19
    017697-00                102742521001 178682192  WHEELER          KAMRYN     19   859679928136081401   07/17/2023           5      $411.26       $0.00
    017697-00                102742521001 178682192  WHEELER          KAMRYN     19   224743778379081401   07/17/2023          15      $368.96       $0.00
    017697-00                102884338001 180600186  LEARN            CRAIG      01   413911920441591401   07/18/2023          30       $37.38       $0.00
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22208630025          05/07/2023           1      $140.00      $46.02
    017697-00                115794029001 180664146  KUDLAWIEC        BRYAN      01   582589558609691401   07/18/2023          30      $334.83      $14.06

                                                                                                                                              PAGE:24 of 72
                                                                                                                                                            
            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        BRYAN      01   22213624562          07/11/2023           1      $145.00      $74.97
    017697-00                115794029001 180664146  KUDLAWIEC        BRYAN      01   51859888495891401    07/18/2023          30       $67.18      $22.96
    017697-00                115794029001 180664146  KUDLAWIEC        LUCAS      19   22208630025          05/07/2023          (1)   ($140.00)       $0.00
    017697-00                103299423001 185646090  NILESKI          STEPHEN    01   596318458458991401   07/18/2023          42    $1,123.92     $901.89
    017697-00                103299423001 185646090  NILESKI          KERRY      18   22613761871          07/20/2023           1       $70.00      $53.48
    017697-00                103299423001 185646090  NILESKI          SAMANTHA   19   533381697423462401   07/22/2023          28       $31.52      $23.88
    017697-00                103299423001 185646090  NILESKI          STEPHEN    01   15361037707032401    07/20/2023          25       $44.51      $35.67
    017697-00                115781222001 185689537  MILLER           CRASH      19   22213655439          07/17/2023           1      $223.00       $0.00
    017697-00                103468306001 187645700  GERGELY          APRIL      18   22413527160          07/10/2023           1       $75.00       $0.00
    017697-00                103468306001 187645700  GERGELY          APRIL      18   22413527160          07/10/2023           1       $60.00       $0.00
    017697-00                103468306001 187645700  GERGELY          APRIL      18   22413527160          07/10/2023           1       $50.00       $0.00
    017697-00                103468306001 187645700  GERGELY          COOPER     19   45637103550842401    07/21/2023          10      $315.69       $0.49
    017697-00                115603314001 187702712  MARINO           HENRY      19   395590904211431401   07/14/2023          30       $76.27      $20.62
    017697-00                115603314001 187702712  MARINO           HENRY      19   22613606437          07/14/2023           1      $150.00     $124.67
    017697-00                103542040001 188603765  CONRAD           CARRIE     18   22113517864          07/12/2023           1      $130.00      $51.19
    017697-00                103542040001 188603765  CONRAD           CARRIE     18   22113517864          07/12/2023           1      $164.00      $55.86
    017697-00                103542040001 188603765  CONRAD           CARRIE     18   22113517864          07/12/2023           1       $31.00       $0.00
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22313301738          07/13/2023           1       $69.00      $22.60
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22313301738          07/13/2023           1       $69.00      $28.53
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22313512788          07/17/2023           2      $141.00      $49.16
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22313301738          07/13/2023           1       $60.00      $12.84
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22313512788          07/17/2023           1       $69.00      $28.53
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22313301738          07/13/2023           2      $141.00      $49.16
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22313512788          07/17/2023           1       $60.00      $12.84
    017697-00                103977327001 193622433  SHOW             JESSICA    18   22313512788          07/17/2023           1       $69.00      $22.60
    017697-00                117751540001 195663631  BARLICK          SARAH      18   22413697683          07/07/2023           1      $175.00      $72.67
    017697-00                117751540001 195663631  BARLICK          SARAH      18   22413697683          07/07/2023           2      $106.00      $94.53
    017697-00                117751540001 195663631  BARLICK          SARAH      18   22413697683          07/07/2023           1      $142.00     $116.01
    017697-00                117751540001 195663631  BARLICK          SARAH      18   22413697683          07/07/2023           1      $234.00      $77.94
    017697-00                117751540001 195663631  BARLICK          SARAH      18   22413697683          07/07/2023           1      $108.00      $28.78
    017697-00                117751540001 195663631  BARLICK          SARAH      18   22413697683          07/07/2023           1      $142.00      $73.46
    017697-00                117751540001 195663631  BARLICK          SARAH      18   637327303793212401   07/19/2023          30       $49.96      $26.12

                                                                                                                                              PAGE:25 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-00                117751540001 195663631  BARLICK          SARAH      18   22413697683          07/07/2023           2      $120.00      $31.14
    017697-00                117751540001 195663631  BARLICK          SARAH      18   22413697683          07/07/2023           1      $229.00      $42.55
    017697-00                117751540001 195663631  BARLICK          SARAH      18   22413697683          07/07/2023           1      $261.00      $45.32
    017697-00                117751540001 195663631  BARLICK          SARAH      18   22413697683          07/07/2023           1      $353.00     $126.68
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22713785970          07/17/2023           1      $215.44      $83.63
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22713785970          07/17/2023           1       $87.00      $24.58
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22713756392          07/15/2023           1      $150.00      $12.36
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22713579347          07/11/2023           1      $209.00     $107.83
    017697-00                104228854001 196584813  FARREN           HEATHER    18   392574347096212401   07/19/2023          28        $8.72       $6.95
    017697-00                104228854001 196584813  FARREN           HEATHER    18   22712360212          06/09/2023           1       $80.00      $49.30
    017697-00                104325873001 197689597  SMORTO           TYLER      19   205194287808812401   07/19/2023          16       $98.81       $0.00
    017697-00                104325873001 197689597  SMORTO           TYLER      19   470269558318812401   07/19/2023           5       $65.97       $0.00
    017697-00                104325873001 197689597  SMORTO           TYLER      19   763497623518812401   07/19/2023           5       $28.01       $0.00
    017697-00                104325873001 197689597  SMORTO           TYLER      19   503016538511912401   07/19/2023          10      $181.61       $0.00
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   22313762565          07/12/2023           2       $11.11       $6.60
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   22313762565          07/12/2023           1       $57.00      $25.42
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   456448698523462401   07/22/2023          30       $25.72       $6.97
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   726557946623462401   07/22/2023          30      $207.20      $10.05
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   22313762565          07/12/2023           1      $142.58      $84.40
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   94733663623462401    07/22/2023          30      $130.00       $7.16
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   548884487623462401   07/22/2023          30      $289.21      $28.99
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   22313762565          07/12/2023           1       $62.00      $28.14
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   22313762565          07/12/2023           2      $107.00      $58.16
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   599883803723462401   07/22/2023          30      $129.21       $5.59
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   916947223623462401   07/22/2023          30      $172.93       $8.54
    017697-00                104565684001 200662396  WEAKLAND         GARY       01   623495180540662401   07/22/2023          30      $351.32     $218.49
    017697-00                116895622001 200707458  CLEVENGER        HANNAH     01   22413798392          07/17/2023           1      $346.00       $0.00
    017697-00                116895622001 200707458  CLEVENGER        HANNAH     01   437478828745771401   07/17/2023          28       $54.29      $10.86
    017697-00                116895622001 200707458  CLEVENGER        HANNAH     01   22413640366          07/12/2023           1       $30.00       $0.00
    017697-00                116895622001 200707458  CLEVENGER        HANNAH     01   22413640366          07/12/2023           1      $145.00       $0.00
    017697-00                104816797001 203661805  ORAVEC           ISAAC      19   22713630553          07/12/2023           1       $25.00       $2.84
    017697-00                104816797001 203661805  ORAVEC           NICOLE     01   326113733295432401   07/20/2023          30       $36.82       $5.62

                                                                                                                                              PAGE:26 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-00                104816797001 203661805  ORAVEC           NICOLE     01   442399768236432401   07/20/2023          30      $197.91      $12.36
    017697-00                104816797001 203661805  ORAVEC           ISAAC      19   22713630553          07/12/2023           1      $317.00     $317.00
    017697-00                104816797001 203661805  ORAVEC           ISAAC      19   22713630553          07/12/2023           1      $120.00     $120.00
    017697-00                104816797001 203661805  ORAVEC           ISAAC      19   22713719588          07/14/2023           1      $557.00     $511.62
    017697-00                104816797001 203661805  ORAVEC           ISAAC      19   22713630553          07/12/2023           1       $32.00      $20.20
    017697-00                104816797001 203661805  ORAVEC           ISAAC      19   22713630553          07/12/2023           1       $26.00      $15.90
    017697-00                104816797001 203661805  ORAVEC           ISAAC      19   22713719588          07/14/2023           1      $324.00     $289.81
    017697-00                104816797001 203661805  ORAVEC           NICOLE     01   254591680495432401   07/20/2023          30      $112.63       $5.84
    017697-00                120266674001 203729232  STANEK           MAKAELA    18   941116028146081401   07/17/2023          30      $149.19       $0.00
    017697-00                104978752001 205608860  LEWIS            BETHANY    01   825978141224451401   07/16/2023          30      $180.90       $0.00
    017697-00                104978752001 205608860  LEWIS            BETHANY    01   22713667815          07/17/2023           1       $40.00       $0.00
    017697-00                104978752001 205608860  LEWIS            BETHANY    01   22713667815          07/17/2023           1       $55.00       $0.00
    017697-00                104978752001 205608860  LEWIS            BETHANY    01   22713667815          07/17/2023           1       $40.00       $0.00
    017697-00                116320743001 206664225  DRENNING         COLLEEN    18   456741160858061401   07/16/2023          30       $84.39       $0.00
    017697-00                116320743001 206664225  DRENNING         COLLEEN    18   854881147858061401   07/16/2023          30       $15.88       $0.00
    017697-00                118583174001 206701815  BURLINGAME       JESSICA    18   22213443228          07/13/2023           1      $178.00      $78.67
    017697-00                112057371001 208660347  RAINEY           KELLY      18   74773083809691401    07/18/2023          10        $8.17       $0.00
    017697-00                105299927001 209482347  DELANEY          WILLIAM    18   22813774170          07/18/2023           5      $280.00      $87.37
    017697-00                105299927001 209482347  DELANEY          MEGAN      19   514230803051441401   07/15/2023          28       $37.50      $14.86
    017697-00                105299927001 209482347  DELANEY          WILLIAM    18   22813774170          07/18/2023           1      $131.00      $57.63
    017697-00                105299927001 209482347  DELANEY          SUZANN     01   931649088512312401   07/19/2023          30      $174.20       $6.89
    017697-00                105299927001 209482347  DELANEY          WILLIAM    18   22813774170          07/18/2023           1       $60.00       $0.00
    017697-00                105299927001 209482347  DELANEY          MEGAN      19   22813587141          07/11/2023           1      $350.00     $110.01
    017697-00                105299927001 209482347  DELANEY          SUZANN     01   155035978357212401   07/19/2023          30       $82.42       $8.55
    017697-00                118616217001 210663340  GOPPMAN          EMMA       19   22609038482          05/11/2023           1      $185.00     $112.39
    017697-00                118616217001 210663340  GOPPMAN          EMMA       19   22609038482          05/11/2023           3      $120.00      $63.63
    017697-00                118616217001 210663340  GOPPMAN          EMMA       19   22609038482          05/11/2023          (1)   ($200.00)   ($200.00)
    017697-00                118616217001 210663340  GOPPMAN          EMMA       19   22609038482          05/11/2023          (3)   ($120.00)    ($63.63)
    017697-00                118616217001 210663340  GOPPMAN          EMMA       19   22609038482          05/11/2023           1      $325.00     $292.66
    017697-00                118616217001 210663340  GOPPMAN          EMMA       19   22609038482          05/11/2023          (1)   ($195.00)   ($125.27)
    017697-00                118616217001 210663340  GOPPMAN          BRIAN      01   359431760261161401   07/16/2023          30       $34.99       $0.00
    017697-00                118616217001 210663340  GOPPMAN          EMMA       19   22609038482          05/11/2023          (1)   ($185.00)   ($112.39)

                                                                                                                                              PAGE:27 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-00                118616217001 210663340  GOPPMAN          EMMA       19   22609038482          05/11/2023          (1)   ($325.00)   ($292.66)
    017697-00                118616217001 210663340  GOPPMAN          EMMA       19   22609038482          05/11/2023          (5)   ($200.00)    ($80.07)
    017697-00                118616217001 210663340  GOPPMAN          EMMA       19   22609038482          05/11/2023           1      $195.00     $125.27
    017697-00                118616217001 210663340  GOPPMAN          EMMA       19   22609038482          05/11/2023           1      $250.00     $202.14
    017697-00                118616217001 210663340  GOPPMAN          EMMA       19   22609038482          05/11/2023           5      $200.00      $80.07
    017697-00                110593418001 233153119  BROOKS           JOHN       01   22513717476          07/14/2023           1       $62.00      $30.81
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   104438798829131401   07/14/2023          30      $123.42      $11.68
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   148278691729131401   07/14/2023          30      $332.01      $20.08
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   600847087819131401   07/14/2023          30      $824.01     $545.13
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   661894492529131401   07/14/2023          30      $303.11      $45.61
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   246282011339131401   07/14/2023          30    $1,357.49     $901.89
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   467117487429131401   07/14/2023          30       $51.90      $15.25
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   275827596629131401   07/14/2023          30       $21.80       $8.65
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   750786700039131401   07/14/2023          30      $117.33      $20.21
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   683936080919131401   07/14/2023          30      $520.54     $342.18
    017697-00                110593418001 233153119  BROOKS           JOHN       01   395333386068061401   07/16/2023          30       $32.80       $6.39
    017697-00                110593418001 233153119  BROOKS           JOHN       01   26175768193871401    07/17/2023          30      $174.20      $14.09
    017697-00                110593418001 233153119  BROOKS           JOHN       01   22513717476          07/14/2023           1      $220.00     $109.89
    017697-00                110593418001 233153119  BROOKS           CANDACE    18   672438290029131401   07/14/2023          30      $218.85     $140.43
    017697-00                110593418001 233153119  BROOKS           JOHN       01   491224627657871401   07/17/2023          30       $72.19       $4.94
    017697-00                110593418001 233153119  BROOKS           JOHN       01   53587716590821401    07/14/2023           3       $58.69       $3.51
    017697-00                110593418001 233153119  BROOKS           JOHN       01   22513717476          07/14/2023           1       $20.00       $5.91
  017697-00 Total                                                                                                                   $29,420.51  $11,218.86
  017697-01
    017697-01                101514236001 163541163  ARFORD           MARYLOU    18   32891317091971401    07/17/2023          30       $26.38       $8.88
    017697-01                101514236001 163541163  ARFORD           MARYLOU    18   734874490420181401   07/17/2023          90       $49.90      $24.39
    017697-01                101514236001 163541163  ARFORD           MARYLOU    18   763762782999081401   07/17/2023         140      $544.33     $391.94
    017697-01                101979949001 169547153  PROSSER          NATALIE    18   931873058238502401   07/19/2023          90      $105.70      $13.13
    017697-01                101979949001 169547153  PROSSER          NATALIE    18   22413728605          07/13/2023           1       $60.00      $42.70
    017697-01                102056797001 170523784  NOLL             VERONICA   18   22113702991          07/11/2023           1       $47.00      $33.32
    017697-01                102056797001 170523784  NOLL             VERONICA   18   599344000657942401   07/21/2023          12       $50.57       $7.59
    017697-01                102056797001 170523784  NOLL             VERONICA   18   780043326067942401   07/21/2023          30      $106.60      $12.93

                                                                                                                                              PAGE:28 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   975827473677491401   07/18/2023          16      $369.77      $10.03
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   829801217882632401   07/19/2023         (30) ($1,483.16)   ($985.93)
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   613769128709152401   07/21/2023          30      $113.81       $9.61
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   22513643575          07/13/2023           1       $35.00      $22.10
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   22513643575          07/13/2023           1       $47.00      $33.32
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   22513643575          07/13/2023           1       $22.00       $0.00
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   744413466019152401   07/21/2023          30      $155.97       $8.23
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   22513795100          07/17/2023           1      $236.00      $69.76
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   22513795100          07/17/2023           1      $130.00      $51.19
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   571277056509152401   07/21/2023          30      $217.84       $6.89
    017697-01                103625384001 189584284  STOY             KAMRYN     19   887279068173991401   07/18/2023          30      $165.87       $7.09
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   79143853196812401    07/19/2023          30    $1,483.16     $985.93
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   444191297969362401   07/22/2023          30       $67.16       $2.55
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   22513643575          07/13/2023           1       $17.00       $0.00
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   22513795100          07/17/2023           1       $31.00       $0.00
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   368788538882632401   07/19/2023          30    $1,483.17     $985.94
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   977084557491232401   07/20/2023           7      $121.00       $3.43
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   22513643575          07/13/2023           1       $34.00      $24.58
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   284612072409152401   07/21/2023          30      $120.94      $13.12
    017697-01                103625384001 189584284  FARABAUGH        BRENDA     01   372813423677491401   07/18/2023          30       $46.03       $9.11
    017697-01                105064449001 206608212  TREXLER          CHRISTIN   18   22613734919          06/27/2023           1      $145.00       $0.00
    017697-01                105064449001 206608212  TREXLER          CHRISTIN   18   22613734919          06/27/2023           1      $149.00       $0.00
    017697-01                105064449001 206608212  TREXLER          CHRISTIN   18   22613734919          06/27/2023           1      $123.00       $0.00
    017697-01                105064449001 206608212  TREXLER          CHRISTIN   18   22613734919          06/27/2023           1      $156.00       $0.00
    017697-01                105064449001 206608212  TREXLER          CHRISTIN   18   22613734919          06/27/2023           1      $172.00       $0.00
    017697-01                105064449001 206608212  TREXLER          CHRISTIN   18   22613734919          06/27/2023           1       $87.25       $0.00
    017697-01                105064449001 206608212  TREXLER          CHRISTIN   18   22613734919          06/27/2023           1      $535.00       $0.00
    017697-01                105064449001 206608212  TREXLER          CHRISTIN   18   22613734919          06/27/2023           1       $84.25       $0.00
    017697-01                105064449001 206608212  TREXLER          CHRISTIN   18   22613734919          06/27/2023           1      $106.00       $0.00
    017697-01                105064449001 206608212  TREXLER          CHRISTIN   18   22613734919          06/27/2023           1      $343.00       $0.00
    017697-01                105064449001 206608212  TREXLER          CHRISTIN   18   22613734919          06/27/2023           1      $124.00       $0.00
    017697-01                105488486001 211561897  YINGLING         MICHAEL    18   222119818303002401   07/18/2023          25       $75.02       $0.00

                                                                                                                                              PAGE:29 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-01                105488486001 211561897  YINGLING         NANCY      01   168680283995641401   07/15/2023          30       $15.35       $0.00
    017697-01                105488486001 211561897  YINGLING         NANCY      01   269369308775081401   07/17/2023          30       $25.49       $0.00
    017697-01                105488486001 211561897  YINGLING         NANCY      01   915476728421641401   07/15/2023          30       $13.59       $0.00
  017697-01 Total                                                                                                                    $6,557.99   $1,791.83
  017697-10
    017697-10                101522332001 163584304  BAIRD            JEFFREY    18   22113732435          07/17/2023           1      $108.00      $27.19
    017697-10                101522332001 163584304  BAIRD            JEFFREY    18   22113732435          07/17/2023           1       $67.00      $34.47
    017697-10                101522332001 163584304  BAIRD            JEFFREY    18   22113732435          07/17/2023           1       $98.00      $47.34
    017697-10                101522332001 163584304  BAIRD            JEFFREY    18   22113531449          07/10/2023           1      $246.00     $106.11
    017697-10                101522332001 163584304  BAIRD            JEFFREY    18   22113732435          07/17/2023           1       $23.00       $0.00
    017697-10                117140617001 165402030  HABER            SANDRA     01   22113318821          07/07/2023           1       $85.00      $47.93
    017697-10                117140617001 165402030  HABER            SANDRA     01   22113318821          07/07/2023           1      $260.00     $135.36
    017697-10                117140617001 165402030  HABER            SANDRA     01   22113318821          07/07/2023           1       $40.00      $25.42
    017697-10                117140617001 165402030  HABER            SANDRA     01   22113318821          07/07/2023           1       $27.95      $14.00
    017697-10                117140617001 165402030  HABER            SANDRA     01   22113318821          07/07/2023           1       $16.98      $11.00
    017697-10                117140617001 165402030  HABER            SANDRA     01   22113318821          07/07/2023           2       $10.00       $6.60
    017697-10                117140617001 165402030  HABER            SANDRA     01   22113318821          07/07/2023           3      $225.00     $150.21
    017697-10                105048232001 206509624  VINGLISH         COLLEEN    18   530329388393162401   07/22/2023          30       $34.45       $6.85
    017697-10                105048232001 206509624  VINGLISH         COLLEEN    18   22713465364          06/12/2023           1      $211.00     $160.83
    017697-10                105048232001 206509624  VINGLISH         COLLEEN    18   22713465364          06/02/2023           1      $211.00     $160.83
    017697-10                105048232001 206509624  VINGLISH         COLLEEN    18   22713465364          06/08/2023           1      $211.00     $160.83
    017697-10                105048232001 206509624  VINGLISH         COLLEEN    18   22713465364          06/15/2023           1      $211.00     $160.83
    017697-10                105048232001 206509624  VINGLISH         COLLEEN    18   22713465364          06/14/2023           1      $211.00     $160.83
    017697-10                105048232001 206509624  VINGLISH         COLLEEN    18   113841737298662401   07/22/2023          30      $145.33       $5.45
    017697-10                105048232001 206509624  VINGLISH         COLLEEN    18   22713465364          06/06/2023           1      $211.00     $160.83
    017697-10                105048232001 206509624  VINGLISH         COLLEEN    18   22713465364          06/01/2023           1      $211.00     $160.83
    017697-10                105048232001 206509624  VINGLISH         COLLEEN    18   593865098393162401   07/22/2023          30      $258.40       $7.20
    017697-10                105048232001 206509624  VINGLISH         COLLEEN    18   22713465364          06/05/2023           1      $211.00     $160.83
    017697-10                105048232001 206509624  VINGLISH         COLLEEN    18   22713756557          07/17/2023           1      $119.00      $54.08
  017697-10 Total                                                                                                                    $3,452.11   $1,965.85
  017697-70
    017697-70                102057668001 170526421  LENZ             SALLY      18   7131260564871401     07/17/2023          30       $33.70      $10.81

