Well, my uncle is the Fire Chief in Norton, MA (Nahtun). He said that basically he applies for all the grants that are available to maintain units. I didn't get the clear take on how the "list price" is set ..but he basically said that they never, except with auto carriers, get the full fee. Most transport is paid by Medicare, due to the aging population. Private pay, or whatever is left over from medical insurance is typically a lost cause ..or rather is not usually collected in full. He considers it a bonus if they actually collect their full fee.
There are plenty of for profit ambulance transport services that do NO emergency service. They function on DPW, Medicare, AARP, and other "managed or regulated" fee structures. Their rigs roll ..their drivers get paid ..and the front office/owner lives large. Now surely the cost of keeping state of the art emergency service/mobile intensive care vehicles is expensive when compared to routine transport, but it appears that the expensive part of it is, more or less, used to soak up any revenue that would be termed "profit" in otherwise routine tranport environments.
In Pottstown, the local ambulance company (for a population of 21,000 people =pottstown "metro" area
) has 15 ambulances. 9 of them never leave the ambilicals. They are there to qualify for "per unit" grants. They are retired units that are typically sold by smaller ambulance companies to partially finance the newer, more needed, purchases. These are retained, just to qualify for more money.
As you can tell, I have a thing about the terms "non-profit" and "not for profit" organizations that appear to be able to have the finest of carte blanche ..blank check equipment and manage to bill you large for it. I've seen the inner workings of such organizations and they aren't at all frugal in most of their operations. They are geared toward revenue generation ...yet can't for the life of them say "why"? So the budgets always expand ..the fund drives expand ..the organization expands ..the costs expand.
..and you pay $685 to go 12 blocks ...and they're broke ..always with thier hand out