vault backup: 2026-04-05 15:37:59

documents/medical/werthman/Progyny_09192025_09062025ELT0022.md

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+---
+type: receipt
+category: payment_receipt
+person: Yanxin Lu
+date: 2025-10-03
+provider: Progyny / ReproSource Fertility Diagnostics
+source: Progyny_09192025_09062025ELT0022.pdf
+---
+
+# Progyny Payment Receipt
+
+**Progyny — Smarter Fertility Benefits**
+
+**Date:** October 03, 2025
+
+---
+
+## Provider Information
+
+| Field | Value |
+|---|---|
+| Provider | Progyny |
+| Address | 1359 Broadway 2nd FL, New York, NY 10018 |
+| Email | collections@progyny.com |
+| Phone | (833) 499-1479 |
+| Account # | 806298980 |
+| Patient | YANXIN LU |
+
+---
+
+Thank you for your payment of $209.67 to Progyny for healthcare services outlined below:
+
+## Service Line Items
+
+| Date of Service | Service | Charges | Insurance | Patient | Balance |
+|---|---|---|---|---|---|
+| 08/18/2025 | 82397 ; CHEMILUMINESCENT ASSAY TEST — Patient: YANXIN LU — Physician: REPROSOURCE FERTILITY DIAGNOSTICS | $69.18 | ($62.26) | $0.00 | $6.92 |
+| 08/18/2025 | 88184 ; SPERM DNA FRAGMENTATION — Patient: YANXIN LU — Physician: REPROSOURCE FERTILITY DIAGNOSTICS | $809.09 | ($728.18) | $0.00 | $80.91 |
+| 08/18/2025 | 88185 ; SPERM DNA FRAGMENTATION — Patient: YANXIN LU — Physician: REPROSOURCE FERTILITY DIAGNOSTICS | $1,031.00 | ($927.90) | $0.00 | $103.10 |
+| 08/18/2025 | 89051 ; SPERM DNA FRAGMENTATION — Patient: YANXIN LU — Physician: REPROSOURCE FERTILITY DIAGNOSTICS | $135.84 | ($122.26) | $0.00 | $13.58 |
+| 08/18/2025 | 89261 ; SPERM DNA FRAGMENTATION — Patient: YANXIN LU — Physician: REPROSOURCE FERTILITY DIAGNOSTICS | $51.57 | ($46.41) | $0.00 | $5.16 |
+
+---
+
+## Payment Information
+
+| Date Paid | Card Ending | Confirmation | Amount Paid |
+|---|---|---|---|
+| 10/03/2025 | Visa 6118 | 276411048801 | $209.67 |
+
+| | |
+|---|---|
+| **Total Paid** | **$209.67** |
+| **Balance Due** | **$0.00** |
+
+---
+
+*Powered by PatientPay*