Summary Report for FSPSAs Ending During the Report Period                                             Center: 04

This report shows the total number of units/fees for FSPSAs ending during the report period.
(i.e., end date of service authorization occurs during the report period). This report does not
represent all FSPSAs that overlap the report period. Note that service authorization periods may
range from 1 to 12 months and may vary in intensity from child to child.

FSPSAs ending between: 01/01/08 and 12/31/08                  Date of Report: 02-16-09                  Page: 1

         Payor Filter: PARH   PAHM   DEI    DEIM         
Eligibility Filter: Program Patients


Services  Cpt Code                                       Number of   Number of   Total Units  Total Cost of        Avg Fee
                                                         Children    Records     Authorized   Auth Services     Per Unit Auth



Screening, Eval, and Assessment, Class # 02
 EVAL  -EVAL      DEVELOPMENTAL EVALUATION                    13         13           13.00         $650.00           $50.00
 MED   -MED       UNSPECIFIED MED OFFICE VISIT                 1          1            1.00         $150.00          $150.00
                                                         --------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                     14         14           14.00         $800.00           $57.14


EI Services, Class # 03
 CONIF -CONIF     CONSULT ITDS, FACE TO FACE                   2          2           16.22         $810.83           $50.00
 CONSF -CONSF     CONSULT, SLP, FACE TO FACE                   1          1            3.40         $170.00           $50.00
 EIIF  -T1024HN   *EI INDIVIDUAL SESSION BY PROF               1          1           33.29        $1664.29           $50.00
 TRAV  -TRAV      PROVIDER TRAVEL TO NATURAL ENVIRONM          4          4          143.71          $71.86            $0.50
                                                         --------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated)                      5          8          196.62        $2716.97           $13.82


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Total                                                                    22          210.62        $3516.97           $16.70
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Number of Children (Unduplicated) With at Least One Authorization  19