If you read the recent Time cover story about medical costs, you'll see examples of people being recursively double-billed for items, at least according to the Medicare guidelines. e.g., and my memory's a little fuzzy on the specifics, but I believe one case was being billed for the operating room, then billed for the prep kit (which is supposed to be included in the room charge), then billed for every individual item in the prep kit.

If I hire a contractor to do something and he charges $X/hour, I don't expect him to mark up the materials he might use, too. I'm already paying for his time and expertise. I shouldn't also be paying the drywall for his expertise.

Hard to tell from the post, there was zero mention of staff costs besides the surgeon and anesthesiologist. So they fit in to the bill in one of two places equipment\drug cost or facilities. My guess is some of both. Time spent changing iv fluids is probably covered by the iv fluid line item vs time spent changing sheets being part of the facilities line item.