CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 Page: 1
Payclass Filters:GR
Eligibility Filter:Not Part C
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 34 15.000000 555.0000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 71 78.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 89 95.000000 3515.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 43 112.000000 4144.0000 37.0000
TCON-TCON-TRANSITION CONFERENCE 1 1.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 97 301.000000 8214.0000 27.2890
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Screening, Eval, and Assessment,Class #02
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 13 26.000000 1443.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 11.607730 831.5798 71.6404
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 26 48.118550 2670.5795 55.4999
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 39.000000 2925.0000 75.0000
Subtotal (Total Children Is Unduplicated) 35 130.726280 8320.1593 63.6456
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EI Services,Class #03
INTR-INTR-INTERPRETER 1 1.000000 50.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 78 7492.000000 3731.0000 0.4980
Subtotal (Total Children Is Unduplicated) 78 7493.000000 3781.0000 0.5046
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Total 7924.726280 20315.1593 2.5635
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Number of Children (Unduplicated) With at Least One Service 98
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Center 53
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 103 2804.000000 5352.5000 5352.5000
T 141 120.500000 3459.5000 3459.5000
381 5000.226280 11503.1593 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 625 7924.726280 20315.1593 8812.0000