CMS/EIP Fiscal Report Center: 04
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 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
EI Services,Class #03
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 84 2234.00 55850.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 38 1196.00 29900.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 16 180.00 9000.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 10 50.75 3444.91 67.88
PHY-97110-PT SESSION BY LICENSED PT 34 61.25 4157.65 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 54 162.50 11030.50 67.88
Subtotal (Total Children Is Unduplicated) 144 3884.50 113383.06 29.19
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Total 3884.50 113383.06 29.19
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Number of Children (Unduplicated) With at Least One Service 144
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Center 04
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
525 3884.50 113383.06 0.00
Other 0 0.00 0.00 0.00
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Total 525 3884.50 113383.06 0.00