CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
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 17 17.000000 201.6200 11.8600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 17 17.000000 140.7600 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 16 16.000000 166.0800 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 16 16.000000 337.2800 21.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 9 9.000000 244.7100 27.1900
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 2.500000 125.0000 50.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 17 18.000000 873.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 5 6.000000 242.5000 40.4167
SPCH-92506-SPEECH EVAL BY LICENSED SLP 14 15.000000 679.0000 45.2667
Subtotal (Total Children Is Unduplicated) 49 116.500000 3009.9500 25.8365
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 49.000000 9467.5900 193.2161
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 130 137.000000 6850.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.500000 12.5000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 17 9.250000 462.5000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 7 2.500000 62.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 23 18.250000 912.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 11 5.250000 131.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 4.250000 212.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 7 3.000000 75.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 35 26.500000 1325.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 16 6.000000 150.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 21 105.000000 2625.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 457 4708.250000 235412.5000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 8 28.500000 1425.0000 50.0000
INTR-INTR-INTERPRETER 2 12.000000 600.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 254 1184.000000 79487.4800 67.1347
OCCT-97530HM-OT SESSION BY OT ASST 31 106.500000 5656.5400 53.1131
PHY-97110-PT SESSION BY LICENSED PT 429 1721.500000 114959.9300 66.7789
PHY-97110HM-PT SESSION BY PT ASST 5 9.500000 516.0400 54.3200
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 3.000000 150.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 441 2165.250000 146094.7300 67.4725
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 33 95.000000 5160.4000 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.2000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 690 178230.0000 89115.0000 0.5000
Subtotal (Total Children Is Unduplicated) 1032 188631.0000 700877.1600 3.7156
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Total 188747.500000 703887.1100 3.7293
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Number of Children (Unduplicated) With at Least One Service 1039
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Center 10
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 4716 183077.500000 369774.6700 369774.6700
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
2269 5670.000000 334112.4400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6985 188747.500000 703887.1100 369774.6700