CMS/EIP Fiscal Report Center: 04
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Agency Filter:EXT
Payclass Filters:LEA
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
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 80 5477.00 136925.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 38 1324.00 33100.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 20 280.00 14000.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 11 60.50 4106.74 67.88
PHY-97110-PT SESSION BY LICENSED PT 24 93.00 6312.84 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 50 148.75 10097.15 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 11 14.00 184.80 13.20
Subtotal (Total Children Is Unduplicated) 141 7397.25 204726.53 27.68
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Total 7397.25 204726.53 27.68
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Number of Children (Unduplicated) With at Least One Service 141
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Center 04
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
547 7397.25 204726.53 0.00
Other 0 0.00 0.00 0.00
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Total 547 7397.25 204726.53 0.00