CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EXT
Payclass Filters:OTHER
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
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 8.00 388.00 48.50
Subtotal (Total Children Is Unduplicated) 8 8.00 388.00 48.50
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EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 4 3.50 175.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 11 9.75 243.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 6 5.50 275.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 16 9.00 225.00 25.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 13 2324.00 20916.00 9.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 17.00 850.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 7 26.50 1798.82 67.88
PHY-97110-PT SESSION BY LICENSED PT 7 27.00 1832.76 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 28 80.50 5464.34 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 3.50 46.20 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 50 4444.00 436241.00 98.16
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 63 3402.00 4089.00 1.20
Subtotal (Total Children Is Unduplicated) 150 10352.3 472156.87 45.61
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Total 10360.25 472544.87 45.61
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Number of Children (Unduplicated) With at Least One Service 153
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Center 57
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 1 3.50 46.20 237.58
H 0 0.00 0.00 0.00
T 1 60.00 30.00 30.00
288 9376.50 461691.50 0.00
Other 128 920.25 10777.17 10802.17
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Total 418 10360.25 472544.87 11069.75