Does Washington County Hospital publish its standard charges and chargemaster?

Yes. Washington County Hospital publishes a machine-readable file with 1,673 standard-charge rows — gross charges, cash prices, and payer-negotiated rates, earning a CMS price transparency compliance grade of A. Browse the negotiated rates by procedure and payer on this page.

How much does Washington County Hospital charge for procedures?

Washington County Hospital (Chatom, AL) publishes a separately negotiated rate for each insurance payer, plus a discounted cash price and a gross (list) charge, for every procedure in its price transparency file. This page compares each procedure's negotiated median against the national median so you can see whether a price is above or below market.

▸ Hospital · AL · CCN 011300

Washington County Hospital

Chatom, AL, 36518

15 bedsCritical Access Hospitals9

Compliance grade

97/100

Rates published

1,673

last crawl 2026-05-22

Procedures tracked

194

of 209 target codes

Payers

with negotiated rates

Procedures tracked

...

Payers

...

▸ Compare with other hospitals All AL hospitalsJSON

The report bundles all published codes × every payer rate + compliance grade as a downloadable PDF + CSV with a data-version manifest.

Source MRF: https://www.wchnh.org/docs/636003514_washington-county-healthcare-authority,-inc_standardcharges.json · JSON

Procedures & rates

vs nat'l shows this hospital's negotiated median against the national median for that code (green = at/below market, amber = 1–1.5×, red = >1.5× the national median).

