25 Benefits In - Network Out - of - Network Benefit Maximum(s): Benefit Maximum(s) are for In - and Out - of - Network visits combined, and for office and outpatient visits combined. • Physical Therapy and Speech Therapy and Manipulation Therapy and Pulmonary Rehabilitation and Occupational Therapy 60 visits per Benefit Period • Cardiac Rehabilitation Unlimited The limits for physical, occupational, and speech therapy will not apply if you get care as part of the Mental Health and Substance Use Disorder benefit (based on the primary diagnosis on the claim form). Note: The limits for physical, occupational, and speech therapy will not apply if you get that care as part of the Hospice benefit. Note: If pulmonary rehabilitation is given as part of physical therapy, the Physical Therapy limit will apply instead of the Pulmonary Rehabilitation limit. Note: When you get physical, occupational, speech therapy , or cardiac rehabilitation , or pulmonary rehabilitation in the home, the Home Health Care Visit limit will apply instead of the Therapy Services limits listed above. Transplant Services See “Human Organ and Tissue Transplant (Bone Marrow / Stem Cell) Services, Cellular and Gene Therapy Services” .” Urgent Care Services (Office & Home* Visits) *Home visits are not the same as Home Health Care. For Home Health Care benefits please see the "Home Health Care" section. • Urgent Care Visit Charge 20% Coinsurance after Deductible 40% Coinsurance after Deductible • Allergy Testing 20% Coinsurance after Deductible 40% Coinsurance after Deductible • Shots / Injections ( other than allergy serum ) 20% Coinsurance after Deductible 40% Coinsurance after Deductible • Allergy Shots / Injections (including allergy serum) 20% Coinsurance after Deductible 40% Coinsurance after Deductible • Diagnostic Labs (other than reference labs) 20% Coinsurance after Deductible 40% Coinsurance after Deductible • Diagnostic x - ray 20% Coinsurance after Deductible 40% Coinsurance after Deductible • Other Diagnostic Tests (including hearing and EKG) 20% Coinsurance after Deductible 40% Coinsurance after Deductible