Best hospitals, health systems to work for by state (2022)

Forbes released its "America's Best Employers by State" list Aug. 24, and 262 hospitals and health systems made the cut.

Forbes, in collaboration with market research company Statista, surveyed 70,000 employees working for businesses with more than 500 employees. A total of 1,382 employers were ranked from varying industries, up to 101 per state. Employers could be ranked more than once if they operate in more than one state.

Fair pay, safe working conditions, inclusive culture, remote work benefits and diversity initiatives were among Forbes' criteria. Read more about the methodology here.

Here are the best hospitals and health systems to work for in each state, ranked:

Note: Single-specialty hospitals, research centers, home health/hospice systems and rehabilitation and behavioral medicine facilities were not compiled by Becker's for this roundup. The numbers to the left of each hospital/health system indicate where they placed on the state's ranking. Each hospital/health system's headquarters is in parentheses.


22. Infirmary Health (Mobile)

32. Huntsville Hospital Health System

36. Southeast Health (Dothan)

40. Community Health Systems (Franklin, Tenn.)

43. Baptist Health Alabama (Montgomery)


3. Providence (Renton, Wash.)


1. Mayo Clinic (Rochester, Minn.)

7. HonorHealth (Scottsdale)

52. Community Health Systems (Franklin, Tenn.)

67. Banner Health (Phoenix)


1. Arkansas Children's Hospital (Little Rock)

4. St. Bernard's Healthcare (Jonesboro)

8. Washington Regional Medical Center (Fayetteville)

15. Baptist Health (Little Rock)

19. Mercy (St. Louis)

20. CommonSpirit Health (Chicago)


9. UCLA Health (Los Angeles)

11. UC Davis Health (Sacramento)

26. Eisenhower Medical Center (Mirage)

30. Community Medical Centers-Central California (Fresno)

45. Children's Hospital Los Angeles

59. Loma Linda University Health

60. Hoag (Newport Beach)

75. Cedars-Sinai Health System (Los Angeles)

85. Scripps Health (San Diego)

91. Kaiser Permanente (Oakland)

98. Stanford Health Care


2. UCHealth (Aurora)

4. Children's Hospital Colorado (Aurora)

18. Denver Health

31. Kaiser Permanente (Oakland, Calif.)

43. SCL Health (Broomfield)


10. Yale New Haven Health

11. Hartford Healthcare


2. ChristianaCare (Newark)

6. Bayhealth (Dover)

14. Nemours Children's Health (Jacksonville, Fla.)


6. Tampa General Hospital

10. BayCare Health System (Clearwater)

13. Orlando Health

22. Sarasota Memorial Hospital

25. Memorial Healthcare System (Hollywood)

36. Mayo Clinic (Rochester, Minn.)

42. Broward Health (Fort Lauderdale)

53. Baptist Health South Florida (Coral Gables)

54. UF Health (Jacksonville)

64. Cleveland Clinic

68. Advent Health (Altamonte Springs)

69. University of Miami Health System

79. Baptist Health Jacksonville

88. Lee Memorial Health System (Fort Myers)

94. Lakeland Regional Health


10. Piedmont Healthcare (Atlanta)

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11. Northside Hospital (Atlanta)

