What sex verification under I-638 would cost, by route

What this dataset measures

The measure lists three bases a provider may rely on, so we priced each one from the most official sources we could open without an account or a license agreement: Washington Apple Health's October 2026 fee schedule, CMS's 2024 Medicare data on what was paid and billed for each lab code, the two largest labs' direct-to-consumer pages, a retail clinic price list, and the plan rules that decide whether a family pays. Press-reported prices are included and labeled because they are the figures voters have seen.

Geography

Washington, United States, United States

Unit of observation

One price for one service, from one payer or seller, of one type (family cost share, payer rate, billed charge, consumer cash price, or press-reported price).

Update cadence

One-time release for the November 3, 2026 election.

Curator

FactHub Research Team

Curated data tables

These related tables form this versioned dataset release. Each table has its own downloadable file and field definitions.

Prices by verification route and source

Every price we found for each route the measure allows, labeled by what kind of price it is. A blank price means the service is not offered by that seller.

Unit of observation: One price for one service from one payer or seller

View this table

sex_verification_test_prices.csv text/csv · 6.7 KB (6,911 bytes)

11 field definitions

Field	Type	Meaning	Units	Value type
row_id	string	Stable row id.	—	observed
route	string	checkup (a record or exam at a routine visit), testosterone (serum test), karyotype (chromosome analysis) or sry-fish (SRY by FISH, component codes).	—	derived
item	string	The service as the source describes it.	—	observed
cpt_code	string	CPT code, where the source gives one.	—	observed
price_usd	number	The price. Blank when the seller does not offer the service (not zero). Zero means the family pays nothing.	US dollars	observed
price_type	string	family_cost_share (what the family pays), payer_rate (what Apple Health or Medicare pays the provider), billed_charge (average list charge labs submitted to Medicare), consumer_cash (price to buy the test directly) or press_reported.	—	derived
payer_or_seller	string	Who pays or sells at this price.	—	observed
as_of	string	Effective date, data year, or the date the page was read.	—	observed
eligible_patients	string	Who can get the service at this price, as the source states.	—	observed
source_id	string	The id of the entry in sources.	—	observed
note	string	Caveats for this row.	—	derived

Washington residents under 19 without health insurance, 2024

How many Washington children and teens had no health insurance, the group for whom a checkup is not covered.

Unit of observation: One ACS estimate

View this table

wa_child_coverage.csv text/csv · 346 bytes

7 field definitions

Field	Type	Meaning	Units	Value type
measure	string	What is estimated.	—	observed
geography	string	Washington.	—	observed
year	integer	Survey year.	—	observed
value	number	The estimate.	people or percent (see unit)	estimated
margin_of_error_90	number	90% margin of error, given for the percent.	percentage points	estimated
unit	string	people or percent.	—	observed
source_id	string	The id of the entry in sources.	—	observed

Supporting files

Source snapshots, manifests, quality reports, documentation, and other materials used to produce or review this release.

• build_costs.js Transformation manifest · text/javascript · 9.9 KB (10,184 bytes)

  Node.js script that writes both CSV files and the karyotype sums from the values read from each source.

• dataset_parts.json Documentation · application/json · 23.5 KB (24,044 bytes)

  This dataset's sources, table definitions, saved analyses and limitations as JSON, exactly as stored in the dataset.

Saved analyses

Sources

1. Washington Health Care Authority, Physician-Related Services fee schedule, effective October 1, 2026 Apple Health maximum allowable fees for CPT 84403, 88230, 88262, 88271, 88275 and 88291.

   Retrieved October 23, 2026. Washington state public record; CPT codes and descriptions are copyright American Medical Association. Figures quoted with attribution; the source document is linked, not hosted.

   Reliability: Government. HCA runs Apple Health, Washington's Medicaid program, and publishes these fee schedules for billing. Fees are what the state pays providers.

2. Washington Health Care Authority, EPSDT Well-Child fee schedule, effective July 1, 2026 Apple Health payment for a well-child checkup, CPT 99394 (established patient, age 12-17).

   Retrieved October 23, 2026. Washington state public record; CPT codes and descriptions are copyright American Medical Association. Figures quoted with attribution; the source document is linked, not hosted.

   Reliability: Government. Official Apple Health fee schedule for EPSDT well-child checkups.

3. Washington Health Care Authority, EPSDT Well-Child Program billing guide, July 1, 2026 How often Apple Health expects well-child checkups (one per calendar year for ages 5 through 20).

   Retrieved October 23, 2026. Washington state public record. Figures quoted with attribution; the source document is linked, not hosted.

   Reliability: Government. Official billing guide for Apple Health well-child checkups.

4. Washington State Department of Health, Child and adolescent well-care visits States that children 0-20 can get a free well visit each year and that most plans, including Apple Health, cover it at no cost.

   Retrieved October 23, 2026. Washington state public record. Figures quoted with attribution; the source document is linked, not hosted.

   Reliability: Government. Consumer guidance from Washington's health department. It promotes well-child visits.

5. Centers for Medicare & Medicaid Services, Medicare Physician & Other Practitioners - by Geography and Service, 2024 data Medicare average allowed amounts and average submitted charges in 2024 for CPT 84403, 88230, 88262, 88271, 88275 and 88291, national and Washington.

   Retrieved October 23, 2026. U.S. government work, public domain. Figures quoted with attribution; the source document is linked, not hosted.

