CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2022 ending 06/30/2022 Date of Report:08/08/2022 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-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 28.7200 28.7200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 13.7100 13.7100
AUDE-92652-AEP THRSHLD EST MLT FREQ I&R 1 1.000000 74.6000 74.6000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
Subtotal (Total Children Is Unduplicated) 11 23.500000 1323.0300 56.2991
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 1219.1900 1219.1900
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 4.750000 237.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 1.000000 50.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 8 8.000000 400.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 6 8.000000 400.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 27 128.000000 6400.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 25 89.250000 4462.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 246 946.000000 9460.0000 10.0000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 32 26.000000 962.0000 37.0000
TRAV-TRAVS-Travel by mile 239 14497.00000 6449.2100 0.4449
Subtotal (Total Children Is Unduplicated) 273 15712.00000 30140.4000 1.9183
-----------------------------------------------------------------------------------------------------------------------
Total 15735.500000 31463.4300 1.9995
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 281
-----------------------------------------------------------------------------------------------------------------------
Center 53
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 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 869 6195.500000 12548.5100 12548.5100
1280 9540.000000 18914.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2149 15735.500000 31463.4300 12548.5100