E450’s may be classified, registered and insured differently due to its weight class (@14,000+ GVWR). It might cost much more in general but, if you need to go bigger structurally or pull a heavier load it might not be a negative but a positive. I’ve heard of people needing commercial insurance to insure E450’s which could become costly.

Most E450’s are tall boxes with an extended box option which, if your in need of just a little more room or a taller person can make the difference of an enjoyable experience or a bruised noggin.

Most E450’s I’ve seen in the northeast have optional rear automatic snow chains and rear airbags for heavier loads or raising and lowering the vehicle (to make it easier to get patients in and out).

Most E450’s have more options due to the sheer cost of the vehicle which can make it nice for having additional comforts that some of the E350’s don’t have. E450’s are structurally different compared to E350’s as well; E450’s have a larger gauged straight frame compared to the 350 series. This is what allows it to carry the load that it does.