| Code | Display | Definition |
| deductible | Deductible | Amount to be collected from a patient to be applied to a periodic deductible |
| coinsurance | Per prescription coinsurance | Amount to be collected from a patient to satisfy a per prescription coinsurance |
| copay | Copay | Amount to be collected from the patient to satisfy a per prescription copay |
| tax | Tax | Amount to be collected from the patient for sales tax |
| cash-price | Full product cash price | Full product cash price before discounts or coupons |
| coupon-discount | Coupon discount amount | Coupon discount reducing the amount to be collected from the patient |
| member-discount | Member discount amount | Member discount reducing the amount to be collected from the patient |
| other-discount | Other discount amount | Other discount reducing the amount to be collected from the patient |
| other-cost | Other cost | Other amount to be collected from the patient |
| eligible | Eligible amount | Amount that is considered for adjudication |
| total | Total patient responsibility | Amount equalling the total patient responsibility for a prescription product's cost |