CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 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-92555-SPEECH AUD THRESHOLD (DETECTION) 6 6.000000 73.4700 12.2450
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 6 6.000000 49.5600 8.2600
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 4 4.000000 36.2400 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 6.000000 148.3900 24.7317
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 78.2400 19.5600
EXIT-EXIT-EXIT ASSESSMENT 1 1.500000 75.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 31.500000 2362.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 13.500000 1012.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 31.000000 1720.5000 55.5000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 20 37.500000 2081.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 44 75.000031 5625.0023 75.0000
Subtotal (Total Children Is Unduplicated) 94 223.500031 13825.1523 61.8575
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 2191.7600 1095.8800
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 22 14.250000 712.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 203 175.000000 8737.5000 49.9286
CONIP-CONIP-CONSULT, ITDS PHONE 7 5.250000 131.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 276 1570.250000 78450.0000 49.9602
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 425 2186.000000 21830.0000 9.9863
TRAV-TRAVS-Travel by mile 362 32802.00000 14575.5900 0.4444
Subtotal (Total Children Is Unduplicated) 427 36755.75000 126653.6000 3.4458
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Total 36979.250031 140478.7523 3.7989
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Number of Children (Unduplicated) With at Least One Service 430
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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 0 0.000000 0.0000 0.0000
T 3342 27270.447431 42705.0923 42705.0900
2797 9708.802600 97773.6600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6139 36979.250031 140478.7523 42705.0900