Good Faith Estimate

Revive and Thrive Consulting, LLC · Kristen Vallely, LMFT

Your Right to a Good Faith Estimate
Under the No Surprises Act, you have the right to receive a Good Faith Estimate explaining how much your medical and mental health care will cost before you schedule a service. You are entitled to this estimate if you are uninsured or if you choose not to use your insurance.

Provider Information

Kristen Vallely, LMFT
Revive and Thrive Consulting, LLC
Telehealth · Arizona and Colorado
hello@kristenvallely.com

Estimated Costs for Common Services

The following estimates apply to clients who are uninsured or paying privately (out of pocket). These are good faith estimates, not a guarantee of final cost. Your actual cost may vary based on the services rendered.

Initial Consultation (90791) Individual intake assessment	$200
Initial Consultation (90847) Couples or family intake assessment	$300
Individual Therapy, 60 min (90837)	$185
Individual Therapy, 75 min (90837)	$185
Couples / Family Therapy, 60 min (90847)	$200
Couples / Family Therapy, 75 min (90847)	$250
Couples / Family Therapy, 90 min (90847)	$300
KAP Preparation / Integration Contact for current rates	Inquire

Important Notes

Individual therapy sessions may be covered by insurance when billed through Headway. Check your coverage at your Headway booking page.
Couples and family sessions are private pay only and are not covered by insurance.
KAP (Ketamine-Assisted Psychotherapy) preparation and integration sessions are private pay only.
A limited number of reduced fee spots are available. Please reach out directly if this applies to your situation.
This estimate does not include services from other providers you may see as part of your care (e.g., prescribers, laboratories).

Dispute Resolution

If you receive a bill that is at least $400 more than this estimate, you have the right to dispute the bill. For questions or to start a dispute, contact the U.S. Department of Health and Human Services at cms.gov/nosurprises or call 1-800-985-3059.

Good Faith Estimate

Provider Information

Estimated Costs for Common Services

Important Notes

Dispute Resolution

Questions