                                                                                                                                              PAGE:30 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  017697-70 Total                                                                                                                       $33.70      $10.81
  017697- Total                                                                                                                     $39,464.31  $14,987.35
  017728-00
    017728-00                101458722001 162684710  WEAKLAND         NICOLE     18   831731607139771401   07/17/2023          30      $124.06       $0.00
    017728-00                113594013001 180509497  TEETER           PAULA      01   590371597703632401   07/20/2023          30        $9.00       $3.96
    017728-00                113594013001 180509497  TEETER           PAULA      01   914567203791532401   07/11/2023         (30)    ($18.00)    ($16.35)
    017728-00                113594013001 180509497  TEETER           PAULA      01   632816008803632401   07/20/2023          30       $60.22      $17.66
    017728-00                113594013001 180509497  TEETER           PAULA      01   501427833991532401   07/11/2023         (30)     ($9.00)     ($3.96)
    017728-00                113594013001 180509497  TEETER           PAULA      01   807903596013812401   07/19/2023           2       $10.38       $4.59
    017728-00                113594013001 180509497  TEETER           PAULA      01   322711790703632401   07/20/2023          30       $18.00      $16.35
    017728-00                113594013001 180509497  TEETER           PAULA      01   486463248491532401   07/11/2023         (30)    ($60.22)    ($17.66)
    017728-00                103807190001 191609569  PARONISH         ANDREW     18   765189118758391401   07/18/2023          30      $172.72       $6.89
    017728-00                103807190001 191609569  PARONISH         ANDREW     18   229314807553162401   07/22/2023          30      $126.41       $9.46
    017728-00                103807190001 191609569  PARONISH         ANDREW     18   22213333947          07/13/2023           1      $120.00     $110.01
    017728-00                115593107001 208604479  HARR             MATTHEW    18   167243343871642401   07/21/2023          30        $6.00       $6.00
    017728-00                115593107001 208604479  HARR             CHRISTIN   01   636009638413642401   07/21/2023          30       $15.00       $7.09
    017728-00                115593107001 208604479  HARR             CHRISTIN   01   369782062662032401   07/20/2023          30       $15.00       $7.16
    017728-00                115593107001 208604479  HARR             CHRISTIN   01   593574507413642401   07/18/2023         (30)    ($15.00)     ($7.09)
    017728-00                115593107001 208604479  HARR             MATTHEW    18   820653048421261401   07/16/2023          30        $6.00       $6.00
    017728-00                115593107001 208604479  HARR             CHRISTIN   01   653413476281591401   07/18/2023          30       $15.00       $7.09
    017728-00                115593107001 208604479  HARR             MATTHEW    18   703036868070381401   07/17/2023           1      $199.22     $160.62
    017728-00                115593107001 208604479  HARR             MATTHEW    18   447935410871642401   07/16/2023         (30)     ($6.00)     ($6.00)
    017728-00                115941556001 210707006  LOWMASTER        TIMOTHY    01   582943683437942401   07/21/2023          30        $4.00       $0.00
  017728-00 Total                                                                                                                      $792.79     $311.82
  017728- Total                                                                                                                        $792.79     $311.82
  104272-02
    104272-02                114410324001 093701737  GETZ             GRETCHEN   18   279917853513462401   07/22/2023          28       $47.65      $15.13
    104272-02                101295757001 160624529  HOOVER           MARIA      18   22113500777          07/12/2023           1       $30.00       $0.00
    104272-02                101295757001 160624529  HOOVER           MARIA      18   22113500777          07/12/2023           1      $145.00       $0.00
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22032335676          07/07/2023           1    $1,134.00     $766.88
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22031995188          07/07/2023           1       $63.50      $21.47
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22032395485          07/18/2023           3      $105.00      $60.60

                                                                                                                                              PAGE:31 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22031995188          07/07/2023         100       $38.75      $45.19
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22031995188          07/07/2023           6   $11,154.00       $0.00
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22032395485          07/18/2023           1      $350.00     $192.51
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22031995188          07/07/2023           1      $112.00       $5.82
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22031995188          07/07/2023           1      $191.00      $56.09
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22031995188          07/07/2023           1    $6,274.75   $2,711.64
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22031995188          07/07/2023           1      $135.00      $39.99
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22031995188          07/07/2023           1    $6,274.75   $5,423.27
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22032395485          07/18/2023           1      $130.00     $119.30
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22032395485          07/18/2023           5      $100.00      $76.25
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22031995188          07/07/2023           2        $4.00       $0.00
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22031995188          07/07/2023           1      $417.00       $5.82
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22031995188          07/07/2023           1       $63.50      $21.47
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22031995188          07/07/2023           4       $65.25      $22.60
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22031995188          07/07/2023           1       $10.25       $5.82
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22032395485          07/18/2023           1      $300.00     $278.72
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22031995188          07/07/2023           8    $6,440.00       $0.00
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22031995188          07/07/2023           1      $184.00       $5.82
    104272-02                113709087001 160726937  DLUGONSKI        BRODY      19   22031995188          07/07/2023          20       $33.75      $10.17
    104272-02                121180814001 161722738  BLOOM            OLIVER     19   50548258381821401    07/14/2023          50      $505.91     $332.40
    104272-02                116841081001 161743781  PARTSCH          SUSAN      18   562743968652312401   07/19/2023          30      $173.08       $0.00
    104272-02                116841081001 161743781  PARTSCH          SUSAN      18   22313634685          07/19/2023           1      $262.77       $0.00
    104272-02                101437249001 162546576  CARBONARA        MATTHEW    19   22413454249          07/14/2023           2       $80.00      $42.42
    104272-02                101437249001 162546576  CARBONARA        MATTHEW    19   22413454249          07/14/2023           1      $220.00     $216.20
    104272-02                101437249001 162546576  CARBONARA        PATRICK    19   22413454237          07/14/2023           1       $40.00       $2.99
    104272-02                101437249001 162546576  CARBONARA        MATTHEW    19   22413454249          07/14/2023           1       $35.00      $16.70
    104272-02                101437249001 162546576  CARBONARA        MATTHEW    19   22413454249          07/14/2023           1      $385.00     $292.72
    104272-02                101437249001 162546576  CARBONARA        MATTHEW    19   22413454249          07/14/2023           1       $40.00       $4.95
    104272-02                101437249001 162546576  CARBONARA        PATRICK    19   22413454237          07/14/2023           1       $35.00      $16.70
    104272-02                101437249001 162546576  CARBONARA        MATTHEW    19   22413454249          07/14/2023           1      $185.00     $130.20
    104272-02                101437249001 162546576  CARBONARA        MATTHEW    19   22413454249          07/14/2023           1       $40.00       $2.99
    104272-02                101437249001 162546576  CARBONARA        PATRICK    19   22413454237          07/14/2023           1       $40.00       $4.95

                                                                                                                                              PAGE:32 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                101437249001 162546576  CARBONARA        PATRICK    19   22413454237          07/14/2023           1      $185.00     $130.20
    104272-02                101448839001 162609446  MARTIN           NICOLE     18   22213516771          07/14/2023           1      $190.00     $100.00
    104272-02                101448839001 162609446  MARTIN           BROCK      19   22213749260          07/19/2023           1       $50.00      $33.32
    104272-02                101448839001 162609446  MARTIN           BROCK      19   22213749260          07/19/2023           1       $40.00      $22.41
    104272-02                101451955001 162628734  NIEBAUER         HEATHER    18   22413347134          07/11/2023           1       $90.00       $0.00
    104272-02                101451955001 162628734  NIEBAUER         ANNALIES   19   22413347133          07/10/2023           1      $120.00     $116.03
    104272-02                101451955001 162628734  NIEBAUER         ANNALIES   19   22413468398          07/10/2023           1      $243.00     $180.14
    104272-02                101451955001 162628734  NIEBAUER         ANNALIES   19   22413347133          07/10/2023           1        $6.00       $4.95
    104272-02                121084549001 162722491  GEORGE           JARED      18   22713365102          07/11/2023           1       $79.00      $31.08
    104272-02                121084549001 162722491  GEORGE           JARED      18   22713365102          07/11/2023           1      $106.00      $22.60
    104272-02                121084549001 162722491  GEORGE           JARED      18   22713764205          07/17/2023           1      $106.00      $22.60
    104272-02                121084549001 162722491  GEORGE           JARED      18   22713764205          07/17/2023           1       $79.00      $31.08
    104272-02                121084549001 162722491  GEORGE           JARED      18   22713365102          07/11/2023           1       $86.00      $24.58
    104272-02                121084549001 162722491  GEORGE           JARED      18   22713764205          07/17/2023           2      $172.00      $49.16
    104272-02                101607826001 164645212  STOHON           NATHAN     18   814454790863032401   07/20/2023          30       $36.21       $0.00
    104272-02                101607826001 164645212  STOHON           GRACE      19   152516048150741401   07/12/2023         (10)    ($24.97)       $0.00
    104272-02                101607826001 164645212  STOHON           NATHAN     18   974518288356791401   07/18/2023          15      $218.20       $0.00
    104272-02                101607826001 164645212  STOHON           GRACE      19   847126228470741401   07/15/2023           7       $17.40       $0.00
    104272-02                101613845001 164701873  MULDOON          BENJAMIN   19   22213440121          07/14/2023           1       $40.00       $4.95
    104272-02                101613845001 164701873  MULDOON          BENJAMIN   19   22213440121          07/14/2023           1      $185.00     $130.20
    104272-02                101613845001 164701873  MULDOON          BENJAMIN   19   22213440121          07/14/2023           1       $40.00       $2.99
    104272-02                101613845001 164701873  MULDOON          BENJAMIN   19   22213440121          07/14/2023           1       $35.00      $16.70
    104272-02                126386044001 164702873  JEFFERSON        EASTON     19   514361950684842401   07/21/2023          30      $103.00       $7.42
    104272-02                126386044001 164702873  JEFFERSON        EASTON     19   509737406304202401   07/05/2023         (10)   ($331.42)    ($63.40)
    104272-02                119564703001 164728504  HILDEBRAND       JESSIE     18   671469448961052401   07/21/2023          30       $31.74       $7.27
    104272-02                119564703001 164728504  HILDEBRAND       ALEX       19   713341307455352401   07/21/2023          10      $113.99      $15.71
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113739054          07/16/2023           1       $52.00       $0.00
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113732417          07/16/2023           1    $1,701.00     $564.51
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113732417          07/16/2023           1       $23.00       $0.00
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113732417          07/16/2023           1      $116.00       $0.00
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113732417          07/16/2023           1       $88.00       $0.00
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113732417          07/16/2023           1    $1,779.00     $419.19

                                                                                                                                              PAGE:33 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113732417          07/16/2023           1      $104.00       $0.00
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113732417          07/16/2023           1      $279.00     $201.96
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113732417          07/16/2023           1       $91.00       $0.00
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113732417          07/16/2023           4    $1,230.38       $0.00
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113623260          07/16/2023           1      $347.00       $0.00
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113732417          07/16/2023           2       $44.10       $0.00
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113732417          07/16/2023           1      $226.00       $0.00
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113732417          07/16/2023          80      $222.62       $0.00
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113732417          07/16/2023           1       $88.00       $0.00
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113732417          07/16/2023           1      $107.00       $0.00
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113732417          07/16/2023           1      $102.00       $0.00
    104272-02                101669329001 165541378  LONG             TIMOTHY    18   22113732417          07/16/2023           1       $67.00       $0.00
    104272-02                118716153001 165649170  CONWAY           KAYLEE     19   22613578799          07/18/2023           1       $45.00       $0.00
    104272-02                118716153001 165649170  CONWAY           KAYLEE     19   22613760673          07/20/2023           1       $45.00       $0.00
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   458835290401691401   07/18/2023          10       $30.99      $14.80
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   817887806193512401   07/19/2023          10      $101.03      $16.29
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   22704208021          03/01/2023          (1)   ($589.00)    ($89.55)
    104272-02                135710323001 165723208  RANCK            BRITTANY   01   22713671577          03/01/2023           1      $589.00      $89.55
    104272-02                101838197001 167645469  PERSIO           CHRISTIA   01   414685340940181401   07/17/2023          30      $276.22       $0.00
    104272-02                101844970001 167720840  LUDWIG           IAN        19   22713489918          07/14/2023           1      $132.00       $0.00
    104272-02                101844970001 167720840  LUDWIG           IAN        19   268577016214541401   07/15/2023          10       $34.08       $0.00
    104272-02                101844970001 167720840  LUDWIG           IAN        19   22713489918          07/14/2023           1       $14.00       $0.00
    104272-02                101844970001 167720840  LUDWIG           IAN        19   22713489918          07/14/2023           1      $132.00       $0.00
    104272-02                115086600001 168522001  URGOLITES        PATRICIA   18   672526148440691401   07/18/2023          30        $9.00       $0.00
    104272-02                115086600001 168522001  URGOLITES        CHARLES    01   22032407363          06/19/2023           1      $320.00     $127.90
    104272-02                115086600001 168522001  URGOLITES        PATRICIA   18   750093283599771401   07/17/2023          30        $4.00       $0.00
    104272-02                115086600001 168522001  URGOLITES        PATRICIA   18   259416708599771401   07/17/2023          30        $9.00       $0.00
    104272-02                101918329001 168627615  MCCOMBIE         BLAZE      18   876797133198662401   07/22/2023          30       $76.27      $20.62
    104272-02                101918329001 168627615  MCCOMBIE         BLAZE      18   121467346988662401   07/22/2023          10      $103.11      $17.50
    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      $466.00       $0.00
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023          (2)   ($138.00)       $0.00

                                                                                                                                              PAGE:34 of 72
                                                                                                                                                            
            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   22713032005          07/05/2023          (1)    ($44.00)    ($16.66)
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   13548738160591401    07/18/2023          30       $15.00       $8.72
    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)    ($69.00)    ($41.37)
    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       $44.00      $16.66
    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)    ($23.00)       $0.00
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023          (1)    ($68.00)    ($24.30)
    104272-02                132053569001 168749233  DUMAN            MARIAH     01   771088837553921401   07/14/2023          30       $15.00       $8.72
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023          (1)    ($67.00)    ($13.34)
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   722353088248412401   07/11/2023         (21)   ($347.76)       $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   22713032005          07/05/2023           2      $138.00       $0.00
    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      $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      $125.00      $30.84
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1      $322.00       $0.00
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1      $130.00      $10.70
    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           3      $153.00       $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          (1)   ($108.00)    ($27.19)
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1       $91.00      $22.91
    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          (1)    ($38.00)     ($6.95)
    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           1      $108.00      $27.19
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1       $38.00       $6.95
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1       $23.00       $0.00
    104272-02                132053569001 168749233  DUMAN            JOSHUA     18   22713032005          07/05/2023           1       $61.00      $17.20

                                                                                                                                              PAGE:35 of 72
                                                                                                                                                            
            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   22713693089          07/13/2023           1      $178.00       $0.00
    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      $328.00       $0.00
    104272-02                101993438001 169628033  BALL             JEFFREY    01   22213376838          07/11/2023           1      $424.00       $0.00
    104272-02                101993438001 169628033  BALL             JEFFREY    01   22213376838          07/11/2023           1       $65.00       $0.00
    104272-02                101993438001 169628033  BALL             JEFFREY    01   22213376838          07/11/2023           1       $92.00       $0.00
    104272-02                101993438001 169628033  BALL             JEFFREY    01   22213334019          07/11/2023           1       $10.00       $0.00
    104272-02                101993438001 169628033  BALL             JEFFREY    01   22213376838          07/11/2023           1      $132.00       $0.00
    104272-02                101993438001 169628033  BALL             JEFFREY    01   22213376838          07/11/2023           1       $97.00       $0.00
    104272-02                113905772001 169663596  WAGNER           WILLIAM    18   22813505997          07/15/2023           1      $160.00     $110.01
    104272-02                113905772001 169663596  WAGNER           WILLIAM    18   22412755576          06/07/2023           1       $60.00      $17.06
    104272-02                113905772001 169663596  WAGNER           WILLIAM    18   22412755576          06/12/2023           1       $32.00      $22.60
    104272-02                113905772001 169663596  WAGNER           WILLIAM    18   22412755576          06/16/2023           1       $32.00      $22.60
    104272-02                113905772001 169663596  WAGNER           WILLIAM    18   22412755576          06/12/2023           1       $32.00      $23.27
    104272-02                113905772001 169663596  WAGNER           WILLIAM    18   22412755576          06/16/2023           1       $32.00      $23.27
    104272-02                102055671001 170520271  GIBSON           MICHELLE   18   305378658599521401   07/14/2023          30      $303.53       $9.60
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   22032463632          06/19/2023           1      $125.70     $120.81
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   41072301899521401    07/14/2023          30      $147.89      $28.66
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   729386670799521401   07/14/2023          30      $172.85      $13.03
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   22032463632          06/19/2023           1       $25.00      $13.00
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   22032463632          06/19/2023           1       $15.00       $2.50
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   22032463632          06/19/2023           1       $10.00       $4.00
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   38046570699521401    07/14/2023          30      $208.58      $16.28
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   384888258799521401   07/14/2023          30       $42.75      $13.37
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   149908408799521401   07/14/2023          30      $227.19      $17.20
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   22032463632          06/19/2023           1       $15.00       $9.50
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   394677037899521401   07/14/2023          30      $159.01       $8.23
    104272-02                102055671001 170520271  GIBSON           ROBERT     01   906082921799521401   07/14/2023          30       $57.85      $16.39
    104272-02                121615384001 170665296  ISENBERG         BREANNE    18   426742522863212401   07/19/2023          30       $33.21       $5.76
    104272-02                121615384001 170665296  ISENBERG         DANIEL     01   929913686204212401   07/19/2023          30       $81.72       $5.81
    104272-02                121615384001 170665296  ISENBERG         DANIEL     01   927392172073212401   07/19/2023          30      $159.01       $8.23
    104272-02                121615384001 170665296  ISENBERG         BREANNE    18   620539798763212401   07/19/2023          30      $148.61       $9.88

                                                                                                                                              PAGE:36 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                121615384001 170665296  ISENBERG         DANIEL     01   904651127073212401   07/19/2023          30      $146.30       $9.32
    104272-02                115236308001 171640207  GRASSI           KADE       19   22213440115          07/16/2023           1       $32.00       $0.00
    104272-02                115236308001 171640207  GRASSI           KADE       19   22213612497          07/18/2023           1      $140.00       $0.00
    104272-02                115236308001 171640207  GRASSI           KADE       19   22213440115          07/16/2023           1      $140.00       $0.00
    104272-02                102159375001 171647155  NIKOLISHEN       JEANNINE   18   879568188532462401   07/22/2023          30       $34.98       $7.95
    104272-02                102159375001 171647155  NIKOLISHEN       ALEK       19   22613506041          07/13/2023           1      $132.00      $87.42
    104272-02                102159375001 171647155  NIKOLISHEN       ALEK       19   22613385557          07/13/2023           1       $10.00       $3.42
    104272-02                102159375001 171647155  NIKOLISHEN       JEANNINE   18   372641497245261401   07/16/2023          30       $52.35      $15.70
    104272-02                102159375001 171647155  NIKOLISHEN       ALEK       19   22613506041          07/13/2023           1      $132.00      $87.42
    104272-02                102159375001 171647155  NIKOLISHEN       JEANNINE   18   22613531493          07/12/2023           1      $254.00     $110.90
    104272-02                102243890001 172685116  KUKLA            LOGAN      19   338857226235232401   07/20/2023          30      $267.93      $54.06
    104272-02                102243890001 172685116  KUKLA            MADISON    19   22213503832          06/12/2023           1      $150.00      $85.70
    104272-02                102243890001 172685116  KUKLA            LISA       18   335113436361591401   07/18/2023          30      $227.19      $17.20
    104272-02                102243890001 172685116  KUKLA            MADISON    19   22213503832          06/12/2023           1       $90.00      $39.79
    104272-02                135851965001 172764065  LOCHER           MARISA     18   830736140968021401   07/14/2023          30       $53.65       $0.00
    104272-02                135851965001 172764065  LOCHER           MARISA     18   590862132827612401   07/19/2023          30      $127.68       $0.00
    104272-02                110157934001 173649775  OSTINOWSKY       SARA       18   624794887025052401   07/21/2023          30    $1,015.47     $673.16
    104272-02                110157934001 173649775  OSTINOWSKY       ISAAC      19   682607336411231401   07/14/2023          30      $581.18     $382.73
    104272-02                110157934001 173649775  OSTINOWSKY       SARA       18   22413614950          07/10/2023           1      $119.53      $36.28
    104272-02                110157934001 173649775  OSTINOWSKY       SARA       18   22413614950          07/10/2023           1      $130.87      $33.50
    104272-02                110157934001 173649775  OSTINOWSKY       SARA       18   938353496130742401   07/21/2023          30       $95.85      $21.25
    104272-02                110157934001 173649775  OSTINOWSKY       SARA       18   949541240766132401   07/20/2023          30      $137.71      $18.93
    104272-02                110157934001 173649775  OSTINOWSKY       SARA       18   225523558726232401   07/20/2023          30       $22.66       $2.26
    104272-02                102327164001 173700970  FORCELLINI       CHAD       01   801807573258391401   07/18/2023          30       $36.83       $7.39
    104272-02                102327164001 173700970  FORCELLINI       CYDNEY     19   22813663053          07/05/2023           1      $346.00     $162.27
    104272-02                102327164001 173700970  FORCELLINI       HUNTER     19   22813650580          07/18/2023           1      $385.00     $292.72
    104272-02                102327164001 173700970  FORCELLINI       CHAD       01   860662842258391401   07/18/2023          30      $258.40       $6.46
    104272-02                102327164001 173700970  FORCELLINI       HUNTER     19   22813650580          07/18/2023           1       $40.00       $2.99
    104272-02                102327164001 173700970  FORCELLINI       CHAD       01   741976928867642401   07/21/2023          30       $29.34       $7.73
    104272-02                102327164001 173700970  FORCELLINI       CHAD       01   372662712358391401   07/18/2023          30      $131.09      $16.96
    104272-02                102327164001 173700970  FORCELLINI       CHAD       01   984956648957281401   07/17/2023          30       $31.60       $6.39
    104272-02                102327164001 173700970  FORCELLINI       CHAD       01   114913368258391401   07/18/2023          30      $158.01       $8.23

