Turquoise Health has detailed its first comprehensive payer price transparency scores in its 2025 impact report, evaluating machine-readable file quality across 97 payers.
Ten key findings:
1. Turquoise Health now tracks 219 payer files monthly. The company has assigned transparency scores to 97 payers to date, with plans to continue expanding coverage. The scores evaluate parsability, conflicting rates, and outlier rates.
2. Conflicting rates remain the most pervasive data quality issue. Turquoise defines conflicting rates as instances where a single service has multiple distinct rates reported with no discernible way to differentiate between them. Of the 97 scored payers, 28 (29%) have at least 50% of their rates marked as conflicting.
3. Several payers have near-total conflicting rate problems. Boston Medical Center’s WellSense Health Plan had 100% conflicting rates, followed by Healthfirst NY (99%), UnitedHealthcare’s PreferredOne (99%), UHA Health Insurance (94%), and Molina Healthcare (93%).
4. Outlier rates are less common but still present. Turquoise found that 6% of payers have more than 15% outlier rates, and 4% have more than 25%. Only six payers exceeded 15% outliers: Capital Health Plan (48%), MVP Health Care (34%), BCBS Tennessee (29%), Aetna and Inova Health’s Innovation Health (23%), Aetna (16%), and Oscar Health (16%).
5. The report found 90% of outliers are surgical HCPCS codes falling outside reasonable bounds when benchmarked against Medicare’s Outpatient Prospective Payment System rates. As an example, the report cited a commercial payer reporting $66,845 for a cervical spinal puncture, when Medicare paid $349.32 at the same facility.
6. File parsability is generally strong across the industry. Of the 219 files tracked, Turquoise successfully parsed 206 (94%). Four payers had less than 50% parsability: UHA Health Insurance (49%), Denver Health Medical Plan (40%), Centivo (16%), and Priority Health’s Physicians Health Plan of Northern Indiana (0%).
7. National payers are performing at a high level overall. UnitedHealthcare scored 99% parsability with 6% conflicting rates and 3% outlier rates. Cigna achieved 100% parsability with 6% conflicting and 4% outlier rates. Anthem reached 87% parsability with 16% conflicting and 3% outlier rates. Aetna had 99% parsability but struggled with 57% conflicting rates and 16% outlier rates.
8. Provider coverage varies significantly by payer. Using Net Patient Revenue weighting, UnitedHealthcare captured 95% NPR share, Aetna captured 91%, Anthem captured 88%, and Cigna captured 85%.
9. Blue Cross Blue Shield affiliates show wide performance variation. Top performers included BCBS Vermont, BCBS North Dakota, and Blue Cross of Idaho, all achieving “Excellent” hospital and ASC scores with 100% NPR share. CareFirst BCBS scored “Missing” for hospitals and “Poor” for ASCs with 0% NPR share.
10. Stop-loss and outlier reimbursement represents a major data gap. The report estimates that standard MRF reimbursement methods miss reporting on over $100 billion in outlier costs related to high-acuity care and stop-loss provisions.