Procedure	Type	Code	Payers	Gross	Cash	Neg min	Neg median	vs nat'l	Neg max
behavioral
Psychoses	MS-DRG	885	5	—	$850	$950	$1,288	0.10×	$2,160.69
Psychiatric diagnostic evaluation	CPT	90791	5	—	$54.17	$57	$80	0.45×	$838.62
Psychiatric eval with medical services	CPT	90792	5	—	$54.17	$57	$80	0.46×	$838.62
Psychotherapy 30 minutes	CPT	90832	5	—	$54.17	$57	$80	0.54×	$386.79
Psychotherapy 45 minutes	CPT	90834	5	—	$54.17	$57	$80	0.50×	$466.51
Psychotherapy 60 minutes	CPT	90837	5	—	$54.17	$57	$80	0.42×	$466.51
Crisis psychotherapy 60 minutes	CPT	90839	5	—	$54.17	$57	$80	0.50×	$466.51
emergency
ED visit level 1	CPT	99281	4	$205.98	$54.17	$117.4	$159.63	1.1×	$185.38
ED visit level 2	CPT	99282	4	$373.95	$54.17	$213.15	$289.81	1.2×	$336.55
ED visit level 3	CPT	99283	4	$657.3	$54.17	$374.66	$509.41	1.3×	$591.57
ED visit level 4	CPT	99284	4	$1,066.59	$54.17	$607.95	$826.61	1.2×	$959.93
ED visit level 5	CPT	99285	4	$1,562.55	$54.17	$890.65	$1,210.98	1.2×	$1,406.29
Critical care, first hour	CPT	99291	4	$2,078.04	$54.17	$1,184.48	$1,610.48	1.5×	$1,870.23
imaging
CT head without contrast	CPT	70450	5	$520.74	$54.17	$147.45	$372.3	1.8×	$468.66
CT head with contrast	CPT	70460	5	$891.45	$54.17	$207.05	$508.12	2.2×	$802.3
CT head with and without contrast	CPT	70470	5	$988.02	$54.17	$243.2	$563.17	2.1×	$889.21
CT neck with contrast	CPT	70491	5	$891.45	$54.17	$191.87	$508.12	1.9×	$802.3
MRI brain without contrast	CPT	70551	5	—	$54.17	$57	$90	0.22×	$7,955.52
MRI brain with contrast	CPT	70552	5	—	$54.17	$57	$90	0.19×	$7,955.52
MRI brain with and without contrast	CPT	70553	5	—	$54.17	$57	$90	0.15×	$7,955.52
Chest X-ray single view	CPT	71045	5	$186.36	$54.17	$32.92	$149.08	1.6×	$182.71
Chest X-ray 2 views	CPT	71046	5	$186.36	$54.17	$22.8	$74.45	0.76×	$182.71
Chest X-ray 3 views	CPT	71047	5	$186.36	$54.17	$53.72	$149.08	1.6×	$182.71
CT chest without contrast	CPT	71250	5	$520.74	$54.17	$185.39	$296.82	1.4×	$468.66
CT chest with contrast	CPT	71260	5	$891.45	$54.17	$191.87	$508.12	1.8×	$802.3
CT chest with and without contrast	CPT	71270	5	$988.02	$54.17	$191.87	$563.17	1.9×	$889.21
MRI chest without contrast	CPT	71550	5	—	$54.17	$57	$90	0.21×	$1,424.14
MRI chest with contrast	CPT	71551	5	—	$54.17	$57	$90	0.11×	$1,424.14
MRI chest with and without contrast	CPT	71552	5	—	$54.17	$57	$90	0.15×	$1,424.14
Lumbosacral spine X-ray	CPT	72100	5	$343.38	$54.17	$50.55	$195.72	1.9×	$309.04
CT cervical spine without contrast	CPT	72125	4	$520.74	$54.17	$181.46	$356.71	1.8×	$468.66
CT thoracic spine without contrast	CPT	72128	4	$520.74	$54.17	$181.02	$356.71	1.8×	$468.66
CT lumbar spine without contrast	CPT	72131	4	$520.74	$54.17	$180.59	$356.71	1.8×	$468.66
MRI cervical spine without contrast	CPT	72141	4	—	$54.17	$57	$85	0.21×	$288.69
MRI thoracic spine without contrast	CPT	72146	4	—	$54.17	$57	$85	0.23×	$288.22
MRI lumbar spine without contrast	CPT	72148	4	—	$54.17	$57	$85	0.23×	$289.15
MRI lumbar spine with and without contrast	CPT	72149	4	—	$54.17	$57	$85	0.19×	$408.65
MRI cervical spine with and without contrast	CPT	72156	4	—	$54.17	$57	$85	0.16×	$484.09
MRI lumbar spine with contrast	CPT	72158	4	—	$54.17	$57	$85	0.16×	$482.69