                                                                                                                                              PAGE:37 of 72
                                                                                                                                                            
            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       HUNTER     19   22813650580          07/18/2023           1      $185.00     $130.20
    104272-02                102327164001 173700970  FORCELLINI       HUNTER     19   22813650580          07/18/2023           1       $40.00      $21.21
    104272-02                102327164001 173700970  FORCELLINI       HUNTER     19   22813650580          07/18/2023           1       $35.00      $16.70
    104272-02                102327164001 173700970  FORCELLINI       HUNTER     19   22813650580          07/18/2023           1       $40.00       $4.95
    104272-02                102403638001 174646831  GERNEY           SCOTT      01   309813006324902401   07/19/2023          30        $9.00       $9.00
    104272-02                102403638001 174646831  GERNEY           DAWNA      18   22032363280          07/11/2023           1    $1,791.00   $1,918.88
    104272-02                102403638001 174646831  GERNEY           DAWNA      18   22032036588          07/11/2023           1      $665.00     $108.80
    104272-02                102403638001 174646831  GERNEY           DAWNA      18   22032363280          07/11/2023           1      $251.00       $0.00
    104272-02                102403638001 174646831  GERNEY           DAWNA      18   22032363280          07/11/2023           1       $99.60       $0.00
    104272-02                102403638001 174646831  GERNEY           DAWNA      18   22032363280          07/11/2023           1      $188.00       $0.00
    104272-02                102403638001 174646831  GERNEY           DAWNA      18   22032363280          07/11/2023           1       $23.15       $0.00
    104272-02                102403638001 174646831  GERNEY           DAWNA      18   22032363280          07/11/2023           1      $277.00       $0.00
    104272-02                102403638001 174646831  GERNEY           DAWNA      18   22032363280          07/11/2023           2      $815.00       $0.00
    104272-02                102403638001 174646831  GERNEY           DAWNA      18   22032363280          07/11/2023           1       $27.78       $0.00
    104272-02                102403638001 174646831  GERNEY           DAWNA      18   22032036589          07/11/2023           1      $204.00       $0.00
    104272-02                102403638001 174646831  GERNEY           SCOTT      01   127663933340032401   07/20/2023          30       $18.00      $15.19
    104272-02                102403638001 174646831  GERNEY           DAWNA      18   22032363280          07/11/2023           8       $32.01       $0.00
    104272-02                102403638001 174646831  GERNEY           DAWNA      18   22032036589          07/11/2023           1      $142.00       $0.00
    104272-02                102403638001 174646831  GERNEY           DAWNA      18   22032363280          07/11/2023          20       $22.05       $0.00
    104272-02                122695741001 174663939  BEDNAR           KIMBERLY   18   16413928025591401    07/18/2023          30       $18.00      $16.35
    104272-02                122695741001 174663939  BEDNAR           KIMBERLY   18   22113736204          07/18/2023           1       $21.00      $15.45
    104272-02                122695741001 174663939  BEDNAR           KIMBERLY   18   63418288715591401    07/18/2023          30       $54.69       $6.46
    104272-02                122695741001 174663939  BEDNAR           CHELSEA    19   22113713457          07/17/2023           4      $140.00      $98.32
    104272-02                122695741001 174663939  BEDNAR           KIMBERLY   18   22113736204          07/18/2023           1      $160.00     $102.69
    104272-02                102484817001 175624053  DEMI             THERESA    18   93433663468691401    07/18/2023          30      $155.17       $5.45
    104272-02                102484817001 175624053  DEMI             THERESA    18   448641477896281401   07/17/2023          30        $7.84       $2.54
    104272-02                102484817001 175624053  DEMI             LUCAS      19   22813721714          07/17/2023           1       $17.00       $4.71
    104272-02                102484817001 175624053  DEMI             LUCAS      19   22813721714          07/17/2023           1       $35.00       $2.84
    104272-02                102484817001 175624053  DEMI             LUCAS      19   22813721714          07/17/2023           1      $200.00     $124.00
    104272-02                102484817001 175624053  DEMI             THERESA    18   576917046468691401   07/18/2023          30      $103.61      $21.89
    104272-02                102484817001 175624053  DEMI             LUCAS      19   22813721714          07/17/2023           1       $54.00      $15.90
    104272-02                102484817001 175624053  DEMI             THERESA    18   701187146212971401   07/17/2023           1      $105.68      $50.42

                                                                                                                                              PAGE:38 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                102484817001 175624053  DEMI             THERESA    18   576445548998061401   07/16/2023           8       $16.19       $5.90
    104272-02                102484817001 175624053  DEMI             THERESA    18   800891877088871401   07/17/2023          20    $2,419.00      $21.53
    104272-02                102567140001 176620059  GIRONDA          JULIAN     19   22813498683          07/11/2023           1       $50.00      $18.31
    104272-02                102567140001 176620059  GIRONDA          JULIAN     19   22813498683          07/11/2023           1      $160.00     $120.81
    104272-02                102567140001 176620059  GIRONDA          JULIAN     19   22813498683          07/11/2023           1       $82.00      $78.11
    104272-02                102636302001 177540502  GILLEN           WENDELL    01   22513471794          07/11/2023           1    $3,509.00   $3,461.95
    104272-02                102636302001 177540502  GILLEN           WENDELL    01   22513471794          07/11/2023           1      $648.65       $0.00
    104272-02                102636302001 177540502  GILLEN           WENDELL    01   22513369649          07/14/2023           1      $150.00      $85.70
    104272-02                102655122001 177649243  MOORE            DAVID      18   210980634495521401   07/14/2023          30       $62.19      $12.90
    104272-02                102655122001 177649243  MOORE            RYAN       19   50885238126132401    07/20/2023          25       $21.80       $8.65
    104272-02                102655122001 177649243  MOORE            RYAN       19   782931827220081401   07/17/2023          22    $1,232.02     $817.98
    104272-02                102655122001 177649243  MOORE            DAVID      18   22613385556          07/10/2023           1      $129.00     $126.85
    104272-02                102655122001 177649243  MOORE            DAVID      18   22613594972          07/18/2023           1       $90.00      $85.70
    104272-02                102655122001 177649243  MOORE            DAVID      18   603309768518032401   07/20/2023          14       $44.84      $20.42
    104272-02                114861273001 177704151  GRUDZIEN         GORDON     01   422807217231341401   07/15/2023          30      $461.50     $244.51
    104272-02                114581870001 178644516  COPOSKY          GLENN      01   708543196805871401   07/17/2023          30       $92.86      $13.12
    104272-02                114581870001 178644516  COPOSKY          GLENN      01   542064090905871401   07/17/2023          30      $174.20       $6.89
    104272-02                114581870001 178644516  COPOSKY          JENNIFER   18   911464640895771401   07/17/2023          30      $219.50      $49.91
    104272-02                114581870001 178644516  COPOSKY          JENNIFER   18   833744727954081401   07/17/2023          28      $287.12     $230.36
    104272-02                114581870001 178644516  COPOSKY          GLENN      01   22813491093          07/13/2023           1       $96.00      $43.25
    104272-02                114581870001 178644516  COPOSKY          GLENN      01   22813491093          07/13/2023           1       $23.00       $0.00
    104272-02                114581870001 178644516  COPOSKY          WYATT      19   22812098260          06/23/2023           1       $23.00       $0.00
    104272-02                114581870001 178644516  COPOSKY          WYATT      19   22812098260          06/23/2023           1      $127.00      $39.06
    104272-02                114581870001 178644516  COPOSKY          GLENN      01   22813491093          07/13/2023           1       $67.00      $34.47
    104272-02                114581870001 178644516  COPOSKY          WYATT      19   22812098260          06/23/2023           1      $127.00      $39.06
    104272-02                114581870001 178644516  COPOSKY          GLENN      01   22813491093          07/13/2023           1      $167.00      $76.20
    104272-02                114581870001 178644516  COPOSKY          WYATT      19   22812098260          06/23/2023          (1)    ($23.00)       $0.00
    104272-02                114581870001 178644516  COPOSKY          JENNIFER   18   22813359066          07/13/2023           6      $495.00     $186.48
    104272-02                114581870001 178644516  COPOSKY          WYATT      19   22812098260          06/23/2023          (1)   ($172.00)    ($42.95)
    104272-02                114581870001 178644516  COPOSKY          WYATT      19   22812098260          06/23/2023           1      $172.00      $42.95
    104272-02                114581870001 178644516  COPOSKY          JENNIFER   18   22813756343          07/19/2023           6      $495.00     $186.48
    104272-02                114581870001 178644516  COPOSKY          GLENN      01   22813491093          07/13/2023           1       $67.00      $20.00

                                                                                                                                              PAGE:39 of 72
                                                                                                                                                            
            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   589476498443032401   07/20/2023          30      $130.00       $7.16
    104272-02                114581870001 178644516  COPOSKY          JENNIFER   18   333138388548241401   07/15/2023          30       $93.29       $8.16
    104272-02                114581870001 178644516  COPOSKY          JENNIFER   18   17227062548241401    07/15/2023          30       $80.45      $24.75
    104272-02                114581870001 178644516  COPOSKY          GLENN      01   22813491093          07/13/2023           1      $108.00      $27.19
    104272-02                114581870001 178644516  COPOSKY          JENNIFER   18   22813633177          07/11/2023           1    $1,590.00     $542.81
    104272-02                114821237001 178664294  RAKAR            GRAYSON    19   22213334026          07/07/2023           1      $122.00       $0.00
    104272-02                118208355001 179643695  NILESKI          CAMDEN     19   22613610910          07/18/2023           1      $120.00     $110.01
    104272-02                118208355001 179643695  NILESKI          CAMDEN     19   22613523480          07/06/2023           1      $120.00     $110.01
    104272-02                118208355001 179643695  NILESKI          ELIZABET   18   628747826052562401   07/22/2023          10       $68.66      $13.75
    104272-02                118208355001 179643695  NILESKI          ELIZABET   18   656015193123931401   07/15/2023          28    $1,122.92     $901.89
    104272-02                118208355001 179643695  NILESKI          ELIZABET   18   70733966441981401    07/18/2023          90      $698.69      $39.84
    104272-02                118477767001 180707184  TEMPLETON        DREW       19   22313584415          07/06/2023           1       $23.00       $8.22
    104272-02                102971874001 181603269  STEPHAN          ADAM       18   263387426836002401   07/18/2023          30        $9.00       $5.18
    104272-02                102971874001 181603269  STEPHAN          ADAM       18   73165228836002401    07/18/2023          30       $88.43       $6.46
    104272-02                102987344001 181769306  KAPCSOS          TRENTON    19   22213513044          07/14/2023           1      $123.00     $108.63
    104272-02                102987344001 181769306  KAPCSOS          TRENTON    19   22213513044          07/14/2023           1      $285.00     $260.55
    104272-02                102987344001 181769306  KAPCSOS          TRENTON    19   22213513044          07/14/2023           2       $46.00      $23.28
    104272-02                102987344001 181769306  KAPCSOS          TRENTON    19   22213513044          07/14/2023           1      $121.00      $97.87
    104272-02                102987344001 181769306  KAPCSOS          TRENTON    19   22213513044          07/14/2023           1       $52.00      $14.55
    104272-02                102987344001 181769306  KAPCSOS          TRENTON    19   22213513044          07/14/2023           4      $128.00      $92.12
    104272-02                110617661001 182683831  GOCHNOUR         PEYTON     19   22213334023          07/07/2023           1       $90.00      $89.99
    104272-02                103127176001 183587982  CAMERON          JOSEPH     18   734658348674152401   07/21/2023          30        $4.00       $0.00
    104272-02                103127176001 183587982  CAMERON          JOSEPH     18   90865548674152401    07/21/2023          30        $9.00       $0.00
    104272-02                124119460001 183588004  BELL             SHAWN      18   32969098931442401    07/21/2023          30       $22.99       $0.00
    104272-02                124119460001 183588004  BELL             SHAWN      18   554536558134261401   07/16/2023          30      $151.99       $0.00
    104272-02                124119460001 183588004  BELL             SHAWN      18   426367576055041401   07/15/2023          30      $147.62       $0.00
    104272-02                103223419001 184685904  DUMM             BRIAN      18   256806898209112401   07/18/2023         (30)     ($8.40)     ($8.40)
    104272-02                103223419001 184685904  DUMM             BRIAN      18   289853348398112401   07/18/2023         (30)    ($36.21)     ($8.23)
    104272-02                103223419001 184685904  DUMM             BRIAN      18   74376478398112401    07/19/2023          30       $36.21       $8.23
    104272-02                103223419001 184685904  DUMM             BRIAN      18   339504380373302401   07/18/2023          30        $9.29       $3.82
    104272-02                103223419001 184685904  DUMM             BRIAN      18   786395728309112401   07/19/2023          30        $8.40       $8.40
    104272-02                103223419001 184685904  DUMM             BRIAN      18   468482642051312401   07/19/2023          30       $34.98       $7.95

                                                                                                                                              PAGE:40 of 72
                                                                                                                                                            
            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             BRIAN      18   675379268488112401   07/19/2023          30        $9.29       $3.82
    104272-02                103223419001 184685904  DUMM             BRIAN      18   724201970373302401   07/18/2023          30       $36.21       $8.23
    104272-02                103223419001 184685904  DUMM             MADELINE   19   873497146923661401   07/07/2023         (30)   ($105.56)    ($53.93)
    104272-02                103223419001 184685904  DUMM             BRIAN      18   901068138488112401   07/18/2023         (30)     ($9.29)     ($3.82)
    104272-02                103223419001 184685904  DUMM             BRIAN      18   839485770373302401   07/18/2023          30        $8.40       $8.40
    104272-02                121084536001 184727534  REESE            SCOTT      01   22303833135          02/11/2023          (1)   ($240.00)   ($170.43)
    104272-02                121084536001 184727534  REESE            SCOTT      01   22303833135          02/11/2023           1      $150.00      $57.18
    104272-02                121084536001 184727534  REESE            SCOTT      01   22303833135          02/11/2023          (1)   ($150.00)    ($57.18)
    104272-02                121084536001 184727534  REESE            SCOTT      01   22303833135          02/11/2023           1      $100.00      $17.61
    104272-02                121084536001 184727534  REESE            SCOTT      01   22303833135          02/11/2023           1      $240.00     $170.43
    104272-02                103293323001 185606084  MORRISON         ERIN       18   440862792173481401   07/17/2023          30      $138.75       $5.45
    104272-02                103293323001 185606084  MORRISON         ERIN       18   523503076705691401   07/17/2023         (28) ($1,724.99) ($1,299.85)
    104272-02                103293323001 185606084  MORRISON         ERIN       18   555483108123871401   07/17/2023          30      $235.55       $9.29
    104272-02                103293323001 185606084  MORRISON         ERIN       18   290646068679161401   07/16/2023           5       $54.99       $4.80
    104272-02                103293323001 185606084  MORRISON         ERIN       18   997575338299161401   07/16/2023           5       $75.99      $15.10
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   777719458358391401   07/18/2023          30      $763.99     $572.10
    104272-02                103293323001 185606084  MORRISON         ERIN       18   769457326223481401   07/17/2023          28    $1,724.99   $1,299.85
    104272-02                103293323001 185606084  MORRISON         WILLIAM    01   68496458735081401    07/17/2023          30       $19.13       $8.86
    104272-02                103293323001 185606084  MORRISON         ERIN       18   22513494596          07/17/2023           1       $40.00      $23.27
    104272-02                103293323001 185606084  MORRISON         ERIN       18   22513494596          07/17/2023           1       $45.00      $24.58
    104272-02                110155283001 185705569  O'BRIEN          SETH       18   22813733901          06/20/2023           1      $200.00       $0.00
    104272-02                115775315001 187704817  SIPE             SCOTT      01   60479318598771401    07/17/2023          30       $18.58       $6.89
    104272-02                115775315001 187704817  SIPE             JULIE      18   22813560879          07/18/2023           1       $42.00      $22.60
    104272-02                115775315001 187704817  SIPE             JULIE      18   22813560879          07/18/2023           1       $30.00       $9.55
    104272-02                115775315001 187704817  SIPE             GABRIEL    19   22813540697          06/11/2023           1       $47.00      $10.50
    104272-02                115775315001 187704817  SIPE             JULIE      18   22813813566          07/21/2023           1       $42.00      $22.10
    104272-02                115775315001 187704817  SIPE             JULIE      18   22813813566          07/21/2023           1       $30.00       $0.00
    104272-02                115775315001 187704817  SIPE             JULIE      18   22813813566          07/21/2023           1       $30.00      $24.58
    104272-02                115775315001 187704817  SIPE             JULIE      18   22813813566          07/21/2023           1       $42.00      $33.32
    104272-02                115775315001 187704817  SIPE             JULIE      18   22813560879          07/18/2023           1       $35.00      $23.27
    104272-02                115775315001 187704817  SIPE             GABRIEL    19   22813540697          06/11/2023           1      $150.00      $85.70
    104272-02                115775315001 187704817  SIPE             JULIE      18   22813560879          07/18/2023           1       $30.00      $24.58

                                                                                                                                              PAGE:41 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                103551054001 188665731  KIM              MIKALAH    19   22613749022          06/21/2023           1      $200.00     $120.81
    104272-02                103551054001 188665731  KIM              MIKALAH    19   22613749022          06/21/2023           1       $47.00      $10.50
    104272-02                103553425001 188685513  KIRSCH           EMMA       19   22113491567          06/10/2023           1      $225.00     $105.99
    104272-02                103553425001 188685513  KIRSCH           EMMA       19   22113491567          06/10/2023           1       $80.00      $33.61
    104272-02                103553425001 188685513  KIRSCH           EMMA       19   22113704618          07/19/2023           1       $40.00      $12.84
    104272-02                103625291001 189584046  WILLETT          AIMEE      01   328963343111742401   07/21/2023          30       $32.53      $10.28
    104272-02                111045735001 189641841  MILLER           JOHN       01   370475800990991401   07/18/2023          30      $139.74       $5.45
    104272-02                111045735001 189641841  MILLER           BRENNAN    19   22031961741          07/05/2023           1      $115.00     $110.01
    104272-02                111045735001 189641841  MILLER           JOHN       01   46714610997362401    07/22/2023          30      $172.93       $8.54
    104272-02                111045735001 189641841  MILLER           ASHLEY     18   114063596669922401   07/20/2023          30      $159.01       $8.23
    104272-02                122351577001 189724811  KOPCZYK          STACY      18   22613733028          07/06/2023           1       $29.00       $0.00
    104272-02                122351577001 189724811  KOPCZYK          STACY      18   22613580870          07/11/2023           1       $31.00       $0.00
    104272-02                122351577001 189724811  KOPCZYK          STACY      18   22613733028          07/06/2023           1      $137.00      $22.48
    104272-02                122351577001 189724811  KOPCZYK          STACY      18   22613733028          07/06/2023           1      $158.00      $41.87
    104272-02                122351577001 189724811  KOPCZYK          STACY      18   22613580870          07/11/2023           1      $123.00      $31.09
    104272-02                122351577001 189724811  KOPCZYK          STACY      18   22613580870          07/11/2023           1      $135.00      $33.03
    104272-02                122351577001 189724811  KOPCZYK          STACY      18   22613733028          07/06/2023           1      $147.00      $35.34
    104272-02                103643051001 189746790  VANFOSSEN        ALESHA     18   22513713954          06/23/2023           1      $200.00     $120.81
    104272-02                103699741001 190489435  SMITH            DORIS      18   850630874728921401   07/14/2023          30       $70.09       $0.00
    104272-02                103699741001 190489435  SMITH            DORIS      18   972524440151442401   07/21/2023          30      $169.50       $0.00
    104272-02                103713375001 190569811  SCHWEITZER       DANIEL     19   912137212596131401   07/14/2023           2      $743.99     $399.25
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313311438          07/12/2023           1        $5.00       $1.56
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313311438          07/06/2023           1      $129.00     $126.85
    104272-02                103713375001 190569811  SCHWEITZER       DANA       18   22313311438          07/12/2023           1       $27.00      $15.94
    104272-02                103713375001 190569811  SCHWEITZER       AMELIA     19   22313311437          06/27/2023           1      $129.00     $126.85
    104272-02                103717291001 190600652  KUPCHELLA        GREGORY    01   22413272875          07/10/2023           1       $23.00       $0.00
    104272-02                103717291001 190600652  KUPCHELLA        GREGORY    01   22413272875          07/10/2023           1      $216.00       $0.00
    104272-02                103717291001 190600652  KUPCHELLA        GREGORY    01   22413272875          07/10/2023          (1)    ($23.00)       $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)   ($102.00)       $0.00
    104272-02                103812819001 191649655  PROKOP           BOBBI      18   22613588240          07/12/2023           1       $16.00       $8.05
    104272-02                103812819001 191649655  PROKOP           BOBBI      18   22613588240          07/12/2023           1      $149.00      $66.60

