CMS/EIP Fiscal Report              Center: 06 
Services beginning 10/01/2009 ending 12/31/2009                Date of Report:02/16/2010   Page:   1
         Agency Filter:EXT       
      Payclass Filters:OTHER    
    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
  PHY-97110-PT SESSION BY LICENSED PT                      1               0.50           33.94           67.88
Subtotal (Total Children Is Unduplicated)                  1               0.50           33.94           67.88
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Total                                                                      0.50           33.94           67.88
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Number of Children (Unduplicated) With at Least One Service          1
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Center 06
Flag      Claims      Units       Chgs       Paid
-------------------------------------------------
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      33.94       0.00 
Other          0       0.00       0.00       0.00 
-------------------------------------------------
Total          1       0.50      33.94       0.00