| Item No. | Location | Size | Depth | Benefit 85% ($) |
|---|---|---|---|---|
| 30026 | Not face/neck | ≤ 7 cm | Superficial | 51.85 |
| 30029 | Not face/neck | ≤ 7 cm | Deeper tissue | 89.25 |
| 30032 | Face/neck | ≤ 7 cm | Superficial | 81.80 |
| 30035 | Face/neck | ≤ 7 cm | Deeper tissue | 116.60 |
| 30038 | Not face/neck | > 7 cm | Superficial | 89.25 |
| 30042 | Not face/neck | > 7 cm | Deeper tissue | 184.00 |
| 30045 | Face/neck | > 7 cm | Superficial | 116.60 |
| 30049 | Face/neck | > 7 cm | Deeper tissue | 184.00 |
| 30052 | Ear, eyelid, nose, lip | Any | Full thickness | 251.90 |
| 30055 | Any | Any | Wound dressing under GA/regional/IV sedation | 73.35 |