Kira Milas has no idea who called 911, summoning an ambulance filled with emergency medical technicians. Ms. Milas, 23, was working as a swim instructor for the summer and had swum into the side of the pool, breaking three teeth.

Shaken, she accepted the ambulance ride to Scripps Memorial Hospital in La Jolla, Calif. The paramedics applied a neck brace as a precaution.

A week later she received a bill for the 15-minute trip: $1,772.42. Though her employer’s workers’ compensation will cover the bill, she still was stunned at the charge. “We only drove nine miles and it was a non-life-threatening injury,” she said in a phone interview. “I needed absolutely no emergency treatment.”

Thirty years ago ambulance rides were generally provided free of charge, underwritten by taxpayers as a municipal service or provided by volunteers. Today, like the rest of the health care system in the United States, most ambulance services operate as businesses and contribute to America’s escalating medical bills. Often, they are a high-cost prequel to expensive emergency room visits.

Although ambulances are often requested by a bystander or summoned by 911 dispatchers, they are almost always billed to the patient involved. And the charges, as well as insurance coverage, range widely, from zero to tens of thousands of dollars.

“There are a significant numbers of patients who have no coverage for this, and the number of self-pay patients has climbed” since the recession, said Jay Fitch, president of Fitch and Associates, the largest emergency medical services consulting firm in the United States.

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