CMS/EIP Fiscal Report Center: 06
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Payclass Filters:OTHER
Eligibility Filter:Program Patients
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 11 260.00 3432.00 13.20
Subtotal (Total Children Is Unduplicated) 11 260.00 3432.00 13.20
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Total 260.00 3432.00 13.20
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Number of Children (Unduplicated) With at Least One Service 11
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Center 06
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
130 260.00 3432.00 0.00
Other 0 0.00 0.00 0.00
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Total 130 260.00 3432.00 0.00