CMS/EIP Fiscal Report              Center: 09 
Services beginning 10/01/2013 ending 12/31/2013                Date of Report:02/18/2014   Page:   1
            List order: No List
    Agency Filter:EXT       
    Payclass Filters:OTHER    
    Eligibility Filter:Part C (excluding not eligible)
 
 
Services                                              Number of            Number of    Fee Reported          Avg Fee
                                                      Children             Units                              Per/Unit
 
EI Services,Class #03
  COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE             3               3.500000          175.0000           50.0000
  CONIF-CONIF-CONSULT ITDS, FACE TO FACE                  52              44.750000         2237.5000           50.0000
  CONOF-CONOF-CONSULT, OT, FACE TO FACE                   19              19.250000          962.5000           50.0000
  CONOP-CONOP-CONSULT, OT, PHONE                           1               1.000000           25.0000           25.0000
  CONPF-CONPF-CONSULT, PT, FACE TO FACE                   19              17.500000          875.0000           50.0000
  CONSF-CONSF-CONSULT, SLP, FACE TO FACE                  36              29.750000         1487.5000           50.0000
  CONSP-CONSP-CONSULT, SLP, PHONE                          2               0.500000           12.5000           25.0000
  TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE        884            74014.00000        37007.0000            0.5000
Subtotal (Total Children Is Unduplicated)                887            74130.25000        42782.0000            0.5771
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Total                                                                  74130.250000        42782.0000            0.5771
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Number of Children (Unduplicated) With at Least One Service        887
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Center 09
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           1326   71602.250000   41270.5000   41270.5000 
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 
              44    2528.000000    1511.5000       0.0000 
Other          0       0.000000       0.0000       0.0000 
---------------------------------------------------------
Total       1370   74130.250000   42782.0000   41270.5000