CMS/EIP Fiscal Report              Center: 55 
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
 
Service Coordination,Class #01
  IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN             1               1.00            0.00            0.00
  TCM-T1017TL-TARGETED CASE MANAGEMENT                     4               6.50          240.50           37.00
Subtotal (Total Children Is Unduplicated)                  4               7.50          240.50           32.07
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Screening, Eval, and Assessment,Class #02
  EVAL-EVAL-DEVELOPMENTAL EVALUATION                       4               5.00          250.00           50.00
  IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT       3               6.00          450.00           75.00
  IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS       3               6.00          333.00           55.50
  IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF     14              21.00         1575.00           75.00
Subtotal (Total Children Is Unduplicated)                 21              38.00         2608.00           68.63
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EI Services,Class #03
  SPL-92507-SPL THERAPY SESSION BY LICENSED SLP            1               0.75           50.91           67.88
Subtotal (Total Children Is Unduplicated)                  1               0.75           50.91           67.88
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Total                                                                     46.25         2899.41           62.69
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Number of Children (Unduplicated) With at Least One Service         26
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Center 55
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 
              31      46.25    2899.41       0.00 
Other          0       0.00       0.00       0.00 
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Total         31      46.25    2899.41       0.00