Hospitals pay a couple dollars for IV saline.

In fact, manufacturers are required to report such prices annually to the federal government, which bases Medicare payments on the average national price plus 6 percent. The limit for one liter of normal saline (a little more than a quart) went to $1.07 this year from 46 cents in 2010, an increase manufacturers linked to the cost of raw materials, fuel and transportation.

http://www.nytimes.com/2013/08/27/health/exploring-salines-s...

(which implies that manufacturers aren't the primary beneficiaries of the price that the hospitals charge)

Thanks. It does seem that, in this case, it's hospitals that are inflating costs. But even so, this is the Medicare reimbursement price. Maybe hospitals are "paying" cash price for saline, with a rebate on some product bundle, which doesn't get allocated properly to their cost basis for saline.