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PMID 21900461

A deficiency can occur for several reasons, such as pernicious anemia (a condition where the body cannot absorb vitamin B12 from the diet), certain medical conditions (e.g., Crohn's disease, celiac disease), surgical removal of part of the stomach or intestine, or strict vegetarian/vegan diets if not adequately supplemented

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Unlike some vitamins, B12 can be stored in the liver for an extended period, sometimes taking years for a deficiency to manifest

However, hospital costs and charges change each year and this results in both changes to the cost-to- ( charge ratios (CCRs) taken from the most currently available cost reports and also differences in the charges on the claims that are the basis of the calculation of the geometric mean costs on which OPPS rates are based