CMS/EIP Fiscal Report Center: 10
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Payclass Filters:LEA
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 4.500000 225.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 44 568.750000 30355.5000 53.3723
Subtotal (Total Children Is Unduplicated) 44 573.250000 30580.5000 53.3458
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Total 573.250000 30580.5000 53.3458
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Number of Children (Unduplicated) With at Least One Service 44
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Center 10
Flag Claims Units Chgs Paid
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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
645 573.250000 30580.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 645 573.250000 30580.5000 0.0000