CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 Page: 1
Agency Filter:EXT
Payclass Filters:GR
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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 12.3300 12.3300
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 4.000000 34.8800 8.7200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 54.0000 10.8000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 4.000000 87.2900 21.8225
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 53.8300 53.8300
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 31.5200 31.5200
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 14 14.000000 1500.0000 107.1429
EXIT-EXIT-TRANSITION ASSESSMENT 15 30.000000 1500.0000 50.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 8 8.000000 388.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.000000 145.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.000000 242.5000 48.5000
Subtotal (Total Children Is Unduplicated) 45 78.000000 4146.8500 53.1647
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 23.000000 3603.4800 156.6730
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 2.000000 143.2200 71.6100
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 25 30.500000 1525.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 7 5.000000 125.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 8.500000 425.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 12.000000 600.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.500000 37.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 8.000000 200.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 28 110.000000 5500.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 88 507.000000 25350.0000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 10.000000 500.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 21 95.250000 6465.5700 67.8800
PHY-97110-PT SESSION BY LICENSED PT 18 109.000000 7398.9200 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 44 258.250000 17530.0100 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 1 8.000000 105.6000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 368 90187.00000 45093.5000 0.5000
Subtotal (Total Children Is Unduplicated) 385 91380.00000 114802.8000 1.2563
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Total 91458.000000 118949.6500 1.3006
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Number of Children (Unduplicated) With at Least One Service 386
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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 851 30503.500000 41639.1400 41622.0200
T 818 31647.750000 41661.4800 41661.4800
703 29306.750000 35649.0300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2372 91458.000000 118949.6500 83283.5000