The $1,000 ride is not the actual cost of the ride, it's the cost for the ambulance to be in the business of giving rides. There are hundreds of factors in the cost of doing business, and you start first with taxes... of that $1000... how much do you think the ambulance company pays in taxes just to get through the day/week/month. All of the expenses for the business have to be billed for someone. Then there are the rides that don't get paid for... at all.