CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 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 6 6.000000 89.5800 14.9300
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 6 6.000000 62.5200 10.4200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 6 6.000000 52.5000 8.7500
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 6.000000 131.0400 21.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 91.6000 22.9000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 15 16.000000 765.7500 47.8594
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 6.000000 306.3000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 26 27.000000 1378.3500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 51 81.000000 3081.8400 38.0474
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 199 171.250000 8562.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 7 5.500000 137.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 315 337.000000 16850.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 26 26.000000 650.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 6.500000 325.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 3.000000 150.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 24 20.000000 1000.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.250000 6.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1390 12953.75000 647687.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1534 17282.00000 172820.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 187 1129.500000 79459.1400 70.3490
OCCT-97530HM-OT SESSION BY OT ASST 8 30.500000 1401.4000 45.9475
PHY-97110-PT SESSION BY LICENSED PT 221 1371.500000 93907.8800 68.4709
PHY-97110HM-PT SESSION BY PT ASST 2 5.500000 314.3800 57.1600
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 283 1887.000000 132896.2600 70.4273
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.500000 85.8000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 2 5.000000 69.4000 13.8800
Subtotal (Total Children Is Unduplicated) 1685 35238.25000 1156371.5100 32.8158
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Total 35319.250000 1159453.3500 32.8278
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Number of Children (Unduplicated) With at Least One Service 1687
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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 8653 25331.500000 640520.0400 640520.0400
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
3065 9987.750000 518933.3100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 11718 35319.250000 1159453.3500 640520.0400