CMS/EIP Fiscal Report              Center: 04 
Services beginning 10/01/2008 ending 12/31/2008                Date of Report:02/17/2009   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            60            2021.00        50525.00           25.00
Subtotal (Total Children Is Unduplicated)                 60            2021.00        50525.00           25.00
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Total                                                                   2021.00        50525.00           25.00
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Number of Children (Unduplicated) With at Least One Service         60
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Center 04
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 
             155    2021.00   50525.00       0.00 
Other          0       0.00       0.00       0.00 
-------------------------------------------------
Total        155    2021.00   50525.00       0.00