15. Northeast Georgia Health System (Gainesville)

17. Augusta University Health

18. Emory Healthcare (Atlanta)

25. Children's Healthcare of Atlanta

43. Kaiser Permanente (Oakland, Calif.)

50. Wellstar Health System (Marietta)

75. Atrium Health (Charlotte, N.C.)

90. Floyd Health System (Rome)

95. Grady Health System (Atlanta)


8. Kaiser Permanente (Oakland, Calif.)


6. Northwestern Medicine (Chicago)

8. Northwest Community Healthcare (Arlington Heights)

22. Carle (Urbana)

25. NorthShore University Health System (Evanston)

35. Rush University Medical Center (Chicago)

38. SSM Health (St. Louis)

39. BJC Healthcare (St. Louis)

46. Unitypoint Health (Des Moines, Iowa)

48. Edward-Elmhurst Health (Elmhurst)

57. OSF HealthCare (Peoria)

86. Ann & Robert H. Lurie Children's Hospital of Chicago

91. University of Chicago Medicine

95. Advocate Aurora Health (Downers Grove, Ill., and Milwaukee)


3. Community Health Network (Indianapolis)

10. Community Healthcare System (Indianapolis)

20. Eskenazi Health (Indianapolis)

25. Deaconess Health System (Evansville)

26. Parkview Health (Fort Wayne)

29. Indiana University Health (Indianapolis)

37. Franciscan Health (Mishawaka)

74. Ascension (St. Louis)


6. University of Iowa Hospitals & Clinics (Iowa City)

21. Unitypoint Health (Des Moines)

27. Broadlawns Medical Center (Des Moines)


4. University of Kansas Health System (Kansas City)

15. Ascension (St. Louis)

26. Stormont-Vail Healthcare (Topeka)


1. Norton Healthcare (Louisville)

8. Baptist Health Kentucky (Louisville)

9. UK Healthcare (Lexington)

16. Pikeville Medical Center

27. St. Elizabeth Healthcare (Edgewood)

28. Graves-Gilbert Clinic (Bowling Green)

35. Owensboro Health

48. King Daughter's Health (Ashland)


9. LSU Health (New Orleans)

13. Ochsner Health System (New Orleans)

19. Willis-Knighton Health System (Shreveport)

20. LCMC Health (New Orleans)

21. Baton Rouge General Medical Center

27. Our Lady of the Lake Regional Medical Center (Baton Rouge)

33. Lake Charles Memorial Health System


3. Mainehealth (Portland)

4. MaineGeneral Health (Augusta)


13. Kaiser Permanente (Oakland, Calif.)

28. Johns Hopkins Medicine (Baltimore)

31. GBMC Healthcare (Baltimore)

33. Sheppard Pratt Health System (Baltimore)

36. University of Maryland Medical Center (Baltimore)

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52. Medstar Health (Columbia)

65. Adventist Healthcare (Gaithersburg)

69. Meritus Health (Hagerstown)


2. Boston Children's Hospital

11. Massachusetts General Hospital (Boston)

22. Harrington Healthcare System (Southbridge)

29. UMass Memorial Health (Worcester)

50. Mass General Brigham (Somerville)

66. Boston Medical Center


15. University of Michigan Health System (Ann Arbor)

31. MyMichigan Health (Midland)

37. Munson Healthcare (Traverse City)

39. Bronson Healthcare (Kalamazoo)

47. Henry Ford Health (Detroit)

48. Sparrow Health System (Lansing)

52. Spectrum Health (Grand Rapids)

53. Beaumont Health (Royal Oak)

66. Holland Hospital


3. Mayo Clinic (Rochester)

10. Gillette Children's Specialty Healthcare (St. Paul)

11. Healthpartners (Bloomington)

14. Children's Hospitals and Clinics of Minnesota (Minneapolis)

20. North Memorial Healthcare (Robbinsdale)

48. Hennepin Healthcare (Minneapolis)

60. Essentia Health (Duluth)


1. Hattiesburg Clinic

3. University of Mississippi Medical System (Jackson)

11. Forrest General Hospital (Hattiesburg)


2. Children's Mercy Kansas City

10. St. Luke's Health System Kansas City

23. BJC Healthcare (St. Louis)

34. University of Missouri Healthcare (Columbia)

35. Mercy (St. Louis)

41. Coxhealth (Springfield)

50. Phelps County Regional Medical Center (Rolla)

52. Lake Regional Health System (Osage Beach)

54. North Kansas City Hospital

56. SSM Health (St. Louis)

58. Boone Hospital Center (Columbia)

68. University Health, Kansas City


2. Billings Clinic


2. Methodist Health System Nebraska (Omaha)

13. Nebraska Medicine (Omaha)

24. Children's Hospital and Medical Center Omaha


35. Renown Health (Reno)

New Hampshire

6. Catholic Medical Center (Manchester)

New Jersey

13. Valley Health System (Ridgewood)

18. Atlantic Health System (Morristown)

23. University Hospital Network (Newark)

24. Englewood Hospital and Medical Center

28. Atlanticare (Atlantic City)

33. Cooper University Healthcare (Camden)

55. Virtua (Marlton)

82. Penn Medicine (Philadelphia)

85. Jefferson Health (Philadelphia)

New Mexico

3. Presbyterian Healthcare Services (Albuquerque)

New York

16. Northwell Health (Great Neck)

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22. University of Rochester Medical Center

