Services rendered as self-pay can be accepted as cash, personal check, or credit card due at the time of the appointment. We are not using any insurance products at this time. You may check with your insurance to see if they will reimburse upon submission of a ‘Superbill.’
Credit card transactions: For each credit card transaction, we add a small percentage to your total (usually around 3%) to cover the cost of Square, our third-party credit card transaction provider.
| Code | Description | Charge |
|---|---|---|
| 90792 | Psychiatric Diagnostic Evaluation - 90 minutes | $300.00 |
| 99205 | Psychiatric Diagnostic Evaluation w/ Medication Evaluation - 90 minutes | $375.00 |
| 90833/ 99214 | Individual Therapy w/ Medication management - 60 Minutes | $180.00 |
| 90834 | Individual Therapy w/ Medication Management w/ Client or Family - 60 minutes | $235.00 |
| 90880 | Hypnotherapy - 60 minutes | $150.00 |
| 90880/ 99214 | Hypnotherapy with Medication management - 90 minutes | $180.00 |
| 90853 | Group Therapy Session - 90 minutes | $125.00 |
| 90853/ 99213 | Group Therapy Session w/ Ketamine - 180 minutes | $350.00 |
| 99213 | Office/Outpatient Visit, Simple (Established Clients) - 20 minutes | $100.00 |
| 99214 | Office/Outpatient Visit, Medication Management (Established Clients) - 30 minutes | $125.00 |
| 99215 | Office/Outpatient Visit, Complex (Established Clients) - 60 minutes | $250.00 |
| 99441 | Phone/Text/Email visit (other than scheduling or brief chats) | $50.00 |
| No Code | Ketamine Assisted Therapy - 180 minutes | $860.00 |
| No Code | Ketamine Assisted Therapy Package - 3 Sessions | $2460.00 |
| No Code |
Late Appointment Cancellation (less than 24 hours notice)
- 1st Late cancellation - 2nd Late cancellation - 3rd+ late cancellation |
$0.00
$15.00 $25.00 |
| No Code |
"No Show" (missed appointment without cancellation)
- 1st no show - 2nd no show -3rd+ no show (up to half of session fee charge but no less than $75) |
$25.00
$50.00 $75.00 |
| No Code | Official Paperwork Request (Evaluation Letters, FMLA, etc.) | $100.00 |
Please print, fill out, and bring or send these forms to your first patient visit. If information has changed, please repeat this process.
If you have a full green bottle, please pay 100% of the fees for service, if you have a ¾ full green bottle, please pay 80% of the fees for service, if you have ½ full green bottle, please pay 60% and if your green bottle is ¼ full, please pay 40% of the service fees.
This scale can be applied to the service fees for a fully established person for follow up work and not to the initial evaluation service fees.