CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
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
SPL-92508-GROUP SPL SESSION PER CHILD 11 194.00 2560.80 13.20
Subtotal (Total Children Is Unduplicated) 11 194.00 2560.80 13.20
----------------------------------------------------------------------------------------------------------------
Total 194.00 2560.80 13.20
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 11
----------------------------------------------------------------------------------------------------------------
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
97 194.00 2560.80 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 97 194.00 2560.80 0.00