CMS/EIP Fiscal Report              Center: 53 
Services beginning 01/01/2015 ending 03/31/2015                Date of Report:03/17/2015   Page:   1
            List order: No List
    Payclass Filters:OTHER    
    Eligibility Filter:Not Part C
 
 
Services                                              Number of            Number of    Fee Reported          Avg Fee
                                                      Children             Units                              Per/Unit
 
  
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