CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 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-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 20.8400 10.4200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 43.6800 21.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 45.8000 22.9000
EXIT-EXIT-EXIT ASSESSMENT 2 3.500000 175.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 3.000000 166.5000 55.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 11.500000 862.5000 75.0000
Subtotal (Total Children Is Unduplicated) 14 26.000000 1425.3200 54.8200
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 25 19.500000 975.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 211 272.500000 13625.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 12 5.500000 137.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 25 90.450000 4522.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 454 2184.000000 21840.0000 10.0000
TRAV-TRAVS-Travel by mile 352 23853.00000 10617.7200 0.4451
Subtotal (Total Children Is Unduplicated) 456 26425.95000 51742.7200 1.9580
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Total 26451.950000 53168.0400 2.0100
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Number of Children (Unduplicated) With at Least One Service 457
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Center 53
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 1908 10236.950000 23928.3900 23928.3900
T 2115 13196.750000 23740.4900 23740.4900
417 3018.250000 5499.1600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4440 26451.950000 53168.0400 47668.8800