CMS/EIP Fiscal Report Center: 07
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
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 6.50 325.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 8.75 593.95 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 225.00 112.50 0.50
Subtotal (Total Children Is Unduplicated) 5 240.25 1031.45 4.29
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Total 240.25 1031.45 4.29
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Number of Children (Unduplicated) With at Least One Service 5
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Center 07
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
6 240.25 1031.45 0.00
Other 0 0.00 0.00 0.00
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Total 6 240.25 1031.45 0.00