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
Payclass Filters:GR
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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 6 6.000000 291.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 61.0000 30.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 7 7.000000 319.5000 45.6429
Subtotal (Total Children Is Unduplicated) 29 90.000000 1761.9500 19.5772
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 41.000000 8551.7700 208.5798
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 184 2034.250000 101712.5000 50.0000
INTR-INTR-INTERPRETER 2 12.000000 600.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 101 507.000000 33691.1200 66.4519
OCCT-97530HM-OT SESSION BY OT ASST 13 56.000000 3013.6600 53.8154
PHY-97110-PT SESSION BY LICENSED PT 146 620.750000 40810.7800 65.7443
PHY-97110HM-PT SESSION BY PT ASST 1 1.500000 81.4800 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 212 1105.500000 74249.8200 67.1640
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 19 62.000000 3367.8400 54.3200
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 690 178210.0000 89105.0000 0.5000
Subtotal (Total Children Is Unduplicated) 821 182967.5000 368002.7200 2.0113
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Total 183057.500000 369764.6700 2.0199
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Number of Children (Unduplicated) With at Least One Service 827
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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 4715 183057.500000 369764.6700 369764.6700
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4715 183057.500000 369764.6700 369764.6700