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Payer Rates and Charges

Reasonable Charges are based on amounts that third parties pay for the same services furnished by private-sector health care providers in the same geographic area. In the past, VA used average cost-based, per diem rates for billing insurers. Reasonable charges are calculated for inpatient and outpatient facility charges, and for professional or clinician charges for inpatient and outpatient care.

Reasonable Charges Rules, Notices, & Federal Register (PDF | Web)
Reasonable Charges Data Tables (Excel)

v4.23 Inpatient Reasonable Charges (October 2022–December 2023)

V4.225 Outpatient Reasonable Charges (January 2022–December 2022)

v4.22 Inpatient Reasonable Charges (October 2021–September 2022)

V4.215 Outpatient Reasonable Charges (January 2021–December 2021)

v4.21 Inpatient Reasonable Charges (October 2020–September 2021)

Reasonable Charges Data Sources (Excel & PDF)
VA Medical Facility Locations (PDF)
Cost-Based and Interagency Rate (PDF | Web)
  • Cost-Based and Interagency Federal Register Notice, 10/01/22 (PDF | WEB)
  • Cost-Based and Interagency Federal Register Notice, 10/01/21 (PDF | WEB)
  • Cost-Based and Interagency Federal Register Notice, 10/01/20 (PDF | WEB)
  • Cost-Based and Interagency Federal Register Notice, 10/01/19 (PDF | WEB)
  • Cost-Based and Interagency Federal Register Notice, 08/28/18 (PDF | WEB)
  • Cost-Based and Interagency Federal Register Notice, 08/29/17 (PDF | WEB)

Third Party Pharmacy Prescription Administrative Charge

Average national administrative cost for prescriptions for CY 2014 through CY 2022 can be viewed at Average Administrative Cost for Prescriptions.

Average Administrative Cost for Prescriptions