CMS/EIP Fiscal Report Center: 03
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.00 21.24 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.00 45.38 15.13
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 110 114.00 979.62 8.59
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 48 49.00 522.48 10.66
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 108 112.00 2301.57 20.55
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.00 163.14 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 8 8.00 226.24 28.28
Subtotal (Total Children Is Unduplicated) 114 291.00 4259.67 14.64
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Total 291.00 4259.67 14.64
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Number of Children (Unduplicated) With at Least One Service 114
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Center 03
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 291 291.00 4259.67 0.00
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Total 291 291.00 4259.67 0.00