Billable Services

Medical service fees include office and telehealth visits with Health Service Physicians, Physician Assistants and Nurse Practitioners.   

• Office Visit (Registered, Paid Health Access Fee) - $0 per visit
• Office Visit (Not Enrolled, Not Paying Health Access Fee) -  $112.00 per term - This Fee Has Temporarily Been Waived
• Office Visit (Part-Time, Not Paying Health Access Fee) - $112.00 per term - This Fee Has Temporarily Been Waived
• Athletic Physical - $115.00 per physical
• DOT, Employment, Peace Corps and Pre-op physicals - $130.00 per physical
• No Show Fees
  • $10.00 for each missed Primary Care appointment
  • $10.00 for each missed Specialty Clinic appointment
  • $25.00 for each missed employee DOT appointment 

Please Note:

• No Show Policy, a $10.00 no show fee will be billed to the student's fees and fines account through the Dartmouth Card Office for each scheduled Primary Care Appointment that is not cancelled prior to the scheduled appointment time, or when a patient arrives more than 5 minutes late for a medical assistant appointment, or more than 10 minutes late to a primary care appointment.

Counseling service fees include office, telehealth and phone visits with Health Service psychologists, psychiatrists, social workers, licensed mental health counselors, psychiatric residents, and psychology interns.

• Office Visit (Registered, Paid Health Access Fee) - $0 per session
• Office Visit (Not Enrolled, Not Paying Health Access Fee) - $112.00 per term - This Fee Has Temporarily Been Waived
• Office Visit (Part-time, Not Paying Health Access Fee) - $112.00 per term - This Fee Has Temporarily Been Waived

• Chicken Pox (Varivax/Varicella) - $224.00
  • Diagnosis:  Z23  
  • Procedure:  90716  
• Hepatitis A (Havrix) - $94.00 
  • Diagnosis:  Z23  
  • Procedure:  90632
• Hepatitis B (Engerix, 3 doses) - $60.00 
  • Diagnosis:  Z23  
  • Procedure:  90746
• Hepatitis B (Heplisav-B, 2 doses) - $163.00
  • Diagnosis:  Z23  
  • Procedure: 90739
• HPV (Gardasil 9) - $376.00
  • Diagnosis:  Z23  
  • Procedure: 90651
• Japanese Encephalitis - $468.00 
  • Diagnosis:  Z23  
  • Procedure: 90738
• Measles/Mumps/Rubella (MMR) - $115.00 
  • Diagnosis:  Z23  
  • Procedure:  90707
• Meningococcal (Bexsero) - $222.00
  • Diagnosis:  Z23  
  • Procedure: 90620
• Meningococcal (Menquadfi) - $210.00
  • Diagnosis:  Z23  
  • Procedure: 90619
• Pneumonia (Pneumococcal) - $192.00  
  • Diagnosis:  Z23  
  • Procedure: 90732
• Polio (Poliovax) - $53.00 
  • Diagnosis:  Z23  
  • Procedure: 90713
• PPD (Tuberculosis) - $24.00 
  • Diagnosis:  Z11.1  
  • Procedure:  86580
• Rabies (Imovax) - $545.00 
  • Diagnosis:  Z23  
  • Procedure: 90687
• Rabies (Rabavert) - $380.00 
  • Diagnosis:  Z23  
  • Procedure: 90685
• Tetanus Diphtheria (Tetanus Diphtheria) - $49.00
  • Diagnosis:  Z23  
  • Procedure: 90714
• Tetanus Diphtheria & Pertussis (Tetanus Diphtheria & Pertussis) - $49.00 
  • Diagnosis:  Z23  
  • Procedure: 90715
• Typhoid (Typhim) - $174.00  
  • Diagnosis:  Z23  
  • Procedure: 90691
• Yellow Fever - $275.00
  • Diagnosis:  Z23  
  • Procedure: 90717

Immunization fees are per dose and some require more than one dose. 

