CMS/EIP Fiscal Report Center: 54
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
Payclass Filters:TPIN
Eligibility Filter:DEI Only
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.50 12.50 25.00
Subtotal (Total Children Is Unduplicated) 1 0.50 12.50 25.00
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Total 0.50 12.50 25.00
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Number of Children (Unduplicated) With at Least One Service 1
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Center 54
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
1 0.50 12.50 0.00
Other 0 0.00 0.00 0.00
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Total 1 0.50 12.50 0.00