CT pelvis without contrast	CPT	72192	5	$520.74	$54.17	$185.88	$416.59	2.1×	$1,008.55
CT pelvis with contrast	CPT	72193	5	$891.45	$54.17	$307.58	$713.16	2.5×	$1,008.55
Shoulder X-ray	CPT	73030	5	—	$54.17	$43.7	$80	0.86×	$182.71
Humerus X-ray	CPT	73060	5	—	$54.17	$40.28	$80	0.89×	$182.71
Hand X-ray 3 views	CPT	73130	5	—	$54.17	$46.14	$80	0.86×	$182.71
MRI upper extremity joint without contrast	CPT	73221	5	—	$54.17	$57	$90	0.22×	$812.68
MRI upper extremity joint with and without contrast	CPT	73223	5	—	$54.17	$57	$90	0.15×	$812.68
Knee X-ray 1-2 views	CPT	73560	5	—	$54.17	$43.18	$80	0.86×	$182.71
Ankle X-ray 3 views	CPT	73610	5	—	$54.17	$46.55	$80	0.87×	$182.71
MRI lower extremity joint without contrast	CPT	73721	5	—	$54.17	$57	$90	0.19×	$812.68
MRI lower extremity joint with and without contrast	CPT	73723	5	—	$54.17	$57	$90	0.14×	$812.68
CT abdomen without contrast	CPT	74150	5	$520.74	$54.17	$192.14	$416.59	2.2×	$1,008.55
CT abdomen with contrast	CPT	74160	5	$891.45	$54.17	$315.63	$713.16	2.5×	$1,008.55
CT abdomen with and without contrast	CPT	74170	5	$988.02	$54.17	$324.24	$790.41	2.4×	$1,008.55
CT abdomen and pelvis without contrast	CPT	74176	5	$918.15	$54.17	$256.72	$734.52	2.0×	$1,008.55
CT abdomen and pelvis with contrast	CPT	74177	5	$1,447.74	$54.17	$430.42	$1,008.55	1.8×	$1,302.96
CT abdomen and pelvis with and without contrast	CPT	74178	5	$1,447.74	$54.17	$481.65	$1,008.55	1.8×	$1,302.96
MRI abdomen without contrast	CPT	74181	4	—	$54.17	$57	$85	0.22×	$296.02
MRI abdomen with and without contrast	CPT	74183	4	—	$54.17	$57	$85	0.15×	$513
Abdominal ultrasound complete	CPT	76700	5	$555.63	$54.17	$150.76	$353.03	2.4×	$500.06
Abdominal ultrasound limited	CPT	76705	5	$343.38	$54.17	$112.69	$274.7	1.9×	$353.03
Retroperitoneal ultrasound complete	CPT	76770	5	—	$54.17	$57	$90	0.63×	$353.03
Obstetric ultrasound first trimester	CPT	76801	5	$404	$54.17	$151.29	$323.2	2.3×	$363.6
Obstetric ultrasound after first trimester	CPT	76805	5	$404	$54.17	$173.28	$323.2	2.1×	$363.6
Obstetric ultrasound with fetal anatomy	CPT	76811	5	—	$54.17	$57	$90	0.38×	$324.42
Transvaginal ultrasound	CPT	76830	5	$343.08	$54.17	$153.45	$274.46	1.9×	$353.03
Pelvic ultrasound complete	CPT	76856	5	$343.38	$54.17	$136.03	$274.7	1.9×	$353.03
Scrotal ultrasound	CPT	76870	5	$343.38	$54.17	$129.54	$274.7	2.1×	$353.03
Diagnostic mammography unilateral	CPT	77065	5	$404.91	$54.17	$160.3	$230.79	1.5×	$364.41
Diagnostic mammography bilateral	CPT	77066	5	$477.45	$54.17	$161.54	$315.27	1.7×	$429.7
Screening mammography bilateral	CPT	77067	5	$400.92	$54.17	$71.25	$162.24	1.0×	$360.82
EKG complete	CPT	93000	5	—	$54.17	$57	$80	3.3×	$90
EKG tracing only	CPT	93005	5	$167.88	$54.17	$84.11	$125.91	1.1×	$151.09
EKG interpretation only	CPT	93010	5	—	$54.17	$57	$80	4.4×	$90
Transthoracic echocardiogram complete	CPT	93306	5	$1,460.07	$54.17	$832.23	$1,168.05	2.0×	$1,480.98
Transthoracic echocardiogram	CPT	93307	5	—	$54.17	$57	$80	0.32×	$1,480.98
Stress echocardiogram	CPT	93350	5	—	$54.17	$57	$80	0.16×	$1,480.98
inpatient
Respiratory infections & inflammations w MCC	MS-DRG	177	5	—	$850	$975	$2,160.69	0.14×	$3,129
