Google Ads management is the ongoing optimization of Google Ads accounts across Search, Shopping, Display, YouTube, Performance Max, Demand Gen, and App Campaigns — with the goal of maximizing conversion value at target CPA or ROAS. MIS Services charges flat monthly retainers ($499/$999/$1,999) instead of percentage-of-spend commissions — so we have no incentive to push budgets higher. Every U.S. campaign is HIPAA-safe for healthcare via server-side conversion tracking, PHI-stripped Enhanced Conversions, and BAA-signed infrastructure per the December 2022 HHS OCR bulletin.
Flat-Fee Retainers, Not Percentage of Spend
Most Google Ads agencies in the U.S. charge a percentage of ad spend — typically 10-20% of what you spend on Google. The math sounds reasonable until you notice the conflict of interest: the agency makes more money when you spend more. There is no incentive to keep your budget lean, to pause underperforming campaigns, or to recommend smaller spend when the ROI is not there. Bigger budgets equal bigger fees.
MIS Services Inc charges flat monthly retainers — $499, $999, or $1,999 per month depending on account complexity. Your ad spend goes directly to Google and is never marked up through us. We do not earn more if you spend $10,000/month versus $3,000/month. Our incentive is to deliver results, not to push spend higher.
We have been managing Google Ads accounts since 2013 — across home services, healthcare, legal, eCommerce, B2B, and professional services. We work all seven Google Ads campaign types (Search, Shopping, Display, YouTube, Performance Max, Demand Gen, App Campaigns), with deep expertise in Performance Max controls and HIPAA-compliant healthcare ads (Consent Mode v2, Enhanced Conversions without PHI, server-side GTM).
Below: the seven campaign types we manage, our HIPAA-safe Google Ads framework, transparent flat-fee pricing, and how to start.
Full Google Ads Stack Coverage
Search Campaigns
High-intent keyword targeting. The bread and butter of most Google Ads accounts. Tightly themed ad groups, exact-match keyword strategy, negative keyword discipline, ad copy A/B testing.
Shopping Campaigns
Product Listing Ads (PLAs) for eCommerce. Merchant Center feed optimization, custom labels for bidding strategy, structured data for product attributes.
Performance Max
Google's AI-driven omnichannel campaign. We work all 20 PMax control levers — asset groups, audience signals, brand exclusions, campaign-level negatives, search themes, channel timeline reporting, value-based bidding.
YouTube Ads
TrueView in-stream, bumper ads, non-skippable, Discovery. Awareness and consideration campaigns. Especially powerful for service businesses needing to explain a complex offering visually.
Display & Remarketing
Visual display network campaigns, retargeting site visitors, similar audiences. Lower-intent traffic but supports the full funnel.
App Campaigns + Demand Gen
App install and app engagement campaigns for mobile-app businesses. Demand Gen for social-feed-style placements. Both gaps in most Google Ads agency offerings.
What Most Google Ads Agencies Don't Build for Healthcare Clients
Most Google Ads agencies running healthcare accounts in 2026 are out of compliance with HIPAA and do not know it. Standard Google Ads conversion tracking, standard remarketing audiences built from condition-specific landing pages, and standard Enhanced Conversions all transmit Protected Health Information without authorization when used on healthcare sites. The Office for Civil Rights opened investigations into 60+ healthcare organizations in 2022-2023 for exactly these patterns.
We build healthcare Google Ads campaigns differently. HIPAA-safe conversion tracking (no PHI in the conversion data layer), Consent Mode v2 properly configured, Enhanced Conversions without PHI (hashed first-party data with PHI stripped before submission), server-side Google Tag Manager to give us control over what data Google receives, and BAA-signed call tracking (CallRail HIPAA plan) for call-conversion campaigns.
Healthcare clients also avoid the audience-building patterns that violate HIPAA — no custom audiences from "Request Depression Treatment" landing-page visitors, no remarketing pixels firing on condition-specific confirmation pages. We use first-party data only, segregated to non-PHI signals. The result: Google Ads campaigns that perform AND keep the practice compliant.
