CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2013 ending 12/31/2013 Date of Report:02/18/2014 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 6.000000 334.7400 55.7900
INTR-INTR-INTERPRETER 7 20.250000 1012.5000 50.0000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 3 386.000000 193.0000 0.5000
Subtotal (Total Children Is Unduplicated) 9 412.250000 1540.2400 3.7362
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Total 412.250000 1540.2400 3.7362
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Number of Children (Unduplicated) With at Least One Service 9
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Center 02
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 4 6.000000 334.7400 334.7400
14 406.250000 1205.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 18 412.250000 1540.2400 334.7400