Healthcare Practices: How to Calculate Your Payroll Costs (2026)

Managed payroll by headcount for a healthcare practice

10 employees: $450 a month, $5,400 a year; 25 employees: $1,125 a month, $13,500 a year; 50 employees: $2,250 a month, $27,000 a year; 100 employees: $4,500 a month, $54,000 a year. Every row is $45 per employee per month, all-inclusive, inside the payroll software you already use, with no monthly minimum, so the per-employee cost is the same at 10 as at 100. Nothing in the healthcare practice setup, shift differentials, on-call pay, credentialing-based pay tiers and multi-location clinic payroll, is billed as an add-on.

The employer-side tax that rides on every healthcare practice wage

At the May 2025 national median for registered nurses, $97,550 a year or about $47 an hour, the employer share of Social Security and Medicare is $7,463 per employee per year and FUTA is $42 after the state credit, before state unemployment at the assigned rate. Those costs are the same whoever runs payroll; the calculator question is only who does the work and who carries the error.

Sign-on bonuses paid to recruit nurses and other staff are wages subject to Social Security, Medicare and FUTA taxes and income tax withholding. Bonuses paid separately from regular wages are supplemental wages withheld at a flat 22 percent, or 37 percent once an employee's supplemental wages exceed $1 million in the calendar year.

The in-house line in the calculation

BLS OEWS May 2025: payroll and timekeeping clerks, national median $58,260, mean $59,630. Add roughly 30 percent for benefits and employer taxes, about $75,738, before the software that person runs, and set it against the headcount rows above. Managed payroll stays under that loaded figure until about 140 employees.