CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/15/2012 Page: 1
List order: No List
Eligibility Filter:DEI Only
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 3 3.000000 111.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.750000 27.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 4 19.500000 721.5000 37.0000
Subtotal (Total Children Is Unduplicated) 4 23.250000 860.2500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
Subtotal (Total Children Is Unduplicated) 1 4.000000 261.0000 65.2500
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EI Services,Class #03
INTR-INTR-INTERPRETER 1 1.000000 20.0000 20.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 34.000000 17.0000 0.5000
Subtotal (Total Children Is Unduplicated) 1 35.000000 37.0000 1.0571
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Total 62.250000 1158.2500 18.6064
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Number of Children (Unduplicated) With at Least One Service 4
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Center 52
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 3 2.000000 74.0000 0.0000
P 20 10.750000 397.7500 397.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 111.0000 0.0000
T 0 0.000000 0.0000 0.0000
20 47.500000 575.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 44 62.250000 1158.2500 397.7500