                                                                                                                                              PAGE:42 of 72
                                                                                                                                                            
            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   22613382719          07/11/2023           1      $142.00      $89.99
    104272-02                103814953001 191669673  LAMARK           TAWNYA     01   22713666091          07/10/2023           1      $330.00     $188.02
    104272-02                103814953001 191669673  LAMARK           TAWNYA     01   22713756389          07/10/2023           1      $391.00      $38.55
    104272-02                103814953001 191669673  LAMARK           TAWNYA     01   22713756389          07/10/2023           1      $369.00      $38.55
    104272-02                103814953001 191669673  LAMARK           TAWNYA     01   144273853281591401   07/18/2023          30       $32.74       $5.20
    104272-02                103814953001 191669673  LAMARK           TAWNYA     01   22713666091          07/10/2023           1      $396.00     $188.02
    104272-02                103815975001 191683834  RHODES           LORI       18   256494860839962401   07/22/2023          30      $124.50       $0.00
    104272-02                124119470001 192585157  TINIK            RITA       18   292607103931381401   07/17/2023          24      $210.63       $0.00
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22213723886          07/17/2023           1       $90.00      $11.87
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22213723886          07/17/2023           1       $70.00      $10.45
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22213348322          07/11/2023           2       $70.00      $49.16
    104272-02                103958453001 193504313  SHAFFER          GREGORY    18   592954372853021401   07/14/2023          90    $1,128.08     $270.96
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22213348322          07/11/2023           1       $70.00      $10.45
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22213723886          07/17/2023           2       $70.00      $49.16
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22213348324          07/13/2023           1       $70.00      $10.45
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22213348322          07/11/2023           1       $90.00      $11.87
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   405690674853021401   07/14/2023          90    $2,484.02   $1,841.85
    104272-02                103958453001 193504313  SHAFFER          SUSAN      01   22213348324          07/13/2023           2       $70.00      $49.16
    104272-02                103960961001 193522698  PAGANO           KAREN      18   270758288037161401   07/16/2023          30       $36.21       $8.23
    104272-02                103960961001 193522698  PAGANO           KAREN      18   745175888037161401   07/16/2023          30        $4.00       $4.00
    104272-02                103960961001 193522698  PAGANO           KAREN      18   206685188037161401   07/16/2023          30       $48.40      $20.62
    104272-02                103960961001 193522698  PAGANO           KAREN      18   113726888037161401   07/16/2023          17       $42.00      $42.00
    104272-02                103960961001 193522698  PAGANO           KAREN      18   22813590135          07/14/2023           1      $160.00     $110.68
    104272-02                103960961001 193522698  PAGANO           KAREN      18   22813590135          07/14/2023           1      $175.00     $105.99
    104272-02                103960961001 193522698  PAGANO           ALBERT     01   940548428447161401   07/16/2023          30      $474.43     $381.48
    104272-02                103960961001 193522698  PAGANO           ALBERT     01   652527786931261401   07/16/2023          30      $128.06     $128.06
    104272-02                103983310001 193665895  MAKIN            NICOLE     18   829492702372312401   07/19/2023          90      $235.30       $0.00
    104272-02                116900492001 193709853  MAZZARELLA       JAMIE      18   22513795115          07/03/2023           1      $513.00     $126.06
    104272-02                116900492001 193709853  MAZZARELLA       JAMIE      18   22513795115          07/03/2023           1      $488.00     $170.47
    104272-02                116900492001 193709853  MAZZARELLA       JAMIE      18   22513497090          07/10/2023           1      $254.00     $110.90
    104272-02                116900492001 193709853  MAZZARELLA       JAMIE      18   22513795115          07/03/2023           1      $232.00     $119.47
    104272-02                116900492001 193709853  MAZZARELLA       JAMIE      18   22513530609          07/03/2023           1       $69.00      $19.00

                                                                                                                                              PAGE:43 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                116900492001 193709853  MAZZARELLA       JAMIE      18   22513530609          07/03/2023           1       $68.00      $20.54
    104272-02                116900492001 193709853  MAZZARELLA       JAMIE      18   22513530609          07/03/2023           1       $93.00      $19.00
    104272-02                117718876001 193709854  QUAGLIA          LATRACE    18   22113525045          06/27/2023           1      $948.60     $182.90
    104272-02                117718876001 193709854  QUAGLIA          LATRACE    18   22113525044          06/27/2023           1      $961.00     $182.90
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   729135548516132401   07/20/2023           8       $15.00       $5.64
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   22513346623          07/12/2023           1      $188.00      $41.33
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   22513613125          07/12/2023           1      $482.00     $248.43
    104272-02                122640710001 193723379  VESCOVI          KIERSTYN   18   791330443431821401   07/14/2023          30      $172.13     $172.13
    104272-02                122025702001 194581386  TAYLOR           JAMES      01   435596768176822401   07/20/2023          30      $127.40       $0.00
    104272-02                119714565001 194708189  HRITZ            JESSICA    01   22313431769          07/11/2023           1    $1,862.00       $0.00
    104272-02                119714565001 194708189  HRITZ            JESSICA    01   325842802267152401   07/21/2023          14       $68.82       $0.00
    104272-02                119714565001 194708189  HRITZ            JESSICA    01   22313301863          07/11/2023           1      $842.00       $0.00
    104272-02                104227685001 196581553  BEYER            JODI       18   539121430852732401   07/05/2023         (30)    ($82.42)     ($8.55)
    104272-02                135291530001 196767240  FARABAUGH        DOMINIC    18   111027096314621401   07/14/2023          30      $309.52      $17.15
    104272-02                110735193001 198603232  DAVIS            JUSTIN     01   501402312719352401   07/10/2023         (25)    ($87.02)    ($70.58)
    104272-02                133177478001 198763668  FOUST            CASIDY     18   22513382935          07/05/2023           1      $119.53      $36.28
    104272-02                104472118001 199604016  KIRSCH           GREGG      01   518746298877642401   07/21/2023          30      $158.01       $0.00
    104272-02                104473668001 199609100  MCHUGH           PATRICK    18   709815350672512401   07/19/2023           1        $9.99       $3.44
    104272-02                104473668001 199609100  MCHUGH           SANDRA     01   689808758079951401   07/16/2023          30       $49.37      $10.53
    104272-02                104473668001 199609100  MCHUGH           PATRICK    18   22313663393          06/29/2023           1      $163.00     $105.99
    104272-02                104561618001 200626571  MYERS            JACQUELI   18   22513761138          07/17/2023           1       $23.00       $0.00
    104272-02                104561618001 200626571  MYERS            JACQUELI   18   802803508748712401   07/19/2023          30       $68.66       $0.00
    104272-02                104561618001 200626571  MCMAHON          JAMES      01   32683723468712401    07/19/2023          30      $159.50       $0.00
    104272-02                104561618001 200626571  MYERS            JULIA      19   22513614409          07/14/2023           1      $410.00       $0.00
    104272-02                104561618001 200626571  MYERS            JACQUELI   18   22513761138          07/17/2023           1       $67.00      $34.47
    104272-02                104561618001 200626571  MYERS            JULIA      19   22513614409          07/14/2023           1      $135.00       $0.00
    104272-02                104561618001 200626571  MYERS            JACQUELI   18   22513761138          07/17/2023           1      $107.00       $0.00
    104272-02                104561618001 200626571  MYERS            JULIA      19   22513614409          07/14/2023           1      $236.00       $0.00
    104272-02                104561618001 200626571  MYERS            JACQUELI   18   22513761138          07/17/2023           1       $44.00       $0.00
    104272-02                104561618001 200626571  MYERS            JULIA      19   22513614409          07/14/2023           1      $273.00       $0.00
    104272-02                104561618001 200626571  MYERS            JULIA      19   22513614409          07/14/2023           1       $31.00       $0.00
    104272-02                104561618001 200626571  MYERS            JACQUELI   18   22513761138          07/17/2023           1      $102.00       $0.00

                                                                                                                                              PAGE:44 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                104561618001 200626571  MYERS            JACQUELI   18   22513761138          07/17/2023           1       $96.00       $0.00
    104272-02                104561618001 200626571  MYERS            JACQUELI   18   22513761139          07/17/2023           1      $497.00     $225.44
    104272-02                104561618001 200626571  MCMAHON          JAMES      01   758573138464871401   07/17/2023          30      $332.01       $0.00
    104272-02                104561618001 200626571  MYERS            JACQUELI   18   22513761139          07/17/2023           1       $48.00      $58.59
    104272-02                121180930001 201720071  FINI-DOMONKOS    CHRISTIN   01   158049438754032401   07/20/2023          28    $4,305.50   $3,683.36
    104272-02                104739733001 202709413  SEMELSBERGER     SUSANNA    18   22113640665          07/12/2023           3      $564.00       $0.00
    104272-02                104739733001 202709413  SEMELSBERGER     SUSANNA    18   22113640665          07/12/2023           1       $83.00       $0.00
    104272-02                104739733001 202709413  SEMELSBERGER     SUSANNA    18   22113640665          07/12/2023           1      $277.00       $0.00
    104272-02                104739733001 202709413  SEMELSBERGER     SUSANNA    18   22113520149          07/12/2023           1      $142.00       $0.00
    104272-02                104739733001 202709413  SEMELSBERGER     SUSANNA    18   22113640665          07/12/2023           1    $5,849.00  $10,774.20
    104272-02                104739733001 202709413  SEMELSBERGER     SUSANNA    18   22113640665          07/12/2023           2       $22.05       $0.00
    104272-02                104739733001 202709413  SEMELSBERGER     SUSANNA    18   22113640665          07/12/2023           2       $55.56       $0.00
    104272-02                104739733001 202709413  SEMELSBERGER     SUSANNA    18   22113520150          07/12/2023           1    $3,162.00       $3.93
    104272-02                104739733001 202709413  SEMELSBERGER     SUSANNA    18   22113640665          07/12/2023           4       $45.15       $0.00
    104272-02                104739733001 202709413  SEMELSBERGER     SUSANNA    18   22113640665          07/12/2023           1       $27.00       $0.00
    104272-02                104739733001 202709413  SEMELSBERGER     SUSANNA    18   22113640665          07/12/2023           8       $44.10       $0.00
    104272-02                104739733001 202709413  SEMELSBERGER     SUSANNA    18   22113640665          07/12/2023           4       $22.05       $0.00
    104272-02                104739733001 202709413  SEMELSBERGER     SUSANNA    18   22113640665          07/12/2023          15       $22.05       $0.00
    104272-02                104739733001 202709413  SEMELSBERGER     SUSANNA    18   22113640665          07/12/2023           4    $6,110.75       $0.00
    104272-02                104739733001 202709413  SEMELSBERGER     SUSANNA    18   22113640665          07/12/2023           1       $44.10       $0.00
    104272-02                104739733001 202709413  SEMELSBERGER     SUSANNA    18   22113640665          07/12/2023           7    $2,260.00       $0.00
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   22413408220          07/12/2023           1       $87.00      $24.58
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   22413456971          07/14/2023           1       $87.00      $24.58
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   22413456971          07/14/2023           1       $97.00      $28.53
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   22413671259          07/17/2023           1       $87.00      $24.58
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   22413408220          07/12/2023           1       $86.00      $22.60
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   22413671259          07/17/2023           1       $97.00      $28.53
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   22413671259          07/17/2023           1       $86.00      $22.60
    104272-02                104795329001 203523973  CORRENTE         BETTINA    01   22413456971          07/14/2023           1       $86.00      $22.60
    104272-02                104801669001 203563037  JENKINS          DAWN       18   758695828150591401   07/18/2023          10       $28.62       $6.09
    104272-02                104801669001 203563037  JENKINS          DAWN       18   857953268940591401   07/18/2023          10       $78.83      $13.89
    104272-02                104801669001 203563037  JENKINS          DAWN       18   22813499140          07/15/2023           1        $9.25       $3.30

                                                                                                                                              PAGE:45 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                104801669001 203563037  JENKINS          EDWARD     01   709045648434661401   07/16/2023          30       $50.33       $6.15
    104272-02                104801669001 203563037  JENKINS          DAWN       18   22813672212          07/17/2023           1      $235.00     $144.32
    104272-02                104801669001 203563037  JENKINS          DAWN       18   22813499140          07/15/2023           1       $83.85      $50.07
    104272-02                104801669001 203563037  JENKINS          DAWN       18   902335500791281401   07/17/2023          16       $91.99      $50.86
    104272-02                104801669001 203563037  JENKINS          DAWN       18   22813671970          07/17/2023           1      $209.00     $126.85
    104272-02                104811837001 203624160  DORSCH           MARIBETH   18   165691727759612401   07/19/2023          15        $9.99       $3.31
    104272-02                104811837001 203624160  DORSCH           SHAWN      01   22613749012          06/23/2023           1      $290.00     $157.86
    104272-02                104816750001 203661643  RODKEY           MICHAEL    01   22513471848          07/13/2023           1      $138.00      $49.71
    104272-02                104816750001 203661643  RODKEY           MICHAEL    01   22513471848          07/13/2023           1       $23.00       $0.00
    104272-02                104816750001 203661643  RODKEY           MICHAEL    01   22513471848          07/13/2023           1       $67.00      $34.47
    104272-02                104900285001 204643617  PABLIC           LISA       18   211457523216942401   07/21/2023          30       $51.90      $15.25
    104272-02                104900285001 204643617  PABLIC           LISA       18   22213454536          07/13/2023           1      $424.00      $23.44
    104272-02                104900285001 204643617  PABLIC           LISA       18   22213454536          07/13/2023           1       $92.00       $0.00
    104272-02                104900285001 204643617  PABLIC           LISA       18   22213454536          07/13/2023           1       $97.00      $68.74
    104272-02                104900285001 204643617  PABLIC           LISA       18   22213454536          07/13/2023           1       $65.00      $39.89
    104272-02                104900285001 204643617  PABLIC           LISA       18   22213334025          07/13/2023           1       $10.00       $0.00
    104272-02                119571853001 205587218  GWIZDAK          LORI       18   22413802161          06/26/2023           1       $40.00       $0.00
    104272-02                119571853001 205587218  GWIZDAK          THOMAS     01   198735718941081401   07/17/2023          30      $498.72      $18.28
    104272-02                119571853001 205587218  GWIZDAK          LORI       18   22413802161          06/26/2023           1       $40.00       $0.00
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22513774985          07/13/2023           1       $56.00      $22.45
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22513774985          07/13/2023           1      $101.00      $42.78
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22513774985          07/13/2023           1       $79.00      $32.70
    104272-02                105057437001 206567193  GILKEY           CATHERIN   01   438897636422341401   07/15/2023          30       $81.00       $7.20
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22513774985          07/13/2023           1       $89.00      $31.36
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22513774985          07/13/2023           1       $89.00      $31.34
    104272-02                105057437001 206567193  GILKEY           COOPER     19   22513774985          07/13/2023           1       $42.00      $17.89
    104272-02                105133377001 207505950  VICINI           TIMOTHY    18   357501110626562401   07/22/2023          30        $9.00       $0.00
    104272-02                110609957001 210620704  STRUNK           JEREMIAH   19   22213558290          07/18/2023           1      $120.00       $0.00
    104272-02                105413964001 210642710  ROBERTSON        RONALD     18   389904050167971401   07/17/2023          30       $31.06      $10.30
    104272-02                105413964001 210642710  ROBERTSON        RONALD     18   273957506967971401   07/17/2023          30      $112.30      $20.62
    104272-02                105413964001 210642710  ROBERTSON        RONALD     18   500579648380181401   07/17/2023          30      $155.97       $8.23
    104272-02                105413964001 210642710  ROBERTSON        RONALD     18   106586748480181401   07/17/2023          30       $55.16      $29.26

                                                                                                                                              PAGE:46 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                105413964001 210642710  ROBERTSON        RONALD     18   22613593817          07/14/2023           1      $209.00     $126.85
    104272-02                105413964001 210642710  ROBERTSON        RONALD     18   243085160062791401   07/18/2023          30      $817.47     $540.75
    104272-02                105413964001 210642710  ROBERTSON        RONALD     18   917094627467971401   07/17/2023          30       $15.03       $3.93
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213531597          07/11/2023           1      $235.00     $144.32
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213594997          07/11/2023           1       $59.00      $24.34
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213594997          07/11/2023           2        $1.05       $0.00
    104272-02                126653510001 210721634  BOLAND           BLAKLEY    19   112331970381161401   07/16/2023           7       $46.56      $15.71
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213594997          07/11/2023           1      $424.00      $54.21
    104272-02                126653510001 210721634  BOLAND           BLAKLEY    19   22213382447          07/15/2023           1      $300.00     $178.53
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213594997          07/11/2023           1      $299.00     $159.41
    104272-02                126653510001 210721634  BOLAND           BLAKLEY    19   22213689119          07/15/2023           1       $32.18       $7.50
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213594997          07/11/2023           1       $27.78       $5.95
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213594997          07/12/2023           1    $2,526.00     $650.76
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213594997          07/11/2023           1    $1,302.00     $339.19
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213594997          07/12/2023           1    $1,456.00     $814.73
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213594997          07/11/2023           1       $24.00      $11.55
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213366269          07/11/2023           1      $499.00      $46.81
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   826706558826791401   07/10/2023         (10)     ($4.00)     ($4.00)
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213594997          07/11/2023           1       $65.00      $34.39
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213594997          07/11/2023           1    $1,134.00     $890.30
    104272-02                126653510001 210721634  BOLAND           REBECCA    18   22213594997          07/11/2023           1       $65.00      $39.89
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22313676454          07/11/2023           1       $29.24       $6.00
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22313604335          07/13/2023           1      $254.00     $110.90
    104272-02                111997101001 211626742  DUNCAN           SIMON      19   22313479792          06/11/2023           1      $150.00      $85.70
    104272-02                111997101001 211626742  DUNCAN           ELI        19   22313479790          06/11/2023           1      $150.00      $85.70
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22313676454          07/11/2023           3       $87.72      $24.00
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22313676454          07/11/2023           1       $60.75       $7.50
    104272-02                111997101001 211626742  DUNCAN           EVE        19   22313479791          06/11/2023           1      $150.00      $85.70
    104272-02                111997101001 211626742  DUNCAN           SIMON      19   22313508025          07/11/2023           1       $67.00      $47.13
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   22313676454          07/11/2023           1       $21.89       $2.00
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   998414470758951401   07/15/2023          84      $116.06      $89.34
    104272-02                111997101001 211626742  DUNCAN           AMANDA     18   868967453958951401   07/15/2023          90    $1,331.65     $980.46

                                                                                                                                              PAGE:47 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-02                122787528001 258714403  MCGREGOR         SHANE      18   22613385555          03/29/2023           1      $220.00       $0.00
    104272-02                128385523001 305155123  LOHR             SYDNEY     18   22113715106          07/18/2023           1      $163.00      $35.54
    104272-02                128385523001 305155123  LOHR             SYDNEY     18   741245408153662401   07/22/2023           5       $17.33       $2.50
    104272-02                128385523001 305155123  LOHR             SYDNEY     18   22113715106          07/18/2023           1      $172.00      $42.49
    104272-02                107536593001 391923055  SHAFFER          LYDIA      19   22313359519          07/11/2023           1      $120.00     $110.01
    104272-02                107536593001 391923055  SHAFFER          THERESE    01   490323913021442401   07/21/2023          30      $156.60      $12.36
  104272-02 Total                                                                                                                  $141,903.26  $56,616.79
  104272-09
    104272-09                101226816001 159666231  STIFFLER         GABRIELL   19   316887313093412401   07/19/2023          30      $145.23      $53.93
    104272-09                101226816001 159666231  STIFFLER         AYDEN      19   22813733909          06/19/2023           1      $150.00      $85.70
    104272-09                101226816001 159666231  STIFFLER         KIRSTEN    18   168043678129862401   07/22/2023           5       $72.50       $6.97
    104272-09                101226816001 159666231  STIFFLER         GABRIELL   19   739683546745561401   07/03/2023         (30)   ($145.23)    ($53.93)
    104272-09                101226816001 159666231  STIFFLER         GABRIELL   19   22032502353          07/20/2023           1      $140.00      $89.99
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713719585          07/03/2023           1      $236.00      $69.76
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713775937          06/20/2023          50       $33.75      $11.50
    104272-09                122665066001 163589264  KASCHALK         MARY       18   787077153076891401   07/18/2023          17       $97.67      $27.17
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713785983          07/17/2023           3      $192.60      $22.71
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713719585          07/03/2023           1      $217.00      $67.68
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713719585          07/03/2023           1      $265.00      $70.27
    104272-09                122665066001 163589264  KASCHALK         MARY       18   208909488884412401   07/19/2023          18      $621.20     $410.99
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713719585          07/03/2023           1       $93.25      $22.73
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713549867          05/22/2023           1    $1,602.30     $262.51
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713478612          07/12/2023          23      $396.54     $253.23
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713785983          07/17/2023          14      $237.92     $154.14
    104272-09                122665066001 163589264  KASCHALK         MARY       18   146691840884412401   07/18/2023         (18)   ($621.20)   ($410.99)
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713647946          07/14/2023           1      $286.00     $120.81
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713785983          07/17/2023          10       $43.20       $9.10
    104272-09                122665066001 163589264  KASCHALK         MARY       18   837826708576891401   07/18/2023          18      $621.20     $410.99
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713465366          06/27/2023           1      $211.00     $165.02
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713775936          06/20/2023           2       $80.05      $27.14
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713785983          07/17/2023           3      $858.00     $729.00
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713478612          07/12/2023           5      $321.00      $37.85

