{
 "sources": [
  {
   "id": "hca-physician-fs",
   "name": "Washington Health Care Authority, Physician-Related Services fee schedule, effective October 1, 2026",
   "url": "https://www.hca.wa.gov/assets/billers-and-providers/physician-20261001.xlsx",
   "retrievedAt": "2026-10-23",
   "role": "Apple Health maximum allowable fees for CPT 84403, 88230, 88262, 88271, 88275 and 88291.",
   "licenseName": "Washington state public record; CPT codes and descriptions are copyright American Medical Association",
   "licenseUrl": null,
   "redistribution": "Figures quoted with attribution; the source document is linked, not hosted.",
   "reliability": {
    "publisherKind": "government",
    "interest": "none",
    "note": "HCA runs Apple Health, Washington's Medicaid program, and publishes these fee schedules for billing. Fees are what the state pays providers."
   }
  },
  {
   "id": "hca-epsdt-fs",
   "name": "Washington Health Care Authority, EPSDT Well-Child fee schedule, effective July 1, 2026",
   "url": "https://www.hca.wa.gov/assets/billers-and-providers/epsdt-20260701.xlsx",
   "retrievedAt": "2026-10-23",
   "role": "Apple Health payment for a well-child checkup, CPT 99394 (established patient, age 12-17).",
   "licenseName": "Washington state public record; CPT codes and descriptions are copyright American Medical Association",
   "licenseUrl": null,
   "redistribution": "Figures quoted with attribution; the source document is linked, not hosted.",
   "reliability": {
    "publisherKind": "government",
    "interest": "none",
    "note": "Official Apple Health fee schedule for EPSDT well-child checkups."
   }
  },
  {
   "id": "hca-epsdt-guide",
   "name": "Washington Health Care Authority, EPSDT Well-Child Program billing guide, July 1, 2026",
   "url": "https://www.hca.wa.gov/assets/billers-and-providers/EPSDT-bg-20260701.pdf",
   "retrievedAt": "2026-10-23",
   "role": "How often Apple Health expects well-child checkups (one per calendar year for ages 5 through 20).",
   "licenseName": "Washington state public record",
   "licenseUrl": null,
   "redistribution": "Figures quoted with attribution; the source document is linked, not hosted.",
   "reliability": {
    "publisherKind": "government",
    "interest": "none",
    "note": "Official billing guide for Apple Health well-child checkups."
   }
  },
  {
   "id": "doh-well-care",
   "name": "Washington State Department of Health, Child and adolescent well-care visits",
   "url": "https://doh.wa.gov/you-and-your-family/infants-and-children/child-and-adolescent-well-care-visits",
   "retrievedAt": "2026-10-23",
   "role": "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.",
   "licenseName": "Washington state public record",
   "licenseUrl": null,
   "redistribution": "Figures quoted with attribution; the source document is linked, not hosted.",
   "reliability": {
    "publisherKind": "government",
    "interest": "none",
    "note": "Consumer guidance from Washington's health department. It promotes well-child visits."
   }
  },
  {
   "id": "cms-mup-geo-2024",
   "name": "Centers for Medicare & Medicaid Services, Medicare Physician & Other Practitioners - by Geography and Service, 2024 data",
   "url": "https://data.cms.gov/provider-summary-by-type-of-service/medicare-physician-other-practitioners/medicare-physician-other-practitioners-by-geography-and-service",
   "retrievedAt": "2026-10-23",
   "role": "Medicare average allowed amounts and average submitted charges in 2024 for CPT 84403, 88230, 88262, 88271, 88275 and 88291, national and Washington.",
   "licenseName": "U.S. government work, public domain",
   "licenseUrl": null,
   "redistribution": "Figures quoted with attribution; the source document is linked, not hosted.",
   "reliability": {
    "publisherKind": "government",
    "interest": "none",
    "note": "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."
   }
  },
  {
   "id": "quest-testosterone",
   "name": "Quest Diagnostics, questhealth.com: Testosterone Test",
   "url": "https://www.questhealth.com/product/testosterone-test/15983M.html",
   "retrievedAt": "2026-10-23",
   "role": "Consumer price ($69 plus a $6 physician service fee) and age eligibility (patients 18 to 100).",
   "licenseName": "Copyright Quest Diagnostics; price quoted for commentary",
   "licenseUrl": null,
   "redistribution": "Figures quoted with attribution; the source document is linked, not hosted.",
   "reliability": {
    "publisherKind": "industry",
    "interest": "none",
    "note": "Quest sells this test directly to consumers. Prices change and promotions apply."
