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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

Reasonable Charges Data Tables

Reasonable Charges Data Sources

VA Medical Facility Locations

Third Party Pharmacy Prescription Administrative Charge

Average national administrative costs prescriptions for CY2014 through CY2017 can be viewed at Average Administrative Cost for Prescriptions.

Cost-Based and Interagency Rates