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

INVOICE NUMBER:     250715583733                                           PAGE:               1 of 3            
BILL ACCOUNT NUMBER:CN02401002                                             PAID CLAIMS MONTH:  July 2025         
BILL ACCOUNT NAME:  Admiral Peary                                          CLAIMS PAID THRU:   07/11/2025        
CLIENT NUMBER:      0240                                                   BILL CYCLE:         2 of 4            
CLIENT NAME:        Admiral Peary                                          PREPARED DATE:      07/15/2025        

Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Pre Pay Coding Validation
  02/24
    Pre Pay Coding Validation
      014267-03                                                                                                     ($168.22)
      014267- Total                                                                                                 ($168.22)
    Pre Pay Coding Validation Total                                                                                 ($168.22)
  02/24 Total                                                                                                       ($168.22)
  12/24
    Pre Pay Coding Validation
      014267-08                                                                                                      ($39.98)
      014267- Total                                                                                                  ($39.98)
    Pre Pay Coding Validation Total                                                                                  ($39.98)
  12/24 Total                                                                                                        ($39.98)
  04/25
    Pre Pay Coding Validation
      017728-00                                                                                                         $2.45
      017728- Total                                                                                                     $2.45
    Pre Pay Coding Validation Total                                                                                     $2.45
  04/25 Total                                                                                                           $2.45
  06/25
    Pre Pay Coding Validation
      014267-05                                                                                                         $7.62
      014267- Total                                                                                                     $7.62
      017728-00                                                                                                         $5.85
      017728- Total                                                                                                     $5.85
      104272-02                                                                                                       $204.29
      104272- Total                                                                                                   $204.29

                                                                                                                                                PAGE:2 of 3
                                                                                                                                                            
Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    Pre Pay Coding Validation Total                                                                                   $217.76
  06/25 Total                                                                                                         $217.76
  07/25
    Pre Pay Coding Validation
      104272-12                                                                                                         $9.67
      104272- Total                                                                                                     $9.67
    Pre Pay Coding Validation Total                                                                                     $9.67
  07/25 Total                                                                                                           $9.67
Pre Pay Coding Validation Total                                                                                        $21.68
                                                                                                                                                            
Prepay Claims Savings Fee
  04/24
    Prepay Claims Savings Fee
      104272-02                                                                                                        $37.47
      104272- Total                                                                                                    $37.47
    Prepay Claims Savings Fee Total                                                                                    $37.47
  04/24 Total                                                                                                          $37.47
  04/25
    Prepay Claims Savings Fee
      017728-00                                                                                                     $1,046.47
      017728- Total                                                                                                 $1,046.47
    Prepay Claims Savings Fee Total                                                                                 $1,046.47
  04/25 Total                                                                                                       $1,046.47
  05/25
    Prepay Claims Savings Fee
      104272-12                                                                                                        $65.03
      104272- Total                                                                                                    $65.03
    Prepay Claims Savings Fee Total                                                                                    $65.03
  05/25 Total                                                                                                          $65.03
  06/25
    Prepay Claims Savings Fee
      014267-03                                                                                                        $24.55

                                                                                                                                                PAGE:3 of 3
                                                                                                                                                            
Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
      014267-05                                                                                                        $68.28
      014267-06                                                                                                         $2.07
      014267-07                                                                                                        $31.90
      014267-08                                                                                                         $3.50
      014267- Total                                                                                                   $130.30
      017697-00                                                                                                       $124.15
      017697- Total                                                                                                   $124.15
    Prepay Claims Savings Fee Total                                                                                   $254.45
  06/25 Total                                                                                                         $254.45
  07/25
    Prepay Claims Savings Fee
      014267-05                                                                                                        $14.74
      014267- Total                                                                                                    $14.74
      104272-02                                                                                                        $44.24
      104272-19                                                                                                         $9.72
      104272- Total                                                                                                    $53.96
    Prepay Claims Savings Fee Total                                                                                    $68.70
  07/25 Total                                                                                                          $68.70
Prepay Claims Savings Fee Total                                                                                     $1,472.12
                                                                                                                                                            
Other Claims Related Fee Summary Total                                                                              $1,493.80