What is the cheapest EHR for therapists in 2026?

Among full practice platforms with telehealth included, CoralEHR's $29/month Starter is the lowest real entry point - and it's deliberately AI-free. Sessions Health starts at $39 and TheraNest at $29 (both add telehealth and AI as paid extras). Watch for decoy pricing: Jane's $54 Balance plan caps at 20 appointments/month, so its real therapist entry is $79.

Are there hidden fees with therapy EHR software?

Yes. Most EHRs charge separately for AI note generation ($15-40/clinician/mo), telehealth ($10-15/mo on some platforms), Wiley Treatment Planners ($15-25/mo), per-claim fees ($0.14-0.25 each), and payment processing (2.9-3.15% + $0.25-0.55 per transaction). The biggest 2026 add-on is AI - it can push a $69-79 plan to $109-114/mo. CoralEHR includes its full AI suite in the $79 Professional plan with no per-seat fee.

Is SimplePractice worth the price?

SimplePractice's plans run $49 / $79 / $99, with 1:1 telehealth now included on all tiers (since March 2025). Its AI Note Taker is a roughly $35/clinician add-on. It's a mature all-rounder with great UX and mobile apps, but solo private-pay therapists who don't bill insurance may find better value in a private-pay-first platform.

Do I need insurance billing features if I'm private-pay only?

No. If you exclusively see private-pay clients, you're paying for features you won't use. EHRs like CoralEHR are built for private-pay practices and issue superbills instead of filing claims, which removes the insurance-billing overhead and typically keeps costs lower.

How much does a solo therapist actually spend on EHR software per year?

For a solo private-pay therapist needing telehealth and notes, annual software costs range from about $348 (CoralEHR Starter, AI-free) to over $1,600 (SimplePractice Plus with AI). With the AI most therapists now want, CoralEHR Professional is $948/year all-in. Payment processing fees add another $600-900/year depending on session rates.

Should I choose an EHR based on price alone?

No. A cheaper EHR that lacks telehealth, AI notes, or a client portal will cost you more in time and workarounds. Calculate the total cost including every add-on you'll actually need, then compare. A $79/mo EHR with everything included can be cheaper than a $29/mo EHR plus $50 in add-ons.

EHR Cost Comparison for Therapists: What You'll Pay in 2026

EHR Pricing Is Confusing on Purpose

Every EHR markets a low starting price. Few of them tell you what you'll actually pay.

Base price. Per-clinician fees. Telehealth add-ons. AI notes add-ons. Per-claim charges. Payment processing markups. Wiley Treatment Planner licenses. It adds up fast, and the math is deliberately hard to do before you're locked into a contract.

This guide does the math for you. We pulled real pricing data for the seven EHR platforms most therapists actually weigh in 2026 and calculated the true annual cost for a solo private-pay practice. No affiliate links, no sponsored rankings - just numbers.

The Full Cost Breakdown: 7 EHRs Compared

Here's what each platform charges across the categories that actually matter to your bank account.

EHR	Base Price	AI Notes	Telehealth	Total (Solo, Private-Pay)
CoralEHR	$29 (AI-free) / $79 (AI included)	Included at $79; drafts from your notes, no recording	Included on all plans (group-capable)	$29 or $79/mo - no per-seat AI fee, no platform markup on Stripe
SimplePractice	$49 / $79 / $99	Note Taker add-on (~$35/clinician)	Included on all plans (1:1) since Mar 2025	$49-$99/mo (+$35 for AI)
TherapyNotes	$69 solo / $79 group + $50/clinician	TherapyFuel add-on (~$40/clinician)	Included (1:1)	$69-$109/mo with AI
Jane App	$54 / $79 / $99	AI Scribe add-on ($15/practitioner)	Included	$79+/mo (real entry; $54 caps at 20 appts)
Upheal	~$1/session, cap ~$69/mo	Ambient scribe (records sessions)	Included (1:1)	~$19-$69/mo (no insurance billing)
Sessions Health	$39 + $29/seat	Add-on (~$35/practitioner) since Apr 2026	+$10/mo (caps at 4)	$39-$84/mo with telehealth + AI
TheraNest (Ensora)	$29 / $59 / $89	Add-on (~$35/provider) every tier	+$12/mo add-on	$41-$124/mo with add-ons

A note on base prices: The lowest advertised price is rarely the price you'll pay. The 2026 pattern is that nearly every competitor now sells AI as a $15-40/clinician add-on on top of the base plan - so a "$69" or "$79" plan becomes $109-$114 once AI is on. Jane's $54 Balance plan caps at 20 appointments/month and excludes online booking and SMS reminders, so its real therapist entry is the $79 Practice plan. Always price the tier (and add-ons) you'll actually use.