24. New York-Presbyterian Hospital

37. Hospital for Special Surgery (New York City)

50. NYU Langone Health (New York City)

53. Bassett Healthcare Network (Cooperstown)

66. Rochester Regional Health System

74. ECMC (Buffalo)

98. Glens Falls Hospital

North Carolina

7. Wakemed (Raleigh)

11. Duke University Health System (Durham)

19. UNC Healthcare (Chapel Hill)

20. Novant Health (Winston-Salem)

26. Atrium Health (Charlotte)

49. Cone Health (Greensboro)

69. Mission Health (Asheville)

77. Vidant Health (Greenville)

99. Cape Fear Valley Health System (Fayetteville)

North Dakota

5. Sanford Health (Sioux Falls, S.D.)


1. Dayton Children's

4. Nationwide Children's Hospital (Columbus)

8. University Hospitals (Cleveland)

9. Cleveland Clinic

11. Cincinnati Children's

12. The Christ Hospital Health Network (Cincinnati)

22. Southwest General Health System (Middleburg Heights)

23. Ohiohealth (Columbus)

27. Ohio State University Wexner Medical Center (Columbus)

28. Akron Children's Hospital

50. Adena Health System (Chillicothe)

61. Wood County Hospital (Bowling Green)

64. Kettering Health Network (Dayton)

75. Promedica (Toledo)

78. Aultman Hospital (Canton)

84. Premier Health Partners (Dayton)

98. Summa Health Systems (Akron)


16. St. Francis Health System (Tulsa)

18. SSM Health (St. Louis)

25. Mercy (St. Louis)

29. Integris Health (Oklahoma City)


8. Legacy Health (Portland)

13. Kaiser Permanente (Oakland, Calif.)

23. Salem Health (Salem)

28. Asante (Medford)

31. Providence Healthcare (Renton, Wash.)

35. PeaceHealth (Vancouver, Wash.)


1. The Children's Hospital of Philadelphia

6. Penn Medicine (Philadelphia)

33. Lehigh Valley Health Network (Allentown)

34. Evangelical Community Hospital (Lewisburg)

53. St. Luke's University Health Network (Bethlehem)

54. Penn State Health (Hershey)

61. Main Line Health (Radnor Township)

70. Temple University Hospital (Philadelphia)

73. Jefferson Health (Philadelphia)

75. Penn Highlands Healthcare (Dubois)

76. Geisinger Health System (Danville)

83. Wellspan Health (York)

85. Allegheny Health Network (Pittsburgh)

88. Einstein Healthcare Network (Philadelphia)

South Carolina

2. Roper St. Francis (Charleston)

4. MUSC Health (Charleston)

7. McLeod Health (Florence)

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31. Spartanburg Regional Healthcare System

41. Anmed Health (Anderson)

50. Prisma Health (Greenville)

52. Self Regional Healthcare (Greenwood)

South Dakota

2. Monument Health (Rapid City)

4. Sanford Health (Sioux Falls)


4. East Tennessee Children's Hospital (Knoxville)

6. Methodist Le Bonheur Healthcare (Memphis)

14. Vanderbilt University Medical Center (Nashville)

24. Erlanger Health System (Chattanooga)

57. Maury Regional Medical Center (Columbia)

60. Ascension (St. Louis)

64. University of Tennessee Medical Center (Knoxville)

69. Regional One Health (Memphis)

72. Universal Health Services (King of Prussia, Pa.)


2. University of Texas Health Center at Houston

7. University of Texas Southwestern Medical Center (Dallas)

12. University of Texas Health Center at San Antonio

23. Kelsey-Seybold Clinic (Pearland)

25. Houston Methodist

27. Christus Health (Irving)

33. Texas Children's Hospital (Houston)

37. Methodist Health System Texas (Dallas)

41. Baptist Health System (San Antonio)

66. Parkland Health and Hospital System (Dallas)


1. University of Utah Healthcare (Salt Lake City)

32. Intermountain Healthcare (Salt Lake City)


3. University of Vermont Health Network (Burlington)


6. WVU Medicine West Virginia University Health System (Morgantown)

8. CAMC Health System (Charleston)

11. University of Virginia Health System (Charlottesville)

14. Carilion Clinic (Roanoke)

17. VCU Health (Richmond)

18. Cabell Huntington Hospital (Huntington)

33. Inova Health System (Falls Church)

38. Sentara Healthcare (Norfolk)

52. Bon Secours Mercy Health (Marriottsville, Md.)

60. Riverside Health System (Newport News)


3. UW Medicine (Seattle)

12. Olympic Medical Center (Port Angeles)

17. Virginia Mason (Seattle)

21. Seattle Children's

27. Multicare Health System (Tacoma)

31. Kaiser Permanente (Oakland, Calif.)

48. Providence Healthcare (Renton)

49. Swedish Medical Center (Seattle)

57.CommonSpirit Health (Chicago)