   }
  },
  {
   "id": "labcorp-ondemand-testosterone",
   "name": "Labcorp OnDemand: Total Testosterone Test",
   "url": "https://ondemand.labcorp.com/lab-tests/total-testosterone-blood-test",
   "retrievedAt": "2026-10-23",
   "role": "Consumer list price ($69, on sale for $51.75 on 2026-10-23) and age eligibility (18-100).",
   "licenseName": "Copyright Laboratory Corporation of America; price quoted for commentary",
   "licenseUrl": null,
   "redistribution": "Figures quoted with attribution; the source document is linked, not hosted.",
   "reliability": {
    "publisherKind": "industry",
    "interest": "none",
    "note": "Labcorp sells this test directly to consumers. The page says the test is clinically appropriate only for people assigned male at birth."
   }
  },
  {
   "id": "quest-catalog",
   "name": "Quest Diagnostics, questhealth.com: Shop all tests",
   "url": "https://www.questhealth.com/shop-tests",
   "retrievedAt": "2026-10-23",
   "role": "Checked for any chromosome, karyotype or SRY test sold to consumers; none was listed.",
   "licenseName": "Copyright Quest Diagnostics",
   "licenseUrl": null,
   "redistribution": "Figures quoted with attribution; the source document is linked, not hosted.",
   "reliability": {
    "publisherKind": "industry",
    "interest": "none",
    "note": "Quest's consumer catalog as shown on 2026-10-23."
   }
  },
  {
   "id": "labcorp-ondemand-catalog",
   "name": "Labcorp OnDemand: All lab tests",
   "url": "https://ondemand.labcorp.com/lab-tests",
   "retrievedAt": "2026-10-23",
   "role": "Checked for any chromosome, karyotype or SRY test sold to consumers; none was listed.",
   "licenseName": "Copyright Laboratory Corporation of America",
   "licenseUrl": null,
   "redistribution": "Figures quoted with attribution; the source document is linked, not hosted.",
   "reliability": {
    "publisherKind": "industry",
    "interest": "none",
    "note": "Labcorp's consumer catalog as shown on 2026-10-23."
   }
  },
  {
   "id": "cvs-minuteclinic-prices",
   "name": "CVS MinuteClinic price list",
   "url": "https://www.cvs.com/minuteclinic/services/price-lists",
   "retrievedAt": "2026-10-23",
   "role": "Cash price of a sports physical ($82), for which MinuteClinic does not accept insurance.",
   "licenseName": "Copyright CVS Health; price quoted for commentary",
   "licenseUrl": null,
   "redistribution": "Figures quoted with attribution; the source document is linked, not hosted.",
   "reliability": {
    "publisherKind": "industry",
    "interest": "none",
    "note": "National retail-clinic price list as shown on 2026-10-23; prices may differ by state."
   }
  },
  {
   "id": "healthcare-gov-children",
   "name": "HealthCare.gov, Preventive care benefits for children",
   "url": "https://www.healthcare.gov/preventive-care-children/",
   "retrievedAt": "2026-10-23",
   "role": "Well-child visits are covered preventive care, generally at no cost in network.",
   "licenseName": "U.S. government work, public domain",
   "licenseUrl": null,
   "redistribution": "Figures quoted with attribution; the source document is linked, not hosted.",
   "reliability": {
    "publisherKind": "government",
    "interest": "none",
    "note": "The federal Marketplace's consumer page on the Affordable Care Act preventive-care rule."
   }
  },
  {
   "id": "spokesman-2026-09-27",
   "name": "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)",
   "url": "https://www.spokesman.com/stories/2026/sep/27/washington-voters-to-decide-whether-transgender-at/",
   "retrievedAt": "2026-10-23",
   "role": "The press-reported prices of a testosterone test ($162) and chromosome testing ($1,310).",
   "licenseName": "Copyright The Spokesman-Review; figures quoted for commentary",
   "licenseUrl": null,
   "redistribution": "Figures quoted with attribution; the source document is linked, not hosted.",
   "reliability": {
    "publisherKind": "news",
    "interest": "none",
    "note": "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."
