CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 Page: 1
Agency Filter:EXT
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 9 9.000000 97.2900 10.8100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 21 21.000000 256.0300 12.1919
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 23 24.000000 292.6200 12.1925
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 22 23.000000 533.7200 23.2052
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 49.7300 49.7300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 97.1900 24.2975
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 9 9.000000 393.2900 43.6989
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 1.000000 125.0000 125.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 5.000000 250.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 5 8.750000 487.5000 55.7143
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 1.000000 55.5000 55.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 8.321600 624.3700 75.0300
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.500000 187.5000 75.0000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 3 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 67 110.670000 8300.9200 75.0061
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 22.186700 1663.9300 74.9967
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 40 65.160000 4850.0000 74.4322
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 6.500000 487.5000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 48.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 47 45.392160 2201.5997 48.5017
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 3 1.500000 81.2300 54.1533
PSTH-97001-EVAL BY LICENSED PT, INITIAL 33 31.500000 1528.5000 48.5238
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 1.000000 29.7600 29.7600
SPCH-92506-SPEECH EVAL BY LICENSED SLP 95 99.920000 4898.8200 49.0274
Subtotal (Total Children Is Unduplicated) 296 511.400460 28069.2497 54.8870
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 47.000000 11431.4400 243.2221
AUD-HA_FUP-AUDIOLOGY SERVICES 3 5.000000 166.3800 33.2760
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 7.000000 350.0000 50.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 3.000000 150.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 1.500000 75.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 1.000000 50.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.250000 6.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 4.750000 237.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 105 404.580000 20212.2700 49.9586
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 10.000000 500.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 515 2211.360190 153106.1090 69.2362
OCCT-97530HM-OT SESSION BY OT ASST 38 124.193769 6768.2500 54.4975
PHY-97110-PT SESSION BY LICENSED PT 591 2619.854695 175604.6197 67.0284
PHY-97110HM-PT SESSION BY PT ASST 16 56.000000 3041.9200 54.3200
SENS-V5014-HEARING AID REPAIR BY MANUFACTURER 1 5.000000 211.5300 42.3060
SENS-V5264-EARMOLD 2 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1014 4320.175547 297341.1800 68.8262
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 25 85.500000 4644.3600 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 17 44.250000 584.1000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 13 1376.000000 651.8000 0.4737
Subtotal (Total Children Is Unduplicated) 1735 11328.41420 675168.7087 59.5996
-----------------------------------------------------------------------------------------------------------------------
Total 11839.814661 703237.9584 59.3960
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1876
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 1 1.000000 67.8800 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
841 868.990000 59468.8500 0.0000
Other 499 432.750000 28598.1600 0.0000
---------------------------------------------------------
Total 1341 1302.740000 88134.8900 0.0000
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
13 22.000000 1620.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13 22.000000 1620.7500 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6 6.000000 407.2800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6 6.000000 407.2800 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 7 26.000000 1300.0000 1300.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 181 467.000000 30956.9200 30732.8200
---------------------------------------------------------
Total 188 493.000000 32256.9200 32032.8200
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
346 238.869720 13389.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 346 238.869720 13389.3000 0.0000
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 20 12.500000 848.5000 848.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1240 882.250000 63130.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1260 894.750000 63978.5500 848.5000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 34 125.500000 7571.3000 7571.3000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
147 735.750000 23711.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 181 861.250000 31282.5700 7571.3000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 36 27.750000 1883.6700 2174.9900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1164 1781.000000 121026.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1200 1808.750000 122910.4500 2174.9900
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1125 1876.000000 124562.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1125 1876.000000 124562.4600 0.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 38 311.500000 5358.2600 5358.2200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
134 278.750000 22441.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 172 590.250000 27800.0500 5358.2200
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 4 9.000000 575.1600 575.1600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
300 645.698226 41709.6923 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 304 654.698226 42284.8523 575.1600
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
481 376.960510 24891.6497 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 481 376.960510 24891.6497 0.0000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
329 1295.080000 40892.7864 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 329 1295.080000 40892.7864 0.0000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
937 674.966205 45175.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 937 674.966205 45175.2900 0.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 7 7.500000 489.7200 489.7200
D 0 0.000000 0.0000 0.0000
S 3 3.000000 184.2600 184.2600
H 0 0.000000 0.0000 0.0000
T 6 8.000000 454.9000 454.9000
319 724.000000 42392.3000 32855.1600
Other 2 2.000000 128.9800 128.9800
---------------------------------------------------------
Total 337 744.500000 43650.1600 34113.0200