COPD w MCC	MS-DRG	190	5	—	$850	$975	$2,160.69	0.19×	$3,129
COPD w CC	MS-DRG	191	5	—	$850	$975	$2,160.69	0.24×	$3,129
COPD w/o CC/MCC	MS-DRG	192	5	—	$850	$975	$2,160.69	0.31×	$3,129
Simple pneumonia & pleurisy w CC	MS-DRG	194	5	—	$850	$975	$2,160.69	0.25×	$3,129
Simple pneumonia & pleurisy w/o CC/MCC	MS-DRG	195	5	—	$850	$975	$2,160.69	0.32×	$3,129
AMI discharged alive w MCC	MS-DRG	280	5	—	$850	$975	$2,160.69	0.14×	$3,129
AMI discharged alive w CC	MS-DRG	281	5	—	$850	$975	$2,160.69	0.22×	$3,129
AMI discharged alive w/o CC/MCC	MS-DRG	282	5	—	$850	$975	$2,160.69	0.28×	$3,129
Heart failure & shock w MCC	MS-DRG	291	5	—	$850	$975	$2,160.69	0.17×	$3,129
Heart failure & shock w CC	MS-DRG	292	5	—	$850	$975	$2,160.69	0.24×	$3,129
Heart failure & shock w/o CC/MCC	MS-DRG	293	5	—	$850	$975	$2,160.69	0.35×	$3,129
Cardiac arrhythmia w MCC	MS-DRG	308	5	—	$850	$975	$2,160.69	0.18×	$3,129
Cardiac arrhythmia w CC	MS-DRG	309	5	—	$850	$975	$2,160.69	0.28×	$3,129
Cardiac arrhythmia w/o CC/MCC	MS-DRG	310	5	—	$850	$975	$2,160.69	0.35×	$3,129
GI hemorrhage w CC	MS-DRG	378	5	—	$850	$975	$2,160.69	0.22×	$3,129
GI hemorrhage w/o CC/MCC	MS-DRG	379	5	—	$850	$975	$2,160.69	0.32×	$3,129
Esophagitis/gastroenteritis w/o MCC	MS-DRG	392	5	—	$850	$975	$2,160.69	0.27×	$3,129
Fractures of femur w/o MCC	MS-DRG	533	5	—	$850	$975	$2,160.69	0.14×	$3,129
Kidney/UTI w MCC	MS-DRG	689	5	—	$850	$975	$2,160.69	0.19×	$3,129
Kidney/UTI w/o MCC	MS-DRG	690	5	—	$850	$975	$2,160.69	0.26×	$3,129
Septicemia or severe sepsis w MV 96+ hrs	MS-DRG	871	5	—	$850	$975	$2,160.69	0.12×	$3,129
Septicemia or severe sepsis w/o MV 96+ hrs	MS-DRG	872	5	—	$850	$975	$2,160.69	0.21×	$3,129
Initial hospital care, low complexity	CPT	99221	4	$283.59	$54.17	$146.39	$209.08	2.2×	$255.23
Initial hospital care, moderate complexity	CPT	99222	4	$386.88	$54.17	$220.52	$299.83	1.8×	$348.19
Initial hospital care, high complexity	CPT	99223	4	—	$54.17	$57	$77.5	0.34×	$90
Hospital discharge, <30 min	CPT	99238	4	$188.79	$54.17	$107.61	$146.31	1.7×	$169.91
Hospital discharge, >30 min	CPT	99239	4	—	$54.17	$57	$77.5	0.64×	$90
lab
Basic metabolic panel (BMP)	CPT	80048	5	$80	$54.17	$9.73	$42.59	1.3×	$72
General health panel	CPT	80050	5	—	$54.17	$26.51	$57	0.53×	$90
Electrolyte panel	CPT	80051	5	$41.52	$54.17	$8.06	$26.51	1.1×	$37.36
Comprehensive metabolic panel	CPT	80053	5	$62.58	$54.17	$12.14	$35.67	0.80×	$56.32
Lipid panel	CPT	80061	5	$49.8	$54.17	$15.4	$28.38	0.74×	$44.82
Renal function panel	CPT	80069	5	$51.39	$54.17	$9.98	$29.29	1.1×	$46.25
Hepatic function panel	CPT	80076	5	$80	$54.17	$9.4	$41.1	1.5×	$72
Urinalysis non-automated	CPT	81002	4	—	$54.17	$4	$68.5	9.8×	$90
Urinalysis automated	CPT	81003	4	—	$54.17	$2.59	$68.5	4.9×	$90
Glucose quantitative	CPT	82947	5	$23.22	$54.17	$4.52	$15.64	0.89×	$20.89
Hemoglobin A1c	CPT	83036	5	$54.45	$54.17	$11.17	$38.72	1.4×	$49
Thyroid stimulating hormone (TSH)	CPT	84443	5	$99.45	$54.17	$19.32	$56.68	1.2×	$89.5
Complete blood count with automated differential	CPT	85025	5	$45	$54.17	$8.94	$25.65	0.97×	$40.5
Complete blood count without differential	CPT	85027	5	$36	$54.17	$7.44	$20.52	0.95×	$32.4