• IUD (Liletta) - $852.00  
• IUD (Paragard) - $1,400.00
• IUD (Kyleena) - $1,374.00
• IUD (Skyla) - $1,243.00
• IUD (Insertion Only) - $533.00
  • IUD purchased through prescription plan
• Etonogestrel Implant (Nexplanon) - $1,677.00

• Cane Deposit - $22.00  ($17.00 will be credited when item returned)
• Crutch Deposit - $29.00  ($24.00 will be credited when item returned)
• Copy Of Medical Record - $15.00 per copy
• Copy Of X-Ray - $12.00 per copy
• Allergy Injection - $10.00 for single injection per visit
• Allergy Injections - $15.00 for two or more injections per visit

• Signature only - $0
• Moderate complexity - $20.00 per form
• Complex - $50.00 per form

Any lab that is not paid for by the Dartmouth College Health Service (Dick's House) will be billed directly to the patient by the Dartmouth-Hitchcock Medical Center who processes the specimens.

Health Service Eligibility Program (HSEP)

• $112.00 per term - This Fee Has Temporarily Been Waived
• Subject to same fee for service schedule as full time registered students paying the Health Access Fee.

HSEP – Full Time Students

All Dartmouth students who are classified as active in the student information system are eligible to receive services at the Health Service.

• Students who are registered for classes and paying the health access fee (HAF) are able to be seen at the Health Service with most services being free of charge. 
• Students who receive services at the Health Service during a term when they are not attending classes or paying the health access fee will be charged for, and enrolled into, the Health Service Eligibility Program (HSEP) for the term. 
  • The HSEP fee will be equivalent to the HAF the student would have paid if registered for classes. 
  • Students enrolled in the HSEP receive the same Health Service access as students paying the HAF and are subject to the same billable services.

A listing of Health Service billable services and the associated fee is available on the Health Service website located at https://students.dartmouth.edu/health-service/.

HSEP – Part Time Students

All Dartmouth students who are classified as active in the student information system are eligible to receive services at the Health Service.

• Students who are registered for classes and paying the health access fee (HAF) are able to be seen at the Health Service with most services being free of charge. 
• Students who receive services at the Health Service during a term when they are enrolled in one class and not paying the health access fee will be charged for, and enrolled into, the Health Service Eligibility Program (HSEP) for the term. 
  • The HSEP fee will be equivalent to the HAF the student would have paid if registered for classes. 
  • Students enrolled in the HSEP receive the same Health Service access as students paying the HAF and are subject to the same billable services.

A listing of Health Service billable services and the associated fee is available on the Health Service website located at https://students.dartmouth.edu/health-service/.

Health Service Spouse and Domestic Partner Primary Care Program

• $615.00 per term
• Must meet Dartmouth's insurance requirements.

Health Service Spouse & Domestic Partner Primary Care Program Application

All billable service fees will automatically be posted to the student's tuition account if not paid for at the time of service with a check or credit card.  Charges posted to a student's tuition account do not state the service or treatment provided as that information is confidential and cannot be released without the patient's written consent. 

We are unable to submit claims to insurance companies; however, upon written request of the patient, an invoice will be provided which may be submitted to his/her health plan for reimbursement -- please send a request to Patient Accounts.

If you are a member of the Dartmouth Student Group Health Plan (DSGHP), most of the billable services will be submitted to the Plan directly for you through a secure portal by the Patient Accounts Office.  A few weeks later the DSGHP Office here on campus will post a "DSGHP Reimbursement" payment to your student tuition account where the charge was posted.  DSGHP reimburses 100% of the following charges when received at the College Health Service:

• Athletic Physicals
• DOT Physicals
• Immunizations
• Birth Control Devices

 The DSGHP does not cover or reimburse the following charges at the Health Service:

• Form Completions
• Cane or Crutch Fees
• X-ray Copy Fees
• Medical Record Copy Fees
• No Show Fees 

If you have waived enrollment into the DSGHP, keeping your own health plan, the Health Service will be an out of network provider and unable to submit claims directly to your health plan on your behalf.  However, the Patient Accounts Office can, at the patient's request, provide an invoice that the patient may submit to their health plan for possible reimbursement.  The amount of the reimbursement, if any, will be determined by your plans terms and conditions.  If you have an outside plan and need a billable service, e-mail or call the Patient Accounts Office to go over the billing prior to receiving the service.