CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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
Screening, Eval, and Assessment,Class #02
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 1 1.00 48.50 48.50
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 2.00 300.00 150.00
PHY-97110-PT SESSION BY LICENSED PT 2 10.00 678.80 67.88
Subtotal (Total Children Is Unduplicated) 3 12.00 978.80 81.57
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Total 13.00 1027.30 79.02
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Number of Children (Unduplicated) With at Least One Service 4
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Center 07
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
5 13.00 1027.30 0.00
Other 0 0.00 0.00 0.00
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Total 5 13.00 1027.30 0.00