AI Receptionist Pricing for Medical Offices: Per Minute or Booking

AI receptionists charge medical offices three main ways: per minute (an allowance of minutes, then an overage rate), per call (a monthly call allowance, then a per-call overage) and per unique caller. Per-booking pricing may appear in quotes, but I found none published. At 650 calls a month, published plans run from roughly $150 to over $1,000.

The model matters more than the headline price. A minute-based plan rises when calls get longer. A per-call plan does not. A per-caller plan does not either, but it counts each phone number once a month. Overage rules, the plan that includes a business associate agreement and the contract terms decide the real bill, so each is worked through below with stated assumptions.

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The four pricing models and what each one counts

The pricing pages for these vendors keep changing, so check the vendor's page on the day you decide. What follows uses the figures as I read them in November 2026.

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Per-minute plans: allowances, overage and the cliff

Per-minute pricing is easy to understand and easy to underestimate. You buy a bundle of minutes. Anything beyond it is charged at an overage rate per minute.

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MedReception, which is built for medical offices, lists managed plans at $495 (Essential, up to two providers), $995 (Professional) and $1,495 (Elite) a month with 500, 1,000 and 2,000 minutes included. Overage is $1.25, $0.99 and $0.95 a minute. Annual billing lowers the monthly figures to $420, $845 and $1,270. There is no setup fee, the plans are month-to-month and a business associate agreement (BAA) is included on every managed plan. Its self-build Studio plan is $299 a month, with EMR scheduling as an add-on at $1,500 one time plus $99 a month. Extra workflows, such as after-hours coverage or smart voicemail, are $99 a month each on some plans.

Dialzara lists $29, $99, $199 and $349 for 60, 220, 500 and 1,000 minutes, with overage of $0.48, $0.45, $0.40 and $0.35 a minute, and no contract. Rosie lists $49, $149 and $299 for 250, 1,000 and 2,000 minutes; I could not find its overage rate published.

The cliff effect, with numbers

Say a two-provider office expects 975 minutes a month. On MedReception Professional ($995, 1,000 minutes) that fits. If a busy month adds 100 minutes, the overage is 75 minutes at $0.99, or $74. Now compare the Essential plan: 975 minutes on 500 included is 475 over at $1.25, $594, on top of $495, a total of $1,089. The cheaper plan costs more. The lesson is general: estimate your minutes first, then choose the smallest plan that includes them with a margin, not the one with the lowest price.

Per-call and per-caller plans: flat until the count moves

Smith.ai's AI receptionist counts calls. The Free plan allows 25 calls a month and charges $3 for each extra; the Pro plan's per-call rate falls as you commit to more, from $2.00 to $1.67, with overage of $2.50, $2.30 and $2.17 a call. The page lists Enterprise at $500 for 300 calls, with 500 calls at $1.60 each and an extra-call rate of $2.10; 1,000-plus is custom. Smith.ai's published rules say every answered call counts by default, calls from known spammers are filtered out automatically, and you can remove up to 10 percent of a cycle's calls as spam. The page does not say whether Free-plan overage is charged automatically, so ask before you rely on it.

Goodcall counts unique callers, not calls or minutes. A caller is one phone number, once a month, so a patient who rings five times is one customer; spam and wrong numbers do not count. Starter is $79 for 100 customers (about 150 calls), Growth $129 for 500 (about 750 calls) and Scale $299 for 2,000 (about 3,000 calls). Extra customers cost 79 cents, 26 cents and 15 cents each. Goodcall states there are no minute charges, and that it will sign a BAA on Scale and Enterprise only.

Flat models suit medical offices where calls are variable in length. They penalise you when the count grows past the allowance, so you want to know your monthly volume within about 20 percent.

A worked example: 650 calls a month at a two-provider office

Assumptions, stated so you can replace them with your own: 150 inbound calls a week, which is about 650 a month; an average handled call of 90 seconds, so 975 minutes; one in three calls ends in a booking, so about 195 bookings; and callers ring about 1.5 times each, so about 433 unique callers. These are illustrative numbers, not benchmarks.

Two cautions before anyone picks the cheapest row. The plans do different jobs: MedReception's managed price includes setup, EMR scheduling and a BAA, which is why it is dearest, while the cheaper plans leave setup and EMR connection to you or do not mention them. And a low price is only a bargain if the agreement is available. The Dialzara, Rosie and Smith.ai AI receptionist pricing pages did not mention a BAA when I read them, so a medical office should ask each in writing before it treats them as an option. For the compliance side, the BAA and retention checklist lists what to ask.

What happens if calls run longer

Now test how the same office fares if its average handled call goes from 90 seconds to 3 minutes (for example, because the AI takes insurance details). Calls stay at 650. Minutes become 1,950.

