Price a diagnostic journey with one request

BASE=https://waypointledger.org

curl -s $BASE/api/table/cms-99213

{
  "ok": true,
  "version": "2026-09-08.1-verified",
  "item": {
    "id": "cms-99213",
    "label": "Doctor's office visit, established patient, low complexity",
    "valueUsd": 95.19,
    "basis": "allowed",
    "year": "2026",
    "population": "Medicare Part B fee-for-service beneficiaries",
    "coverage": "A follow-up visit with a doctor you have seen before, for a straightforward problem. HOW THIS NUMBER WAS MADE: CMS does not publish a dollar column in …",
    "sourceTitle": "CMS, CY2026 National Physician Fee Schedule Relative Value File (RVU26C, July release, pub …",
    "sourceUrl": "https://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files/rvu26c",
    "confidence": "DERIVED",
    "code": "CPT 99213",
    "rules": {
      "summable": true,
      "mutuallyExclusiveWith": [],
      "bundlesAncillaries": false,
      "alternates": {
        "…": "5 alternate measures of the same service (a CY2024 average allowed amount, an average submitted charge, the hospital outpatient facility fee), each with a note saying why it is an alternative and never an addition"
      }
    }
  }
}

BASE=https://waypointledger.org

curl -s -X POST $BASE/api/journeys \
  -H 'content-type: application/json' \
  -d '{"title":"Two years of looking",
       "entries":[{"raw":"saw my regular doctor about the fatigue","itemId":"cms-99213","times":6},
                  {"raw":"echocardiogram","itemId":"cms-img-echo","times":1}]}'

{
  "ok": true,
  "id": "91dec6a1-5886-417d-9078-c842aaa1d93c",
  "slug": "7nvjqbdhmf",
  "url": "http://localhost:8792/ledger?s=7nvjqbdhmf",
  "savedTo": "link"
}

BASE=https://waypointledger.org

curl -s -X POST $BASE/api/price \
  -H 'content-type: application/json' \
  -d '{"story":"saw my regular doctor three times, then an echocardiogram",
       "coverage":"uninsured", "state":"IA"}'

{
  "ok": true,
  "input": "story",
  "context": {
    "coverage": "uninsured",
    "locality": {
      "key": "IA-00",
      "name": "Iowa",
      "state": "IA",
      "stateName": "Iowa",
      "mac": "05102",
      "workGpci": 1,
      "practiceExpenseGpci": 0.915,
      "malpracticeGpci": 0.397
    },
    "localityFrom": "state",
    "figureBasis": "Medicare allowed amounts for Iowa (CMS locality IA-00), CY2026 fee schedule formula"
  },
  "segments": [
    {
      "raw": "saw my regular doctor three times",
      "times": 3,
      "itemId": "cms-99213",
      "valueUsd": 95.19,
      "lineTotalUsd": 285.57,
      "…": "basis, year, population, coverage, sourceTitle and sourceUrl as before",
      "localityUsd": 89.23,
      "localityName": "Iowa",
      "nationalUsd": 95.19,
      "fit": {
        "verdict": "BILLED AGAINST THIS",
        "why": "With no insurance you are billed the provider’s charge, not an allowed amount. This is the average charge submitted for this same service in CY2024.",
        "figureUsd": 189.25,
        "figureNote": "Average submitted charge, CY2024 · billed charge, never added to an allowed amount",
        "which": "charge",
        "offerGap": false,
        "lineTotalUsd": 567.75
      },
      "localityRange": {
        "nationalUsd": 95.19,
        "lowUsd": 86.86,
        "lowLocalityKey": "AR-13",
        "lowLocalityName": "Arkansas",
        "highUsd": 120.13,
        "highLocalityKey": "CA-65",
        "highLocalityName": "San Jose-Sunnyvale-Santa Clara (San Benito County)",
        "localityCount": 109,
        "formula": "(work RVU x work GPCI + non-facility PE RVU x PE GPCI + MP RVU x MP GPCI) x 33.4009"
      }
    },
    { "…": "1 more segment, priced and fitted the same way" }
  ],
  "fitted": {
    "totalUsd": 1258.3,
    "suppressedReason": null,
    "describedCount": 2,
    "notDescribedCount": 0,
    "figureKindsUsed": ["charge"],
    "labels": {
      "primary": "What providers billed on average for these services",
      "secondary": "What the published Medicare figures add up to in Iowa"
    },
    "verdicts": [{ "verdict": "BILLED AGAINST THIS", "lines": 2 }],
    "basisWarning": null
  },
  "totals": { "totalUsd": 482.3, "pricedCount": 2, "basesUsed": ["allowed"], "…": "" },
  "tableVersion": "2026-09-08.1-verified"
}

BASE=https://waypointledger.org

curl -s -X POST $BASE/api/price \
  -H 'content-type: application/json' \
  -d '{"story":"saw my regular doctor three times, then an echocardiogram",
       "coverage":"medicaid", "locality":"TX-18"}'

"fitted": {
  "totalUsd": null,
  "suppressedReason": "No published federal figure describes this person on any line here, so there is no total to report. This is a gap in the published data, not a cost of zero. The lines carry what each figure is and who it does describe, and every one of them can be counted at POST /api/gap.",
  "describedCount": 0,
  "notDescribedCount": 2,
  "figureKindsUsed": [],
  "verdicts": [{ "verdict": "NOT DESCRIBED", "lines": 2 }]
}

BASE=https://waypointledger.org

# a state with more than one CMS payment locality
curl -s -X POST $BASE/api/price -H 'content-type: application/json' \
  -d '{"story":"a doctor visit","state":"TX"}'

