CMS/EIP Fiscal Report Center: 10
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EXT
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
Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 19 27.50 1375.00 50.00
Subtotal (Total Children Is Unduplicated) 19 27.50 1375.00 50.00
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EI Services,Class #03
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.00 50.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 23 81.00 4050.00 50.00
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 13 97.50 4875.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 14 127.25 6362.50 50.00
PHY-97110-PT SESSION BY LICENSED PT 4 75.75 5141.91 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 1.00 54.32 54.32
SHIN-EIIF_NM-INITIAL SHINE SERVICES, IND NONMED 5 21.50 1075.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 13 67.50 3375.00 50.00
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 19 181.75 9087.50 50.00
Subtotal (Total Children Is Unduplicated) 56 654.25 34071.23 52.08
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Total 681.75 35446.23 51.99
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Number of Children (Unduplicated) With at Least One Service 57
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Center 10
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
295 681.75 35446.23 0.00
Other 0 0.00 0.00 0.00
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Total 295 681.75 35446.23 0.00