Could they have been using AdvancedMD software along with their billing services? Yes obviously there is a big cost that a small practice wouldn' t need..but before saying that there are a few things to consider. If the practice is brand new could it be that the practice will grow INTo the services and fees? If they cut out AdvancedMD and their billing services this leaves the practice with another expense with software/support/clearinghouse and then your fees OR if they use your system you will want to make sure you are compensated for the setup (conversion/manual conversion) into your system. So maybe they won't pay $1500 a month to start there should be a startup fee and then the pricing should accomodate not only the volume today but the goals of the practice, staff growth, patient potential volume, credentialing etc. Now if this practice is somewhat already grown as much as they want or have the goal to grow then IMHO it would be better to consult with them to setting up in-house with a less costly but long term solution.
When I take on a new client I do my very best not to compare costs of another billing company. I don't get involved in what they were paying or trying to beat their price, etc.