Dr. Fontaine Fees — Brookside anxiety

GOOD FAITH ESTIMATE & TABLE OF SERVICES AND FEES

This Good Faith Estimate explains your therapist’s rate for each service provided. Your therapist will collaborate with you throughout your treatment to determine how many sessions and/or services you may need to receive the greatest benefit based on your diagnosis(es)/presenting clinical concerns.

Please note that Place of Service (in office vs. telehealth) is not delineated above since the charges are identical.

90791 Initial Diagnostic Evaluation - $375

90834 Psychotherapy, 45-50 minutes - $185

90832 Psychotherapy, 20-25 minutes - $93

90837 Psychotherapy ≥ 60 minutes Prorated based on the amount of time spent at hourly rate ($20 per 5 min increments)

90839 Psychotherapy for a Crisis (requested within 48 hours with no regular availability) Prorated based on the amount of time spent at hourly rate ($30 per 5 min increments)

+90840 Psychotherapy for a Crisis (add on code for each additional 30 mins) Prorated based on the amount of time spent at hourly rate ($30 per 5 min increments)

90846 Family Psychotherapy without Patient Present, 50 minutes - $185

90847 Family Psychotherapy with Patient Present, 50 minutes - $185

90853 Group Psychotherapy - Price Varies based on group

98966-98968 Telephone Assessment & Management Prorated based on the amount of time spent at hourly rate ($20 per 5 min increments)

98970-98972 Online Digital Evaluation & Mgt (Responding to Email & Text Messages) Prorated based on the amount of time spent at hourly rate ($20 per 5 min increments)

Cancelation Fee (Your Therapist Requires a 24-Hour Cancelation Fee) $50 first time, full session fee for subsequent

Production of Records Prorated based on the amount of time spent at hourly rate ($20 per 5 min increments)

Legal Fees - $375 per hour