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
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) 6 6.000000 73.4700 12.2450
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 41.3000 8.2600
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.000000 27.1800 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 4 4.000000 97.7700 24.4425
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 59.6900 19.8967
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 10 14.000000 1050.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 10.000000 555.0000 55.5000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
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 9 15.081231 1131.0923 75.0000
Subtotal (Total Children Is Unduplicated) 36 70.081231 3709.0023 52.9243
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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 32 152.866200 7643.3100 50.0000
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 35338.36620 55846.9100 1.5803
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Total 35408.447431 59555.9123 1.6820
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Number of Children (Unduplicated) With at Least One Service 429
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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 3338 27265.447431 42405.0923 42405.0900
1278 8143.000000 17150.8200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4616 35408.447431 59555.9123 42405.0900