   }
  },
  {
   "id": "acs-2024-dp03",
   "name": "U.S. Census Bureau, American Community Survey 2024 1-year, Data Profile DP03, Washington",
   "url": "https://data.census.gov/table/ACSDP1Y2024.DP03",
   "retrievedAt": "2026-10-23",
   "role": "Washington residents under 19 with no health insurance (3.9%, margin of error 0.4 points).",
   "licenseName": "U.S. government work, public domain",
   "licenseUrl": null,
   "redistribution": "Figures quoted with attribution; the source document is linked, not hosted.",
   "reliability": {
    "publisherKind": "government",
    "interest": "none",
    "note": "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)."
   }
  }
 ],
 "tables": [
  {
   "id": "prices",
   "title": "Prices by verification route and source",
   "artifactId": "prices-csv",
   "description": "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.",
   "unitOfObservation": "One price for one service from one payer or seller",
   "fields": [
    {
     "name": "row_id",
     "type": "string",
     "description": "Stable row id.",
     "nullable": false,
     "valueType": "observed",
     "units": null,
     "derivation": null,
     "sourceIds": []
    },
    {
     "name": "route",
     "type": "string",
     "description": "checkup (a record or exam at a routine visit), testosterone (serum test), karyotype (chromosome analysis) or sry-fish (SRY by FISH, component codes).",
     "nullable": false,
     "valueType": "derived",
     "units": null,
     "derivation": "Assigned by FactHub from the service.",
     "sourceIds": []
    },
    {
     "name": "item",
     "type": "string",
     "description": "The service as the source describes it.",
     "nullable": false,
     "valueType": "observed",
     "units": null,
     "derivation": null,
     "sourceIds": []
    },
    {
     "name": "cpt_code",
     "type": "string",
     "description": "CPT code, where the source gives one.",
     "nullable": true,
     "valueType": "observed",
     "units": null,
     "derivation": null,
     "sourceIds": [
      "hca-physician-fs",
      "hca-epsdt-fs",
      "cms-mup-geo-2024"
     ]
    },
    {
     "name": "price_usd",
     "type": "number",
     "description": "The price. Blank when the seller does not offer the service (not zero). Zero means the family pays nothing.",
     "nullable": true,
     "valueType": "observed",
     "units": "US dollars",
     "derivation": null,
     "sourceIds": [
      "hca-physician-fs",
      "hca-epsdt-fs",
      "cms-mup-geo-2024",
      "quest-testosterone",
      "labcorp-ondemand-testosterone",
      "cvs-minuteclinic-prices",
      "healthcare-gov-children",
      "doh-well-care",
      "spokesman-2026-09-27"
     ]
    },
    {
     "name": "price_type",
     "type": "string",
     "description": "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.",
     "nullable": false,
     "valueType": "derived",
     "units": null,
     "derivation": "Assigned by FactHub from the source.",
     "sourceIds": []
    },
    {
     "name": "payer_or_seller",
     "type": "string",
     "description": "Who pays or sells at this price.",
     "nullable": false,
     "valueType": "observed",
     "units": null,
     "derivation": null,
     "sourceIds": []
    },
    {
     "name": "as_of",
     "type": "string",
     "description": "Effective date, data year, or the date the page was read.",
     "nullable": false,
     "valueType": "observed",
     "units": null,
     "derivation": null,
     "sourceIds": []
    },
    {
     "name": "eligible_patients",
     "type": "string",
     "description": "Who can get the service at this price, as the source states.",
     "nullable": false,
     "valueType": "observed",
     "units": null,
     "derivation": null,
     "sourceIds": [
      "quest-testosterone",
      "labcorp-ondemand-testosterone",
      "hca-epsdt-guide"
     ]
    },
    {
     "name": "source_id",
     "type": "string",
     "description": "The id of the entry in sources.",
     "nullable": false,
     "valueType": "observed",
     "units": null,
     "derivation": null,
     "sourceIds": []
    },
    {
     "name": "note",
     "type": "string",
     "description": "Caveats for this row.",
     "nullable": true,
     "valueType": "derived",
     "units": null,
     "derivation": "Written by FactHub.",
     "sourceIds": []
    }
   ]
  },
  {
   "id": "wa-child-coverage",
   "title": "Washington residents under 19 without health insurance, 2024",
   "artifactId": "coverage-csv",
   "description": "How many Washington children and teens had no health insurance, the group for whom a checkup is not covered.",
   "unitOfObservation": "One ACS estimate",
   "fields": [
    {
     "name": "measure",
     "type": "string",
     "description": "What is estimated.",
     "nullable": false,
     "valueType": "observed",
     "units": null,
     "derivation": null,
     "sourceIds": [
      "acs-2024-dp03"
     ]
    },
    {
     "name": "geography",
     "type": "string",
     "description": "Washington.",