                                                                                                                                              PAGE:48 of 72
                                                                                                                                                            
            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   22713478612          07/12/2023           5    $1,430.00   $1,215.00
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713775937          06/20/2023           2       $19.00       $6.44
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713775937          06/20/2023          20      $284.00      $96.20
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713719585          07/03/2023           1      $129.00      $31.97
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713465366          06/21/2023           1      $211.00     $165.02
    104272-09                122665066001 163589264  KASCHALK         MARY       18   22713775937          06/20/2023           2       $13.50       $4.58
    104272-09                122665066001 163589264  KASCHALK         MARY       18   158285288466891401   07/18/2023           7       $19.18       $8.95
    104272-09                112895895001 171602746  MESORAS          BELLA      19   999043438470152401   07/21/2023          30      $128.17       $8.39
    104272-09                118503729001 181720719  SANTINI          EMILY      01   22032338616          07/17/2023          90    $2,410.68   $1,035.00
    104272-09                105389627001 210488446  MCGILL           LAURA      18   967854227792002401   07/18/2023          30       $70.09      $18.98
    104272-09                105389627001 210488446  MCGILL           ROGER      01   802353138459922401   07/20/2023          30       $38.32      $14.85
  104272-09 Total                                                                                                                   $10,907.92   $5,249.65
  104272-12
    104272-12                101670217001 165543863  BURKEY           PATRICIA   18   239382872021442401   07/21/2023          30      $858.99     $644.00
    104272-12                101670217001 165543863  BURKEY           PATRICIA   18   63313913121442401    07/21/2023          30      $681.99     $540.75
    104272-12                101670217001 165543863  BURKEY           PATRICIA   18   110283323021442401   07/21/2023          30      $763.99     $572.10
    104272-12                102796755001 179543072  MINOR            KAREN      18   670392951439521401   07/14/2023          30       $17.37       $5.48
    104272-12                102796755001 179543072  MINOR            KAREN      18   786223213590442401   07/21/2023          30        $9.00       $0.00
    104272-12                102796755001 179543072  MINOR            KAREN      18   743923526690442401   07/21/2023          30       $16.70       $0.00
    104272-12                103106444001 183468278  YOUNG            FELICIA    18   22513717144          07/17/2023           1      $222.00       $0.00
    104272-12                135039874001 183502743  MAZZARELLA       MARY       18   522253173113042401   07/21/2023          90      $112.00       $0.00
    104272-12                118612993001 198525370  RIDGELEY         DONNA      18   451793788006132401   07/20/2023          30      $107.69       $0.00
    104272-12                118612993001 198525370  RIDGELEY         DONNA      18   376733736995132401   07/20/2023          30      $184.47       $0.00
    104272-12                104623467001 201509415  PERSIO           MARIA      18   22613585968          07/13/2023           1      $419.00      $17.61
    104272-12                104623467001 201509415  PERSIO           MARIA      18   22613585968          07/13/2023           1      $263.00      $85.70
    104272-12                104623467001 201509415  PERSIO           MARIA      18   63787163082281401    07/17/2023          90       $49.90       $0.00
  104272-12 Total                                                                                                                    $3,706.10   $1,865.64
  104272-19
    104272-19                104483547001 199688014  STRITTMATTER     STEPHANI   01   620242692750871401   07/17/2023          10       $19.12       $4.42
    104272-19                104483547001 199688014  STRITTMATTER     JADON      19   613323803634181401   07/17/2023          30       $14.13       $3.52
    104272-19                104483547001 199688014  STRITTMATTER     STEPHANI   01   935834570550871401   07/17/2023           6       $46.00      $12.54
    104272-19                104483547001 199688014  STRITTMATTER     JOHN       18   647028628444512401   07/19/2023          30      $817.47     $540.75

                                                                                                                                              PAGE:49 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    104272-19                104483547001 199688014  STRITTMATTER     JOHN       18   382943018285412401   07/19/2023          30      $112.63       $5.84
  104272-19 Total                                                                                                                    $1,009.35     $567.07
  104272- Total                                                                                                                    $157,526.63  $64,299.15
HDHP PPO Total                                                                                                                     $253,361.65 $104,400.63
                                                                                                                                                            
Major Medical
  053264-01
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22712036203          06/06/2023           1       $53.00      $20.00
    053264-01                107311465001 363488272  DONGELL          EDWARD     01   22712036202          06/14/2023           1      $220.00     $176.00
    053264-01                107311465001 363488272  DONGELL          EDWARD     01   22712036204          06/08/2023           1       $53.00      $20.00
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22712036205          06/12/2023           1       $55.00      $44.00
    053264-01                107311465001 363488272  DONGELL          EDWARD     01   22712036206          06/15/2023           1       $55.00      $44.00
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22712036205          06/12/2023           1       $53.00      $20.00
    053264-01                107311465001 363488272  DONGELL          LINDA      18   22712036203          06/06/2023           1       $55.00      $44.00
    053264-01                107311465001 363488272  DONGELL          EDWARD     01   22712036206          06/15/2023           1       $53.00      $20.00
    053264-01                107311465001 363488272  DONGELL          EDWARD     01   22712036204          06/08/2023           1       $55.00      $44.00
    053264-01                107311465001 363488272  DONGELL          EDWARD     01   22712036201          06/15/2023           1       $84.00      $67.20
  053264-01 Total                                                                                                                      $736.00     $499.20
  053264- Total                                                                                                                        $736.00     $499.20
Major Medical Total                                                                                                                    $736.00     $499.20
                                                                                                                                                            
PPO
  014267-01
    014267-01                101377897001 161663518  BALDISH          EDWARD     18   22713764346          07/18/2023           1      $142.00      $61.50
    014267-01                101911501001 168586533  GEORGE           TERESA     18   22113353555          07/11/2023           1      $118.11       $0.00
    014267-01                101911501001 168586533  GEORGE           TERESA     18   22113353555          07/11/2023           1       $88.07       $0.00
    014267-01                101911501001 168586533  GEORGE           TERESA     18   22113353618          07/11/2023           1       $60.75       $0.00
    014267-01                101911501001 168586533  GEORGE           TERESA     18   22113353555          07/11/2023           1       $45.50       $0.00
    014267-01                101911501001 168586533  GEORGE           TERESA     18   22113353555          07/11/2023           1      $148.10       $0.00
    014267-01                101911501001 168586533  GEORGE           TERESA     18   22113353618          07/11/2023           1       $29.24       $0.00
    014267-01                101911501001 168586533  GEORGE           TERESA     18   22113353555          07/11/2023           1       $38.07       $0.00
    014267-01                101911501001 168586533  GEORGE           TERESA     18   22113685019          06/24/2023           1      $200.00     $105.81

                                                                                                                                              PAGE:50 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-01                101911501001 168586533  GEORGE           TERESA     18   22113685019          06/24/2023           1       $50.00       $0.00
    014267-01                101911501001 168586533  GEORGE           TERESA     18   22113685019          06/24/2023           1       $16.00       $0.00
    014267-01                101911501001 168586533  GEORGE           TERESA     18   22113353555          07/11/2023           1      $120.36       $0.00
    014267-01                101911501001 168586533  GEORGE           TERESA     18   22113353555          07/11/2023           1       $51.40       $0.00
    014267-01                102062170001 170549666  HARKER           ROSEMARI   18   22113588153          06/06/2023           1      $120.36       $0.00
    014267-01                102062170001 170549666  HARKER           ROSEMARI   18   22113588153          06/06/2023           1       $45.50       $0.00
    014267-01                102062170001 170549666  HARKER           ROSEMARI   18   22113588153          06/06/2023           1       $88.07       $0.00
    014267-01                102062170001 170549666  HARKER           ROSEMARI   18   22113588153          06/06/2023           1      $148.10      $13.00
    014267-01                102062170001 170549666  HARKER           ROSEMARI   18   22113588153          06/06/2023           1      $241.84       $0.00
    014267-01                102062170001 170549666  HARKER           ROSEMARI   18   22113588153          06/06/2023           1       $55.12       $0.00
    014267-01                113324089001 181506290  MCINTOSH         CONSTANC   18   22413527187          06/29/2023           1      $308.00     $115.55
    014267-01                113324089001 181506290  MCINTOSH         CONSTANC   18   22413527187          06/29/2023           2       $48.00      $15.36
    014267-01                113324089001 181506290  MCINTOSH         CONSTANC   18   22413527187          06/29/2023           1      $220.00      $94.89
    014267-01                103106368001 183468098  RABATIN          DEBORA     18   22113772262          07/18/2023           1       $13.00       $2.21
    014267-01                103106368001 183468098  RABATIN          DEBORA     18   22113614090          07/11/2023           1      $220.00      $94.89
  014267-01 Total                                                                                                                    $2,615.59     $503.21
  014267-03
    014267-03                100658703001 125504688  MULLIGAN         ANDREA     18   22313706280          05/16/2023           1      $183.00      $69.99
    014267-03                112172536001 159687597  KOKUS            MICHAEL    18   22113688361          07/14/2023           1       $30.00       $0.00
    014267-03                112172536001 159687597  KOKUS            MICHAEL    18   22113585067          07/14/2023           1      $135.00       $0.00
    014267-03                112172536001 159687597  KOKUS            MICHAEL    18   22113585067          07/14/2023           1      $204.00       $0.00
    014267-03                112172536001 159687597  KOKUS            MICHAEL    18   22113585067          07/14/2023           1      $236.00       $0.00
    014267-03                112172536001 159687597  KOKUS            MICHAEL    18   22113585067          07/14/2023           1       $31.00       $0.00
    014267-03                110652030001 161544709  ANDREWS          SHANNON    18   22032406759          07/18/2023           1      $155.00       $0.00
    014267-03                110652030001 161544709  ANDREWS          SHANNON    18   22032490052          07/17/2023           1       $31.00       $0.00
    014267-03                110652030001 161544709  ANDREWS          EDWARD     01   22032430602          07/17/2023           1       $80.00       $0.00
    014267-03                110652030001 161544709  ANDREWS          EDWARD     01   22032430602          07/17/2023           1      $318.00      $75.99
    014267-03                110652030001 161544709  ANDREWS          SHANNON    18   22032490052          07/17/2023           1      $217.00       $0.00
    014267-03                110652030001 161544709  ANDREWS          SHANNON    18   22032490052          07/17/2023           1      $236.00       $0.00
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613734905          07/10/2023           1      $512.00     $180.92
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613734905          07/10/2023           1       $75.00      $48.06
    014267-03                101369778001 161607101  LACUE            ERIN       18   22613734905          07/10/2023           1      $400.00     $358.24

                                                                                                                                              PAGE:51 of 72
                                                                                                                                                            
            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   22513471113          07/12/2023           1    $1,579.90       $0.00
    014267-03                101375474001 161644485  DAVIS            DANA       18   22513736343          07/17/2023           1      $715.00      $38.56
    014267-03                101375474001 161644485  DAVIS            DANA       18   22513761140          07/17/2023           1       $48.00      $58.59
    014267-03                101375474001 161644485  DAVIS            DANA       18   22513736343          07/17/2023           1      $358.00      $30.99
    014267-03                101375474001 161644485  DAVIS            DANA       18   22513761140          07/17/2023           1      $497.00     $225.44
    014267-03                101375474001 161644485  DAVIS            DANA       18   22513471113          07/12/2023           1       $92.00       $0.00
    014267-03                101375474001 161644485  DAVIS            DANA       18   22513559774          07/12/2023           1      $283.00     $140.43
    014267-03                101593218001 164562405  HOOVER           SAVANNAH   19   22313632219          07/17/2023           1       $54.00      $22.22
    014267-03                101593218001 164562405  HOOVER           SIERRA     19   22313632218          07/17/2023           1       $10.00       $2.52
    014267-03                101593218001 164562405  HOOVER           SAVANNAH   19   22313632219          07/17/2023           1      $240.00     $226.49
    014267-03                101593218001 164562405  HOOVER           SIERRA     19   22313632218          07/17/2023           1      $231.00     $115.94
    014267-03                101593218001 164562405  HOOVER           SAVANNAH   19   22313632219          07/17/2023           1       $35.00       $2.67
    014267-03                101593218001 164562405  HOOVER           SAVANNAH   19   22313632219          07/17/2023           1       $10.00       $2.52
    014267-03                101593218001 164562405  HOOVER           SAVANNAH   19   22313632219          07/17/2023           1       $36.00      $14.88
    014267-03                101593218001 164562405  HOOVER           SIERRA     19   22313632218          07/17/2023           1       $35.00       $2.67
    014267-03                101593218001 164562405  HOOVER           SIERRA     19   22313520252          07/13/2023           1      $100.00      $55.70
    014267-03                101593218001 164562405  HOOVER           SIERRA     19   22313632218          07/17/2023           1       $36.00      $14.88
    014267-03                101593218001 164562405  HOOVER           SAVANNAH   19   22313632219          07/17/2023           1      $231.00     $115.94
    014267-03                101760095001 166629321  BLAKE            JOSHUA     19   22211167193          10/27/2022           1       $29.50       $0.00
    014267-03                101760095001 166629321  BLAKE            JOSHUA     19   22211167193          10/26/2022           1       $68.00       $0.00
    014267-03                101760095001 166629321  BLAKE            JOSHUA     19   22211167193          10/27/2022          12    $1,488.00       $0.00
    014267-03                101760095001 166629321  BLAKE            JOSHUA     19   22211167193          10/26/2022           5      $620.00       $0.00
    014267-03                101913203001 168601612  DUBREUCQ         MARY       19   22213698971          07/12/2023           1       $12.00       $0.00
    014267-03                101913203001 168601612  DUBREUCQ         MARY       19   22213698971          07/12/2023           1       $37.00       $0.00
    014267-03                101913203001 168601612  DUBREUCQ         SARAH      01   22213742909          07/17/2023           1      $497.00     $225.44
    014267-03                101913203001 168601612  DUBREUCQ         SARAH      01   22213742909          07/17/2023           1       $48.00      $58.59
    014267-03                101913203001 168601612  DUBREUCQ         MARY       19   22213698971          07/12/2023           1      $300.00     $121.73
    014267-03                102137743001 171520828  KOCHINSKY        DARLA      18   22113599823          07/11/2023           1       $46.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          NATHAN     19   22613519891          07/14/2023           2      $150.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22613519892          07/13/2023           1       $50.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22613519892          07/13/2023           1       $50.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          NATHAN     19   22613519891          07/14/2023           1       $84.00       $0.00

                                                                                                                                              PAGE:52 of 72
                                                                                                                                                            
            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   22613375975          07/13/2023           1       $80.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          NATHAN     19   22613375975          07/13/2023           1       $84.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          NATHAN     19   22613375975          07/13/2023           2      $150.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ZACHARY    19   22613279602          07/06/2023           1      $150.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          NATHAN     19   22613519891          07/14/2023           1       $80.00       $0.00
    014267-03                102151761001 171602272  MISLEVY          ROBIN      01   22613519892          07/13/2023           2      $160.00       $0.00
    014267-03                114762902001 171664326  SOWERS           SAMANTHA   01   22513732494          07/18/2023           1      $200.00     $120.00
    014267-03                120477354001 172722160  KISS             JENNIFER   01   22613505565          07/12/2023           1    $1,212.23       $0.00
    014267-03                120477354001 172722160  KISS             JENNIFER   01   22613506649          07/12/2023           1       $23.00       $0.00
    014267-03                120477354001 172722160  KISS             JENNIFER   01   22613506649          07/12/2023           1      $108.00       $0.00
    014267-03                120477354001 172722160  KISS             JENNIFER   01   22613506649          07/12/2023           1       $86.00       $0.00
    014267-03                120477354001 172722160  KISS             JENNIFER   01   22613506649          07/12/2023           1       $96.00       $0.00
    014267-03                120477354001 172722160  KISS             JENNIFER   01   22613506649          07/12/2023           1       $67.00      $34.47
    014267-03                102406662001 174668462  BENDER           AMANDA     18   22512179892          06/22/2023           1      $120.00      $42.49
    014267-03                102406662001 174668462  BENDER           AMANDA     18   22512179892          06/22/2023           1      $318.00      $75.99
    014267-03                102486556001 175629643  HRITZ            DARREN     01   22113673222          07/12/2023           1      $450.00       $0.00
    014267-03                131374207001 175763820  BEARER           MAIVE      19   22113542760          07/17/2023           1      $190.00     $153.40
    014267-03                131374207001 175763820  BEARER           MAIVE      19   22113542760          07/17/2023           1       $20.00      $16.02
    014267-03                131374207001 175763820  BEARER           MAIVE      19   22113542760          07/17/2023           1      $365.00     $306.67
    014267-03                131374207001 175763820  BEARER           MAIVE      19   22113542760          07/17/2023           1       $35.00      $21.21
    014267-03                131374207001 175763820  BEARER           MAIVE      19   22113542760          07/17/2023           1       $20.00      $16.02
    014267-03                131374207001 175763820  BEARER           MAIVE      19   22113542760          07/17/2023           1       $45.00      $35.55
    014267-03                131374207001 175763820  BEARER           MAIVE      19   22113542760          07/17/2023           1      $145.00     $112.39
    014267-03                102732865001 178607248  NAGEL            ERIC       18   22713678483          07/07/2023           1       $90.00      $33.51
    014267-03                102732865001 178607248  NAGEL            ERIC       18   22713678483          07/07/2023          49    $4,410.00     $474.14
    014267-03                102732865001 178607248  NAGEL            TAMMY      01   22713578672          07/11/2023           1      $200.00     $100.00
    014267-03                102732865001 178607248  NAGEL            TAMMY      01   22713364896          07/11/2023           1      $142.00      $69.99
    014267-03                102741496001 178667598  KOSS             SUMMER     19   22713367704          07/11/2023           1       $90.00      $69.99
    014267-03                102741496001 178667598  KOSS             SUMMER     19   22713411009          07/11/2023           1      $132.00       $0.00
    014267-03                102741496001 178667598  KOSS             SUMMER     19   22713411009          07/11/2023           1      $128.00       $0.00
    014267-03                102741496001 178667598  KOSS             SUMMER     19   22713367704          07/11/2023           1        $4.00       $0.00
    014267-03                102741496001 178667598  KOSS             SUMMER     19   22713367704          07/11/2023           1       $27.00       $0.00

                                                                                                                                              PAGE:53 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                102741496001 178667598  KOSS             SUMMER     19   22713416562          07/06/2023           1      $120.00       $0.00
    014267-03                102741496001 178667598  KOSS             SUMMER     19   22713411009          07/11/2023           1      $141.00       $0.00
    014267-03                102741496001 178667598  KOSS             SUMMER     19   22713411009          07/11/2023           1      $141.00       $0.00
    014267-03                102741496001 178667598  KOSS             SUMMER     19   22713367704          07/11/2023           1       $10.00       $0.00
    014267-03                102813097001 179642584  MOREALLI         MICHAEL    18   22413640364          07/11/2023           1      $127.00     $126.32
    014267-03                102813097001 179642584  MOREALLI         MICHAEL    18   22413640364          07/11/2023           1       $20.00       $0.00
    014267-03                116282269001 179701087  COMMONS          MEGAN      18   22113530727          07/11/2023           1      $322.00     $127.86
    014267-03                102894572001 180662763  HOLTZ            BRANDON    01   22213503800          06/12/2023           1      $150.00      $65.70
    014267-03                114720476001 182663889  YAHNER           JUSTIN     01   22513669816          07/13/2023           1      $499.00       $0.00
    014267-03                114720476001 182663889  YAHNER           JUSTIN     01   22513459785          07/13/2023           1      $336.00       $0.00
    014267-03                103373563001 186587333  BEUNIER-SMITH    YVETTE     18   22413551242          07/13/2023           1      $715.00      $38.56
    014267-03                103373563001 186587333  BEUNIER-SMITH    YVETTE     18   22413730033          07/18/2023           1      $190.00     $100.00
    014267-03                103373563001 186587333  BEUNIER-SMITH    YVETTE     18   22413468394          07/13/2023           1      $427.00     $427.00
    014267-03                103373563001 186587333  BEUNIER-SMITH    YVETTE     18   22413468394          07/13/2023           1       $53.00      $53.00
    014267-03                103373563001 186587333  BEUNIER-SMITH    YVETTE     18   22413551242          07/13/2023           1      $358.00      $30.99
    014267-03                103379409001 186624451  LOBICK           CARSON     19   22032322506          07/18/2023           1      $140.00      $69.99
    014267-03                103385315001 186667472  LUDWIG           JULIE      18   22213699174          07/17/2023           1      $346.00     $129.19
    014267-03                103385315001 186667472  LUDWIG           JULIE      18   22213699001          07/17/2023           1      $137.00       $0.00
    014267-03                103385315001 186667472  LUDWIG           JULIE      18   22213699174          07/17/2023           1      $138.00       $0.00
    014267-03                103529602001 188526813  VENESKY          EMMA       18   22113719232          04/25/2023           1      $320.00     $124.83
    014267-03                103536981001 188580018  MALLOY           KAREN      18   22032395894          07/18/2023           1      $150.00      $85.00
    014267-03                103536981001 188580018  MALLOY           KAREN      18   22032395894          07/18/2023           1       $40.00       $4.00
    014267-03                103536981001 188580018  MALLOY           KAREN      18   22032395894          07/18/2023           1       $25.00       $4.01
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213536323          07/12/2023           8      $165.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213442849          06/28/2023           1      $300.00     $117.00
    014267-03                103624049001 189580744  SPRENGER         KEITH      19   22213566194          07/13/2023           1       $90.00      $14.47
    014267-03                103624049001 189580744  SPRENGER         KARL       01   22213566192          07/13/2023           1      $230.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213698636          07/12/2023           1      $226.00      $46.59
    014267-03                103624049001 189580744  SPRENGER         KEITH      19   22213801021          07/21/2023           1      $125.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         KEITH      19   22213566194          07/13/2023           1      $142.00      $69.30
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213324336          07/12/2023           3      $549.00       $0.00
    014267-03                103624049001 189580744  SPRENGER         RHONDA     18   22213324336          07/12/2023           8       $74.02       $0.00