   Reliability: Government. Built by CMS from Medicare Part B fee-for-service claims. Covers Medicare beneficiaries only, mostly 65 and older; prices for children are not reported.

6. Quest Diagnostics, questhealth.com: Testosterone Test Consumer price ($69 plus a $6 physician service fee) and age eligibility (patients 18 to 100).

   Retrieved October 23, 2026. Copyright Quest Diagnostics; price quoted for commentary. Figures quoted with attribution; the source document is linked, not hosted.

   Reliability: Industry. Quest sells this test directly to consumers. Prices change and promotions apply.

7. Labcorp OnDemand: Total Testosterone Test Consumer list price ($69, on sale for $51.75 on 2026-10-23) and age eligibility (18-100).

   Retrieved October 23, 2026. Copyright Laboratory Corporation of America; price quoted for commentary. Figures quoted with attribution; the source document is linked, not hosted.

   Reliability: Industry. Labcorp sells this test directly to consumers. The page says the test is clinically appropriate only for people assigned male at birth.

8. Quest Diagnostics, questhealth.com: Shop all tests Checked for any chromosome, karyotype or SRY test sold to consumers; none was listed.

   Retrieved October 23, 2026. Copyright Quest Diagnostics. Figures quoted with attribution; the source document is linked, not hosted.

   Reliability: Industry. Quest's consumer catalog as shown on 2026-10-23.

9. Labcorp OnDemand: All lab tests Checked for any chromosome, karyotype or SRY test sold to consumers; none was listed.

   Retrieved October 23, 2026. Copyright Laboratory Corporation of America. Figures quoted with attribution; the source document is linked, not hosted.

   Reliability: Industry. Labcorp's consumer catalog as shown on 2026-10-23.

10. CVS MinuteClinic price list Cash price of a sports physical ($82), for which MinuteClinic does not accept insurance.

    Retrieved October 23, 2026. Copyright CVS Health; price quoted for commentary. Figures quoted with attribution; the source document is linked, not hosted.

    Reliability: Industry. National retail-clinic price list as shown on 2026-10-23; prices may differ by state.

11. HealthCare.gov, Preventive care benefits for children Well-child visits are covered preventive care, generally at no cost in network.

    Retrieved October 23, 2026. U.S. government work, public domain. Figures quoted with attribution; the source document is linked, not hosted.

    Reliability: Government. The federal Marketplace's consumer page on the Affordable Care Act preventive-care rule.

12. The Spokesman-Review, "Washington voters to decide whether transgender athletes can continue to compete in K-12 girls sports in I-638" (September 27, 2026) The press-reported prices of a testosterone test ($162) and chromosome testing ($1,310).

    Retrieved October 23, 2026. Copyright The Spokesman-Review; figures quoted for commentary. Figures quoted with attribution; the source document is linked, not hosted.

    Reliability: News report. A news story by Mitchell Roland. The prices appear in the reporter's voice, next to quotes from a family physician who opposes the measure; no source for them is named.

13. U.S. Census Bureau, American Community Survey 2024 1-year, Data Profile DP03, Washington Washington residents under 19 with no health insurance (3.9%, margin of error 0.4 points).

    Retrieved October 23, 2026. U.S. government work, public domain. Figures quoted with attribution; the source document is linked, not hosted.

    Reliability: Government. A sample survey; the margin of error is a 90% interval. Retrieved through the Census Data API (variables DP03_0100E, DP03_0101E, DP03_0101PE, DP03_0101PM).

Limitations and reproducibility

Reproducible: Every value was read from the source named in its source_id on 2026-10-23 and typed into build_costs.js, which writes both CSV files and the karyotype sums. Medicare figures come from the CMS data API for dataset 6fea9d79-0129-4e4c-b1b8-23cd86a4f435 (file MUP_PHY_R26_P05_V10_D24_Geo.csv), filtered to the HCPCS codes and to the National and Washington rows. Apple Health figures come from the Maximum Allowable NFS column of HCA's physician-related and EPSDT fee schedule spreadsheets.

• We did not use the CMS Clinical Laboratory Fee Schedule file for 2026, because CMS serves it only after the user accepts an American Medical Association license. Medicare's 2024 average allowed amounts are what Medicare actually paid, which tracks that fee schedule closely, but they are not the 2026 rates.
• No published self-pay price for a minor's testosterone or chromosome test was found. The two largest labs sell testosterone tests to consumers only for patients 18 and older, and neither sells a chromosome or SRY test to consumers.
• Billed charges are what labs list on Medicare claims; uninsured patients often get a lower self-pay price, so billed charges are an upper reference, not a quote.
• The press-reported prices ($162 and $1,310) could not be traced to a public Labcorp page. They are kept and labeled because voters saw them.
• Medicare volumes for the karyotype codes are small (147 and 3,540 services in 2024), because most cytogenetics is billed by hospital labs outside this file.
• SRY testing has no single billing code. We list FISH component rates only and do not total them, because how a lab bills an SRY test varies.
• Family cost for a checkup depends on the plan, the network and how the visit is billed. HealthCare.gov says $0 is not guaranteed in all cases.
• Whether insurers or Apple Health would pay for a lab test ordered only to establish sports eligibility has not been stated by any of them. The dataset records prices, not coverage decisions.