Opexia - Healthcare Software Engineering & EHR Integration

Practical reference

Healthcare Cloud Cost Estimator

Last verified 2026-09-26. Vendor terms and prices change; every row links to its source.

A pilot-scale healthcare stack (managed PostgreSQL, two app servers, customer-managed encryption keys, audit logs, backups and a load balancer) comes to roughly $200 to $240 a month at public list prices on AWS, Google Cloud or Azure. A multi-tenant platform for about 10,000 patients, with a high-availability database, lands near $760 to $980 a month. The database is the largest line at every size; after that, cost grows with log volume, messaging and data sent out of the cloud. Pick a preset, change any quantity, and compare the three clouds line by line against each provider's own pricing page.

Estimate your monthly cloud bill

Start from a preset

Presets change quantities only. Edit any field below.

Database

2 vCPU / 8 GB class, no standby. Fine for a pilot; one zone outage takes it down.

4 vCPU / 16 GB class with a synchronous standby in a second zone and automatic failover.

SSD storage provisioned for single-zone databases.

SSD storage for HA databases. Each cloud bills the standby's copy, so the rate is double.

Automated backups. AWS and Azure include backup up to your provisioned size; Google bills all of it.

Compute

Burstable Linux VM for the API, web app and background workers.

Alternative to VMs: pay for container vCPU time. One always-on vCPU is about 730 hours a month.

Memory for the serverless containers above. 2 GB always on is about 1,460 GB-hours a month.

Storage and network

Standard-tier object storage for uploads, faxes, PDFs and data exports.

Traffic from the cloud to users and partners. First paid tier; free monthly allowance applied.

Layer-7 load balancer that terminates TLS. Base charge only; capacity-unit and data fees are extra.

Keys, secrets and audit logs

HSM-backed keys you control for encrypting databases, storage and backups.

Encrypt, decrypt and secret-read calls. Busy apps cache data keys to keep this small.

Database passwords, API keys and signing keys held in a managed secrets store.

Logs written to the managed log service each month. Often the surprise line on the bill.

Logs kept for audit history. HIPAA documentation rules often drive multi-year retention.

Messaging and sign-in

Invites, password resets and reminders. Keep PHI out of email and SMS bodies.

Appointment and care-plan reminders. Base price per segment; carrier fees are extra.

Staff and patient accounts that sign in during the month. Free tiers are applied per provider.

AI (example only)

Example only: one mainstream model per cloud, for summaries or drafting. Models differ in class.

Example only: output tokens for the same models. Output usually costs 4-8x input.

AWS

$228
per month
$2,733
per year

US East (N. Virginia), us-east-1

Google Cloud

Lowest here
$199
per month
$2,392
per year

Iowa, us-central1

Azure

$240
per month
$2,878
per year

East US

Estimate from public list prices on 2026-09-26; actual bills vary with region, commitments and free tiers.

AWS US East (N. Virginia), Google Cloud Iowa (us-central1, the default region on Google's pricing pages) and Azure East US. On-demand list prices in USD, before taxes, credits, commitments or negotiated discounts.

What this estimate leaves out

  • Paid support plans (often the larger of a flat minimum or a percentage of the bill)
  • NAT gateways and private endpoints for private networking
  • Data transfer between availability zones and between regions, including cross-region replication
  • Manual snapshots and backups kept beyond the automated retention window
  • Web application firewall, DDoS protection and threat detection services
  • Load balancer capacity units, provisioned IOPS and throughput add-ons
  • Staging and development environments
  • Staff time to build, operate, patch and audit the platform
  • Third-party SaaS on the BAA-eligible plan tiers you need (email, SMS, monitoring, support desk)