                                                                                                                                              PAGE:54 of 72
                                                                                                                                                            
            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         KEITH      19   22213566194          07/13/2023           1      $230.00       $0.00
    014267-03                103710443001 190560450  BOGUS            CODY       19   22513549317          06/23/2023           2      $260.00      $26.34
    014267-03                103710443001 190560450  BOGUS            CODY       19   22513549317          06/23/2023          12    $2,052.00     $365.76
    014267-03                103710443001 190560450  BOGUS            CODY       19   22513549317          06/23/2023           1      $204.00      $37.63
    014267-03                103710443001 190560450  BOGUS            CODY       19   22513549317          06/23/2023           1      $142.00      $40.64
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22513340625          07/13/2023           1       $25.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22513753556          07/20/2023           1       $25.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22513484977          07/17/2023           1       $50.00       $3.32
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22513753556          07/20/2023           1       $25.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22813591161          07/17/2023           1       $25.00      $19.08
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22813591161          07/17/2023           1      $165.00      $91.29
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22513484977          07/17/2023           1       $25.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22513340625          07/13/2023           1       $50.00       $3.32
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22513659069          07/19/2023           1       $50.00       $3.32
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22513484977          07/17/2023           1       $25.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22513659069          07/19/2023           1       $25.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22513753556          07/20/2023           1       $50.00       $3.32
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22513340625          07/13/2023           1       $25.00       $0.00
    014267-03                103817438001 191700343  BROWN            ALEXA      01   22513659069          07/19/2023           1       $25.00       $0.00
    014267-03                103968095001 193564829  KINNEY           EVAN       19   22513525381          07/11/2023           1       $35.00       $0.00
    014267-03                103968095001 193564829  KINNEY           EVAN       19   22513525381          07/11/2023           1       $63.33       $0.00
    014267-03                103968095001 193564829  KINNEY           EVAN       19   22513525381          07/11/2023           1       $63.33      $33.50
    014267-03                103968095001 193564829  KINNEY           EVAN       19   22513525381          07/11/2023           1       $63.34      $33.50
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813633139          07/09/2023          62    $2,997.01     $982.94
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813633139          07/09/2023           2    $2,268.00     $743.84
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813568561          07/09/2023           1      $347.00     $209.59
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813640542          07/01/2023           1       $52.00      $10.06
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813568532          07/13/2023           1      $500.00       $0.00
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813633139          07/09/2023          39    $3,564.00   $1,168.89
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813633139          07/09/2023           5      $959.00     $314.52
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813633139          07/09/2023           4    $4,040.00   $1,325.01
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813573264          06/27/2023           1      $948.60     $365.80

                                                                                                                                              PAGE:55 of 72
                                                                                                                                                            
            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   22813633139          07/09/2023           2      $650.00     $213.18
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813633139          07/09/2023           1      $270.00      $88.55
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813633139          07/09/2023         304    $1,030.31     $337.91
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813633139          07/09/2023           2      $504.00     $165.37
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813573367          07/07/2023           1      $250.00      $11.97
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813633139          07/09/2023           1    $2,183.00     $715.96
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813633165          06/28/2023           1      $617.00     $410.62
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813633139          07/09/2023           1      $180.00      $59.03
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813756341          06/30/2023           1    $3,720.00     $708.00
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813633139          07/09/2023           2    $6,818.00   $1,204.04
    014267-03                104051735001 194527150  THOMAS           EDWARD     18   22813756337          06/30/2023           1    $3,672.00     $708.00
    014267-03                135232407001 195780857  VENESKY          AMANDA     18   22032171040          07/14/2023           1      $125.00      $42.85
    014267-03                135232407001 195780857  VENESKY          AMANDA     18   22032409588          04/07/2023           1      $167.00      $23.48
    014267-03                135232407001 195780857  VENESKY          AMANDA     18   22032409589          12/02/2022           1      $167.00      $23.48
    014267-03                104385940001 198563222  ALBRIGHT         PAULA      18   22713671555          07/13/2023           1       $12.00       $0.00
    014267-03                104385940001 198563222  ALBRIGHT         ALEXANDE   19   22713437362          07/13/2023           1      $184.00      $83.61
    014267-03                104385940001 198563222  ALBRIGHT         PAULA      18   22713671555          07/13/2023           1      $142.00      $55.70
    014267-03                104400727001 198662868  MCGOWAN          EMMA       19   22713539828          06/10/2023           1      $150.00      $65.70
    014267-03                104400727001 198662868  MCGOWAN          EMMA       19   22713539828          06/10/2023           1       $50.00       $0.00
    014267-03                104400727001 198662868  MCGOWAN          EMMA       19   22713539828          06/10/2023           1       $16.00       $0.00
    014267-03                117356283001 199567270  CENCE            WILLIAM    01   22032238387          07/12/2023           1      $629.00       $0.00
    014267-03                117356283001 199567270  CENCE            JULIE      18   22032225083          07/14/2023           1      $190.00     $100.00
    014267-03                114913504001 199665874  PETRE            JACK       01   22113349563          06/26/2023           1      $139.84      $33.40
    014267-03                114913504001 199665874  PETRE            JACK       01   22113521367          06/26/2023           1      $133.37      $43.10
    014267-03                119613821001 199689276  ZADZILKO         MEGAN      18   22513652396          07/17/2023           1      $234.00       $0.00
    014267-03                120189904001 199707914  KEENER           CHARLOTT   19   22707630681          04/21/2023           1      $325.00     $292.66
    014267-03                120189904001 199707914  KEENER           CHARLOTT   19   22707630681          04/21/2023          (5)   ($200.00)    ($80.07)
    014267-03                120189904001 199707914  KEENER           CHRISTIN   18   22713364604          07/12/2023           1      $142.00      $55.70
    014267-03                120189904001 199707914  KEENER           CHRISTIN   18   22713568079          07/12/2023           1      $230.00     $116.03
    014267-03                120189904001 199707914  KEENER           CHARLOTT   19   22707630681          04/21/2023          (1)   ($195.00)   ($125.27)
    014267-03                120189904001 199707914  KEENER           CHARLOTT   19   22707630681          04/21/2023           1      $195.00     $125.27
    014267-03                120189904001 199707914  KEENER           CHARLOTT   19   22707630681          04/21/2023          (3)   ($120.00)    ($63.63)

                                                                                                                                              PAGE:56 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                120189904001 199707914  KEENER           CHARLOTT   19   22707630681          04/21/2023           5      $200.00      $80.07
    014267-03                120189904001 199707914  KEENER           CHARLOTT   19   22707630681          04/21/2023           1      $250.00     $202.14
    014267-03                120189904001 199707914  KEENER           CHARLOTT   19   22707630681          04/21/2023          (1)   ($200.00)   ($200.00)
    014267-03                120189904001 199707914  KEENER           CHARLOTT   19   22707630681          04/21/2023           3      $120.00      $63.63
    014267-03                120189904001 199707914  KEENER           CHARLOTT   19   22707630681          04/21/2023          (1)   ($325.00)   ($292.66)
    014267-03                120189904001 199707914  KEENER           CHARLOTT   19   22707630681          04/21/2023          (1)   ($185.00)   ($112.39)
    014267-03                120189904001 199707914  KEENER           CHARLOTT   19   22707630681          04/21/2023           1      $185.00     $112.39
    014267-03                104567865001 200681648  MCCULLOUGH       KIMBERLY   18   22613594036          07/10/2023           1      $200.00     $100.00
    014267-03                104567865001 200681648  MCCULLOUGH       KIMBERLY   18   22613687410          07/16/2023           1      $235.00     $144.32
    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    $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)   ($760.27)    ($38.55)
    014267-03                104697984001 202442564  MEIDINGER        JEFFREY    18   22313488511          07/05/2023           1      $335.00     $138.43
    014267-03                104968290001 205547039  DIAMOND          COLIN      19   22313672716          06/20/2023           1       $47.00      $10.50
    014267-03                104968290001 205547039  DIAMOND          COLIN      19   22313672716          06/20/2023           1      $290.00     $137.86
    014267-03                104968290001 205547039  DIAMOND          COLIN      19   22313672716          06/20/2023           1      $150.00      $57.18
    014267-03                105161905001 207722715  BERZONSKY        ALYSSA     18   22113491560          06/09/2023           1      $200.00     $100.81
    014267-03                105161905001 207722715  BERZONSKY        ALYSSA     18   22113491560          06/09/2023           1       $47.00       $0.00
    014267-03                105161905001 207722715  BERZONSKY        EARL       01   22113491619          06/10/2023           1      $200.00     $100.81
    014267-03                115784377001 208708748  THOMAS           MELODY     18   22713581993          07/18/2023          18      $396.00       $0.00
    014267-03                115784377001 208708748  THOMAS           MELODY     18   22713553236          07/17/2023           2        $4.00       $0.00
    014267-03                115784377001 208708748  THOMAS           MELODY     18   22713553236          07/17/2023           1       $30.00       $0.00
    014267-03                105399036001 210547835  MCEVOY           MALLORY    19   22032072840          07/12/2023           1      $103.48      $33.50
    014267-03                105399036001 210547835  MCEVOY           MALLORY    19   22032072840          07/12/2023           1      $103.49      $33.50
    014267-03                105399036001 210547835  MCEVOY           MALLORY    19   22032318024          07/12/2023           1      $163.00     $118.11
    014267-03                105507342001 211689914  SCOTT            TAMMY      18   22032240834          07/07/2023           1      $142.00      $69.99
    014267-03                105507342001 211689914  SCOTT            GEORGE     01   22032240833          07/07/2023           1      $319.00     $154.29
    014267-03                114739500001 211701060  FEES             JORDAN     18   22313643724          06/24/2023           1       $20.00      $21.00
    014267-03                114739500001 211701060  FEES             JORDAN     18   22313643724          06/24/2023           1       $73.00      $10.96
    014267-03                114739500001 211701060  FEES             JORDAN     18   22313643724          06/24/2023           4        $8.00       $2.48
    014267-03                114739500001 211701060  FEES             JORDAN     18   22313643724          06/24/2023           1      $469.00     $151.82

                                                                                                                                              PAGE:57 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-03                114739500001 211701060  FEES             JORDAN     18   22313643724          06/24/2023           1      $112.00      $68.03
  014267-03 Total                                                                                                                   $72,827.75  $18,749.85
  014267-05
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22813497316          07/13/2023           3      $147.00      $92.40
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22813568496          01/17/2023           1        $7.00       $2.50
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22813672173          07/17/2023           1      $283.00     $145.43
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22813473241          07/14/2023           1      $110.00      $72.50
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22813497317          07/11/2023           3      $147.00      $92.40
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22813672173          07/17/2023           1        $7.00       $2.50
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22813672173          07/17/2023           1       $36.00      $12.68
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22813497318          07/06/2023           3      $147.00      $92.40
    014267-05                101665655001 165520467  FISANICK         BASIL      01   22813568496          01/17/2023           1      $209.00      $95.81
    014267-05                109938670001 166680558  SHUTTY           DAWSON     19   22713590736          07/17/2023           1      $170.00     $130.20
    014267-05                101995157001 169643849  WENDEROTH        FRED       18   22213332351          06/26/2023           1       $34.56      $21.60
    014267-05                101995157001 169643849  WENDEROTH        FRED       18   22213651196          07/14/2023           1    $1,275.00     $853.67
    014267-05                101995157001 169643849  WENDEROTH        FRED       18   22213655413          07/14/2023           1    $1,050.00     $238.84
    014267-05                102075179001 170640732  SHUTTY           BENJAMIN   19   22513733203          07/19/2023           1       $40.00       $4.95
    014267-05                102075179001 170640732  SHUTTY           BENJAMIN   19   22513733203          07/19/2023           1       $35.00      $16.70
    014267-05                102075179001 170640732  SHUTTY           BENJAMIN   19   22513733203          07/19/2023           1      $185.00     $130.20
    014267-05                102075179001 170640732  SHUTTY           ZAKARY     19   22513530235          07/07/2023           1      $335.00     $143.43
    014267-05                102075179001 170640732  SHUTTY           ZAKARY     19   22513530235          07/07/2023           1      $166.00       $0.00
    014267-05                102075179001 170640732  SHUTTY           BENJAMIN   19   22513733203          07/19/2023           1       $40.00       $2.99
    014267-05                112950694001 171683760  GONZALEZ         AMANDA     18   22113450586          07/14/2023           1      $150.00      $85.00
    014267-05                112950694001 171683760  GONZALEZ         AMANDA     18   22113450586          07/14/2023           1       $25.00       $4.01
    014267-05                129935534001 172742640  CAMPBELL         KENNETH    01   22513713895          07/19/2023           1       $45.00       $8.32
    014267-05                129935534001 172742640  CAMPBELL         KENNETH    01   22513531382          07/17/2023           1       $45.00       $8.32
    014267-05                102567951001 176622574  LOMBARDO         TINA       18   22032391441          07/06/2023           3      $399.00      $83.64
    014267-05                102794894001 179527800  MCMULLEN         DIANE      18   22813490411          07/14/2023           1      $427.00     $427.00
    014267-05                102794894001 179527800  MCMULLEN         DIANE      18   22813573380          07/14/2023           1      $715.00      $38.56
    014267-05                102892610001 180645375  PARONISH         CAMDEN     19   22213627977          07/15/2023           1      $545.00      $64.12
    014267-05                102892610001 180645375  PARONISH         CAMDEN     19   22213627977          07/15/2023           1      $252.00      $35.80
    014267-05                102892610001 180645375  PARONISH         CAMDEN     19   22213536760          07/12/2023           1      $128.00      $95.81

                                                                                                                                              PAGE:58 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                102892610001 180645375  PARONISH         CAMDEN     19   22213742869          07/15/2023           1       $24.00      $11.55
    014267-05                102892610001 180645375  PARONISH         CAMDEN     19   22213541944          07/15/2023           1      $235.00     $144.32
    014267-05                102892610001 180645375  PARONISH         CAMDEN     19   22213742869          07/15/2023           1        $3.15       $0.00
    014267-05                102892610001 180645375  PARONISH         CAMDEN     19   22213742869          07/15/2023           1      $503.00     $512.82
    014267-05                102892610001 180645375  PARONISH         JACQUELI   18   22213438933          07/13/2023           1      $190.00     $100.00
    014267-05                102892610001 180645375  PARONISH         CAMDEN     19   22213742869          07/15/2023           1      $807.00     $461.73
    014267-05                102892610001 180645375  PARONISH         CAMDEN     19   22213742869          07/15/2023           1      $527.00     $345.66
    014267-05                102971934001 181603444  NELSON           JULIE      01   22032409984          07/19/2023           1       $30.00      $12.22
    014267-05                102971934001 181603444  NELSON           JULIE      01   22032409984          07/19/2023           2        $4.00       $0.80
    014267-05                116687100001 185720983  GETZ             KATHYJO    18   22313455989          07/14/2023           1      $178.00      $53.67
    014267-05                133298619001 193702336  SMITH            LAUREN     18   22613568323          07/05/2023           1    $1,085.64     $184.40
    014267-05                133298619001 193702336  SMITH            LAUREN     18   22613567256          07/05/2023           1      $147.00      $46.81
    014267-05                133298619001 193702336  SMITH            BRANDON    01   22613506075          07/05/2023           1      $363.00     $257.88
    014267-05                104144215001 195582778  DUMM             SCOTT      01   22413640076          06/29/2023           1      $149.00      $46.89
    014267-05                114823092001 195700139  BORLIE           JOHN       19   22313658488          07/12/2023           1    $2,044.00     $311.15
    014267-05                104213378001 196487222  MICCO            DINA       18   22213634796          07/13/2023           1      $246.00     $106.11
    014267-05                104241138001 196668859  MCCRACKEN        ALIVIA     19   22613555407          06/13/2023           1       $90.00       $0.00
    014267-05                104241138001 196668859  MCCRACKEN        ALIVIA     19   22613555407          06/13/2023           1       $47.00       $0.00
    014267-05                104241138001 196668859  MCCRACKEN        ALIVIA     19   22613555407          06/13/2023           1      $225.00      $80.99
    014267-05                104241138001 196668859  MCCRACKEN        KIMBERLY   18   22613506712          06/29/2023           1      $251.00      $88.49
    014267-05                104318685001 197640477  HUDAK            DANIEL     19   22032252797          07/13/2023           1       $40.00       $0.00
    014267-05                104318685001 197640477  HUDAK            DANIEL     19   22032252797          07/13/2023           1      $100.00      $60.70
    014267-05                126331099001 197728059  MCKEE            LOGAN      18   22713781051          07/17/2023           1      $424.00       $0.00
    014267-05                126331099001 197728059  MCKEE            LOGAN      18   22713781051          07/17/2023           1       $65.00       $0.00
    014267-05                126331099001 197728059  MCKEE            LOGAN      18   22713781051          07/17/2023           1       $14.00       $0.00
    014267-05                126331099001 197728059  MCKEE            LOGAN      18   22713781051          07/17/2023           1       $97.00       $0.00
    014267-05                126331099001 197728059  MCKEE            LOGAN      18   22713781051          07/17/2023           1      $259.00       $0.00
    014267-05                104478830001 199648158  KLINE            SARAH      01   22813733895          06/21/2023           1       $47.00       $0.00
    014267-05                104478830001 199648158  KLINE            MATTHEW    18   22813733894          06/21/2023           1       $47.00       $0.00
    014267-05                104478830001 199648158  KLINE            MATTHEW    18   22813733894          06/21/2023           1      $150.00      $60.70
    014267-05                104478830001 199648158  KLINE            SARAH      01   22813733895          06/21/2023           1      $150.00      $60.70
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613583540          07/07/2023           1      $319.00     $149.29

                                                                                                                                              PAGE:59 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613083332          06/30/2023           1    $2,511.00     $904.44
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613677700          07/03/2023           1      $159.00      $54.43
    014267-05                104564922001 200649293  BRADLEY          SCOTT      01   22613083332          06/30/2023           1      $243.00      $71.31
    014267-05                104564922001 200649293  BRADLEY          RACHEL     19   22613340641          06/28/2023           1      $135.00     $110.01
    014267-05                104821823001 203725621  DAISLEY          BRITTENY   18   22213699433          07/12/2023           1      $130.87      $33.50
    014267-05                104821823001 203725621  DAISLEY          BRITTENY   18   22213599303          07/12/2023           1       $60.75       $0.00
    014267-05                104821823001 203725621  HASSEN           LILLIAN    19   22213634585          07/17/2023           1      $210.00     $101.13
    014267-05                104821823001 203725621  DAISLEY          BRITTENY   18   22213699433          07/12/2023           1      $119.53      $36.28
    014267-05                104821823001 203725621  HASSEN           LELAND     19   22212580254          05/23/2023           1       $85.00      $75.69
    014267-05                104821823001 203725621  DAISLEY          BRITTENY   18   22213599303          07/12/2023           1       $47.59       $0.00
    014267-05                104821823001 203725621  HASSEN           LELAND     19   22213634584          07/17/2023           1      $210.00     $101.13
    014267-05                104821823001 203725621  DAISLEY          BRITTENY   18   22213699433          07/12/2023           1       $70.87      $24.46
    014267-05                119055015001 204700537  KERR             MARYBETH   18   22032309306          06/19/2023           1       $45.00       $3.00
    014267-05                119055015001 204700537  KERR             MARYBETH   18   22032309306          06/19/2023           1      $108.16      $23.00
    014267-05                119055015001 204700537  KERR             MARYBETH   18   22032309306          06/19/2023           1       $44.99       $3.00
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   22613583545          07/12/2023           1       $49.00      $15.94
    014267-05                116301876001 206603688  SHAFFER          ANNE       18   22613583545          07/12/2023           1       $10.00       $1.56
    014267-05                105133917001 207507140  BORN             LIZA       19   22313658489          07/14/2023           1       $40.50       $0.00
    014267-05                105133917001 207507140  BORN             LIZA       19   22313658489          07/14/2023           1      $289.00     $173.88
    014267-05                105133917001 207507140  BORN             TIMOTHY    01   22313672597          06/24/2023           1      $200.00      $95.81
    014267-05                105133917001 207507140  BORN             LIZA       19   22313658489          07/14/2023           1    $1,585.00     $136.08
    014267-05                105133917001 207507140  BORN             LIZA       19   22313658489          07/14/2023           1      $207.00      $79.99
    014267-05                105133917001 207507140  BORN             LIZA       19   22313512571          07/12/2023         185    $2,690.52     $564.25
    014267-05                105133917001 207507140  BORN             TIMOTHY    01   22313672597          06/24/2023           1      $210.00      $91.96
    014267-05                105133917001 207507140  BORN             LIZA       19   22313584480          07/14/2023           1      $256.00      $83.01
    014267-05                105133917001 207507140  BORN             LIZA       19   22313658489          07/14/2023           1      $241.00      $88.52
    014267-05                112105056001 208606192  TARANTO          PAUL       18   22313507352          07/17/2023          20      $380.00     $330.80
    014267-05                112105056001 208606192  TARANTO          JESSICA    01   22313508274          07/12/2023           1      $209.00      $82.83
    014267-05                105242584001 208640494  SHERRY           JENNIFER   18   22413620226          07/12/2023           1      $250.00       $0.00
    014267-05                105242584001 208640494  SHERRY           JENNIFER   18   22413702147          07/12/2023           1      $115.00       $0.00
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970823          07/05/2023           1       $40.00      $28.02
    014267-05                105312745001 209560853  KUDLAWIEC        MARY       19   22113583755          07/10/2023           1      $114.00      $77.42

