Vitamin supplement, 100 capsules

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Dialysis/stress vitamin supplement, oral, 100 capsules

Payers reporting HCPCS S0194

Payer pricing summary

Low

Average

$24

Median

$16

High

$77

Payer rate distribution

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#
1	Cigna fee schedule · outpatient · +7 other terms	182	$19	$31	$22	72%	—	$9 – $86
2	Blue Cross Blue Shield fee schedule · outpatient · +5 other terms	126	$57	$60	$29	49%	—	$8 – $214
3	Aetna fee schedule · outpatient · +7 other terms	64	$15	$26	$27	104%	—	$9 – $189
4	Anthem fee schedule · outpatient · +6 other terms	34	$11	$17	$8	46%	—	$10 – $47
5	Bcbs Tx fee schedule · outpatient · +1 other terms	30	$83	$75	$25	33%	—	$31 – $131
6	UnitedHealthcare fee schedule · both · +8 other terms	26	$10	$11	$2	18%	—	$10 – $18
7	Caresource facility · case rate · outpatient · +1 other terms	15	$9	$10	$2	23%	—	$6 – $15
8	Molina facility · case rate · outpatient · +2 other terms	15	$9	$10	$2	23%	—	$6 – $15
9	Wellmark fee schedule · both · +2 other terms	13	$14	$14	—	—	—	$14 – $14
10	Bcbs Nj fee schedule · outpatient	12	$10	$10	—	—	—	$10 – $10
11	Highmark fee schedule · outpatient · +3 other terms	11	$11	$11	$0	1%	—	$10 – $11
12	Optum facility · case rate · outpatient · +2 other terms	11	$8	$9	$2	22%	—	$7 – $13
13	Medica fee schedule · outpatient · +4 other terms	10	$20	$20	$5	25%	—	$12 – $26
14	Aetna Better Health fee schedule · inpatient · +1 other terms	7	$10	$10	—	—	—	$10 – $10
15	Excellus facility · fee schedule · outpatient	5	$66	$77	$82	106%	—	$14 – $265
16	Humana fee schedule · inpatient · +2 other terms	5	$9	$9	—	—	—	$9 – $9
17	First Health facility · fee schedule · outpatient · +2 other terms	4	$30	$30	—	—	—	$30 – $30
18	Medicaid percent of total billed charges · bothfrom % of charges	3	$2	$2	$1	41%	—	$1 – $3
19	Sanford Health Plan fee schedule · outpatient · +1 other terms	3	$57	$57	—	—	—	$57 – $57
20	MultiPlan percent of total billed charges · bothfrom % of charges	2	$2	$2	$0	5%	—	$2 – $3
21	Bcbs Id professional · fee schedule · outpatient	1	$57	$57	—	—	—	$57 – $57
22	Bcbs Nc facility · fee schedule · outpatient	1	$30	$30	$26	88%	—	$11 – $67
23	Bcbs Nv fee schedule · outpatient	1	$10	$10	—	—	—	$10 – $10
24	Bcbs Vt professional · fee schedule · outpatient	1	$10	$10	—	—	—	$10 – $10
25	Kaiser fee schedule · outpatient	1	$21	$21	—	—	—	$21 – $21