     "nullable": false,
     "valueType": "observed",
     "units": null,
     "derivation": null,
     "sourceIds": [
      "acs-2024-dp03"
     ]
    },
    {
     "name": "year",
     "type": "integer",
     "description": "Survey year.",
     "nullable": false,
     "valueType": "observed",
     "units": null,
     "derivation": null,
     "sourceIds": [
      "acs-2024-dp03"
     ]
    },
    {
     "name": "value",
     "type": "number",
     "description": "The estimate.",
     "nullable": false,
     "valueType": "estimated",
     "units": "people or percent (see unit)",
     "derivation": null,
     "sourceIds": [
      "acs-2024-dp03"
     ]
    },
    {
     "name": "margin_of_error_90",
     "type": "number",
     "description": "90% margin of error, given for the percent.",
     "nullable": true,
     "valueType": "estimated",
     "units": "percentage points",
     "derivation": null,
     "sourceIds": [
      "acs-2024-dp03"
     ]
    },
    {
     "name": "unit",
     "type": "string",
     "description": "people or percent.",
     "nullable": false,
     "valueType": "observed",
     "units": null,
     "derivation": null,
     "sourceIds": []
    },
    {
     "name": "source_id",
     "type": "string",
     "description": "The id of the entry in sources.",
     "nullable": false,
     "valueType": "observed",
     "units": null,
     "derivation": null,
     "sourceIds": []
    }
   ]
  }
 ],
 "analyses": [
  {
   "id": "route-price-comparison",
   "title": "What each verification route costs, by type of price",
   "question": "What does each route the measure allows cost, from what a family pays at a checkup to what labs bill for a chromosome test?",
   "operation": "Select one representative price per route and price type from the prices table; karyotype prices are the sum of codes 88230, 88262 and 88291.",
   "parameters": {
    "table": "prices",
    "karyotypeCodes": [
     "88230",
     "88262",
     "88291"
    ],
    "medicareGeography": "National",
    "testosteroneConsumerPrice": "Quest test plus physician fee"
   },
   "scope": "U.S. and Washington prices, 2024 (Medicare) to October 2026 (Apple Health, consumer and press prices).",
   "resultShape": "table",
   "structuredResult": [
    {
     "label": "Checkup: Apple Health family cost",
     "route": "Checkup (record or exam)",
     "basis": "Family cost share",
     "price_usd": 0
    },
    {
     "label": "Checkup: insured family cost, in network",
     "route": "Checkup (record or exam)",
     "basis": "Family cost share",
     "price_usd": 0
    },
    {
     "label": "Checkup: retail sports physical, cash",
     "route": "Checkup (record or exam)",
     "basis": "Consumer cash price",
     "price_usd": 82
    },
    {
     "label": "Testosterone: Apple Health pays",
     "route": "Testosterone test",
     "basis": "Payer rate",
     "price_usd": 20.65
    },
    {
     "label": "Testosterone: Medicare pays (average)",
     "route": "Testosterone test",
     "basis": "Payer rate",
     "price_usd": 25.19
    },
    {
     "label": "Testosterone: consumer cash, adults only",
     "route": "Testosterone test",
     "basis": "Consumer cash price",
     "price_usd": 75
    },
    {
     "label": "Testosterone: lab billed charge (average)",
     "route": "Testosterone test",
     "basis": "Billed charge",
     "price_usd": 148.21
    },
    {
     "label": "Testosterone: press-reported cash price",
     "route": "Testosterone test",
     "basis": "Press-reported",
     "price_usd": 162
    },
    {
     "label": "Chromosomes: Apple Health pays",
     "route": "Chromosome test (karyotype)",
     "basis": "Payer rate",
     "price_usd": 213.65
    },
    {
     "label": "Chromosomes: Medicare pays (average)",
     "route": "Chromosome test (karyotype)",
     "basis": "Payer rate",
     "price_usd": 270.16
    },
    {
     "label": "Chromosomes: lab billed charge (average)",
     "route": "Chromosome test (karyotype)",
     "basis": "Billed charge",
     "price_usd": 1062.19
    },
    {
     "label": "Chromosomes: press-reported price",
     "route": "Chromosome test (karyotype)",
     "basis": "Press-reported",
     "price_usd": 1310
    }
   ],
   "displayResult": "A covered checkup costs insured and Apple Health families $0. A testosterone test is paid at $20.65 (Apple Health) to $25.19 (Medicare average), sold to adults for $69-$75, and billed at $148 on average; the press reported $162. A chromosome test is paid at $213.65 (Apple Health) to $270.16 (Medicare average), billed at $1,062.19 on average, and reported in the press at $1,310.",
   "methodologicalNotes": [
    "Family cost share rows are $0 for an in-network ACA-compliant plan and for Apple Health; the retail sports physical ($82 cash) is shown because a family without coverage pays it, though the physical is already required.",
    "Payer rates and billed charges are not family prices. They bracket what an uninsured family might be charged: payer rates are a floor that labs accept, billed charges are list prices."