                                                                                                                                              PAGE:60 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                105312745001 209560853  KUDLAWIEC        MARY       19   22113583755          07/10/2023           1       $65.00      $33.21
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22113732397          07/17/2023           1       $14.00       $0.00
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970823          07/05/2023         390      $390.00     $163.80
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970823          07/05/2023           1       $55.00      $40.16
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970823          07/05/2023           1      $256.00     $189.14
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970823          07/05/2023           1       $11.00       $6.49
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970823          07/05/2023          10      $450.00      $14.70
    014267-05                105312745001 209560853  KUDLAWIEC        MARY       19   22113583755          07/10/2023           1       $14.00       $0.00
    014267-05                105312745001 209560853  KUDLAWIEC        MARY       19   22113583755          07/10/2023           1       $65.00      $49.85
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970823          07/05/2023           2       $20.00      $17.94
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22113732397          07/17/2023           1      $424.00      $54.21
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970823          07/05/2023          19      $133.00     $105.83
    014267-05                105312745001 209560853  KUDLAWIEC        MARY       19   22113583755          07/10/2023           1       $91.00      $65.50
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22113732397          07/17/2023           1       $65.00      $39.89
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970823          07/05/2023           1      $283.00     $145.43
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970823          07/05/2023          10       $10.00       $2.40
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22113732397          07/17/2023           1       $62.00      $31.01
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970823          07/05/2023           1      $160.00      $61.45
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970823          07/05/2023          10       $10.00       $0.70
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970823          07/05/2023           1       $10.00       $8.97
    014267-05                105312745001 209560853  KUDLAWIEC        MARY       19   22113583755          07/10/2023           1      $424.00      $54.21
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970823          07/05/2023           1      $275.00     $185.41
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22113732397          07/17/2023           1      $191.00      $97.34
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970823          07/05/2023           2      $102.00      $33.98
    014267-05                105312745001 209560853  KUDLAWIEC        MARY       19   22113583755          07/10/2023           1       $97.00      $68.74
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970823          07/05/2023           1        $7.00       $4.44
    014267-05                105312745001 209560853  KUDLAWIEC        MARY       19   22113583755          07/10/2023           1       $63.00      $33.21
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970823          07/05/2023          10      $100.00      $89.70
    014267-05                105312745001 209560853  KUDLAWIEC        KENNETH    01   22112970823          07/05/2023          20        $2.00       $2.00
    014267-05                105322961001 209620623  DELOSH           JOSEPH     01   22213608848          07/17/2023           1      $151.50      $73.36
    014267-05                105399373001 210548948  ROCCO            SUSAN      18   22413483823          07/17/2023           1      $115.00     $110.01
    014267-05                105408339001 210604721  MULLEN           THOMAS     18   22613516983          07/13/2023           1      $125.00      $47.85

                                                                                                                                              PAGE:61 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-05                127479959001 210721282  DOUGHERTY        BRANDON    01   22813477285          07/14/2023           1      $195.74       $0.00
    014267-05                127479959001 210721282  DOUGHERTY        BRANDON    01   22813756623          07/14/2023           1      $250.00       $0.00
    014267-05                127479959001 210721282  DOUGHERTY        BRANDON    01   22813477285          07/14/2023           1      $109.30      $28.48
    014267-05                105507489001 211702122  BASSETT          DEANNA     18   22313418052          07/14/2023           1      $109.30      $28.48
    014267-05                105507489001 211702122  BASSETT          DEANNA     18   22313571955          07/14/2023           1      $159.00     $103.86
    014267-05                105507489001 211702122  BASSETT          DEANNA     18   22313419809          07/14/2023           1      $150.00      $10.04
    014267-05                105507594001 211703743  TENEROWICZ       JUDE       01   22032440020          03/27/2023           1      $140.00     $110.01
    014267-05                114849848001 591546855  RANCK            AUBREY     19   22213789255          07/20/2023           1       $35.00      $16.70
    014267-05                114849848001 591546855  RANCK            AUBREY     19   22213789255          07/20/2023           1       $40.00       $2.99
    014267-05                114849848001 591546855  RANCK            AUBREY     19   22213789255          07/20/2023           1       $40.00       $4.95
    014267-05                114849848001 591546855  RANCK            AUBREY     19   22213789255          07/20/2023           1      $185.00     $130.20
  014267-05 Total                                                                                                                   $32,735.97  $11,756.75
  014267-06
    014267-06                112636195001 161586341  PARRISH          ROBERT     01   22713665360          07/14/2023           1      $150.00       $9.27
    014267-06                112636195001 161586341  PARRISH          ROBERT     01   22713689130          07/14/2023           1      $521.00     $263.52
    014267-06                112636195001 161586341  PARRISH          ROBERT     01   22713689130          07/14/2023           1      $239.00     $139.54
    014267-06                112636195001 161586341  PARRISH          ROBERT     01   22713578697          07/14/2023           1      $124.00      $85.54
    014267-06                112636195001 161586341  PARRISH          ROBERT     01   22713665360          07/14/2023           1      $150.00       $9.66
    014267-06                112636195001 161586341  PARRISH          ROBERT     01   22713689130          07/14/2023           1      $239.00     $128.19
    014267-06                102234268001 172609097  SMITH            BRIANA     19   22113457175          06/28/2023           1      $120.00     $110.01
    014267-06                102234268001 172609097  SMITH            BRIANA     19   22113430777          07/10/2023           1      $120.00     $110.01
    014267-06                102234268001 172609097  SMITH            BRIANA     19   22113706273          07/19/2023           1      $120.00     $110.01
    014267-06                110058092001 179504663  MCGOUGH          GERALD     18   22813762255          07/12/2023           1        $5.00       $2.50
    014267-06                110058092001 179504663  MCGOUGH          GERALD     18   22813762255          07/12/2023           1      $186.00      $82.69
    014267-06                103211068001 184601686  LEFFERTS         MARTHA     18   22413711683          07/19/2023           2       $94.00      $45.20
    014267-06                103211068001 184601686  LEFFERTS         MARTHA     18   22413711683          07/17/2023           2       $94.00      $45.20
    014267-06                103211068001 184601686  LEFFERTS         MARTHA     18   22413711683          07/17/2023           1       $60.00      $40.00
    014267-06                103211068001 184601686  LEFFERTS         MARTHA     18   22413711683          07/18/2023           2       $94.00      $45.20
    014267-06                103272483001 185482246  DUMM             RALPH      18   22313695355          07/17/2023           1      $120.00      $42.10
    014267-06                103272483001 185482246  DUMM             RALPH      18   22313695355          07/17/2023           1      $120.00      $42.10
    014267-06                103272483001 185482246  DUMM             RALPH      18   22313695355          07/17/2023           1      $484.00     $137.86
    014267-06                103272483001 185482246  DUMM             RALPH      18   22313695350          07/17/2023           1      $110.00      $50.08

                                                                                                                                              PAGE:62 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-06                103272483001 185482246  DUMM             RALPH      18   22313695350          07/17/2023           1      $110.00      $50.08
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   22213634105          07/14/2023           1      $200.00     $100.00
    014267-06                110123084001 185580984  WININGS          KATHLEEN   18   22213605147          07/13/2023           1       $77.70       $9.50
    014267-06                103371598001 186582068  SEDLOCK          JOHN       01   22113500469          07/12/2023           1      $220.00      $89.89
    014267-06                104212846001 196485949  DAISLEY          TODD       18   22113497579          07/13/2023           1       $18.00       $3.28
    014267-06                104212846001 196485949  DAISLEY          TODD       18   22102758567          02/08/2023          (1)   ($242.00)   ($137.86)
    014267-06                104212846001 196485949  DAISLEY          LAUREN     19   22113687736          07/18/2023           1      $130.00     $100.81
    014267-06                104212846001 196485949  DAISLEY          TODD       18   22113497579          07/13/2023           1      $187.00     $100.81
  014267-06 Total                                                                                                                    $3,850.70   $1,815.19
  014267-07
    014267-07                121106664001 159703665  KANE             MELISSA    18   22032411288          07/11/2023           1      $119.53      $36.28
    014267-07                121106664001 159703665  KANE             MELISSA    18   22032411288          07/11/2023           1      $130.87      $33.50
    014267-07                121106664001 159703665  KANE             ALANNAH    19   22032220641          07/12/2023           1      $107.00      $57.03
    014267-07                121106664001 159703665  KANE             SHANE      19   22032427773          07/19/2023           1      $195.00       $0.00
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513305830          06/26/2023          24      $377.52     $377.52
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513305618          07/07/2023          24      $377.52     $377.52
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513305830          06/30/2023          24      $377.52     $377.52
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513305618          07/07/2023           9      $202.05     $202.05
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513305830          06/27/2023          24      $377.52     $377.52
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513305830          06/28/2023          24      $377.52     $377.52
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513305618          07/06/2023          25      $393.25     $393.25
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513305618          07/05/2023          24      $377.52     $377.52
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513305830          06/29/2023          24      $377.52     $377.52
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513305830          06/28/2023           3       $71.10      $71.10
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513305618          07/03/2023          24      $377.52     $377.52
    014267-07                113678744001 162669503  MICHAEL          GAVIN      19   22513305830          06/27/2023          18      $426.60     $426.60
    014267-07                101529427001 163623940  WATT             MORGAN     19   22413618003          07/18/2023           1      $125.00       $0.00
    014267-07                101605583001 164627824  SALEME           MARAH      19   22213545153          07/18/2023           1       $25.00      $22.50
    014267-07                101605583001 164627824  SALEME           MARAH      19   22213513046          07/13/2023           1      $265.00     $236.45
    014267-07                101605583001 164627824  SALEME           MARAH      19   22213513046          07/13/2023           1        $8.00       $5.50
    014267-07                101605583001 164627824  SALEME           MARAH      19   22213513046          07/13/2023           1       $30.00      $26.70
    014267-07                101605583001 164627824  SALEME           MARAH      19   22213545153          07/18/2023           1       $30.00      $12.22

                                                                                                                                              PAGE:63 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-07                101605583001 164627824  SALEME           MARAH      19   22213545153          07/18/2023           2      $150.00     $150.00
    014267-07                101605583001 164627824  SALEME           MARAH      19   22213513046          07/13/2023           1        $8.00       $5.00
    014267-07                101605583001 164627824  SALEME           MARAH      19   22213513046          07/13/2023           1       $25.00      $21.33
    014267-07                101605583001 164627824  SALEME           MARAH      19   22213513046          07/13/2023           1      $142.00     $112.97
    014267-07                101762054001 166645996  MCCAULLEY        MELISSA    01   22813359397          07/11/2023           1      $316.00     $100.81
    014267-07                101762054001 166645996  MCCAULLEY        MELISSA    01   22813359397          07/11/2023           1      $150.00      $53.31
    014267-07                101762054001 166645996  MCCAULLEY        MELISSA    01   22813359397          07/11/2023           1      $950.00     $341.78
    014267-07                119882305001 167727872  CATTOI           SANTINO    19   22112306412          05/29/2023           1      $200.00     $105.81
    014267-07                102080665001 170683038  MICHINA          LUKE       19   22113500779          07/10/2023           1      $250.00     $216.12
    014267-07                102080665001 170683038  MICHINA          LUKE       19   22113500779          07/10/2023           1       $25.00      $25.00
    014267-07                102080665001 170683038  MICHINA          LUKE       19   22113500779          07/10/2023           1      $119.00     $116.05
    014267-07                102080665001 170683038  MICHINA          LUKE       19   22113500779          07/10/2023           1       $29.00      $17.97
    014267-07                102222699001 172543654  SCHREYER         RENEE      18   22613449242          07/13/2023           1      $150.00      $85.99
    014267-07                123674799001 172727548  BROWN            LOGAN      19   22313601392          07/11/2023           1      $346.00     $139.19
    014267-07                123674799001 172727548  BROWN            AMBER      18   22313518576          07/14/2023           1      $142.00      $65.70
    014267-07                123674799001 172727548  BROWN            AMBER      18   22313695191          07/15/2023           1      $218.00       $0.00
    014267-07                123674799001 172727548  BROWN            AMBER      18   22313610786          07/13/2023           1      $230.00     $116.03
    014267-07                102404201001 174648572  MANNING          MANDIE     01   22513800089          07/18/2023           1      $220.00      $94.89
    014267-07                102404201001 174648572  MANNING          MANDIE     01   22513617431          07/10/2023           1      $130.87      $33.50
    014267-07                102404201001 174648572  MANNING          MANDIE     01   22513626528          07/11/2023           1       $50.00      $31.00
    014267-07                102404201001 174648572  MANNING          MANDIE     01   22513446620          07/11/2023           1       $75.00      $48.06
    014267-07                102404201001 174648572  MANNING          MANDIE     01   22513446620          07/11/2023           1      $236.00       $0.00
    014267-07                102404201001 174648572  MANNING          MANDIE     01   22513617431          07/10/2023           1       $95.62      $27.79
    014267-07                102404201001 174648572  MANNING          MANDIE     01   22513446620          07/11/2023           1      $130.00       $0.00
    014267-07                102404201001 174648572  MANNING          MANDIE     01   22513446620          07/11/2023           1       $31.00       $0.00
    014267-07                102404201001 174648572  MANNING          MANDIE     01   22513626528          07/11/2023           1       $55.00      $37.00
    014267-07                102404201001 174648572  MANNING          MANDIE     01   22513446620          07/11/2023           1      $512.00     $180.92
    014267-07                102489118001 175647993  ODONNELL         BRETT      01   22713665231          07/17/2023           1      $178.00      $58.67
    014267-07                129427228001 175749560  HANNOLD          SUZAN      18   22113617035          06/29/2023           1      $250.00     $111.37
    014267-07                129427228001 175749560  HANNOLD          SUZAN      18   22113617035          06/29/2023           1      $278.00      $78.26
    014267-07                129427228001 175749560  HANNOLD          SUZAN      18   22113617035          06/29/2023           1      $250.00      $97.45
    014267-07                102562858001 176587306  GIBBONS          SYDNEY     19   22112040614          05/25/2023           1       $47.00       $0.00

                                                                                                                                              PAGE:64 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-07                102562858001 176587306  GIBBONS          ANGELA     18   22113623227          07/17/2023           1      $234.00       $0.00
    014267-07                102562858001 176587306  GIBBONS          SYDNEY     19   22112040614          05/25/2023           1      $200.00     $105.81
    014267-07                102562858001 176587306  GIBBONS          SYDNEY     19   22112040614          05/25/2023           1       $90.00       $0.00
    014267-07                102568549001 176624391  GUMMO            XAVIER     19   22413527796          07/13/2023           1      $200.00     $196.13
    014267-07                102568549001 176624391  GUMMO            XAVIER     19   22413527796          07/13/2023           1       $32.00      $23.03
    014267-07                102807156001 179604238  RABATIN          SOPHIA     19   22313519891          07/17/2023           1      $210.00     $205.90
    014267-07                102807156001 179604238  RABATIN          SOPHIA     19   22313519891          07/17/2023           1      $250.00     $237.04
    014267-07                102807156001 179604238  RABATIN          SOPHIA     19   22313519891          07/17/2023           1      $160.00     $124.00
    014267-07                102807156001 179604238  RABATIN          SOPHIA     19   22313519891          07/17/2023           2       $70.00      $40.40
    014267-07                102807156001 179604238  RABATIN          SOPHIA     19   22313519891          07/17/2023           1       $25.00       $4.71
    014267-07                102967311001 181580382  BLACK            BRAD       01   22313658779          06/28/2023           1    $3,896.00   $1,028.50
    014267-07                102970458001 181589405  BROWN            THOMAS     01   22032245209          07/17/2023           1       $60.00      $12.84
    014267-07                102970458001 181589405  BROWN            THOMAS     01   22032245209          07/17/2023           3      $211.50      $73.74
    014267-07                102970458001 181589405  BROWN            THOMAS     01   22032245209          07/17/2023           1       $69.00      $22.60
    014267-07                122806756001 181726437  MARRA            BRITTANY   01   22113629956          07/18/2023           1      $195.74       $0.00
    014267-07                103024367001 182466226  WARNER           DAVID      01   22813666052          07/13/2023           1      $178.00      $58.67
    014267-07                103024367001 182466226  WARNER           DAVID      01   22813549726          05/10/2023           1      $145.00      $60.61
    014267-07                103024367001 182466226  WARNER           SOPHIA     19   22813568986          07/13/2023           1      $145.00      $57.39
    014267-07                124239642001 182745822  LINK             DYLAN      18   22613771844          07/17/2023           1      $120.00       $0.00
    014267-07                124239642001 182745822  LINK             DYLAN      18   22613521290          07/14/2023           1      $135.00      $74.99
    014267-07                124239642001 182745822  LINK             DYLAN      18   22613521290          07/14/2023           1       $25.00      $19.08
    014267-07                124239642001 182745822  LINK             DYLAN      18   22613771844          07/17/2023           1      $484.00     $137.86
    014267-07                113012253001 183647983  WATT             HEIDI      19   22032322502          07/18/2023           3      $120.00      $63.63
    014267-07                113012253001 183647983  WATT             HEIDI      19   22032322502          07/18/2023           1      $195.00     $125.27
    014267-07                113012253001 183647983  WATT             HEIDI      19   22032322502          07/18/2023           1      $185.00     $112.39
    014267-07                113012253001 183647983  WATT             HEIDI      19   22032322502          07/18/2023           5      $200.00      $80.07
    014267-07                113012253001 183647983  WATT             HEIDI      19   22032322502          07/18/2023           1      $250.00     $202.14
    014267-07                113012253001 183647983  WATT             HEIDI      19   22032322502          07/18/2023           1      $350.00     $292.66
    014267-07                103271964001 185481106  ZELENSKI         MARIA      18   22613488776          07/05/2023           1       $62.00      $28.14
    014267-07                103271964001 185481106  ZELENSKI         MARIA      18   22613488776          07/05/2023           1      $142.58      $84.40
    014267-07                103271964001 185481106  ZELENSKI         MARIA      18   22613488776          07/05/2023           1       $57.00      $25.42
    014267-07                103271964001 185481106  ZELENSKI         MARIA      18   22613488776          07/05/2023           1       $18.58      $11.00