Breakdown by provider

Monthly cost of each line item at the quantities above. Each service name links to the pricing page it came from.
Line itemQuantityAWS / monthGoogle Cloud / monthAzure / month
Managed PostgreSQL, small (single zone)
Database
1 instance-month
Managed PostgreSQL, medium with HA standby
Database
0 instance-month
Database storage, single zone
Database
50 GB-month
Database storage, HA
Database
0 GB-month
Database backup storage
Database
0 GB-month
Application server (2 vCPU / 4 GB VM)
Compute
2 instance-month
Serverless containers, vCPU time
Compute
0 vCPU-hour
Serverless containers, memory time
Compute
0 GB-hour
$0.00
Fargate per GB-hour
$0.00445 each
Object storage (documents, exports)
Storage and network
50 GB-month
$1.15
S3 Standard, first 50 TB
$0.023 each
Data transfer out to the internet
Storage and network
50 GB
Load balancer (base hourly charge)
Storage and network
1 load balancer-month
Customer-managed encryption keys
Keys, secrets and audit logs
3 key-month
Key and secret operations
Keys, secrets and audit logs
50 10,000 requests
$1.50
KMS requests
$0.03 each
$1.50
Key Vault operations
$0.03 each
Stored secrets
Keys, secrets and audit logs
10 secret-month
Audit and application log ingestion
Keys, secrets and audit logs
10 GB
Log retention (long-term)
Keys, secrets and audit logs
60 GB-month
Transactional email
Messaging and sign-in
5 1,000 emails
$0.50
Amazon SES
$0.10 each
SMS messages (US)
Messaging and sign-in
1,000 message
User sign-in (monthly active users)
Messaging and sign-in
100 MAU
$0.00
Cognito Essentials (first 10,000 MAU free)
$0.015 each, first 10,000 free
$0.00
Entra External ID Basic (first 50,000 MAU free)
$0.03 each, first 50,000 free
LLM input tokens (example model)
AI (example only)
0 1M tokens
LLM output tokens (example model)
AI (example only)
0 1M tokens
Total
$228 / month
$2,733 / year
$199 / month
$2,392 / year
$240 / month
$2,878 / year

What drives healthcare cloud cost

  • The database and its standby. Managed PostgreSQL is the largest line at every size, roughly half the bill. Turning on high availability doubles database compute and storage, because each cloud bills the standby too.
  • Log volume. Audit and application logs are billed per GB ingested: $0.50 on CloudWatch and Cloud Logging, $2.30 on Azure Log Analytics. Verbose debug logging can outgrow the servers that produce it.
  • Retention you are required to keep. HIPAA documentation rules push many teams to keep audit history for years. Long-term log retention and backup storage are cheap per GB but only grow.
  • Data leaving the cloud. Internet egress runs $0.09 to $0.12 per GB after a small free allowance. Report downloads, document delivery and integrations with partner systems add up.
  • Messaging and sign-in at scale. SMS reminders cost under a cent each before carrier fees, which matters at tens of thousands a month. Sign-in is free up to 10,000 to 50,000 monthly users depending on the cloud.

Related

Sizing a platform that will store PHI? Opexia can review your architecture and the assumptions behind these numbers before you commit to a cloud. Talk to us about your project.

Sources

Questions this page answers

Which cloud is cheapest for a small HIPAA SaaS?

At the list prices on this page, Google Cloud comes out lowest in all three presets. The gap is small next to what commitments, credits and your team's familiarity change, so choose on BAA coverage, managed services and operations first, then negotiate price.

Does a BAA cost extra?

No. AWS, Google Cloud and Microsoft each sign a Business Associate Agreement without a separate fee. What costs money is the configuration HIPAA expects around your PHI: encryption keys, audit logs, backups, high availability and private networking, which is what this estimator prices. Some third-party SaaS vendors only sign a BAA on higher plan tiers.

Why multi-AZ/HA?

The HIPAA Security Rule requires a contingency plan, including data backup, disaster recovery and emergency mode operation. A single-zone database goes down with its zone. A high-availability pair keeps a synchronous standby in a second zone and fails over automatically, at roughly double the database cost. Backups are still needed, because a standby replicates mistakes as faithfully as good writes.

Are logs really that expensive?

They can be. Ingestion costs $0.50 per GB on AWS and Google Cloud and $2.30 per GB on Azure's Analytics Logs tier, after small free allowances. Keep the audit trail (who viewed or changed which record) separate from debug output, trim or sample the debug logs, move old logs to low-cost retention, and never write PHI into log messages.

What does this leave out?

Paid support plans (often the larger of a flat minimum or a percentage of the bill); NAT gateways and private endpoints for private networking; Data transfer between availability zones and between regions, including cross-region replication; Manual snapshots and backups kept beyond the automated retention window; Web application firewall, DDoS protection and threat detection services; Load balancer capacity units, provisioned IOPS and throughput add-ons; Staging and development environments; Staff time to build, operate, patch and audit the platform; Third-party SaaS on the BAA-eligible plan tiers you need (email, SMS, monitoring, support desk). Taxes, credits and committed-use discounts are also excluded.

Where do these prices come from?

Public on-demand list prices checked on 2026-09-26: AWS from its Price List files for us-east-1, Azure from its Retail Prices API for East US, and Google Cloud from its pricing pages for us-central1. Each line in the breakdown links to the provider's pricing page.