CMS/EIP Fiscal Report Center: 05
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Payclass Filters:LEA
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
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 21 68.00 3400.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 12 28.50 1425.00 50.00
Subtotal (Total Children Is Unduplicated) 33 96.50 4825.00 50.00
----------------------------------------------------------------------------------------------------------------
Total 96.50 4825.00 50.00
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 33
----------------------------------------------------------------------------------------------------------------
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
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
53 96.50 4825.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 53 96.50 4825.00 0.00