   ],
   "limitations": [
    "Medicare figures are 2024 averages for Medicare patients, not 2026 rates or children's prices.",
    "Consumer testosterone tests from Quest and Labcorp are sold only to people 18 and older.",
    "The press-reported prices could not be verified at a public Labcorp page."
   ],
   "executedAt": "2026-10-23T22:00:00Z"
  },
  {
   "id": "karyotype-totals",
   "title": "Chromosome test (karyotype) price, by payer",
   "question": "What does a karyotype cost when its three billing codes are added together?",
   "operation": "Sum CPT 88230 (culture), 88262 (analysis) and 88291 (interpretation) for each price type.",
   "parameters": {
    "codes": [
     "88230",
     "88262",
     "88291"
    ],
    "medicare88291PlaceOfService": "O (office)"
   },
   "scope": "Apple Health fee schedule effective 2026-10-01; Medicare national averages, 2024.",
   "resultShape": "table",
   "structuredResult": [
    {
     "payer": "Apple Health maximum allowable",
     "c88230": 93.19,
     "c88262": 100.39,
     "c88291": 20.07,
     "total_usd": 213.65
    },
    {
     "payer": "Medicare average allowed, 2024",
     "c88230": 113.29,
     "c88262": 122.49,
     "c88291": 34.38,
     "total_usd": 270.16
    },
    {
     "payer": "Average billed charge to Medicare, 2024",
     "c88230": 501.7,
     "c88262": 479.71,
     "c88291": 80.78,
     "total_usd": 1062.19
    }
   ],
   "displayResult": "Apple Health pays $213.65; Medicare paid $270.16 on average; labs billed $1062.19 on average.",
   "methodologicalNotes": [
    "A lab may bill other or additional codes for a karyotype; these three are the standard set for a peripheral-blood chromosome analysis."
   ],
   "limitations": [
    "Medicare volumes for 88230 are small (147 services in 2024).",
    "Hospital-lab prices are not in the Medicare practitioner file."
   ],
   "executedAt": "2026-10-23T22:00:00Z"
  },
  {
   "id": "wa-under19-uninsured",
   "title": "Washington residents under 19 with no health insurance, 2024",
   "question": "What share of Washington children and teens lack health insurance, and so would pay cash for any checkup?",
   "operation": "Read ACS 2024 1-year DP03_0101PE and its margin of error for Washington.",
   "parameters": {
    "variables": [
     "DP03_0100E",
     "DP03_0101E",
     "DP03_0101PE",
     "DP03_0101PM"
    ],
    "geography": "state:53"
   },
   "scope": "Washington civilian noninstitutionalized population under 19, 2024.",
   "resultShape": "table",
   "structuredResult": [
    {
     "population_under_19": 1745961,
     "uninsured": 68017,
     "uninsured_percent": 3.9,
     "moe_points": 0.4
    }
   ],
   "displayResult": "3.9% (plus or minus 0.4 points) of Washington residents under 19, about 68,000, had no health insurance in 2024.",
   "limitations": [
    "Survey estimate with sampling error.",
    "Counts all children under 19, not only girls who play school sports."
   ],
   "executedAt": "2026-10-23T22:00:00Z"
  }
 ],
 "limitations": [
  "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."
 ]
}