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
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 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 14 14.000000 687.1000 49.0786
PSTH-97001-EVAL BY LICENSED PT, INITIAL 5 5.000000 255.2500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 21 21.000000 1072.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 42 70.000000 2543.7400 36.3391
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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 420 4060.000000 203000.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1534 17282.00000 172820.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 145 788.250000 55582.0100 70.5132
OCCT-97530HM-OT SESSION BY OT ASST 8 24.500000 1161.4000 47.4041
PHY-97110-PT SESSION BY LICENSED PT 175 897.750000 61732.9600 68.7641
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 248 1635.000000 115844.8200 70.8531
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.500000 85.8000 57.2000
Subtotal (Total Children Is Unduplicated) 1684 25261.00000 637956.7400 25.2546
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Total 25331.000000 640500.4800 25.2852
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Number of Children (Unduplicated) With at Least One Service 1686
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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 8652 25331.000000 640500.4800 640500.4800
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 8652 25331.000000 640500.4800 640500.4800