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