The short version The cheapest therapy-first AI scribe that still ships with a signed BAA, no training on customer data, and audio deletion after note generation is **Twofold at $19 for the first month** (1-week free trial before that), followed by standard pricing. Nothing in the therapy-native tier undercuts it today while meeting all three of those bars.
Free tiers exist — **Upheal's** free plan gives you 10 sessions/month with a BAA — but "free" only makes sense if 10 sessions covers your caseload. For a full-time solo therapist doing 20–30 sessions a week, the free tier runs out on day two of the month and you fall back to $59/mo Starter, which is the highest entry price in the category.
The honest price ladder (US, monthly, therapy-first tools with BAA)
| Tool | Entry price | What you get | When it's the cheapest choice |
|---|---|---|---|
| Twofold | $19 first month, 1-week free trial | Full features, therapy-native templates, Golden Thread, BAA | Solo/small US practice, standard caseload |
| Upheal (Free) | $0 | 10 sessions/mo, BAA, EN/ES/DE/FR | Sub-10 sessions/mo caseload (part-time, coaching-adjacent) |
| Mentalyc Starter | $39.99/mo | 30 sessions/mo, BAA, wide template library | 20–30 sessions/mo with EMDR/DBT template needs |
| Upheal Starter | $59/mo | Unlimited sessions, EU residency option, multilingual | UK/EU or multilingual caseload |
| Heidi | ~$99/mo | Broader medical + behavioral, AU/US regions | Multi-specialty clinic |
Prices are USD, verified against vendor pricing pages on 2026-06-15. Always click through and re-check — pricing pages change monthly in this category.
The traps that make "cheap" not cheap 1. Per-session pricing looks cheap at low volume and becomes the most expensive option above ~25 sessions/mo. Prefer flat unlimited when your caseload is stable. 2. "Starter" tiers that exclude BAA. A tier without a BAA is not usable for PHI in the US. Confirm the BAA is on the tier you're actually paying for, not just the enterprise one. 3. Overage fees on session caps. Ask what happens on session 31 of a 30-session plan. Some vendors soft-cap (warn you), others hard-cap (block the recorder), others auto-upgrade the plan. 4. Annual pricing quoted as monthly. The "$19/mo" on a pricing page is often $228 billed annually. That's still competitive, but budget accurately.
Recommendation by profile - Solo therapist, 15–30 sessions/wk, US, English-speaking — start with Twofold at $19 first month. It's the lowest defensible entry point that still ships full features. - Part-time or coaching-adjacent, under 10 sessions/mo — Upheal free genuinely covers you at $0. - Established practice with wide modality mix — Mentalyc Starter at $39.99 is worth the $20 delta over Twofold for the deeper EMDR/DBT/couples template library. - Multilingual or EU-residency requirement — Upheal Starter at $59 is the honest answer even though it's more expensive.
See also: pricing page for the current published numbers and best AI scribe for private practice for the full rubric.