CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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
ASST-ASST-ASSISTIVE TECHNOLOGY 1 5.00 2253.82 450.76
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 8 8.00 400.00 50.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 64.00 1600.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 10 38.25 1912.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 71.00 3550.00 50.00
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 6 42.25 2112.50 50.00
Subtotal (Total Children Is Unduplicated) 24 228.50 11828.82 51.77
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Total 228.50 11828.82 51.77
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Number of Children (Unduplicated) With at Least One Service 24
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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
56 228.50 11828.82 0.00
Other 0 0.00 0.00 0.00
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Total 56 228.50 11828.82 0.00