CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/17/2009 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
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 8.00 543.04 67.88
Subtotal (Total Children Is Unduplicated) 3 8.00 543.04 67.88
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Total 8.00 543.04 67.88
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Number of Children (Unduplicated) With at Least One Service 3
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Center 09
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 3 8.00 543.04 543.04
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
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Total 3 8.00 543.04 543.04