West Virginia

6. WVU Medicine West Virginia University Health System (Morgantown)

8. CAMC Health System (Charleston)

18. Cabell Huntington Hospital (Huntington)


1. Mayo Clinic (Rochester, Minn.)

16. Children's Wisconsin (Milwaukee)

21. University of Wisconsin Hospitals and Clinics Authority (Madison)

30. Froedtert Health (Milwaukee)

31. Unitypoint Health (Des Moines, Iowa)

40. Bellin Health (Green Bay)

47. ThedaCare (Appleton)

56. Advocate Aurora Health (Milwaukee; Downers Grove, Ill.)

59. Mercyhealth (Janesville)

61. ProHealth Care (Waukesha)

(Video) Largest Hospital Systems in the US

65. Gundersen Health System (La Crosse)


Which state has the best hospital system? ›

Hawaii is the top state for health care. It's followed by Massachusetts, Connecticut, New Jersey and California to round out the top five. Learn more about the Best States for health care below.

Which hospital has best employee benefits? ›

Hospitals With Great Employee Benefits
  • Johns Hopkins Hospital. ...
  • Schneck Medical Center. ...
  • Baptist Medical Center. ...
  • Ann & Robert H. ...
  • Houston Methodist Hospital. ...
  • Rhode Island Hospital. ...
  • Mayo Clinic. ...
  • Cedars-Sinai Medical Center.
12 Feb 2020

Which hospital is #1 in the US? ›

U.S. News & World Report has again recognized Mayo Clinic as the No. 1 hospital overall and top ranked in fourteen specialties. Complex care often requires medical experts from more than one specialty.

What is the best hospital in the United States 2022? ›

The best hospitals in the U.S. 2021-2022
  • Mayo Clinic, Rochester, Minnesota.
  • Cleveland Clinic.
  • UCLA Medical Center, Los Angeles.
  • Johns Hopkins Hospital, Baltimore.
  • Massachusetts General Hospital, Boston.
  • Cedars-Sinai Medical Center, Los Angeles.
  • New York-Presbyterian Hospital-Columbia and Cornell, New York.
30 Jul 2021

What is the busiest hospital in the US? ›

New York-Presbyterian Hospital – New York. Methodist Hospital – Texas. Indiana University Hospital – Indiana. NYU Langone Hospitals – New York.
What are the busiest ERs in the United States?
Hospital FacilityNumber of VisitsState
Parkland Health and Hospital System241,968TX
15 more rows
16 Dec 2021

What hospital has the best nurses? ›

50 Best Nurse Friendly Hospitals
  1. Schneck Medical Center. ...
  2. Johns Hopkins Hospital. ...
  3. Baptist Medical Center. ...
  4. West Virginia University Hospitals. ...
  5. Ann & Robert H. ...
  6. Houston Methodist Hospital. ...
  7. Rhode Island Hospital. ...
  8. Mayo Clinic.

What are the top 100 hospitals in the United States? ›

The top US hospitals
  • UPMC Pinnacle Harrisburg* (Harrisburg, PA)
  • Munson Medical Center (Traverse City, MI)
  • Froedtert Hospital* (Milwaukee, WI)
  • UCHealth University of Colorado Hospital* (Aurora, CO)
  • Houston Methodist Hospital (Houston, TX)
  • Tampa General Hospital* (Tampa, FL)
  • University Hospital* (Madison, WI)
6 Jul 2022

Where is the best hospital in the world? ›

The top 10 hospitals in the world:
  • Mayo Clinic.
  • Cleveland Clinic.
  • Massachusetts General Hospital.
  • Toronto General Hospital (Toronto, Canada)
  • Charité-Universitätsmedizin Berlin (Berlin, Germany)
  • The Johns Hopkins Hospital (Baltimore)
  • AP-HP - Hôpital Universitaire Pitié Salpêtrière (Paris, France)
2 Mar 2022

Do hospitals have good benefits? ›

There are plenty of benefits to working in a hospital as opposed to other locations in the healthcare industry. Some of the best benefits include career growth opportunities, competitive benefits and compensation packages, and a dynamic ever-changing environment.

