CMS/EIP Fiscal Report Center: 55
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:TPIN
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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 23 33.749469 2531.2100 75.0000
Subtotal (Total Children Is Unduplicated) 23 33.749469 2531.2100 75.0000
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 8.000000 400.0000 50.0000
Subtotal (Total Children Is Unduplicated) 2 8.000000 400.0000 50.0000
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Total 41.749469 2931.2100 70.2095
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Number of Children (Unduplicated) With at Least One Service 24
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Center 55
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
34 41.749469 2931.2100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 34 41.749469 2931.2100 0.0000