Good Faith Estimate
The Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created, and does not include any unknown or unexpected costs that may arise during treatment.
Provider estimate for working with Kristin Dickie:
This is the cost of 55-minute individual session and frequency per month up until December 31, 2025
One month of services is the following: Weekly $900 Bi-weekly $450 Monthly $225
Two consecutive months: Weekly $1800 Bi-weekly $900 Monthly $450
Four consecutive months Weekly $3600 Bi-weekly $1800 Monthly $900
Six consecutive months: Weekly $5400 Bi-weekly $2700 Monthly $1350
This estimated list of charges does not include 90 minute sessions or other services such as intensives. This estimate also does not include no show or late cancellation fees. Sessions not canceled within 48 hours are subject to a cancellation fee of $225.
Provider estimate for working with Callie Ann Munson:
Below is cost per month for intake and 55 minute individual sessions:
Initial 90-Minute Assessment/Intake Session: $280
One month 55-minute individual sessions: Weekly $740 Bi-weekly $370 Monthly $185
Two consecutive months: Weekly $1480 Bi-weekly $740
6 consecutive months: Weekly $4,440 Bi-Weekly $2,220
1 year of consecutive sessions: Weekly $8,880 Bi-weekly $4,440
This estimated list of charges does not include other types of services such as 90 minute individual sessions or intensives. This estimated list also does not include no show or late cancellation fees. Sessions not canceled within 24 hours are subject to a cancellation fee of $185.
Provider estimate for working with Hannah Bennett-Chew:
This is the cost of 55 minute individual session based on frequency per month up until December 31, 2025
One month Weekly $640 Bi-weekly $320 Monthly $160
Two consecutive months: Weekly $1280 Bi-weekly $640 Monthly $320
Four consecutive months Weekly $2560 Bi-weekly $1280 Monthly $640
Six consecutive months: Weekly $3840 Bi-weekly $1920 Monthly $960
This estimated list of charges does not include other services such as 90 minute sessions or intensives. This estimate also does not include no show or late cancellation fees. Sessions not canceled within 48 hours are subject to a cancellation fee of $160.
Throughout your treatment, the provider may recommend additional items or services as part of your treatment that are not reflected in this estimate. These would need to be scheduled separately with your consent and the understanding that any additional service costs are in addition to the Good Faith Estimate. If your needs change during treatment, your provider should supply a new, updated Good Faith Estimate to reflect the changes to treatment, and the accompanying cost changes. You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. The Good Faith Estimate is not a contract between provider and client and does not obligate or require the client to obtain any of the listed services from the provider. You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount. To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call HHS at (800) 985-3059. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call (800) 985-3059. Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount.