CMS/EIP Fiscal Report              Center: 51 
Services beginning 10/01/2008 ending 12/31/2008                Date of Report:02/17/2009   Page:   1
         Agency Filter:EIP DEI DEIP     
      Payclass Filters:TPIN    
    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
  SPL-92507-SPL THERAPY SESSION BY LICENSED SLP            1               2.00          135.76           67.88
Subtotal (Total Children Is Unduplicated)                  1               2.00          135.76           67.88
----------------------------------------------------------------------------------------------------------------
Total                                                                      2.00          135.76           67.88
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service          1
----------------------------------------------------------------------------------------------------------------
 
Center 51
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 
               2       2.00     135.76       0.00 
Other          0       0.00       0.00       0.00 
-------------------------------------------------
Total          2       2.00     135.76       0.00