A bag of saline is one of the most basic elements of an emergency room visit. A mixture of sodium chloride and water, this simple solution — saltwater, in plain English — is commonly used to replenish fluids or deliver medications intravenously to patients. 

You might therefore think the price of saline solution should be predictable — especially since anyone can research a hospital’s prices online, in theory. Under the Hospital Price Transparency Rule, hospitals have been legally required since January 2021 to publish machine-readable files of their procedure prices on their websites. 

But a Goodbill analysis of saline prices published by more than 2,000 hospitals across the country uncovered prices so exorbitant that they could be the sticker price on a brand-new car. Could a single 1000ML bag of saline really cost $26,667.03 at one hospital in Florida, $6,837.65 at another hospital in Oklahoma, or $1,031.00 at yet another hospital in Virginia? 

So Goodbill asked those hospitals: Are those prices accurate, or the result of an administrative fat finger? Unfortunately, patients may never know until the charge hits their hospital bill: All except two of the 11 priciest hospitals that Goodbill contacted while researching this article responded to confirm their prices. Those two hospitals — Sioux Falls Specialty Hospital in South Dakota, and Resolute Health Hospital in Florida — both said they rarely bill saline as an individual line item, making the published price less relevant; saline is usually included in the charge for the patient's primary procedure.

Our analysis reinforced how, even with price transparency regulations — which aim to give patients more access to pricing data and reduce the likelihood of surprising hospital bills — the information that hospitals publish can be questionable or confusing, making it challenging for consumers to navigate that information.

Even with price transparency regulations, the information that hospitals publish can be questionable or confusing.

Below are the highlights of our analysis, which examined the price of a 1000ML bag of saline at 2,365 hospitals across the country. To compare apples to apples, we looked for the standard procedure code of J7030 and description of “normal saline solution infusion, 1000cc.” The price is for the saline only; it does not include the cost of administering the saline, which is charged separately as a hydration service. 

Even when setting aside outliers to look at national trends, saline remains surprisingly expensive. While a 1000ML bag of 0.9% sodium chloride solution is available online for just $10, even insured patients may end up paying many times more at the hospital. The most expensive state for insured patients is Oregon, where the median rate negotiated with insurers is $69.89. For uninsured patients, South Carolina has the highest median cash rate of $113.75. Our results suggest that little has changed in the decade since The New York Times investigated the cost of saline and found that some hospitals charged markups of 100 to 200 times the manufacturer’s price, which ranged between 44 cents and $1 at the time. 

Even when setting aside outliers to look at national trends, saline remains surprisingly expensive.

The Most Expensive Hospitals

The hospitals below have published extremely high prices for saline. Can they possibly be real? We didn't always get an answer from the hospital.

For reference, “minimum” and “maximum insured rate” refers to the lowest and highest prices the hospital has negotiated with various insurance companies. Depending on the specific plan, insurance companies may cover none or some portion of that rate and pass along the rest to the patient. “Cash rate” refers to the discounted price that uninsured patients usually pay. We did not include gross rates below, as they are usually irrelevant to a patient’s hospital bill.

Florida

Baptist Hospital and Gulf Breeze Hospital (Baptist Healthcare system) 

• Minimum insured rate: $15,939.15 under the “EAPG” classification (EAPG stands for “enhanced ambulatory patient groups,” or ambulatory care)
• Maximum insured rate: $19,126.98 under EAPG
• The hospital did not return a request for comment
• See their published prices

Jay Hospital (Baptist Healthcare system)

• Minimum insured rate: $26,168.58 for saline under the “EAPG” classification
• Maximum insured rate: $26,667.03 under EAPG
• The hospital did not return a request for confirmation
• See their published prices

Lehigh Regional Medical Center (Prime Healthcare system)

• Minimum insured rate: $1,071.00
• Maximum insured rate: $1,581.00
• A hospital spokeswoman said she would “look into” the prices, but did not provide an answer.
• See their published prices.

Oklahoma

Mcalester Regional Health Center 

• Minimum insured rate: $153.75
• Maximum insured rate: $6,837.65, including $3,550.38 listed for certain plans like Cigna, United Healthcare, Aetna, and BCBS 
• Maximum cash rate: $4,165.58
• The hospital did not return a request for comment
• See their published prices

South Dakota

Sioux Falls Specialty Hospital

• Insured rate: $1,927.71 for certain plans under insurers including: All Savers, Bind, Bind Benefits, Golden Rule, National Rural Electric, UMR, United Health One, United Healthcare
• Hospital CFO Marty Appelhof shared a revised price list with Goodbill that shows insured rates ranging from $2.64 to $29; the published list has since been updated to reflect this. He added that the hospital does not generally bill saline as an individual line item, but as part of the patient's primary procedure. He confirmed $0 saline charges for 2021 and 2022.
• See their published prices (since updated to reflect the revised rates)

Texas

Resolute Health Hospital (Tenet Health system)

• Cash rate: $446.97
• A hospital spokeswoman said the “total charge” should be $123.00, though she did not specify whether that was the gross, insured, or cash rate. She added that the website would be updated: “Work is going on to figure out the issue and get it corrected.”
• See their published prices

Virginia

Johnston-Willis Hospital (HCA Healthcare system)

• Cash rate: $831.00 and $1,031.00 (no insured prices published)
• The hospital did not return a request for comment
• See their published prices

Chippenham Hospital, Henrico Doctors’ Hospital, and Parham Doctors’ Hospital (HCA Healthcare system)

• Cash rate: $902.00 and $1,031.00 (no insured prices published)
• The hospital did not return a request for comment
• See their published prices

National Trends

To control for outliers, we used statewide medians and removed the top and bottom 2% of outliers in our dataset. 

Insured patients

The 5 MOST expensive states

Mississippi, Nebraska, Oregon, South Carolina and South Dakota all have median insured prices of more than $63. Oregon is the most expensive, at $69.89.

The 5 LEAST expensive states

Washington D.C., Maryland, New Jersey, Rhode Island and Utah all had median insured prices of under $6.02. Utah is the most affordable, at $2.65.

Uninsured patients

The 5 MOST expensive states

Illinois, Nebraska, South Carolina, South Dakota, and Utah all have median cash rates of more than $72. South Carolina is the most expensive in the country, with a median cash rate of $113.75.

The 5 LEAST expensive states

Connecticut, Hawaii, Massachusetts, Maryland and New York all have median cash rates under $11.21. Massachusetts is the most affordable, at $5.67. 

Insured vs. Uninsured

States where the prices are better if you’re uninsured

The median insured rates are higher than the cash rates for uninsured patients in 15 states: Connecticut, Delaware, Georgia, Hawaii, Iowa, Kentucky, Massachusetts, Maine, Mississippi, Montana, North Dakota, New Mexico, Nevada, Oregon and Washington. 

In 15 states, the median price of saline for insured patients was higher than the median price for uninsured patients.

Here's what this all means for patients: For insured patients, depending on the plan, that expensive charge for saline could be entirely footed by the insurance provider, or a portion or all of it could be passed on to you. Uninsured patients are usually responsible for the entire charge on their bill.

In either case, the best way to protect yourself is to research your hospital’s published prices for saline, ask for your itemized bill to understand how much you were charged, and review your explanation of benefits to check how much your insurance covered. For tips, read our guide on how to negotiate a hospital bill.

It’s probably safe to say that if you see a charge of more than $100 for a normal saline solution infusion, it’s worth challenging your hospital on the accuracy of their price.

Got a tip to share, an exorbitant hospital bill, or other burning questions you think the Goodbill team should investigate? Let us know at help@goodbill.com.