CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 13 71.75 3587.50 50.00
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 5 32.00 1600.00 50.00
Subtotal (Total Children Is Unduplicated) 18 103.75 5187.50 50.00
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Total 103.75 5187.50 50.00
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Number of Children (Unduplicated) With at Least One Service 18
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Center 01
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
49 103.75 5187.50 0.00
Other 0 0.00 0.00 0.00
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Total 49 103.75 5187.50 0.00