Urine culture bacterial	CPT	87086	5	$47.79	$54.17	$9.28	$27.24	1.2×	$43.01
Urine culture identification	CPT	87088	5	—	$54.17	$9.3	$57	2.6×	$90
Tissue exam by pathologist level IV	CPT	88305	5	$144	$54.17	$30.71	$82.08	0.80×	$129.6
maternity
Fetal non-stress test	CPT	59025	5	—	$54.17	$57	$80	0.43×	$588.01
Routine obstetric care including vaginal delivery	CPT	59400	4	—	$54.17	$57	$77.5	0.03×	$90
Vaginal delivery only	CPT	59409	5	—	$54.17	$57	$80	0.04×	$6,928.28
Vaginal delivery with postpartum	CPT	59410	5	—	$54.17	$57	$80	0.08×	$6,928.28
Routine obstetric care with C-section	CPT	59510	4	—	$54.17	$57	$77.5	0.03×	$90
C-section delivery only	CPT	59514	4	—	$54.17	$57	$77.5	0.08×	$90
C-section with postpartum	CPT	59515	4	—	$54.17	$57	$77.5	0.06×	$90
office
Office visit, new patient, 15-29 min	CPT	99202	4	$221.04	$54.17	$125.99	$171.31	2.0×	$198.93
Office visit, new patient, 30-44 minutes	CPT	99203	4	$290.88	$54.17	$165.8	$225.43	1.8×	$261.79
Office visit, new patient, 45-59 min	CPT	99204	4	—	$54.17	$57	$77.5	0.45×	$90
Office visit, new patient, 60-74 min	CPT	99205	4	—	$54.17	$57	$77.5	0.35×	$90
Office visit, established patient, 5 min	CPT	99211	4	$170.31	$54.17	$14.97	$48.61	0.75×	$153.27
Office visit, established patient, 10-19 min	CPT	99212	4	$221.04	$54.17	$125.99	$171.31	2.1×	$198.93
Office visit, established patient, 20-29 minutes	CPT	99213	4	$221.04	$54.17	$125.99	$171.31	1.5×	$198.93
Office visit, established patient, 30-39 minutes	CPT	99214	4	—	$54.17	$57	$77.5	0.51×	$90
Office visit, established patient, 40-54 min	CPT	99215	4	—	$54.17	$57	$77.5	0.41×	$90
preventive
Upper GI endoscopy diagnostic	CPT	43235	5	—	$54.17	$57	$80	0.09×	$3,052.74
Upper GI endoscopy with biopsy	CPT	43239	5	—	$54.17	$57	$80	0.08×	$3,052.74
Sigmoidoscopy diagnostic	CPT	45330	4	—	$54.17	$57	$77.5	0.09×	$90
Sigmoidoscopy with biopsy	CPT	45331	4	—	$54.17	$57	$77.5	0.09×	$90
Colonoscopy diagnostic	CPT	45378	4	—	$54.17	$57	$77.5	0.09×	$90
Colonoscopy with biopsy	CPT	45380	4	—	$54.17	$57	$77.5	0.06×	$90
Colonoscopy with polyp removal	CPT	45385	5	—	$54.17	$57	$80	0.07×	$6,531.95
surgery
Total shoulder arthroplasty	CPT	23472	5	—	$54.17	$57	$80	0.02×	$29,754
Hip hemiarthroplasty	CPT	27125	5	—	$54.17	$57	$80	0.06×	$29,754
Total hip replacement	CPT	27130	5	—	$54.17	$57	$80	0.02×	$29,754
Total knee replacement	CPT	27447	5	—	$54.17	$57	$80	0.02×	$29,754
Knee revision arthroplasty single component	CPT	27486	5	—	$54.17	$57	$80	0.05×	$29,754
Knee revision arthroplasty all components	CPT	27487	4	—	$54.17	$57	$77.5	0.04×	$90
Shoulder arthroscopy with decompression	CPT	29826	5	—	$54.17	$57	$80	0.24×	$7,134.64
Shoulder arthroscopy with rotator cuff repair	CPT	29827	5	—	$54.17	$57	$80	0.02×	$17,847
Knee arthroscopy with meniscectomy	CPT	29881	5	—	$54.17	$57	$80	0.04×	$7,134.64
ACL reconstruction	CPT	29888	5	—	$54.17	$57	$80	0.02×	$17,847
Major small/large bowel procedures w MCC	MS-DRG	329	5	—	$850	$975	$2,160.69	0.05×	$3,129
Major small/large bowel procedures w CC	MS-DRG	330	5	—	$850	$975	$2,160.69	0.09×	$3,129
Major small/large bowel procedures w/o CC/MCC	MS-DRG	331	5	—	$850	$975	$2,160.69	0.13×	$3,129
CABG single arterial graft	CPT	33533	4	—	$54.17	$57	$77.5	0.04×	$90
