CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:MED
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
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 1 2.000000 102.1000 51.0500
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EI Services,Class #03
AUD-92633-AUD REHAB POSTLING HEARING LOSS 1 2.000000 143.2200 71.6100
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 18 45.000000 2250.0000 50.0000
Subtotal (Total Children Is Unduplicated) 19 47.000000 2393.2200 50.9196
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Total 49.000000 2495.3200 50.9249
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Number of Children (Unduplicated) With at Least One Service 20
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Center 07
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
20 49.000000 2495.3200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 20 49.000000 2495.3200 0.0000