CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 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 46 48.000000 860.1600 17.9200
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 49 51.000000 643.1100 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 47 49.000000 404.7400 8.2600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 52 54.000000 1366.7400 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 23 23.000000 426.6500 18.5500
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 4 5.000000 103.4000 20.6800
AUDE-V5010-ASSESSMENT FOR HEARING AID 3 3.000000 135.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 4 7.000000 805.0000 115.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 8 8.000000 408.4000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 8.000000 408.4000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 78 265.000000 6021.0500 22.7209
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 9.000000 4027.0600 447.4511
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 235 212.500000 10625.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 9 7.250000 181.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 281 269.750000 13487.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 9 11.000000 275.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 27 26.500000 1325.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 61 60.250000 3012.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 372 358.250000 17912.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 12 12.000000 300.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 536 5562.750000 278137.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1729 20931.00000 209310.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 127 681.750000 48704.2200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 57.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 137 792.250000 56598.3400 71.4400
SENS-V5050-IN EAR MONAURAL HEARING AID 2 4.000000 912.0000 228.0000
SENS-V5264-EARMOLD 3 8.000000 144.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 216 1363.000000 97372.7200 71.4400
Subtotal (Total Children Is Unduplicated) 1877 30310.25000 742381.7900 24.4928
-----------------------------------------------------------------------------------------------------------------------
Total 30575.250000 748402.8400 24.4774
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1888
-----------------------------------------------------------------------------------------------------------------------
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 9896 30571.250000 748242.8400 748242.8400
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
3 4.000000 160.0000 60.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9899 30575.250000 748402.8400 748302.8400