Where is the best place to live healthcare? ›

Dan Grunebaum Data Journalist
Minneapolis-St. Paul225.70
16 more rows

What's the top three hospitals in United States? ›

— Nancy Cooper
1Mayo Clinic - RochesterRochester
2Cleveland ClinicCleveland
3Massachusetts General HospitalBoston
4The Johns Hopkins HospitalBaltimore
53 more rows

What are the top 5 hospitals in the world? ›

The lists
  • Mayo Clinic-Rochester (Rochester, Minnesota)
  • Cleveland Clinic (Cleveland)
  • Massachusetts General Hospital (Boston)
  • Toronto General-University Health Network (Toronto)
  • The Johns Hopkins Hospital (Baltimore)
  • Charité-Universitätsmedizin Berlin (Berlin)
  • Karolinska Universitetssjukhuset (Solna, Sweden)
10 Mar 2021

What is the most advanced hospital in the world? ›

World's Best Hospitals 2020 - Top 100 Global
1Mayo Clinic - RochesterRochester, MN
2Cleveland ClinicCleveland, OH
3Massachusetts General HospitalBoston, MA
4Toronto General (University Health Network)Toronto
84 more rows

Who is the world best doctor? ›


Dr. Shiong is known as the best doctor in the world and also one of the richest doctors in the world. He is a South African-American transplant surgeon, billionaire businessman, bioscientist, and media owner.

What state has the best hospitals and doctors? ›

States with Best Health Care Systems
Overall RankStateTotal Score
1Rhode Island65.12
47 more rows
1 Aug 2022

Where is the best city for a doctor? ›

Top 50 Cities for Doctors
RankCityLocation Quotient
1Janesville, WI2.33
2Terre Haute, IN1.72
3Albany, GA1.53
4Killeen, TX2.52
6 more rows
25 Apr 2022

What is the number 1 trauma center in the US? ›

Baylor Scott & White Medical Center—Temple Trauma Center Recognized among the Best in North America.

Where is the largest ER in America? ›

New York Presbyterian is the largest hospital in the US and the 7th largest in the world.

What is the largest hospital in the world? ›

First Affiliated Hospital of Zhengzou University

The First Affiliated Hospital of Zhengzou University is comfortably the biggest hospital in the world by number of beds; it currently has around 7,000.

What is the best teaching hospital in the US? ›

15 Top Major Teaching Hospitals
  1. Penn Presbyterian Medical Center. Location: Philadelphia. ...
  2. St. Luke's University Hospital – Bethlehem Campus. ...
  3. Pennsylvania Hospital. ...
  4. St. ...
  5. Baylor Scott & White Medical Center – Temple. ...
  6. Baylor University Medical Center. ...
  7. University of Utah Health. ...
  8. NorthShore University HealthSystem.
30 Jun 2022

Where do the happiest nurses work? ›

Happiest Nursing Jobs. Nurses are employed in school systems, health care facilities, community organizations, and many other environments. Some nurses work with children while others work with adults and families. Some work in outpatient clinics, while others work in hospitals.

What state has highest RN salary? ›

California tops the list of 15 highest-paying states for nurses. According to the U.S. Bureau of Labor Statistics (BLS), the average annual salary for RNs in California is $124,000 per year, or $59.62 per hour, compared to the national average salary of $82,750.

Which states have the happiest nurses? ›

Top Happiest 5 states for nurses in the US
  • #5 Colorado. Quality of life ranking: #10. Average RN salary: $69,990.00. ...
  • #4 Alaska. Quality of life ranking: #19. Average RN salary: $88,510.00. ...
  • #3 Oregon. Quality of life ranking: #18. ...
  • #2 Wisconsin. Quality of life ranking: #3. ...
  • #1 Minnesota. Quality of life ranking: #2.

