CMS/EIP Fiscal Report Center: 04
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:LEA
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
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 1 1.000000 51.0500 51.0500
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 69 2290.000000 57250.0000 25.0000
PHY-97110-PT SESSION BY LICENSED PT 3 1.500000 107.1600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 17 15.000000 857.4000 57.1600
SPL-92508-GROUP SPL SESSION PER CHILD 5 2.250000 31.2300 13.8800
Subtotal (Total Children Is Unduplicated) 69 2308.750000 58245.7900 25.2283
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Total 2309.750000 58296.8400 25.2395
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Number of Children (Unduplicated) With at Least One Service 69
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Center 04
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
114 2309.750000 58296.8400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 114 2309.750000 58296.8400 0.0000