Managed IT for a medical practice is priced by device and by mailbox, not by headcount. Braintek’s packages run $150 to $250 per device per month plus $15 to $35 per staff mailbox per month, with Microsoft licensing billed separately and shared mailboxes free. That’s the same structure we publish for every industry we serve.
But a range isn’t an answer, so let’s do something more useful: walk through the actual monthly invoice, line by line, for two common practice shapes, and explain why each line exists. Practices are unusual among small businesses in one specific way that drives the total, so start there.
Why your device count is bigger than your headcount
In most offices, one person means one computer. In a medical practice, the building has computers of its own. Every exam room has a machine so the provider can chart without leaving the patient. Nurse stations have shared workstations. The front desk runs check-in, eligibility, and scheduling. Add a server if your EHR or imaging lives on premises, and a 15-person practice can easily run 22 to 25 managed endpoints.
Every one of those machines touches patient information, which means every one needs the same patching, endpoint protection, encryption, and access controls as the office manager’s PC. HIPAA doesn’t have a category for computers that matter less. So when you evaluate any managed IT quote, the first number to pin down isn’t the rate, it’s the endpoint count, and the honest way to get it is to walk the floor plan, not the org chart.
Now, the invoices.
The invoice: a 5-provider, single-location practice
Picture a Houston practice: 5 providers, a practice manager, 4 front-office and billing staff, and 5 clinical staff. Fifteen people, one location, 10 exam rooms, and the EHR vendor hosts the application but the practice keeps a local server for imaging and file storage. Here’s what the monthly invoice looks like and what each line is doing.
Provider and staff workstations — 11 devices — $1,650 to $2,750. One machine per person for the 5 providers and 6 of the administrative and clinical staff who have their own desks. This line carries the everyday value of the agreement: help desk support when the front desk can’t print a superbill, monitoring that catches a failing drive before it fails during clinic hours, patching that happens after hours instead of mid-morning, and endpoint protection on the machines your billing team uses to move money.
Exam room and nurse station machines — 10 devices — $1,500 to $2,500. This is the line that surprises practices comparing quotes against a generic small-business estimate, and it’s usually the difference between a quote that holds and one that grows after signing. These machines sit in clinical areas, display charts, and get shared by everyone on shift, which makes them more of a security and uptime concern, not less. If a competing quote is dramatically lower, check whether it counted these at all.
On-premises server — 1 device — $150 to $250. The server holding imaging and shared files gets monitored around the clock, patched on a schedule, and backed up with restores that actually get tested. If your EHR runs fully hosted and you’ve moved files to Microsoft 365, this line disappears, which is one of the quiet financial arguments for going cloud-first. What good backup looks like for a practice, across EHR data, imaging, and Microsoft 365, is its own topic, covered in our guide to medical practice backup.
Staff mailboxes — 15 mailboxes — $225 to $525. Each person’s mailbox gets email security, encryption for messages that touch patient information, and backup. Email is the front door for most healthcare ransomware, so this line is doing more defensive work than its size suggests.
Shared mailboxes — appointments@, referrals@, billing@ — $0. Shared mailboxes are free. A practice runs on them, and they shouldn’t cost anything. If a quote you’re comparing charges for shared mailboxes, that’s worth a question.
Estimated monthly total: roughly $3,525 to $6,025.
Separately on the invoice, at Microsoft’s own pricing with no markup hiding inside the support number: Microsoft 365 licensing.
What you’re buying against: an hour of a stalled waiting room
Before the second invoice, the comparison that makes the first one make sense. A practice doesn’t buy patching and monitoring; it buys mornings that run on schedule.
Do the arithmetic with your own numbers. If each of your 5 providers sees 3 to 4 patients an hour, one hour of downed systems is 15 to 20 visits that get delayed, shortened, or rescheduled. Behind that sit costs the schedule never shows: staff burning the afternoon on callbacks and rework, providers charting from memory that evening, and patients in the waiting room deciding what kind of practice this is. A single bad morning routinely costs more than the entire monthly invoice above, and that’s before any question of whether patient data was exposed, where the stakes stop being financial and regulatory penalties can reach well beyond an IT budget.
