P: {{ ohiInfo?.primaryOhi?.otherPayerName }} {{ getPayerIdString(ohiInfo?.primaryOhi?.ohiPayerId) }} S: {{ ohiInfo?.secondaryOhi?.otherPayerName }} {{ getPayerIdString(ohiInfo?.secondaryOhi?.ohiPayerId) }} T: {{ ohiInfo?.tertiaryOhi?.otherPayerName }} {{ getPayerIdString(ohiInfo?.tertiaryOhi?.ohiPayerId) }} P: {{ ohiInfo?.primaryOhi?.otherPayerName }} {{ getPayerIdString(ohiInfo?.primaryOhi?.ohiPayerId) }} S: {{ ohiInfo?.secondaryOhi?.otherPayerName }} {{ getPayerIdString(ohiInfo?.secondaryOhi?.ohiPayerId) }} T: {{ ohiInfo?.tertiaryOhi?.otherPayerName }} {{ getPayerIdString(ohiInfo?.tertiaryOhi?.ohiPayerId) }}
Claim Level Adjustments:  Primary Paid Adj. Adj. Amount Secondary Paid Adj. Adj. Amount Tertiary Paid Adj. Adj. Amount
  {{ getDollarSignString(claimLevelAdjustmentsRows[i]?.primaryOhiInfo?.payerPaidAmount) }}
{{claimLevelAdjustmentsRows[i]?.primaryOhiInfo?.adjustmentCode }} {{ claimLevelAdjustmentsRows[i]?.primaryOhiInfo?.adjustmentCode }}: {{ claimLevelAdjustmentsRows[i]?.primaryOhiInfo?.adjCodeGroupDescription }}
{{ '$' + claimLevelAdjustmentsRows[i]?.primaryOhiInfo.adjustmentAmount }} {{ getDollarSignString(claimLevelAdjustmentsRows[i]?.secondaryOhiInfo.payerPaidAmount) }}
{{ claimLevelAdjustmentsRows[i]?.secondaryOhiInfo?.adjustmentCode }} {{ claimLevelAdjustmentsRows[i]?.secondaryOhiInfo?.adjustmentCode }}: {{ claimLevelAdjustmentsRows[i]?.secondaryOhiInfo?.adjCodeGroupDescription }}
{{ getDollarSignString(claimLevelAdjustmentsRows[i]?.secondaryOhiInfo?.adjustmentAmount) }} {{ getDollarSignString(claimLevelAdjustmentsRows[i]?.tertiaryOhiInfo?.payerPaidAmount) }}
{{ claimLevelAdjustmentsRows[i]?.tertiaryOhiInfo?.adjustmentCode }} {{ claimLevelAdjustmentsRows[i]?.tertiaryOhiInfo?.adjustmentCode }}: {{ claimLevelAdjustmentsRows[i]?.tertiaryOhiInfo?.adjCodeGroupDescription }}
{{ getDollarSignString(claimLevelAdjustmentsRows[i]?.tertiaryOhiInfo?.adjustmentAmount) }}
  {{ getDollarSignString(claim?.primaryOhiInfo?.payerPaidAmount) }}
{{ claim?.primaryOhiInfo?.adjustmentCode }} {{ claim?.primaryOhiInfo?.adjustmentCode }}: {{ claim?.primaryOhiInfo?.adjCodeGroupDescription }}
{{ getDollarSignString(claim?.primaryOhiInfo?.adjustmentAmount) }} {{ getDollarSignString(claim?.secondaryOhiInfo?.payerPaidAmount) }}
{{ claim?.secondaryOhiInfo?.adjustmentCode }} {{ claim?.secondaryOhiInfo?.adjustmentCode }}: {{ claim?.secondaryOhiInfo?.adjCodeGroupDescription }}
{{ getDollarSignString(claim?.secondaryOhiInfo?.adjustmentAmount) }} {{ getDollarSignString(claim?.tertiaryOhiInfo?.payerPaidAmount) }}
{{ claim?.tertiaryOhiInfo?.adjustmentCode }} {{ claim?.tertiaryOhiInfo?.adjustmentCode }}: {{ claim?.tertiaryOhiInfo?.adjCodeGroupDescription }}
{{ getDollarSignString(claim?.tertiaryOhiInfo?.adjustmentAmount) }}
Line # Svc. From Amount Proc. Mod. Primary Paid Adj. Adj. Amount Secondary Paid Adj. Adj. Amount Tertiary Paid Adj. Adj. Amount
{{ ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.lineNumber }} {{ ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.beginDateOfService }} {{ ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.charge ? '$' + ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.charge : '' }} {{ ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.primaryPayerProcedureCode }} {{ ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.ohiModifiers }} {{ getDollarSignString(ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.primaryPayerPaidAmount) }}
