Tendon/ligament/rotator cuff two or more, surgical repair $1,400 Concussion $275 Paralysis - monoplegia $12,500 Paralysis - hemiplegia $17,500 Paralysis - paraplegia $18,000 Paralysis - quadriplegia $27,000 Event Benefit Non-surgical/ 2 Dislocations surgical repair Hip joint $5,000/$10,000 Knee $3,000/$6,000 Ankle or foot bone(s) $1,800/$3,600 other than toes Shoulder $2,200/$4,400 Elbow $1,500/$3,000 Wrist $1,500/$3,000 Finger/toe $350/$700 Hand bone(s) other than fingers $1,500/$3,000 Lower jaw $1,500/$3,000 Collarbone $1,500/$3,000 Partial dislocations 25% of the non-surgical repair amount Non-surgical/ 3 Fractures surgical repair Hip $6,000/$12,000 Leg $2,800/$5,600 Ankle $2,500/$5,000 Kneecap $2,500/$5,000 Foot excluding toes, heel $2,500/$5,000 Upper arm $2,750/$5,500 Forearm, hand, wrist except fingers $2,500/$5,000 Finger, toe $400/$800 Vertebral body $4,200/$8,400 Vertebral processes $2,000/$4,000 Pelvis except coccyx $4,000/$8,000 Coccyx $500/$1,000 Bones of face except nose $1,400/$2,800 Nose $750/$1,500 Upper jaw $1,750/$3,500 Lower jaw $2,000/$4,000 Collarbone $2,000/$4,000 Rib or ribs $600/$1,200 Skull – simple except bones of face $1,750/$3,500 Skull – depressed except bones of face $5,000/$10,000 Sternum $500/$1,000