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Here is my ISP's (http://www.ikr.ru) price-list:
Monthly fee:
con. speed 64 KB/sec(+100 MB free of incoming traffic) 60 roubles
con. speed 128 KB/sec(+200 MB free of incoming traffic) 300 roubles....

In 90% of cases it's ethernet twisted pair connection. ISP just installs switches in a building and makes a LAN. Usually it's 100 Mb ethernet LAN.
They install one or more servers per a building...