After developing a chest cold and breathing problems last year, Susan Alexander went to First Choice ER, an independent emergency room in League City, Texas, drawn by its motto: "Real ER. Real Fast." Treatment was indeed speedy, about 20 minutes. It was also real expensive, Alexander said. The bill was about $2,000, or as much as five times what she might have paid for similar care at a doctor's office. The charges included a $1,518 "facility fee," typically assessed by hospitals and their ERs to support the space, services and equipment needed to keep dozens to hundreds of beds available.