CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 Page: 1
List order: No List
Payclass Filters:LEA
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 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 1 1.000000 51.0500 51.0500
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 13 311.000000 7775.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 10 95.000000 4750.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 81 204.000000 14573.7600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 67 158.000000 9037.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 13 18.750000 1339.5000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 49 118.750000 6787.7500 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 64 99.500000 7108.2800 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 105 276.500000 15815.8000 57.2000
Subtotal (Total Children Is Unduplicated) 157 1281.500000 67187.6900 52.4289
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Total 1282.500000 67238.7400 52.4279
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Number of Children (Unduplicated) With at Least One Service 157
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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
624 1282.500000 67238.7400 67238.7400
Other 0 0.000000 0.0000 0.0000
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Total 624 1282.500000 67238.7400 67238.7400