I have only had one "surprise" bill ever. Going to an ER means you will be charged for the ER visit, charged separately for any x-rays, probably charged separately for the ER doc (they tend to subcontract out doctor coverage) and then, possibly, a charge for any pharmaceuticals or extra care. My surprise bill was not an ER charge but for a hospital stay - I was due to have staples out after an operation - the night before, the resident was bored and asked if I wanted half of them removed (supposedly for more comfort). Figuring sure, why not, I said yes. I then got a bill for a "surgical" charge (removing the staples). Had I waited 10 hours for my regular doctor to make rounds, all the staples would have been removed (as part of his overall charge) with no charges. Live and learn.