{"ok":false,"error":"Texas has more than one CMS payment locality, so a state is
not enough to price a line. Send one of: TX-31 (Austin), TX-20 (Beaumont),
TX-09 (Brazoria), TX-11 (Dallas), TX-28 (Fort Worth), TX-15 (Galveston),
TX-18 (Houston), TX-99 (Rest Of Texas)."}

# a coverage we do not have a rule for
{"ok":false,"error":"coverage must be one of: employer, marketplace, medicaid,
medicare, uninsured, unsure. Send no coverage at all and every line comes back
as a reference price."}

BASE=https://waypointledger.org

curl -s $BASE/data/locality-prices.csv -o locality-prices.csv

head -1 locality-prices.csv
price_id,code,label,state,locality,locality_key,locality_name,mac,work_rvu,
pe_nonfacility_rvu,mp_rvu,pw_gpci,pe_gpci,mp_gpci,conversion_factor,allowed_usd,
national_usd,pct_of_national,formula,basis,year,population,locality_audit_status,
national_audit_status,rvu_file,rvu_file_sha256,gpci_file,gpci_file_sha256,table_version

grep '^cms-img-echo,.*,TX-18,' locality-prices.csv | cut -d, -f1,6,7,16,17
cms-img-echo,TX-18,HOUSTON,197.09,196.73

BASE=https://waypointledger.org

# one row, priced where the person actually lives
curl -s "$BASE/api/table/cms-99213?locality=IA-00"

# the whole table for one place, or a state where CMS gives it a single locality
curl -s "$BASE/api/table?locality=IA-00"
curl -s "$BASE/api/table?state=IA"

# the index of every locality, and every figure published for one of them
curl -s $BASE/api/localities
curl -s $BASE/api/localities/IA-00

{
  "ok": true,
  "locality": {
    "key": "IA-00", "name": "Iowa", "state": "IA", "stateName": "Iowa",
    "mac": "05102", "workGpci": 1, "practiceExpenseGpci": 0.915, "malpracticeGpci": 0.397
  },
  "item": {
    "id": "cms-99213",
    "label": "Doctor's office visit, established patient, low complexity",
    "code": "CPT 99213",
    "valueUsd": 95.19,
    "nationalUsd": 95.19,
    "localityUsd": 89.23,
    "localityGeography": "Iowa (CMS payment locality IA-00, Medicare Administrative Contractor 05102)",
    "localityFormula": {
      "code": "99213",
      "text": "(work_rvu*pw_gpci + pe_nonfacility_rvu*pe_gpci + mp_rvu*mp_gpci) * 33.4009",
      "conversionFactor": 33.4009,
      "parts": [
        { "name": "Work",             "rvu": 1.3,  "gpci": 1,     "product": 1.3 },
        { "name": "Practice expense", "rvu": 1.46, "gpci": 0.915, "product": 1.3359 },
        { "name": "Malpractice",      "rvu": 0.09, "gpci": 0.397, "product": 0.03573 }
      ],
      "rvuSum": 2.67163,
      "total": 89.23
    },
    "…": "every other field of the row, unchanged"
  },
  "localityRange": {
    "nationalUsd": 95.19,
    "lowUsd": 86.86,  "lowLocalityKey": "AR-13", "lowLocalityName": "Arkansas",
    "highUsd": 120.13, "highLocalityKey": "CA-65",
    "highLocalityName": "San Jose-Sunnyvale-Santa Clara (San Benito County)",
    "localityCount": 109,
    "formula": "(work RVU x work GPCI + non-facility PE RVU x PE GPCI + MP RVU x MP GPCI) x 33.4009"
  }
}

# a locality that does not exist: refused, never quietly national
{"ok":false,"error":"No CMS locality has the key \"IA-99\". A key is the two-letter
state and the two-digit CMS locality number, like \"IA-00\" or \"TX-31\". All 109 are
published at /data/locality-prices.json."}

# a state CMS splits into several: refused, and it names them
{"ok":false,"error":"Texas has more than one CMS payment locality, so a state is not
enough to price a line. Send one of: TX-31 (Austin), TX-20 (Beaumont), TX-09
(Brazoria), TX-11 (Dallas), TX-28 (Fort Worth), TX-15 (Galveston), TX-18 (Houston),
TX-99 (Rest Of Texas)."}

BASE=https://waypointledger.org

# the catalog, in the shape data.gov harvests
curl -s $BASE/data.json

# the whole application: source, data, migrations, tests, and a README to run from
curl -sL $BASE/waypoint-ledger-source.tar.gz | tar -xz && cd waypoint-public
npm install
npm run build:static        # the static export the size budgets measure
npm test                    # the suite that guards every rule below
npm run dev                 # http://localhost:3000

BASE=https://waypointledger.org

curl -s "$BASE/api/citation/cms-99213?format=text"

PUBLIC CORRECTION REPORT: Waypoint Ledger

Published figure: Doctor's office visit, established patient, low complexity
Row identifier:   cms-99213  ·  code CPT 99213
Published value:  $95.19 (2026)
Basis:            allowed (the negotiated or fee-schedule amount)
Geography:        United States, national (geographic practice cost indices set to 1.000)
Population:       Medicare Part B fee-for-service beneficiaries
Published by:     Centers for Medicare & Medicaid Services
Source:           CMS, CY2026 National Physician Fee Schedule Relative Value File (RVU26C, July release, published 2026-06-30)
Source URL:       https://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files/rvu26c

What the public said about this row: 0 responses: 0 say the figure describes them, 0 say it does not.
Median amount respondents said they actually paid: none reported.

Sample: self-selected members of the public using a free tool. Counts are reported exactly as entered: no weighting, no imputation, no extrapolation to a population.
Counted as of: 2026-09-09
Method and every source: https://waypointledger.org/method