Hidden Costs Most Therapists Miss

The comparison table above covers the obvious costs. Here are the ones that show up on your credit card statement three months in.

Telehealth Add-Ons: $10-15/mo

In 2026, telehealth isn't optional - it's baseline. Yet some EHRs still charge extra for it, or cap it:

Sessions Health: +$10/mo, and it caps at 4 participants
TheraNest (Ensora): +$12/mo add-on

CoralEHR, SimplePractice (1:1, since March 2025), TherapyNotes, Jane App, and Upheal include telehealth on all plans. CoralEHR's is group-capable on every plan, including the $29 Starter tier - most competitors' included video is 1:1 only.

AI Notes Add-Ons: $15-40/mo

AI-powered clinical notes save 15-30 minutes per session. The dominant 2026 pattern is the per-clinician AI add-on - you pay the base plan, then pay again for AI:

SimplePractice: Note Taker, ~$35/clinician add-on (a recording scribe)
TherapyNotes: TherapyFuel, ~$40/clinician add-on (so a solo clinician's all-in is ~$109/mo)
Jane App: AI Scribe, $15/practitioner add-on
Sessions Health: ~$35/practitioner add-on (added April 2026)
TheraNest (Ensora): ~$35/provider add-on on every tier
Upheal: ambient scribe is the core product (records sessions)

CoralEHR is the outlier on structure: its $79 Professional plan includes the full AI suite - note drafting, SOAP agent, AI treatment plans, form builder, reports - with no per-seat AI fee, and the AI drafts from your typed notes rather than a recording. Its $29 Starter plan is deliberately AI-free for therapists who want none.

Per-Claim Fees (Only If You Bill Insurance)

If you bill insurance, clearinghouse per-claim fees add up. TherapyNotes is the lowest among these platforms at $0.14/claim. Private-pay therapists avoid per-claim fees entirely - which is the whole point of a private-pay-first EHR like CoralEHR, which issues superbills instead of filing claims.

Payment Processing: Who Controls Your Processor

Every EHR that takes payments routes a card-processing fee. The fee itself (standard Stripe is roughly 2.9% + $0.30 per transaction) is similar across platforms - but who controls the processor relationship differs, and that's where you can get locked in:

Jane: moved everyone onto Jane Payments (2.85% + $0.25) in May 2026; reviews report clients can't even remove their own stored card.
TheraNest (Ensora): forces in-house payments at roughly 2.99% + $0.30.
CoralEHR: uses Stripe directly - it's your own processor relationship at standard rates, with no platform markup on top.

On a $150 session, processing is roughly $4.50-$4.90 regardless of platform. The markup and lock-in are what vary.

Treatment Planning: Built-In vs. a Paid Add-On

Some platforms sell evidence-based treatment planning as a Wiley Treatment Planner license - TheraNest charges about $25/mo for it, and SimplePractice now bundles Wiley into its Essential/Plus tiers. Jane has no treatment-plan module at all. CoralEHR includes its own treatment-planning module - objectives with progress tracking tied to assessment metrics - at no extra license cost.

The Real Math: Annual Cost for a Solo Private-Pay Therapist

Let's get specific. Here's the scenario:

Solo therapist, private-pay only
20 clients per week, 48 weeks per year (960 sessions/year)
Needs telehealth + clinical notes
$150 average session rate
No insurance billing

Annual EHR Software Cost (Before Payment Processing)

EHR	Monthly Cost	Annual Cost	What's Included
CoralEHR (Starter)	$29	$348	Telehealth, scheduling, reminders, billing, 35+ assessments - no AI
CoralEHR (Professional)	$79	$948	Everything in Starter + full AI suite included, no per-seat fee
Upheal	~$19-$69	$228-$828	Telehealth, ambient AI scribe (records sessions); no insurance billing
Sessions Health	$39 (+$10 video)	$588	Telehealth add-on; AI +$35; insurance e-claims included
TheraNest (Ensora)	$59 (+$12 video)	$852	Telehealth add-on; AI +$35/provider
TherapyNotes	$69 (+$40 AI)	$1,308	Telehealth included; TherapyFuel AI add-on
Jane App	$79 (+$15 AI)	$1,128	Telehealth + AI Scribe; no treatment-plan module
SimplePractice (Essential)	$79 (+$35 AI)	$1,368	Telehealth included; Note Taker AI extra
SimplePractice (Plus)	$99 (+$35 AI)	$1,608	Everything + waitlist; AI extra

Add Payment Processing (Stripe Standard)

At $150/session and 960 sessions/year:

Per-transaction fee: 2.9% + $0.30 = $4.65 per session
Annual processing cost: $4,464

This cost is roughly the same across all EHRs using standard Stripe rates - it's the base-plan and AI-add-on differences above that actually move your total.

