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

INVOICE NUMBER:     230117583406                                           PAGE:               1 of 3            
BILL ACCOUNT NUMBER:2401631001                                             PAID CLAIMS MONTH:  January 2023      
BILL ACCOUNT NAME:  Utz Quality Foods                                      CLAIMS PAID THRU:   01/13/2023        
CLIENT NUMBER:      240163                                                 BILL CYCLE:         2 of 4            
CLIENT NAME:        Utz Quality Foods                                      PREPARED DATE:      01/17/2023        

Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Claims Service Program: Non-Contracted Providers
  12/22
    Claims Service Program: Non-Contracted Providers
      025620-01
        INVAZ                                                                                                          $93.92
      025620-01 Total                                                                                                  $93.92
    Claims Service Program: Non-Contracted Providers Total                                                             $93.92
  12/22 Total                                                                                                          $93.92
  01/23
    Claims Service Program: Non-Contracted Providers
      025620-02
          ADM                                                                                                         $143.78
      025620-02 Total                                                                                                 $143.78
    Claims Service Program: Non-Contracted Providers Total                                                            $143.78
  01/23 Total                                                                                                         $143.78
Claims Service Program: Non-Contracted Providers Total                                                                $237.70
                                                                                                                                                            
Pre Pay Coding Validation
  01/23
    Pre Pay Coding Validation
      025620-01
        SBUNB                                                                                                           $6.68
      025620-01 Total                                                                                                   $6.68
    Pre Pay Coding Validation Total                                                                                     $6.68
  01/23 Total                                                                                                           $6.68
Pre Pay Coding Validation Total                                                                                         $6.68

                                                                                                                                                PAGE:2 of 3
                                                                                                                                                            
Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Prepay Claims Savings Fee
  12/22
    Prepay Claims Savings Fee
      025620-01
         PLT3                                                                                                          $34.83
      025620-01 Total                                                                                                  $34.83
    Prepay Claims Savings Fee Total                                                                                    $34.83
  12/22 Total                                                                                                          $34.83
  01/23
    Prepay Claims Savings Fee
      025620-01
          ADM                                                                                                          $19.60
      025620-01 Total                                                                                                  $19.60
      025620-02
        SLSUP                                                                                                          $24.78
      025620-02 Total                                                                                                  $24.78
    Prepay Claims Savings Fee Total                                                                                    $44.38
  01/23 Total                                                                                                          $44.38
Prepay Claims Savings Fee Total                                                                                        $79.21
                                                                                                                                                            
Reprocessing Fee
  12/22
    Reprocessing Fee
      025620-01
          ADM                                                                                                          $25.00
        FLEET                                                                                                          $50.00
         PLT3                                                                                                          $25.00
        PLTAD                                                                                                          $25.00
        SLSUP                                                                                                          $25.00
      025620-01 Total                                                                                                 $150.00
      025620-02
         PLT2                                                                                                          $25.00

                                                                                                                                                PAGE:3 of 3
                                                                                                                                                            
Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
      025620-02 Total                                                                                                  $25.00
    Reprocessing Fee Total                                                                                            $175.00
  12/22 Total                                                                                                         $175.00
Reprocessing Fee Total                                                                                                $175.00
                                                                                                                                                            
Other Claims Related Fee Summary Total                                                                                $498.59