Per-minute plans can nearly double with longer calls. Per-call and per-caller plans do not move. That is the strongest argument for choosing a model that matches how your calls behave. If you do not know your average call length, you can estimate it from your phone system's call log or from a week of timed calls.

Turning a per-booking quote into a number you can compare

A sales rep may offer "pay only when we book". It can be a good deal or a poor one. Convert it before you answer.

1. Ask what counts as a booking. A confirmed slot in your system? A request the patient later cancels? A reschedule? Each definition changes the bill.
2. Ask for the monthly minimum and the cap. A per-booking fee with a monthly floor is a subscription in disguise.
3. Multiply by your own bookings. Using the 195 bookings above, a $5 fee costs $975 a month; a $3 fee, $585.
4. Compare with the flat plans. On the table above, the cheaper flat plans work out at $0.76 to $1.79 a booking. A per-booking quote above that is paying for something else, so ask what.
5. Check who decides what is a booking. If the vendor's log is the only record, you cannot audit it.

An illustrative quote: "$4 per booked appointment, $400 minimum a month." At 195 bookings the cost is $780, and in a slow month of 70 bookings it is $400, which is $5.71 a booking. The flat price of $299 would be cheaper in both months. That kind of comparison is easy to do on a page of paper and rarely done before the contract is signed.

What the plan includes that is not minutes or calls

When two plans look equal, the line items outside the headline decide it.

• The BAA tier. Goodcall's agreement comes with Scale ($299). MedReception includes it on every managed plan. If you handle protected health data, the plan with the agreement is the plan you price.
• EMR scheduling. MedReception includes it on managed plans and charges $1,500 plus $99 a month on Studio. If the AI cannot write to your scheduling system, a person re-enters every booking, which erases much of the saving.
• Add-on workflows. MedReception lists after-hours coverage and smart voicemail at $99 a month each on its smallest plan, and referrals, rescheduling, intake and chart prep at $99 a month each or included on higher plans.
• Text messages. Dialzara's AI SMS agent is $19 a month plus $0.05 an AI message, with carrier fees passed through. Goodcall can text a caller but not receive replies, so a two-way confirmation flow is not possible on it.
• Setup and support. Smith.ai's Pro plan adds dedicated onboarding and live support over the Free plan; Dialzara's Elite includes initial prompt setup and priority support.

The tutorial on what each type of AI receptionist does explains the setup differences between do-it-yourself and managed products.

Contract terms to read before you pay

1. Term and cancellation. MedReception and Dialzara list month-to-month or no-contract terms. Smith.ai's AI receptionist is month-to-month but asks for 30 days' notice to cancel, and it also offers a six-month plan with rollover calls and a lower per-call rate, which is a commitment. A discount for committing is only worth it when your volume is steady.
2. Overage rules. Is the overage rate published? Is it charged automatically? Smith.ai publishes its overage rates but not whether they switch on automatically on the Free plan; Rosie's overage is not published on the page I read. Both are reasons to ask.
3. What is counted. Spam, wrong numbers, test calls and transfers should not count. Smith.ai filters known spammers, lets you remove up to 10 percent of calls as spam and lists a separate allowance of test calls; Goodcall says spam and wrong numbers do not count at all.
4. Annual versus monthly. MedReception's annual price is $420 against $495 for Essential, about 15 percent lower; that is $900 saved over the year, and also $5,040 committed.
5. Number porting and recordings. Can you keep your number by forwarding it? Goodcall says yes. What happens to recordings and transcripts when you leave?
6. Price changes. Get the plan price and the overage rate in writing, with notice before changes.

For a broader tour of per-minute and per-call providers outside healthcare, virtual receptionist pricing from Ruby, Smith.ai and Rosie and Smith.ai pricing for 50, 150 and 300 calls add detail on those two models, and what an AI answering service costs a doctor's practice adds the clinic view.

How to count your own volume in an hour

1. Export your phone system's call log for the last 60 days. Separate inbound from outbound and drop duplicates.
2. Count inbound calls per week and the share that go unanswered or to voicemail. Those are the calls an AI receptionist would add.
3. Time ten calls by listening to recordings if you have them. Take the average, and add 20 percent for AI back-and-forth.
4. Note the share of calls that end in a booking, a cancellation, a refill request or a general question.
5. Multiply: calls x average minutes for minute-based plans; calls for call-based plans; unique numbers for caller-based plans.

A filled-in example: 160 inbound calls a week with 24 percent unanswered gives 38 extra calls a week, about 165 a month. At 2 minutes each, that is 330 minutes. A 60-minute Dialzara plan would be far too small; the 500-minute Business Plus plan at $199 fits, and Smith.ai Pro at 150 calls ($270) would be slightly over its allowance, so overage would apply. The count showed that the problem was not "all calls" but the unanswered fraction, which changes which plan is cheapest.

