CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2017 ending 06/30/2017 Date of Report:08/05/2017 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
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 11.000000 825.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 9.000000 499.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 2.251822 168.8867 75.0000
Subtotal (Total Children Is Unduplicated) 21 22.251822 1493.3867 67.1130
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 10 5.000000 250.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.750000 18.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 199 201.000000 10050.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 11 5.500000 137.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 20 88.750000 4437.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 503 2946.500000 29465.0000 10.0000
TRAV-TRAVS-Travel by mile 436 43208.00000 19230.5000 0.4451
Subtotal (Total Children Is Unduplicated) 506 46455.50000 63589.2500 1.3688
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Total 46477.751822 65082.6367 1.4003
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Number of Children (Unduplicated) With at Least One Service 506
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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 5935 46476.501822 65060.1367 65060.1400
2 1.250000 22.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5937 46477.751822 65082.6367 65060.1400