---
type: receipt
category: medical
person: Yanxin Lu
date: 2025-10-03
provider: Progyny / ReproSource Fertility Diagnostics
source: progyny_statement_09_2025.pdf
---

# Progyny Payment Receipt

**Progyny — Smarter Fertility Benefits**

**Date:** October 03, 2025

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## 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 |

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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 |

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## 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** |

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