CMS/EIP Fiscal Report Center: 04
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Agency Filter:EXT
Payclass Filters:OTHER
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 53 1518.00 37950.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 39 848.00 21200.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 41.00 2050.00 50.00
Subtotal (Total Children Is Unduplicated) 93 2407.00 61200.00 25.43
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Total 2407.00 61200.00 25.43
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Number of Children (Unduplicated) With at Least One Service 93
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Center 04
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
208 2407.00 61200.00 0.00
Other 0 0.00 0.00 0.00
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Total 208 2407.00 61200.00 0.00