CABG 2 arterial grafts	CPT	33534	4	—	$54.17	$57	$77.5	0.04×	$90
CABG 3 arterial grafts	CPT	33535	4	—	$54.17	$57	$77.5	0.03×	$90
CABG 4+ arterial grafts	CPT	33536	4	—	$54.17	$57	$77.5	0.03×	$90
Laparoscopic cholecystectomy w/o CDE w MCC	MS-DRG	418	5	—	$850	$975	$2,160.69	0.13×	$3,129
Laparoscopic cholecystectomy w/o CDE w CC	MS-DRG	419	5	—	$850	$975	$2,160.69	0.16×	$3,129
Laparoscopic cholecystectomy w/o CDE w/o CC/MCC	MS-DRG	420	5	—	$850	$975	$2,160.69	0.07×	$3,129
Open appendectomy	CPT	44950	4	—	$54.17	$57	$77.5	0.07×	$90
Laparoscopic appendectomy	CPT	44970	4	—	$54.17	$57	$77.5	0.05×	$90
Major joint replacement w MCC	MS-DRG	469	5	—	$850	$975	$2,160.69	0.07×	$3,129
Major joint replacement w/o MCC	MS-DRG	470	5	—	$850	$975	$2,160.69	0.11×	$3,129
Laparoscopic cholecystectomy	CPT	47562	4	—	$54.17	$57	$77.5	0.04×	$90
Lap cholecystectomy with cholangiography	CPT	47563	4	—	$54.17	$57	$77.5	0.04×	$90
Hip & femur procedures except major joint w MCC	MS-DRG	480	5	—	$850	$975	$2,160.69	0.08×	$3,129
Hip & femur procedures except major joint w CC	MS-DRG	481	5	—	$850	$975	$2,160.69	0.11×	$3,129
Hip & femur procedures except major joint w/o CC/MCC	MS-DRG	482	5	—	$850	$975	$2,160.69	0.14×	$3,129
Lap inguinal hernia repair	CPT	49650	4	—	$54.17	$57	$77.5	0.07×	$90
Total abdominal hysterectomy	CPT	58150	4	—	$54.17	$57	$77.5	0.08×	$90
Vaginal hysterectomy	CPT	58260	4	—	$54.17	$57	$77.5	0.04×	$90
Lap-assisted vaginal hysterectomy	CPT	58550	4	—	$54.17	$57	$77.5	0.05×	$90
Lap-assisted vaginal hysterectomy >250g	CPT	58552	4	—	$54.17	$57	$77.5	0.03×	$90
Lap salpingo-oophorectomy	CPT	58661	4	—	$54.17	$57	$77.5	0.04×	$90
OR procedure for obesity w MCC	MS-DRG	619	5	—	$850	$975	$2,160.69	0.08×	$3,129
OR procedure for obesity w CC	MS-DRG	620	5	—	$850	$975	$2,160.69	0.13×	$3,129
OR procedure for obesity w/o CC/MCC	MS-DRG	621	5	—	$850	$975	$2,160.69	0.14×	$3,129
Complex cataract surgery	CPT	66982	5	—	$54.17	$57	$80	0.04×	$5,502.03
Cataract surgery with lens implant	CPT	66984	5	—	$54.17	$57	$80	0.04×	$5,502.03
Intravitreal injection	CPT	67028	5	—	$54.17	$57	$80	0.23×	$1,005.88
Vitrectomy mechanical	CPT	67042	5	—	$54.17	$57	$80	0.03×	$10,287
Uterine & adnexa procedures w CC/MCC	MS-DRG	743	5	—	$850	$975	$2,160.69	0.18×	$3,129
Uterine & adnexa procedures w/o CC/MCC	MS-DRG	744	5	—	$850	$975	$2,160.69	0.11×	$3,129
PCI single major coronary artery	CPT	92920	5	—	$54.17	$57	$80	0.01×	$27,447
PCI with drug-eluting stent	CPT	92928	5	—	$54.17	$57	$80	0.01×	$27,447
PCI bypass graft	CPT	92937	5	—	$54.17	$57	$80	0.01×	$27,447
Left heart catheterization	CPT	93452	5	—	$54.17	$57	$80	0.03×	$7,513.23
Coronary angiography with cath	CPT	93455	5	—	$54.17	$57	$80	0.03×	$7,513.23
Coronary angiography with bypass cath	CPT	93458	5	—	$54.17	$57	$80	0.03×	$7,513.23

Rate history available after the next quarterly refresh. We re-crawl all hospital MRFs each quarter to track rate changes over time.

Payer mix (top 5)

Payer	Codes covered	Median rate
Aetna	194	$140.6
blue advantage	194	$80
Humana	194	$90
UnitedHealthcare	194	$57
Blue Cross Blue Shield	138	$1,424.14

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