CMS/EIP Fiscal Report Center: 57
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
Agency Filter:EIP DEI DEIP
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
ECE-ECE-EARLY CHILDHOOD EDUCATION 3 124.00 1116.00 9.00
OCCT-97530-OT SESSION BY LICENSED OT 1 1.50 101.82 67.88
PHY-97110-PT SESSION BY LICENSED PT 1 1.00 67.88 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.50 101.82 67.88
Subtotal (Total Children Is Unduplicated) 3 128.00 1387.52 10.84
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Total 128.00 1387.52 10.84
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Number of Children (Unduplicated) With at Least One Service 3
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Center 57
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
6 128.00 1387.52 0.00
Other 0 0.00 0.00 0.00
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Total 6 128.00 1387.52 0.00