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

INVOICE NUMBER:     250708581712                                           PAGE:               1 of 2            
BILL ACCOUNT NUMBER:CN02401002                                             PAID CLAIMS MONTH:  July 2025         
BILL ACCOUNT NAME:  Admiral Peary                                          CLAIMS PAID THRU:   07/04/2025        
CLIENT NUMBER:      0240                                                   BILL CYCLE:         1 of 4            
CLIENT NAME:        Admiral Peary                                          PREPARED DATE:      07/08/2025        

Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Pre Pay Coding Validation
  06/25
    Pre Pay Coding Validation
      017697-01                                                                                                        $49.05
      017697- Total                                                                                                    $49.05
      017728-00                                                                                                         $5.85
      017728- Total                                                                                                     $5.85
      104272-02                                                                                                        $74.73
      104272- Total                                                                                                    $74.73
    Pre Pay Coding Validation Total                                                                                   $129.63
  06/25 Total                                                                                                         $129.63
Pre Pay Coding Validation Total                                                                                       $129.63
                                                                                                                                                            
Prepay Claims Savings Fee
  08/24
    Prepay Claims Savings Fee
      014267-36                                                                                                       $219.83
      014267- Total                                                                                                   $219.83
    Prepay Claims Savings Fee Total                                                                                   $219.83
  08/24 Total                                                                                                         $219.83
  04/25
    Prepay Claims Savings Fee
      014267-03                                                                                                         $0.00
      014267- Total                                                                                                     $0.00
    Prepay Claims Savings Fee Total                                                                                     $0.00
  04/25 Total                                                                                                           $0.00
  05/25

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Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    Prepay Claims Savings Fee
      014267-05                                                                                                      ($25.20)
      014267- Total                                                                                                  ($25.20)
    Prepay Claims Savings Fee Total                                                                                  ($25.20)
  05/25 Total                                                                                                        ($25.20)
  06/25
    Prepay Claims Savings Fee
      104272-02                                                                                                       $365.56
      104272- Total                                                                                                   $365.56
    Prepay Claims Savings Fee Total                                                                                   $365.56
  06/25 Total                                                                                                         $365.56
Prepay Claims Savings Fee Total                                                                                       $560.19
                                                                                                                                                            
Other Claims Related Fee Summary Total                                                                                $689.82