Who has the best hospitals in the world? ›

The top ten World's Best Hospitals are:
  • Mayo Clinic - Rochester (US)
  • Cleveland Clinic (US)
  • Massachusetts General Hospital (US)
  • Toronto General - University Health Network (Canada)
  • Charité - Universitätsmedizin Berlin (Germany)
  • The Johns Hopkins Hospital (US)
  • AP-HP - Hôpital Universitaire Pitié Salpêtrière (France)
2 Mar 2022

Which is better Shands or Mayo Clinic? ›

University of Florida Health Shands Hospital emerged as Florida's top health center in the U.S. News & World Report's 2020-21 Best Hospitals survey Tuesday, with nine medical specialties placing in the nation's Top 50. Mayo Clinic in Jacksonville tied with UF Health Shands as the top Florida hospital.

Where does the US rank in Healthcare 2022? ›

Best Healthcare in the World 2022
CountryLPI 2020 RankingCEO World Ranking
United States1830
124 more rows

What is the #1 hospital in US 2020? ›

For 2020-21, the Mayo Clinic in Rochester, MN claimed the No. 1 spot on the Best Hospitals Honor Roll. Cleveland Clinic ranked No. 2, followed by Johns Hopkins Hospital at No.

Which state has the best surgeons? ›

Our research shows that Maine is the best state in the country for surgeons.
1. Maine.
Total Surgeon Jobs:103
Highest 10 Percent Earn:$244,000
3 more rows
6 Apr 2021

What state has the best healthcare for retirees? ›

The analysis, conducted by insurance technology company, ranked Minnesota first with North Dakota close behind. Massachusetts and California followed in the third and fourth spots. Nebraska ranked fifth, and Hawaii followed in sixth.

What is the best state to live in USA 2022? ›

Massachusetts topped 2022's list, touting a score of 62.65 out of 100. New Jersey came in second, dropping from the top spot last year. New York, Idaho and Virginia fill out the rest of the top five states to live in, in that order.

What is the busiest hospital in the US? ›

New York-Presbyterian Hospital – New York. Methodist Hospital – Texas. Indiana University Hospital – Indiana. NYU Langone Hospitals – New York.
What are the busiest ERs in the United States?
Hospital FacilityNumber of VisitsState
Parkland Health and Hospital System241,968TX
15 more rows
16 Dec 2021

What's the top three hospitals in United States? ›

— Nancy Cooper
1Mayo Clinic - RochesterRochester
2Cleveland ClinicCleveland
3Massachusetts General HospitalBoston
4The Johns Hopkins HospitalBaltimore
53 more rows

What city in the US has the best doctors? ›

The offbeat city of Portland, Oregon, is ranked number one.

Which state have the best doctors? ›

Best States to Practice Medicine
Overall RankStateTotal Score
1South Dakota69.37
47 more rows
21 Mar 2022

What is the #1 Orthopedic hospital in the US? ›

Hospital for Special Surgery, New York

What is the #1 best state to live in? ›

According to the report, the best state to live in the U.S. is Massachusetts. That isn't the only northern state to appear near the top of the rankings. New Jersey, New York, Idaho, New Hampshire, Wyoming, Minnesota, and Wisconsin all made the top 10.

What states to avoid when retiring? ›

Places to retire
Worst States for RetirementWhy You Should Think Twice
1) IllinoisPoor fiscal health
2) CaliforniaExpensive, and its finances are in disarray
3) New YorkVery high taxes, including property taxes
4) Rhode IslandWorst-off state in the Northeast from a financial viewpoint; high taxes
6 more rows

Which state has the best doctors and hospitals? ›

The 10 Best U.S. States for Health Care
  • Hawaii.
  • Massachusetts.
  • Connecticut.
  • Washington.
  • Rhode Island.
  • New Jersey.
  • California.
  • Maryland.
17 Dec 2019

What is the best state to live in financially? ›

The five best states for your personal finances in 2022 are (No. 1 being best):
  • New Jersey.
  • Hawaii.
  • Connecticut.
  • Alaska.
  • Illinois.
30 Mar 2022

What is the nicest state in America? ›

Best States 2021
  • #1. Washington.
  • #2. Minnesota.
  • #3. Utah.
  • #4. New Hampshire.
  • #5. Idaho.

What state has cheapest cost of living? ›

Mississippi has the lowest cost of living in the United States. With a cost of living index of 83.3, expenses are nearly 17% less than the national average. Mississippi's housing costs are the lowest in the nation.


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