{{ ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.primaryServiceLineAdjustment?.adjustmentCode }} {{ ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.primaryServiceLineAdjustment?.adjustmentCode }}: {{ ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.primaryServiceLineAdjustment?.adjCodeGroupDescription }}
{{ getDollarSignString(ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.primaryServiceLineAdjustment?.adjustmentAmount) }} {{ getDollarSignString(ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.secondaryPayerPaidAmount) }}
{{ ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.secondaryServiceLineAdjustment?.adjustmentCode }} {{ ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.secondaryServiceLineAdjustment?.adjustmentCode }}: {{ ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.secondaryServiceLineAdjustment?.adjCodeGroupDescription }}
{{ getDollarSignString(ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.secondaryServiceLineAdjustment?.adjustmentAmount) }} {{ getDollarSignString(ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.tertiaryPayerPaidAmount) }}
{{ ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.tertiaryServiceLineAdjustment?.adjustmentCode }} {{ ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.tertiaryServiceLineAdjustment?.adjustmentCode }}: {{ ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.tertiaryServiceLineAdjustment?.adjCodeGroupDescription }}
{{ getDollarSignString(ohiInfo?.quickviewServiceLineOhiOutputRows[i]?.tertiaryServiceLineAdjustment?.adjustmentAmount) }}
{{ line?.lineNumber }} {{ line?.beginDateOfService }} {{ line?.charge ? '$' + line?.charge : '' }} {{ line?.primaryPayerProcedureCode }} {{ line?.ohiModifiers }} {{ getDollarSignString(line?.primaryPayerPaidAmount) }}
{{ line?.primaryServiceLineAdjustment?.adjustmentCode }} {{ line?.primaryServiceLineAdjustment?.adjustmentCode }}: {{ line?.primaryServiceLineAdjustment?.adjCodeGroupDescription }}
{{ getDollarSignString(line?.primaryServiceLineAdjustment?.adjustmentAmount) }} {{ getDollarSignString(line?.secondaryPayerPaidAmount) }}
{{ line?.secondaryServiceLineAdjustment?.adjustmentCode }} {{ line?.secondaryServiceLineAdjustment?.adjustmentCode }}: {{ line?.secondaryServiceLineAdjustment?.adjCodeGroupDescription }}
{{ getDollarSignString(line.secondaryServiceLineAdjustment?.adjustmentAmount) }} {{ getDollarSignString(line?.tertiaryPayerPaidAmount) }}
{{ line?.tertiaryServiceLineAdjustment?.adjustmentCode }},  {{ line?.tertiaryServiceLineAdjustment?.adjustmentCode }}: {{ line?.tertiaryServiceLineAdjustment?.adjCodeGroupDescription }}
{{ getDollarSignString(line?.tertiaryServiceLineAdjustment?.adjustmentAmount) }}
Remittance Remark Codes: 
{{ohiInfo?.primaryOhi?.remittanceRemarkCodes[i]?.code}} {{ohiInfo?.primaryOhi?.remittanceRemarkCodes[i]?.code}}: {{ohiInfo?.primaryOhi?.remittanceRemarkCodes[i]?.remarkLong}}
{{remarkCode?.code}},  {{remarkCode?.code}}: {{remarkCode?.remarkLong}}
{{ohiInfo?.secondaryOhi?.remittanceRemarkCodes[i]?.code}} {{ohiInfo?.secondaryOhi?.remittanceRemarkCodes[i]?.code}}: {{ohiInfo?.secondaryOhi?.remittanceRemarkCodes[i]?.remarkLong}}
{{remarkCode?.code}},  {{remarkCode?.code}}: {{remarkCode?.remarkLong}}
{{ohiInfo?.tertiaryOhi?.remittanceRemarkCodes[i]?.code}} {{ohiInfo?.tertiaryOhi?.remittanceRemarkCodes[i]?.code}}: {{ohiInfo?.tertiaryOhi?.remittanceRemarkCodes[i]?.remarkLong}}
{{remarkCode?.code}},  {{remarkCode?.code}}: {{remarkCode?.remarkLong}}