                                                                                                                                              PAGE:65 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-07                103271964001 185481106  ZELENSKI         MARIA      18   22613488776          07/05/2023           1      $353.50     $216.13
    014267-07                103271964001 185481106  ZELENSKI         MARIA      18   22613488776          07/05/2023           1      $264.35     $156.50
    014267-07                136429345001 186687603  WYLAND           FREDERIC   01   22113702995          07/14/2023           1       $47.00      $13.32
    014267-07                136429345001 186687603  WYLAND           JESSICA    18   22113702993          07/11/2023           1       $47.00      $13.32
    014267-07                103469057001 187648299  ICKES            BRANDON    18   22813588492          07/17/2023           2      $300.00       $0.00
    014267-07                103469057001 187648299  ICKES            BRANDON    18   22813588492          07/17/2023           1       $97.00      $33.48
    014267-07                103469057001 187648299  ICKES            BRANDON    18   22813588492          07/17/2023           1      $150.00       $0.00
    014267-07                103723690001 190641355  GLASS            ROBERT     19   22413730774          07/19/2023           1       $40.00       $4.95
    014267-07                103723690001 190641355  GLASS            ROBERT     19   22413730774          07/19/2023           1       $35.00       $0.00
    014267-07                103723690001 190641355  GLASS            ROBERT     19   22413730774          07/19/2023           1      $185.00     $116.03
    014267-07                103723690001 190641355  GLASS            SHARON     18   22413483831          07/14/2023           1      $200.00     $100.81
    014267-07                103723690001 190641355  GLASS            ROBERT     19   22413730774          07/19/2023           1       $40.00       $2.99
    014267-07                103723690001 190641355  GLASS            ROBERT     01   22413672406          07/14/2023           1      $324.02       $0.00
    014267-07                103879349001 192529999  WATT             HAYLEE     19   22813829761          07/20/2023           1      $140.02      $48.94
    014267-07                104394007001 198606951  MADISON          BRIAN      01   22113585069          07/13/2023           1      $842.00       $0.00
    014267-07                104630583001 201560699  BAKER            DEBORAH    18   22313513119          07/12/2023           1      $215.00      $65.70
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22713737439          07/08/2023           1      $311.00     $190.00
    014267-07                112923331001 201725616  BARTO            COHEN      19   22713477921          07/14/2023           1      $138.00     $107.03
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22713737435          07/10/2023           1      $311.00     $190.00
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22713737437          07/11/2023           1      $311.00     $190.00
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22713737438          07/12/2023           1      $311.00     $190.00
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22713662013          07/07/2023           1      $311.00     $190.00
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22713662012          07/06/2023           1      $311.00     $190.00
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22713737434          07/13/2023           1      $311.00     $190.00
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22713737440          07/09/2023           1      $311.00     $190.00
    014267-07                112923331001 201725616  SEMANCHIKBARTO   BOYA       19   22713737649          07/13/2023           1      $340.00     $133.51
    014267-07                104804112001 203580135  SMITH            MICHELE    18   22313676113          07/14/2023           1      $220.00      $94.89
    014267-07                135952257001 204760740  MYERS            KATELYN    18   22313331320          05/28/2023           1    $1,375.00     $628.11
    014267-07                135952257001 204760740  MYERS            KATELYN    18   22313331320          05/28/2023          12      $210.00     $129.25
    014267-07                105150385001 207605575  KUNTZ            THERESA    18   22113684716          07/18/2023           1      $125.00      $52.85
    014267-07                105150385001 207605575  KUNTZ            THERESA    18   22113684716          07/18/2023           1       $40.00       $6.00
    014267-07                105150385001 207605575  KUNTZ            THERESA    18   22113684716          07/18/2023           1      $175.00      $94.50

                                                                                                                                              PAGE:66 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-07                121862944001 207724279  DODSON           ADRIENNE   18   22113599814          07/11/2023           1      $200.00      $96.38
    014267-07                116799533001 208689153  HANLON           PATRICK    01   22813725440          06/27/2023           1      $131.00       $0.00
    014267-07                116799533001 208689153  HANLON           PATRICK    01   22813725440          06/27/2023           1       $76.00       $0.00
    014267-07                105308353001 209527301  HABERKORN        TIMOTHY    01   22113310583          07/13/2023           1       $80.00      $22.60
    014267-07                105308353001 209527301  HABERKORN        TIMOTHY    01   22113713135          07/18/2023           4      $336.00      $98.32
    014267-07                105308353001 209527301  HABERKORN        TIMOTHY    01   22113310583          07/13/2023           3      $252.00      $73.74
    014267-07                105413169001 210629784  HARROLD          GARRETT    19   22313479825          06/12/2023           1      $260.00     $110.50
    014267-07                131402363001 230555409  MCMAHON          EVAN       19   22513713948          06/24/2023           1      $150.00      $70.70
  014267-07 Total                                                                                                                   $29,728.34  $14,534.28
  014267-08
    014267-08                127928506001 162602138  TREON            TINA       18   22413623642          07/13/2023           1       $50.00      $31.00
    014267-08                127928506001 162602138  TREON            TINA       18   22413623642          07/13/2023           1       $55.00      $37.00
    014267-08                101747063001 166560149  KRUISE           EDWARD     01   22213627837          07/17/2023           1      $178.00      $48.67
    014267-08                132465085001 175547949  VENESKY          JOHN       01   22713751660          07/14/2023           1       $40.00       $0.00
    014267-08                132465085001 175547949  VENESKY          JOHN       01   22713751660          07/14/2023           1       $47.00       $3.32
    014267-08                102490553001 175663819  TAYLOR           SCOTT      01   22213354804          07/03/2023           1       $44.00       $0.00
    014267-08                102490553001 175663819  TAYLOR           JEANETTE   18   22213376876          06/29/2023           1      $211.00      $66.80
    014267-08                102490553001 175663819  TAYLOR           SCOTT      01   22213354804          07/03/2023           1       $42.00       $0.00
    014267-08                102490553001 175663819  TAYLOR           SCOTT      01   22213354804          07/03/2023           1      $139.00       $0.00
    014267-08                102490553001 175663819  TAYLOR           SCOTT      01   22213354804          07/03/2023           1       $80.00       $0.00
    014267-08                102490553001 175663819  TAYLOR           JEANETTE   18   22213376876          06/29/2023           1      $251.00      $88.49
    014267-08                102490553001 175663819  TAYLOR           SCOTT      01   22213354804          07/03/2023           1      $209.00       $0.00
    014267-08                102490553001 175663819  TAYLOR           JEANETTE   18   22213638151          07/19/2023           1       $45.00       $0.00
    014267-08                102490553001 175663819  TAYLOR           SCOTT      01   22213354804          07/03/2023           1       $56.00       $0.00
    014267-08                102490553001 175663819  TAYLOR           SCOTT      01   22213354804          07/03/2023           1       $70.00       $0.00
    014267-08                102490553001 175663819  TAYLOR           SCOTT      01   22213354804          07/03/2023           1       $44.00       $0.00
    014267-08                102490553001 175663819  TAYLOR           JEANETTE   18   22213638151          07/19/2023           1       $45.00       $0.00
    014267-08                102490553001 175663819  TAYLOR           SCOTT      01   22213354804          07/03/2023           1      $158.00       $0.00
    014267-08                102490553001 175663819  TAYLOR           SCOTT      01   22213354804          07/03/2023           1      $183.00      $90.81
    014267-08                102576284001 176682098  YARNISH          MISTY      18   22813820153          07/17/2023           1       $55.00      $37.00
    014267-08                102576284001 176682098  YARNISH          MISTY      18   22813820153          07/17/2023           1       $50.00      $31.00
    014267-08                103031088001 182508904  ZUNGALI          PHILIP     18   22613350725          07/11/2023           1      $149.00      $41.89

                                                                                                                                              PAGE:67 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-08                103031088001 182508904  ZUNGALI          PHILIP     18   22613350725          07/11/2023           1      $693.00       $0.00
    014267-08                103036754001 182545346  DELOZIER         BARBARA    01   22213776884          07/05/2023           1      $298.00       $0.00
    014267-08                103046886001 182605120  HENDRICK         JILL       18   22032433072          07/10/2023           1      $175.00     $100.81
    014267-08                103537183001 188580574  HEBERT           LINDA      18   22413566071          07/12/2023           1      $172.00      $75.99
    014267-08                103711350001 190563467  PASSONETTI       DAVID      01   22512022770          04/28/2023           1      $220.00      $89.89
    014267-08                131856746001 193764814  CAVALLO          MARISSA    18   22513713923          06/17/2023           1      $225.00      $85.99
    014267-08                131856746001 193764814  CAVALLO          MARISSA    18   22513713923          06/17/2023           1       $90.00       $0.00
    014267-08                131856746001 193764814  CAVALLO          MARISSA    18   22513713923          06/17/2023           1       $47.00       $0.00
    014267-08                104393562001 198605554  MCBREEN          TRICIA     01   22613580872          07/13/2023           1      $349.00       $0.00
    014267-08                104393562001 198605554  MCBREEN          TRICIA     01   22613654219          07/13/2023           1      $175.00      $90.81
    014267-08                105062910001 206603687  WESTRICK         DIANE      18   22613588138          07/12/2023           1      $358.00      $30.99
    014267-08                105062910001 206603687  WESTRICK         DIANE      18   22613588138          07/12/2023           1      $715.00      $38.56
    014267-08                105062910001 206603687  WESTRICK         DIANE      18   22613506037          07/12/2023           1       $53.00      $53.00
    014267-08                105062910001 206603687  WESTRICK         DIANE      18   22613506037          07/12/2023           1      $427.00     $427.00
    014267-08                105418614001 210682423  PIERCE           KRISTY     18   22313508273          07/10/2023           1      $230.00      $98.63
  014267-08 Total                                                                                                                    $6,428.00   $1,567.65
  014267-12
    014267-12                103337724001 186380155  LASOTA           KATHLEEN   18   22313587494          07/11/2023           1      $140.00      $38.56
    014267-12                103337724001 186380155  LASOTA           KATHLEEN   18   22313587494          07/11/2023           1      $100.00      $30.99
  014267-12 Total                                                                                                                      $240.00      $69.55
  014267-15
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22213602994          07/18/2023           1       $50.00      $22.60
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22213602994          07/18/2023           3      $120.00      $73.74
    014267-15                101653166001 165420843  ARFORD           SUSAN      18   22213602994          07/18/2023           1       $40.00      $10.45
    014267-15                102057315001 170525384  LEAHEY           BRADY      18   22613767136          07/17/2023           1      $110.00      $60.70
    014267-15                102304935001 173545673  PARONISH         FRANK      18   22032498921          07/12/2023           1       $84.56      $50.07
    014267-15                102304935001 173545673  PARONISH         FRANK      18   22032498921          07/12/2023           1       $18.58      $11.00
    014267-15                102304935001 173545673  PARONISH         FRANK      18   22032498921          07/12/2023           1      $228.63     $135.36
    014267-15                102304935001 173545673  PARONISH         FRANK      18   22032498921          07/12/2023           1       $62.00      $28.14
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023           1       $37.00       $0.00
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023           1      $132.00       $0.00
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023           1      $132.00       $0.00

                                                                                                                                              PAGE:68 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023           1       $76.00       $0.00
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023           1       $65.00       $0.00
    014267-15                102736003001 178626862  HOGAN            MICHAEL    18   22413468395          07/12/2023           1       $14.00       $0.00
    014267-15                103115531001 183523270  SHEA             EDWARD     18   22213724055          07/12/2023           1      $161.00      $47.85
    014267-15                103115531001 183523270  SHEA             EDWARD     18   22213724055          07/12/2023           1        $5.00       $0.00
    014267-15                104458562001 199522908  SERAFIN          SANDRA     18   22813672656          07/14/2023           1       $25.00      $12.84
    014267-15                104458562001 199522908  SERAFIN          SANDRA     18   22813672656          07/14/2023           1      $142.00      $51.50
    014267-15                104458562001 199522908  SERAFIN          SANDRA     18   22813633141          07/14/2023           1      $238.00     $176.86
    014267-15                104458562001 199522908  SERAFIN          SANDRA     18   22813633141          07/14/2023           1       $57.00      $31.52
    014267-15                104458562001 199522908  SERAFIN          SANDRA     18   22813633141          07/14/2023           1       $37.00      $13.86
    014267-15                104458562001 199522908  SERAFIN          SANDRA     18   22813633141          07/14/2023           1       $14.00       $0.00
    014267-15                104458562001 199522908  SERAFIN          SANDRA     18   22813633141          07/14/2023           1       $76.00      $62.07
    014267-15                104458562001 199522908  SERAFIN          SANDRA     18   22813633141          07/14/2023           1       $76.00      $26.59
    014267-15                104458562001 199522908  SERAFIN          SANDRA     18   22813633141          07/14/2023           1       $80.00      $23.21
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22513569083          07/16/2023           2       $90.00      $30.00
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22513804014          07/06/2023           1      $140.00      $95.81
    014267-15                104714087001 202525913  JUBAS            DEBORAH    18   22513569085          07/16/2023           1      $295.00       $0.00
  014267-15 Total                                                                                                                    $2,605.77     $964.17
  014267-22
    014267-22                104709255001 202500368  KLEZEK           JANA       18   22613385554          07/10/2023           1       $90.00      $69.99
    014267-22                104709255001 202500368  KLEZEK           JANA       18   22613385554          07/10/2023           1       $27.00      $15.94
    014267-22                104709255001 202500368  KLEZEK           JANA       18   22613385554          07/10/2023           1        $7.00       $6.07
    014267-22                104709255001 202500368  KLEZEK           JANA       18   22613385554          07/10/2023           1        $4.00       $0.16
  014267-22 Total                                                                                                                      $128.00      $92.16
  014267-26
    014267-26                101590378001 164544186  NATCHER          LYNNE      18   22713382112          07/12/2023           1       $45.00      $14.41
    014267-26                101590378001 164544186  NATCHER          LYNNE      18   22713382112          07/12/2023           1       $35.00      $24.58
    014267-26                101590378001 164544186  NATCHER          LYNNE      18   22713382112          07/12/2023           1       $70.00      $10.45
    014267-26                101590378001 164544186  NATCHER          LYNNE      18   22713382112          07/12/2023           1       $90.00      $11.87
    014267-26                102716636001 178509898  THOMAS           BRUCE      18   22513625878          07/11/2023           1      $681.00     $262.43
    014267-26                103945030001 193422246  BROWN            JOHN       18   22713751339          07/18/2023           1       $98.57      $74.18
    014267-26                105050264001 206525459  MCCOY            ROBERT     18   22513382178          07/11/2023           1      $530.00      $75.93

                                                                                                                                              PAGE:69 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-26                105050264001 206525459  MCCOY            ROBERT     18   22513613143          07/11/2023           1    $1,590.00     $542.81
  014267-26 Total                                                                                                                    $3,139.57   $1,016.66
  014267-36
    014267-36                117735369001 162603838  KIRSCH           RICHARD    01   22613677876          07/12/2023           1      $145.00      $59.97
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513487349          07/12/2023           1      $101.00       $0.00
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513554190          07/12/2023           1      $215.00      $65.70
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513554182          07/12/2023           1      $380.00      $52.15
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513487349          07/12/2023           1      $453.00     $374.51
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513487349          07/12/2023           1       $66.00       $0.00
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513487349          07/12/2023           1       $34.00       $0.00
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513487349          07/12/2023           1       $57.00       $0.00
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513487349          07/12/2023           1      $194.00       $0.00
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513487349          07/12/2023           1      $425.00       $0.00
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513554187          07/12/2023           1    $1,270.00     $249.02
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513560190          06/24/2023           1      $181.38     $181.38
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513487349          07/12/2023           1      $311.00       $0.00
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513487349          07/12/2023           1       $83.00       $0.00
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513560191          06/25/2023           1       $82.75      $66.37
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513563412          07/12/2023           1       $25.00      $12.72
    014267-36                109914485001 163626883  SHROYER          ROY        01   22513487349          07/12/2023           1       $62.00       $0.00
    014267-36                101597846001 164585882  BECQUET          DAWN       18   22513713917          06/22/2023           1      $150.00      $70.70
    014267-36                101742475001 166526179  CLAYCOMB         PAMALA     01   22413714895          07/10/2023           1      $115.00      $34.40
    014267-36                101742475001 166526179  CLAYCOMB         DYLAN      19   22413623862          07/12/2023           1      $163.00     $102.70
    014267-36                115426142001 168701689  ZERNICK          REBECCA    18   22813540702          06/09/2023           1      $225.00      $90.99
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813491095          07/11/2023           1      $642.00     $248.43
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1      $266.00      $31.12
    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)   ($133.00)    ($31.12)
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1      $251.00      $57.51
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1      $188.00      $31.02
    014267-36                132201566001 182642148  REVESZ           STACEY     19   22813780949          07/12/2023           1       $67.00      $25.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1      $127.00      $15.55

                                                                                                                                              PAGE:70 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1       $84.00      $65.52
    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)    ($23.00)       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1       $98.00      $36.74
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023          (1)    ($87.00)    ($37.84)
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813672188          07/13/2023           1    $2,725.00   $1,563.06
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813672187          07/13/2023           1    $2,725.00     $180.69
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1       $53.00      $11.04
    014267-36                132201566001 182642148  REVESZ           STACEY     19   22813780949          07/12/2023           1      $167.00      $76.20
    014267-36                132201566001 182642148  REVESZ           STACEY     19   22813780949          07/12/2023           1       $86.00      $23.22
    014267-36                132201566001 182642148  REVESZ           MEGAN      19   22813784856          07/14/2023           1       $21.00      $15.45
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1       $96.00      $15.47
    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       $76.00      $38.82
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023          (1)    ($98.00)    ($36.74)
    014267-36                132201566001 182642148  REVESZ           MEGAN      19   22813784856          07/14/2023           1      $205.00      $93.93
    014267-36                132201566001 182642148  REVESZ           STACEY     19   22813780949          07/12/2023           1       $91.00      $12.20
    014267-36                132201566001 182642148  REVESZ           STACEY     19   22813780949          07/12/2023           1       $96.00      $43.25
    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)    ($53.00)    ($11.04)
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           3      $441.00     $196.56
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1       $23.00       $0.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1       $87.00      $37.46
    014267-36                132201566001 182642148  REVESZ           STACEY     19   22813780949          07/12/2023           1       $67.00      $34.47
    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      $226.00      $35.37
    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)    ($76.00)    ($38.82)
    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       $67.00      $20.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1       $90.00      $29.68
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           5      $535.00     $230.79

                                                                                                                                              PAGE:71 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-36                132201566001 182642148  REVESZ           MEGAN      19   22813784856          07/14/2023           1       $95.00      $57.85
    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          (1)    ($96.00)    ($15.47)
    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      $148.00      $30.89
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           3      $690.00     $196.56
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1      $141.00      $27.65
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813008957          07/06/2023           1       $37.00      $31.02
    014267-36                132201566001 182642148  REVESZ           STACEY     19   22813780949          07/12/2023           1       $67.00      $20.00
    014267-36                132201566001 182642148  REVESZ           MICHAEL    18   22813359323          07/11/2023           1      $312.00      $44.85
    014267-36                132201566001 182642148  REVESZ           STACEY     19   22813780949          07/12/2023           1      $108.00      $27.19
    014267-36                132201566001 182642148  REVESZ           STACEY     19   22813780949          07/12/2023           1      $104.00      $17.25
    014267-36                103457061001 187582626  BAILEY           CYNTHIA    01   22032087870          07/06/2023           1      $120.00     $110.01
    014267-36                103457061001 187582626  BAILEY           DAVID      18   22032437651          07/18/2023           1      $211.00      $70.10
    014267-36                103555014001 188707325  BATEMAN          NICOLE     01   22613752561          07/14/2023           1      $118.00     $118.00
    014267-36                103555014001 188707325  BATEMAN          NICOLE     01   22613555367          07/05/2023           1      $215.00      $85.99
    014267-36                105326129001 209640969  WURM             JACQUELI   18   22213238561          07/07/2023           1    $3,650.00     $127.07
    014267-36                105326129001 209640969  WURM             JACQUELI   18   22213536433          07/13/2023           1    $1,520.00      $37.77
    014267-36                112912518001 209687274  MAZZARELLA       MATTHEW    18   22313479802          06/11/2023           1      $200.00     $105.81
    014267-36                112912518001 209687274  MAZZARELLA       MATTHEW    18   22313479802          06/11/2023           1      $125.00       $0.00
  014267-36 Total                                                                                                                   $21,526.13   $5,468.43
  014267-37
    014267-37                101976715001 169527779  SMILNAK          JAMES      18   22113596762          07/14/2023           1      $335.00     $148.43
    014267-37                102139943001 171527840  TARWATER         PATRICIA   18   22513743706          07/18/2023           1      $200.00     $100.00
    014267-37                102139943001 171527840  TARWATER         PATRICIA   18   22513586972          07/07/2023           1      $153.00      $65.70
    014267-37                103035623001 182542100  TOMASELLI        ANTHONY    18   22513652694          07/18/2023           1      $246.00     $124.83
    014267-37                103459963001 187600390  BRYAN            KAREN      18   22413368439          07/12/2023         200    $1,270.54   $1,270.54
    014267-37                103619466001 189546549  RODGERS          RAMONA     18   22032212117          06/09/2023           1      $200.00     $105.81
    014267-37                103619466001 189546549  RODGERS          RAMONA     18   22032212117          06/09/2023           1       $47.00      $10.50
    014267-37                104382358001 198542829  EVANS            SANDRA     18   22713672430          07/17/2023           1       $56.00       $0.00
    014267-37                104382358001 198542829  EVANS            SANDRA     18   22713387623          07/13/2023           1       $56.00       $0.00
    014267-37                104382358001 198542829  EVANS            SANDRA     18   22713387623          07/13/2023           1      $124.00       $0.00

                                                                                                                                              PAGE:72 of 72
                                                                                                                                                            
            Group                UMI      Agreement        Patient Name         Rel          Claim          Incurred     #Days/    Submitted      Paid    
                                            Number   Last                First  Code           ID             Date       #Units     Charges      Claims   
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-37                104382358001 198542829  EVANS            SANDRA     18   22713672430          07/17/2023           1       $56.00       $0.00
    014267-37                104382358001 198542829  EVANS            SANDRA     18   22713387623          07/13/2023           2      $160.00       $0.00
    014267-37                104382358001 198542829  EVANS            SANDRA     18   22713672430          07/17/2023           2      $160.00       $0.00
    014267-37                104382358001 198542829  EVANS            SANDRA     18   22713387623          07/13/2023           1       $56.00       $0.00
  014267-37 Total                                                                                                                    $3,119.54   $1,825.81
  014267- Total                                                                                                                    $178,945.36  $58,363.71
PPO Total                                                                                                                          $178,945.36  $58,363.71
Paid Claims Detail Total                                                                                                                       $236,259.56