CMS/EIP Fiscal Report Center: 09
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 11.00 550.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 3 15.00 1018.20 67.88
PHY-97110-PT SESSION BY LICENSED PT 1 11.00 746.68 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 10.00 678.80 67.88
Subtotal (Total Children Is Unduplicated) 6 47.00 2993.68 63.70
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Total 47.00 2993.68 63.70
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Number of Children (Unduplicated) With at Least One Service 6
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Center 09
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 5 19.00 1128.80 1128.80
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
8 28.00 1864.88 0.00
Other 0 0.00 0.00 0.00
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Total 13 47.00 2993.68 1128.80