Line # Adj. Date OHI ID PST From B/U Rev. Proc. Modifiers Line Charge OHI Paid Qty. Adj. Total Non-Covered Amount
{{ getDisplayString(ohiSrvcLineAdjInfo[i]?.lineNumber) }} {{ getDisplayString(ohiSrvcLineAdjInfo[i]?.adjudicationDate) }} {{ getDisplayString(ohiSrvcLineAdjInfo[i]?.payerId) }} {{ getDisplayString(ohiSrvcLineAdjInfo[i]?.paymentSequenceIndicator) }} {{ getDisplayString(ohiSrvcLineAdjInfo[i]?.beginDateOfService) }} {{ getDisplayString(ohiSrvcLineAdjInfo[i]?.bundledUnbundledLineNumber) }} {{ getDisplayString(ohiSrvcLineAdjInfo[i]?.revenueCode) }} {{ getDisplayString(ohiSrvcLineAdjInfo[i]?.procedureCode) }} {{ getDisplayString(ohiSrvcLineAdjInfo[i]?.modifiers) }} {{ getDisplayString(ohiSrvcLineAdjInfo[i]?.lineCharge) }} {{ getDisplayString(ohiSrvcLineAdjInfo[i]?.payerPaidAmount) }} {{ getDisplayString(ohiSrvcLineAdjInfo[i]?.quantity) }}
{{ ohiSrvcLineAdjInfo[i]?.adjustment?.adjustmentCode }} {{ ohiSrvcLineAdjInfo[i]?.adjustment?.adjustmentCode }}: {{ ohiSrvcLineAdjInfo[i]?.adjustment?.descriptionLong }}
{{ getDollarSignString(ohiSrvcLineAdjInfo[i]?.adjustment?.adjustmentAmount) }}
{{ getDisplayString(row?.lineNumber) }} {{ getDisplayString(row?.adjudicationDate) }} {{ getDisplayString(row?.payerId) }} {{ getDisplayString(row?.paymentSequenceIndicator) }} {{ getDisplayString(row?.beginDateOfService) }} {{ getDisplayString(row?.bundledUnbundledLineNumber) }} {{ getDisplayString(row?.revenueCode) }} {{ getDisplayString(row?.procedureCode) }} {{ getDisplayString(row?.modifiers) }} {{ getDollarSignString(row?.lineCharge) }} {{ getDollarSignString(row?.payerPaidAmount) }} {{ getDisplayString(row?.quantity) }}
{{ row?.adjustment?.adjustmentCode }} {{ row?.adjustment?.adjustmentCode }}: {{ row?.adjustment?.descriptionLong }}
{{ getDollarSignString(row.adjustment?.adjustmentAmount) }}