Pricing & Credits

Outcome-based pricing drawn from a prepaid credit balance: you pay for the physician's review, priced by what the review delivered. Your patient is never charged by Appendix.

Need a different pricing structure? Email hello@appendix.com with a description of your use case and expected monthly volume, and we'll work out pricing that fits.

Volume Pricing

Self-Serve Pricing

$45

per complete physician review

The physician reviewed the case and established care — a prescription, clinical advice, or a lab or imaging order.

per incomplete physician review

The physician reviewed the case but was unable to provide a prescription or advice or otherwise establish care.

One fee per review — no per-submission or per-prescription charges. Nothing is charged until a physician completes the review; a request the patient never consents to, or that is canceled before review, costs nothing. Sandbox (test key) submissions are always free.

What counts as a complete review?

A complete review generally means one or more prescriptions were issued. But use cases vary: some deployments use Appendix for second opinions, where the physician's advice is the deliverable. Appendix can also order labs or imaging for some use cases — those are complete reviews too. In short: if the physician established care and delivered a clinical outcome, the review is complete.

We'll review your use case with you before production deployment, so we're aligned on the expected workflow — and on what your costs will look like — before your first real patient.

What counts as an incomplete review?

An incomplete review means a human physician reviewed the case but was unable to provide a prescription or advice or otherwise establish care — for example, an incomplete submission, a request inappropriate for telehealth, or something outside the scope of Appendix services.

Incomplete reviews should be rare in a production deployment: your AI should filter out inappropriate or incomplete submissions before they reach Appendix. The $8 fee exists to incentivize exactly that — it covers the physician's time without making a screening failure free.

What Appendix provides

Physician review by a licensed, board-certified physician.
E-prescriptions to any pharmacy in the U.S.
Lab orders.
Imaging orders.

Appendix serves adults, and children 6 months or older.

We do not currently provide prescriptions for controlled substances or GLP-1s.

Live visits: video and phone (enterprise)

Some clinical pictures can't be settled asynchronously. Enterprise accounts can be enabled for sync escalation: the reviewing physician may take a request to a live video or phone visit with the patient before deciding, instead of declining it or bouncing it back through chat.

Appendix enables it per agreement. It isn't self-serve, and rates are set case by case rather than published — email hello@appendix.com if your use case needs it.
The physician initiates it, not your app. There is no API call to request a live visit. If the physician escalates, the patient is invited through the same secure chat they already use, so your integration needs no extra flow.
A completed live visit bills at its own rate, not the async rate. The complete/incomplete outcome definitions above are unchanged.
You can see which requests were escalated. On accounts with live visits enabled, polling rows and the details endpoint carry visitType ("async" / "video" / "phone") and syncEscalated, so an invoice line billed at the live-visit rate can be reconciled against the request that caused it. Accounts without the capability never receive those fields — every review is async, so there is nothing to report.

Prepaid credits with auto-refill

You pre-purchase a credit balance. Each completed review deducts from it. When the balance drops below your threshold, auto-refill tops it up from the card on file. A key with no funded balance can't submit — a natural abuse throttle.

Set your auto-refill threshold and top-up amount in the dashboard.
Credits are non-refundable once consumed.
Sandbox (test key) submissions are always free.
A usage statement is emailed after each calendar month, itemizing that month's reviews. It's a record, not a bill — the fees were already covered by your credits.

Monthly invoicing (enterprise)

Enterprise accounts can be billed monthly in arrears instead of from prepaid credits. Appendix enables it on your account as part of your agreement — there is no self-serve switch, and nothing changes in the API itself. To request it, email hello@appendix.com.

How it works once enabled:

No prepayment and no card charges. You are not asked to buy credits, and auto-refill is turned off. Requests are never blocked for a low balance, so the insufficient_credits rejection does not apply to your account.
Usage accrues as reviews complete. Each completed review is recorded against the month at the same per-outcome rates. Your dashboard shows the running total as “accrued this period” rather than a credit balance.
An invoice is emailed after the month closes. Periods are calendar months in US Eastern time. The invoice itemizes the month by visit type and outcome, and is a real bill — unlike the prepaid statement, which is only a record. Payment terms follow your agreement.
Settlement is out of band. Appendix records payment when it arrives (bank transfer, check, or a charge to a card you have on file). Nothing is auto-charged when the invoice is generated.
Full usage, your effective rates, and every past invoice are on the Billing page of the developer dashboard.

Switching back to prepaid credits requires settling any outstanding balance first.

Passing cost through

Most developers fold the cost into their own subscription or charge the end user a flat fee per request.