CMS/EIP Fiscal Report Center: 57
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:OTHER
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
ECE-ECE-EARLY CHILDHOOD EDUCATION 1 120.000000 120.0000 1.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 4.000000 200.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 10.500000 712.7400 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 3 6.000000 325.9200 54.3200
PHY-97110-PT SESSION BY LICENSED PT 2 4.750000 322.4300 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 14.500000 984.2600 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 0.500000 27.1600 54.3200
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 39 3005.000000 1554.5000 0.5173
Subtotal (Total Children Is Unduplicated) 50 3167.250000 4347.0100 1.3725
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Total 3167.250000 4347.0100 1.3725
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Number of Children (Unduplicated) With at Least One Service 50
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Center 57
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
103 3060.500000 3022.5400 0.0000
Other 15 106.750000 1324.4700 1324.4700
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Total 118 3167.250000 4347.0100 1324.4700