- Setup and onboarding. Commonly $500–$2,500 with enterprise-leaning vendors. Ask whether it is waived on annual terms.
- PMS integration fee. Sometimes billed separately per system, sometimes per location.
- Overage. What happens at call 501 or minute 1,001 — a rate, a hard stop, or an automatic tier bump?
- Per-location fees. Multi-site practices often discover the quoted price was per site.
- Telephony pass-through. Some vendors bill carrier minutes on top of the platform fee.
- Contract length. A cheap monthly number attached to a 24-month term is not a cheap number.
The break-even question
A practice missing 25% of 600 monthly calls loses roughly 150 conversations. If one in six of those was a new patient worth $1,200 in first-year production, that is around $30,000 of exposure a month before you count reschedules and emergencies routed to voicemail.
Against that, a $999 flat plan breaks even if it recovers a single new patient. Run your own numbers on the missed-call revenue calculator rather than trusting a vendor slide.
