https://masaaccess.com/learning-center/why-your-insurance-may-not-fully-cover-your-ambulance-ride#%3A%7E%3Atext=Out-of-network+billing+refers+to+a+situation+where%2C*+Air+transport+is+a+gray+area.

It looks like there was a new law passed in 2022 i wasn't aware of but billers have found loopholes to bill after the fact for larger amounts.

I've taken an ambulance and after whatever insurance covered my bill was over 5k. A few years ago, my sister had a fall outside and was unconscious and an ambulance was called. She had a bill for close to 10k.

There are a lot of private ambulance companies that charge different rates and different hospitals have different rates so a lot of the time it depends on who picks you up.