CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2019 ending 06/30/2019 Date of Report:07/21/2019 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) 1 1.000000 13.8700 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 9.0800 9.0800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 27.8300 27.8300
EXIT-EXIT-EXIT ASSESSMENT 4 4.500000 225.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 0.500000 37.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
Subtotal (Total Children Is Unduplicated) 13 19.500000 1058.7800 54.2964
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 17 11.250000 562.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 221 255.000000 12737.5000 49.9510
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 32 219.500000 10975.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 571 3103.000000 31030.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 30.000000 2143.2000 71.4400
TRAV-TRAVS-Travel by mile 530 45693.00000 20326.9600 0.4449
Subtotal (Total Children Is Unduplicated) 571 49313.75000 77825.1600 1.5782
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Total 49333.250000 78883.9400 1.5990
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Number of Children (Unduplicated) With at Least One Service 572
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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 1 1.000000 10.0000 9.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3935 27459.500000 48612.6500 48612.6500
T 0 0.000000 0.0000 0.0000
2634 21872.750000 30261.2900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6570 49333.250000 78883.9400 48621.9000