True Annual Cost (Software + Processing)

The cleanest apples-to-apples view is "the plan with the AI documentation you'll actually use." CoralEHR's $79 Professional includes the full AI suite; every other platform here charges an AI add-on on top of its base plan.

EHR (with AI you'll want)	Software	Processing	Total Annual
CoralEHR (Starter, AI-free)	$348	$4,464	$4,812
Sessions Health (+telehealth)	$588	$4,464	$5,052
TheraNest (+telehealth)	$852	$4,464	$5,316
CoralEHR (Professional, all AI included)	$948	$4,464	$5,412
Jane App (+AI Scribe)	$1,128	$4,464	$5,592
TherapyNotes (+TherapyFuel AI)	$1,308	$4,464	$5,772
SimplePractice Essential (+Note Taker AI)	$1,368	$4,464	$5,832
SimplePractice Plus (+Note Taker AI)	$1,608	$4,464	$6,072

The headline: once you add the AI most therapists now want, CoralEHR Professional ($948/yr, all AI included) undercuts every comparable all-AI plan by $180-660/year - and if you want no AI at all, the $29 Starter is the cheapest real practice tier here. The spread across "with-AI" options is over $1,200/year in software alone - roughly 8 sessions of income.

When Cheap Isn't Actually Cheaper

A low sticker price sounds great until you realize you're spending an extra 15-30 minutes per session on documentation because AI notes cost extra, or paying separately for a telehealth add-on that should be included, or manually chasing invoices because the client portal is thin.

Here's what false economy looks like in practice:

Time cost of manual notes: If you spend an extra 15 minutes per session writing notes without AI assistance, that's about 240 hours/year (960 sessions × 15 minutes). At your effective hourly rate, that's real money - an EHR with AI documentation included can pay for itself quickly.

Client no-shows without automated reminders: Practices without solid scheduling and automated reminders tend to see meaningfully higher no-show rates. On a 960-session practice, even a few percentage points of improvement is dozens of recovered appointments - real revenue at $150/session. (CoralEHR includes SMS and email reminders on every plan, including the $29 Starter.)

Switching costs: Migrating EHRs takes 20-40 hours of setup, data transfer, and retraining. Choosing the cheapest option now and upgrading later costs more than choosing the right tool from the start.

The real question isn't "which EHR has the lowest price?" It's "which EHR delivers the most value per dollar for how I actually practice?"

Our Take: Best Value for Private-Pay in 2026

After analyzing the real costs, here's how the landscape breaks down for solo private-pay therapists:

Best AI-free value: CoralEHR Starter at $29/mo - A complete private-pay practice - group-capable telehealth, scheduling with reminders, Stripe billing and superbills, 35+ auto-scored assessments, modality builders - with deliberately zero AI. It's the cheapest real practice tier here, for therapists who want no AI on principle.

Best all-AI-included value: CoralEHR Professional at $79/mo - The full AI suite is included (note drafting, SOAP agent, AI treatment plans, form builder, reports) with no per-seat fee, and it drafts from your typed notes rather than a recording. At $948/year it undercuts every comparable all-AI plan, where the AI is a $15-40/clinician add-on on top of the base.

Best low-volume / ambient scribe: Upheal - ~$1/session (capped ~$69/mo) with a free tier is clever for a building caseload, if an ambient scribe that records sessions fits your consent model. No insurance billing.

Best for the feature-complete crowd: SimplePractice at $49-$99/mo - The industry standard: mature UX, strong mobile apps, included 1:1 telehealth, large community. Budget ~$35/clinician more for Note Taker AI.

Pricing data sourced from public EHR pricing pages and verified against our comparison matrix. Last updated June 2026. All prices in USD unless noted otherwise. Payment processing fees assume Stripe standard rates; CoralEHR adds no platform markup on top of your processor's rate.

Compare and Calculate

Best EHR for Private-Pay Therapists in 2026 - Full feature-by-feature comparison
SimplePractice Alternatives - Side-by-side with CoralEHR
Jane App Comparison - How Jane stacks up for therapy practices
Upheal vs CoralEHR - AI-native EHR showdown
Practice Savings Calculator - See your personalized annual cost breakdown