Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Lefort i-3/> piece w/ graft
Devils Lake, ND
See all hospitals reporting CPT 21147 →Price type
Altru Hospital Devils Lake’s median price of $4.5k is 28% below the median hospital's median price ($6.3k), higher than 34% of the 1,382 hospitals reporting CPT 21147. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 5 payers, 10 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Blue Cross Blue Shield medicaid managed care plan facility · fee schedule · outpatient | $623 | $623 | — | — | — | $623 – $623 |
| 2 | Medica medicaid managed care plan facility · fee schedule · outpatient | $1.7k | $1.7k | $646 | 39% | — | $1.0k – $2.3k |
| 3 | Medica medicaid managed care plan – hmo facility · fee schedule · outpatient | $1.7k | $1.7k | $646 | 39% | — | $1.0k – $2.3k |
| 4 | Medica medicare managed care plan facility · fee schedule · outpatient | $2.3k | $2.3k | $518 | 22% | — | $1.8k – $2.9k |
| 5 | Blue Cross Blue Shield all commercial plans facility · fee schedule · outpatient | $3.0k | $3.0k | — | — | — | $3.0k – $3.0k |
| 6 | Medica all commercial plans facility · fee schedule · outpatient | $6.0k | $6.0k | $3.0k | 50% | — | $3.0k – $8.9k |
| 7 | Aetna medicare managed care plan facility · fee schedule · outpatient | $6.0k | $6.0k | — | — | — | $6.0k – $6.0k |
| 8 | Aetna all commercial plans facility · fee schedule · outpatient | $6.5k | $7.9k | $2.1k | 27% | — | $6.4k – $10.9k |
| 9 | Sanford Health Plan all commercial plans facility · fee schedule · outpatient | $8.3k | $8.3k | $1.2k | 15% | — | $7.1k – $9.5k |
| 10 | UnitedHealthcare all commercial plans facility · fee schedule · outpatient | $11.8k | $11.8k | — | — | — | $11.8k – $11.8k |
Last updated: Mar 1, 2026
See Midface reconstruction with Le Fort I bone cuts in three or more pieces, with bone grafting pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.