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

INVOICE NUMBER:     250722585752                                           PAGE:               1 of 4            
BILL ACCOUNT NUMBER:CN02401002                                             PAID CLAIMS MONTH:  July 2025         
BILL ACCOUNT NAME:  Admiral Peary                                          CLAIMS PAID THRU:   07/18/2025        
CLIENT NUMBER:      0240                                                   BILL CYCLE:         3 of 4            
CLIENT NAME:        Admiral Peary                                          PREPARED DATE:      07/22/2025        

Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Pre Pay Coding Validation
  12/24
    Pre Pay Coding Validation
      014267-05                                                                                                       $932.13
      014267- Total                                                                                                   $932.13
    Pre Pay Coding Validation Total                                                                                   $932.13
  12/24 Total                                                                                                         $932.13
  05/25
    Pre Pay Coding Validation
      017697-01                                                                                                         $7.65
      017697- Total                                                                                                     $7.65
    Pre Pay Coding Validation Total                                                                                     $7.65
  05/25 Total                                                                                                           $7.65
  07/25
    Pre Pay Coding Validation
      104272-09                                                                                                        $43.72
      104272- Total                                                                                                    $43.72
    Pre Pay Coding Validation Total                                                                                    $43.72
  07/25 Total                                                                                                          $43.72
Pre Pay Coding Validation Total                                                                                       $983.50
                                                                                                                                                            
Prepay Claims Savings Fee
  12/24
    Prepay Claims Savings Fee
      014267-05                                                                                                        $65.55
      014267- Total                                                                                                    $65.55
    Prepay Claims Savings Fee Total                                                                                    $65.55

                                                                                                                                                PAGE:2 of 4
                                                                                                                                                            
Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  12/24 Total                                                                                                          $65.55
  04/25
    Prepay Claims Savings Fee
      014267-08                                                                                                         $0.00
      014267- Total                                                                                                     $0.00
    Prepay Claims Savings Fee Total                                                                                     $0.00
  04/25 Total                                                                                                           $0.00
  05/25
    Prepay Claims Savings Fee
      014267-05                                                                                                      ($38.76)
      014267- Total                                                                                                  ($38.76)
    Prepay Claims Savings Fee Total                                                                                  ($38.76)
  05/25 Total                                                                                                        ($38.76)
  06/25
    Prepay Claims Savings Fee
      014267-03                                                                                                        $13.11
      014267-07                                                                                                        $10.88
      014267- Total                                                                                                    $23.99
      017728-00                                                                                                         $9.89
      017728- Total                                                                                                     $9.89
    Prepay Claims Savings Fee Total                                                                                    $33.88
  06/25 Total                                                                                                          $33.88
  07/25
    Prepay Claims Savings Fee
      014267-03                                                                                                         $5.00
      014267-05                                                                                                        $32.53
      014267-07                                                                                                        $15.93
      014267-54                                                                                                        $10.13
      014267- Total                                                                                                    $63.59
      017697-01                                                                                                        $13.67
      017697- Total                                                                                                    $13.67
    Prepay Claims Savings Fee Total                                                                                    $77.26

                                                                                                                                                PAGE:3 of 4
                                                                                                                                                            
Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  07/25 Total                                                                                                          $77.26
Prepay Claims Savings Fee Total                                                                                       $137.93
                                                                                                                                                            
Reprocessing Fee
  07/24
    Reprocessing Fee
      014267-37                                                                                                        $25.00
      014267- Total                                                                                                    $25.00
    Reprocessing Fee Total                                                                                             $25.00
  07/24 Total                                                                                                          $25.00
  01/25
    Reprocessing Fee
      014267-54                                                                                                        $25.00
      014267- Total                                                                                                    $25.00
      017728-00                                                                                                        $25.00
      017728- Total                                                                                                    $25.00
    Reprocessing Fee Total                                                                                             $50.00
  01/25 Total                                                                                                          $50.00
  03/25
    Reprocessing Fee
      017728-00                                                                                                        $25.00
      017728- Total                                                                                                    $25.00
      104272-02                                                                                                        $25.00
      104272- Total                                                                                                    $25.00
    Reprocessing Fee Total                                                                                             $50.00
  03/25 Total                                                                                                          $50.00
  04/25
    Reprocessing Fee
      014267-54                                                                                                        $25.00
      014267- Total                                                                                                    $25.00
      017728-00                                                                                                        $25.00
      017728- Total                                                                                                    $25.00

                                                                                                                                                PAGE:4 of 4
                                                                                                                                                            
Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    Reprocessing Fee Total                                                                                             $50.00
  04/25 Total                                                                                                          $50.00
  05/25
    Reprocessing Fee
      014267-36                                                                                                        $50.00
      014267- Total                                                                                                    $50.00
      017728-00                                                                                                        $25.00
      017728- Total                                                                                                    $25.00
      104272-02                                                                                                        $50.00
      104272- Total                                                                                                    $50.00
    Reprocessing Fee Total                                                                                            $125.00
  05/25 Total                                                                                                         $125.00
  06/25
    Reprocessing Fee
      014267-36                                                                                                        $75.00
      014267-54                                                                                                        $50.00
      014267- Total                                                                                                   $125.00
      017728-00                                                                                                        $25.00
      017728- Total                                                                                                    $25.00
      104272-02                                                                                                        $25.00
      104272- Total                                                                                                    $25.00
    Reprocessing Fee Total                                                                                            $175.00
  06/25 Total                                                                                                         $175.00
Reprocessing Fee Total                                                                                                $475.00
                                                                                                                                                            
Other Claims Related Fee Summary Total                                                                              $1,596.43