In some areas (those with municipal ambulance services), that's exactly what happens. In my case, I volunteer with a combination career/volunteer fire/rescue/E

In some areas (those with municipal ambulance services), that's exactly what happens. In my case, I volunteer with a combination career/volunteer fire/rescue/EMS agency. Our 'operating costs' are payed by taxes, but if you use the service, you get a bill ranging from ~$100 for a routine BLS transport to ~$500 for a 'significant' ALS call (lots of drugs and advanced interventions). We don't itemize, but we do adjust billing based on what was done.