That’s the frame for every line item: each one exists to keep a specific kind of bad morning from happening, or to make it short when it does. Our typical response is answering within about 60 seconds and resolving most issues in around two hours, which matters most on the day the schedule is full.
The invoice: a 15-provider, multi-site group
Now a Dallas–Fort Worth group: 15 providers across 3 locations, 30 staff covering front office, clinical support, billing, and administration. Each site has 10 exam rooms. The EHR is vendor-hosted; two servers carry imaging and shared storage. Same invoice anatomy, bigger numbers, plus two lines the single-location practice didn’t have to think about.
Provider and staff workstations — 45 devices — $6,750 to $11,250. Same line as before, at group scale. The per-device rate doesn’t climb because you grew; the count does.
Exam room and nurse station machines — 30 devices — $4,500 to $7,500. Ten rooms per site, three sites. At this scale the clinical machines are a bigger line than most groups expect, and it’s exactly where underscoped quotes fall apart later.
Servers — 2 devices — $300 to $500. Imaging and file storage, monitored, patched, and backed up with tested restores, same as before.
Staff mailboxes — 45 mailboxes — $675 to $1,575. Shared mailboxes across all three sites: still free.
Estimated monthly total: roughly $12,225 to $20,825.
The two things multi-site adds aren’t really new line items, they’re new obligations inside the existing ones. First, the network between locations becomes clinical infrastructure: if site two loses its connection, its providers lose the EHR, so connectivity gets monitored and gets a failover plan like any other system patients depend on. Second, consistency becomes a security control in itself. Three sites drifting on their own patching and access habits is how one location’s bad click becomes the whole group’s incident. A managed agreement holds every site to the same baseline, which is most of what a HIPAA security program looks like in daily practice.
At this size, some groups also weigh hiring internal IT instead. The honest comparison, including the co-managed middle path where your hire and our team split the work, is a separate question we’ve written up in internal IT versus an MSP for medical practices.
What should never appear on this invoice
Reading an invoice line by line also means knowing which lines shouldn’t exist. When you compare quotes, watch for these:
- Hourly or per-ticket support charges. If calling the help desk costs extra, your staff will hesitate to call, and small problems will grow quietly until they aren’t small. Support belongs inside the per-device rate.
- HIPAA safeguards sold as add-ons. Encryption, MFA, audit logging, and the documentation behind them are the reason a practice buys managed IT. A rate that excludes them isn’t a lower price, it’s a smaller product.
- Charges for shared mailboxes. Free, as covered above.
- Software licensing marked up inside the support fee. Licensing should be its own visible line at the vendor’s pricing, so you always know what support actually costs.
- Vague “security bundle” surcharges. If a line can’t be explained in one sentence, the way every line above just was, ask until it can be.
The pattern behind all five: a good managed IT invoice for a practice is boring. The same lines, the same math, every month, with changes only when your device or mailbox count changes. If you want the fuller checklist of what belongs in the underlying contract, from offboarding terms to data ownership, we’ve written up what a managed IT agreement for a medical practice should say.
Getting your number
Braintek has supported Houston and Dallas–Fort Worth businesses since 2002, and our sweet spot is exactly where most independent practices and small groups live: roughly 10 to 50 people, fully managed or co-managed alongside your existing IT. The healthcare work, HIPAA safeguards, EHR environment support, and ransomware defense, is covered in depth on our healthcare IT page, with a dedicated page for independent medical practices if that’s you.
Your practice won’t match either invoice above exactly, and it doesn’t need to. Count your people, walk your floor plan and count the machines, note whether your EHR is hosted or on premises, and the same arithmetic produces your number. Or send us those four facts and we’ll produce it for you, itemized and explained, before you’ve committed to anything.