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Pricing is weird in the US.
One of the main reasons the list price is so high is because they know the insurance companies will negotiate and reduce the price. It’s like if you’re listing something on eBay or Marketplace and want $500 for it, you might list it for $600 or $650, because you know buyers will negotiate down to $500.
However, they can’t charge the insurance one amount while charging out-of-pocket customers a lower amount, because they’ll be sued by the insurance companies for insurance fraud.
Because of that, hospitals, ambulances, etc. need to initially charge everyone the same inflated prices, but they’ll basically always offer a discount if you say you’re paying out of pocket.
I’m from Melbourne in Australia (but living in the US now). In Melbourne, we pay around $60/year for an ambulance membership, and every ambulance ride (both road and air) is 100% covered.
It’s also included in most private insurance plans. We have a hybrid system where there’s both a public health care system (Medicare) as well as a private one. For whatever reason, ambulances aren’t included as part of the public system.