Google Ads management pricing: what you should pay and get

How Google Ads management is priced

• Flat monthly fee. The same fee whatever you spend. Easy to budget, and it doesn't reward raising spend.
• Percentage of ad spend. The fee is a share of your monthly budget. It scales automatically, in both directions.
• Hybrid. A minimum fee plus a percentage above a spend threshold.
• Tiered. A flat fee that steps up at set spend bands.
• Setup fee. A one-time charge for an audit, restructuring and tracking. Should come with a list of deliverables.

You also pay for the clicks themselves, separately and directly to Google. Our guide to what the clicks themselves cost has average click prices for 17 patient searches.

What you should get for the fee

Good management for a practice is mostly unglamorous, recurring work:

• Search-term reviews and negative keywords. Someone reads the actual searches that triggered your ads and blocks the wrong ones: jobs, schools, free clinics, services you don't offer.
• Budget pacing. Google can spend up to twice your average daily budget (opens in a new tab) on a given day while capping the month at 30.4 times the daily figure. Pacing keeps the money spread so ads still run on the last week of the month. Our explainer on budget pacing explained covers the mechanics.
• Ad copy testing within health ad policies. New headlines and descriptions tested regularly, checked against Google's Healthcare and medicines policy (opens in a new tab), which restricts prescription drug terms and requires certification for categories such as addiction services.
• Conversion tracking that doesn't send patient data. Calls, form submissions and booking clicks counted as conversions, with no form contents passed to Google. Google itself says it doesn't offer a BAA for Google Analytics (opens in a new tab) and that authenticated pages shouldn't carry its tags.
• A written change log. What changed, when, why, and who made the change.
• A monthly report on cost per lead by campaign and what happens next.

Our guide to Google Ads management for practices goes deeper on each task.

Flat fee vs percent of spend, side by side

Hypothetical arithmetic. The $500 flat fee and the 15% rate are invented for this example; they are not market rates. Compare them at three monthly spend levels:

What the table shows:

• Break-even is where the two fees match: $500 ÷ 15% ≈ $3,333 a month in spend. Below it, the percentage is cheaper; above it, the flat fee is.
• At low spend, a flat fee is a large share of the budget. At $1,000 a month, a $500 fee adds 50% to what you pay for clicks. That's why percentage-based managers often set minimum fees.
• At high spend, the percentage grows without more work. Going from $3,000 to $10,000 in spend triples the percentage fee, though the account may have the same campaigns.

Run the same math with your real quotes and your planned spend for the next 12 months, not just this month.

How to choose between real quotes:

• If your spend will stay below the break-even point all year, a percentage quote may cost less, provided it comes with a written scope.
• If you plan to grow spend, for a new service or a second provider, a flat fee keeps management cost steady while the budget rises.
• Whichever you pick, ask what happens to the fee if you pause ads for a month, for example when the schedule is full.

Hidden costs: setup, landing pages and tracking

Line items that often sit outside the monthly fee:

• Setup or onboarding. An audit and account rebuild. Fair if it's itemized.
• Landing pages. One page per service is usually the biggest single improvement to cost per lead, and agencies often bill for it separately.
• Conversion tracking. Setting up call, form and booking-click tracking safely takes real work.
• Call tracking. Some managers add tracking phone numbers through a third-party service with its own fee.
• Creative. Images and video for Performance Max or display campaigns.
• Minimum terms. Months you pay for even if you leave early.

Ask for each one in writing before you compare monthly fees.

Want to see how your current account looks from the outside first? Our free audit with an ads score checks your ads and flags privacy risks such as pixels on patient forms, using public information only.

Red flags: marked-up spend, locked accounts, no change log

• Marked-up spend. Ad spend billed through the manager's invoice, with no access to Google's own invoices. Ask for spend charged by Google to your card.
• Locked accounts. The account is opened under the manager's business, or you have no login. Keep at least one practice login with admin access (opens in a new tab), the level that adds and removes users. Note that a linked manager account with ownership can also change who has access to your account.
• No change log. If nobody can tell you what changed last month and why, you can't judge the work.
• A percentage with no scope or cap. The fee grows; the work doesn't have to.
• Promised positions or patient numbers. No one controls the auction.
• Pixels on forms. A manager who wants tracking tags on intake or appointment forms hasn't thought about patient data.

If you already have an account, a quick self-check helps: our guide to audit your Google Ads account lists what to look at.

What Medfy's $199/month add-on includes

Medfy's Google Ads management is an add-on to the $349/month base plan, priced at $199/month whatever you spend. As listed on our pricing page, it includes:

• daily search-term reviews and negative keywords;
• budget pacing with a monthly ceiling the practice controls;
• new ad copy suggestions, checked against healthcare policy;
• every change logged and reversible.

You choose whether Medfy only suggests changes or applies safe ones itself. Budget increases always wait for your approval, and daily changes are capped. Ad spend is paid directly to Google, never marked up. Billed monthly, cancel anytime.

What it doesn't include: call tracking numbers or phone answering, which Medfy doesn't provide. See the Google Ads add-on details. For other fee structures, our guide to agency pricing models compares retainers, percentages and pay-per-lead deals.

Frequently asked questions

How much does Google Ads management cost?

It depends on the pricing model and the scope. Managers charge a flat monthly fee, a percentage of ad spend, or a minimum plus a percentage, sometimes with a setup fee. We know of no reliable public average for practices. Compare quotes on the work included: search-term reviews, negative keywords, budget pacing, policy-checked ad copy, safe conversion tracking and a written change log.

Is a percentage of ad spend or a flat fee better?

For most small practices, a flat fee. A percentage rises every time you raise the budget, even when the work doesn't change, and it rewards spending more. A percentage can make sense for large accounts where more spend means more campaigns. Work out both at your actual spend: below the break-even point the percentage is cheaper, above it the flat fee is.

What should Google Ads management include each month?

Regular search-term reviews with new negative keywords, budget pacing so money lasts the month, ad copy tests that stay within Google's healthcare policies, conversion tracking for calls, forms and booking clicks that doesn't send patient data to Google, a monthly report on cost per lead by campaign, and a written log of every change made to your account.

Should I own my Google Ads account if someone else manages it?

Yes. The account and its payment profile should be in the practice's name, with at least one practice login holding admin access, which controls who else can get in. Your manager then works through their own user access or a linked manager account. If you change managers, your history, conversion data and billing stay with you instead of starting from zero.