CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 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 54 684.00 34200.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.00 50.00 50.00
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 5 36.00 1800.00 50.00
SHIN-EIIF_NM-INITIAL SHINE SERVICES, IND NONMED 2 25.00 1250.00 50.00
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 29 333.00 16650.00 50.00
Subtotal (Total Children Is Unduplicated) 73 1079.00 53950.00 50.00
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Total 1079.00 53950.00 50.00
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Number of Children (Unduplicated) With at Least One Service 73
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Center 01
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
345 1079.00 53950.00 0.00
Other 0 0.00 0.00 0.00
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Total 345 1079.00 53950.00 0.00