The lowest and highest bills were not freak occurrences; many cases involved charges well over $100,000 and under $2,000, Hsia said. Also, within geographic regions, the lowest and highest charges differed by tens of thousands of dollars.

Itemized bills for appendix removal can include fees for staying overnight in the hospital, the surgery and surgical supplies, operating room expenses, anesthesia, imaging tests, medicine and lab tests.

The analysis echoes other reports, including a study of 66 hospitals in the U.S. and Canada that found charges for the same services varied widely in both countries. Other studies have found big geographic disparities in health care costs.

Data from the federal Agency of Healthcare Research and Quality and the International Federation of Health Plans suggest the nationwide average price for an appendectomy is almost $28,000.

Dr. David Goodman, director of Dartmouth College’s Center for Health Policy Research, said the differences found in the study are credible and “very concerning.”

Caroline Steinberg, a vice president at the American Hospital Association, said hospitals partly set charges based on their costs of providing services, which vary by community. Steinberg said if two patients with the exact same condition received exactly the same services in the same hospital, the charges would be similar.

But Hsia said the problem is that most hospitals don’t advertise charges, and sick patients generally don’t get to choose the exact drugs or surgical techniques that are used on them.

The study was paid for by the Robert Wood Johnson Foundation, which funds health research and programs.

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LINDSEY TANNER AP Medical Writer