People without insurance end up with bills that are much higher than those for covered patients, because the uninsured are charged the hospital’s gross rates.

“People don’t realize that the prices on the bill are just a starting point,” said Dr. Jesse M. Pines, an associate professor of emergency medicine and health policy at the Center for Health Care Quality at George Washington University. “Prices listed on the bill often don’t represent what the insurer or the patient will ultimately pay.”

The prices ultimately paid to a hospital can vary considerably for treatment of similar medical problems. “It’s kind of like the airline industry,” Dr. Pines said. “It’s rare that two people on a plane will have paid the same amount for their seats.”

THE SURPRISES Besides being charged for each service you receive, you will be charged an emergency room fee corresponding to the complexity of treatment that your injury required.

Normally there are five levels of care  Level 1 is for minor problems like an earache. Level 5 is for more severe problems like a broken bone. (There are higher levels of care reserved for critically ill patients.) Charlie’s stitches, for instance, were considered Level 2 care, and the emergency room fee was $488.

When an outside doctor is called in, you will receive a bill directly from the doctor or from your insurance company. The fee will be high, but your insurer probably will pay for most of it, depending on your plan and whether you have met your deductible.