1. Row ID (provides linkage to primary file)
2. Revenue Code
3. HCPCS Code (when available: outpatient only)
4. Date of Service (when available: outpatient only)
5. Units of Service
6. Charge
7. Revenue Type
8. Revenue Category
9. Submission Type (Inpatient or Outpatient)
Ill. Admin. Code tit. 77, pt. 1010, app H