CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 Page: 1
List order: No List
Payclass Filters:LEA
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 92.000000 2300.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 34.000000 1700.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 142.8800 71.4400
Subtotal (Total Children Is Unduplicated) 9 128.000000 4142.8800 32.3663
-----------------------------------------------------------------------------------------------------------------------
Total 128.000000 4142.8800 32.3663
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 9
-----------------------------------------------------------------------------------------------------------------------
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
10 128.000000 4142.8800 4142.8800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10 128.000000 4142.8800 4142.8800