Questions to put to every vendor, in writing

A demo shows what the product can do; an email shows what the contract says. Send the same list to each vendor and compare the replies side by side.

Subject: Pricing questions for a [number]-provider medical office

We expect about [650] inbound calls a month, an average handled call of about [90] seconds, and roughly [195] bookings.

1. Which plan would you recommend, and what would our monthly cost be at those numbers?
2. What is the overage rate, and is it charged automatically?
3. What counts as a call, a minute or a unique caller? Are spam, wrong numbers, transfers and test calls excluded?
4. Will you sign a business associate agreement on that plan? Is it included in the price?
5. Does the AI write bookings into our scheduling system? If so, what is the one-off and monthly cost?
6. What is the contract term, the cancellation notice, and what happens to our recordings and transcripts on exit?
7. Are there per-message or per-number charges for texts and phone numbers?
8. How much notice do you give before a price change?

Replies that give a number for question 1 and a clear yes or no for question 4 are the ones worth a trial. A reply that says "it depends" to everything usually means the price is negotiated per customer, which is fine, but you should then negotiate with the competing quotes in hand.

The first invoice: what to check against your own log

After the first month, do not just pay the invoice. Reconcile it with your own data. Illustrative example: the invoice shows 1,090 minutes on a 1,000-minute plan, 90 over at $0.99, which is $89. Your own log shows 612 calls handled. Divide: 1,090 minutes over 612 calls is 1.78 minutes a call, longer than the 1.5 you assumed. Two things might explain it: the AI is asking more questions than needed, or patients are staying on the line after the booking is made. Either can be fixed in the script, and every 10 seconds you cut from an average call saves about 100 minutes at this volume. Look at ten call recordings that ran longer than three minutes and ask what could have been shorter.

Do the same for per-call and per-caller plans. If you are on a call-based plan and 12 percent of your counted calls were wrong numbers or spam, ask the vendor why they were not excluded. A minute here and a call there are small, but they are the difference between the cheap plan and the one above it.

What a missed call costs, and when the price is worth paying

A price is only high or low against the value of what it recovers. Use your own figures rather than a vendor calculator. MedReception's page includes a calculator with placeholder values that it says are not benchmarks, which is the right attitude: set the share of missed callers who never ring back, and what a new patient is worth, from your own records.

An illustrative sum. If an office loses 38 calls a week and a quarter of those callers never call back, that is about 9.5 lost callers a week. If one in three of them would have booked, that is about 3 bookings, or 13 a month. At an assumed $120 per visit, that is $1,560 a month. A $299 plan is covered if even a fifth of that is real. A $995 plan needs a larger recovery or other savings (staff time, after-hours coverage) to justify it. The question to ask the vendor is not "how much do I save?" but "what should I measure after 60 days to know if this works?", and a good answer lists call answer rate, bookings per week and patient complaints.

If you would rather work through your own call log with someone, that is what my AI implementation consultation covers; the contact page is the place to start.

Pricing questions medical office managers ask

Is per-booking pricing common for AI receptionists?

Not on the pricing pages I read. The published models were per minute, per call and per unique caller. Per-booking pricing may appear in a sales quote, so convert any offer into a cost per call and a cost per month at your volumes and compare it with the published plans.

Which model is cheapest when calls are long?

Per-call and per-caller models, because the price does not rise with call length. Per-minute plans rise with every extra minute once you pass the allowance. If patients take three minutes to book rather than one, a minute-based plan can double in cost while a per-call plan stays flat.

Why does the plan with a signed BAA cost more?

Some vendors put the agreement on higher tiers only. Goodcall offers a business associate agreement on its Scale and Enterprise plans, not Starter, and MedReception includes one on every managed plan. If you handle protected health data, price the plan that includes the agreement, not the cheapest one.

What should I do before signing an annual contract?

Run a month-to-month trial on real calls, count minutes or calls and spam, and read the overage line. Several vendors list no-contract or cancel-anytime terms, and annual billing only saves money if your volume is stable. Set a review date at 60 days.

Further reads

• Healthcare AI Call Centre: When a Group Practice Should Centralise Calls — When a group practice should centralise its calls.
• AI Receptionist for Medical Clinics With Two Sites: Routing and Hand-Offs — Routing and hand-offs for a clinic with two sites.
• AI Receptionist for Medical Practices: Should It Verify Callers First? — Whether the AI should verify callers first.
• AI Answering Service for a Doctor's Office: After-Hours Call Rules — After-hours call rules for a doctor's office.
• AI Tools and AI Development: The Complete 2026 Guide — the AI hub, including every tutorial in the AI-for-business series.

Sources: pricing and FAQ pages for MedReception, Smith.ai, Dialzara, Rosie and Goodcall, checked in November 2026. All prices are USD list prices; the volumes and call lengths in the worked example are labelled assumptions.