CMS/EIP Fiscal Report Center: 05
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:OTHER
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
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 4.00 200.00 50.00
Subtotal (Total Children Is Unduplicated) 1 4.00 200.00 50.00
----------------------------------------------------------------------------------------------------------------
Total 4.00 200.00 50.00
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1
----------------------------------------------------------------------------------------------------------------
Center 05
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
2 4.00 200.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2 4.00 200.00 0.00