Three Tiers. Ad Spend Separate — Never Marked Up.
Most U.S. Google Ads agencies charge 10-20% of ad spend (conflict of interest) plus hidden minimums. We charge flat. Your spend goes to Google. Period.
Starter
Small business spending $500-$3,000/month on Google Ads
- ✓ 1-2 campaign types (Search + Local)
- ✓ Up to 5 ad groups
- ✓ Monthly performance report
- ✓ Quarterly competitive audit
- ✓ 1× 30-min strategy call/month
Practice
Established business spending $3,000-$15,000/month, multi-campaign
- ✓ Everything in Starter
- ✓ Up to 15 ad groups across 3-4 campaign types
- ✓ Performance Max management
- ✓ HIPAA-safe setup (if healthcare)
- ✓ Conversion tracking + attribution
- ✓ Monthly strategy call
Network
Enterprise / multi-location spending $15,000+/month
- ✓ Everything in Practice
- ✓ Multi-location campaign architecture
- ✓ All 7 campaign types managed
- ✓ Custom dashboard + attribution
- ✓ Bi-weekly strategy reviews
- ✓ Dedicated senior PPC strategist
Flat-Fee Retainer vs % of Ad Spend Agency
The US Google Ads agency market is dominated by percentage-of-spend pricing (10-20% of monthly ad spend). Here is how MIS Services flat-fee model compares:
| Factor | % of Spend Agency | MIS Flat-Fee |
|---|---|---|
| Monthly management fee | 10-20% of ad spend | $499 / $999 / $1,999 flat |
| Fee on $5,000/mo ad spend | $500-$1,000/mo | $499/mo (Starter) |
| Fee on $15,000/mo ad spend | $1,500-$3,000/mo | $999/mo (Practice) |
| Fee on $50,000/mo ad spend | $5,000-$10,000/mo | $1,999/mo (Network) |
| Conflict of interest | Yes — earns more if you spend more | None — flat fee regardless of spend |
| Incentive to pause underperforming campaigns | Weak — cuts their fee | Strong — improves your ROAS + our results |
| HIPAA-safe conversion tracking | Rarely (still uses standard tracking) | Yes — server-side, PHI-stripped, BAA |
| Ad spend markup | Sometimes (hidden margin) | Zero — you pay Google direct |
| Month-to-month contract | Rarely — 6-12 month lock-in typical | Yes — no long-term commitment |
Where the Statistics and Benchmarks Come From
Every statistic on this page is drawn from a primary source: Google Ads investor materials, WordStream / LocaliQ 2024 Search Advertising Benchmarks (300+ million U.S. keywords analyzed), HHS OCR HIPAA guidance, and industry standards from Search Engine Land + Search Engine Journal.
- Google Ads Insights — Think with Google. Primary Google resource for Ads performance benchmarks + Performance Max case studies. thinkwithgoogle.com
- Alphabet Q4 2024 Earnings — Google Ads Revenue. $237.9 billion worldwide Google Ads revenue in 2024. Baseline for market-size claims. abc.xyz/investor
- WordStream / LocaliQ 2024 Search Advertising Benchmarks Report. Analysis of 300+ million US Google Ads search terms across 20 industries. Source for CPC + CTR + conversion rate benchmarks. localiq.com/search-advertising-benchmarks
- Google Ads Quality Score Help Documentation. Official technical documentation for Quality Score calculation (expected CTR ~35%, ad relevance ~30%, landing page experience ~35%). support.google.com/google-ads
- HHS Office for Civil Rights — HIPAA Online Tracking Bulletin (December 2022, updated March 2024). Regulatory foundation for HIPAA-compliant Google Ads on healthcare intake pages. hhs.gov/hipaa/online-tracking
- Search Engine Land — Performance Max Adoption Analysis. PMax now generates ~24% of US Google Ads revenue by end of 2024. searchengineland.com
- Search Engine Journal — Google Ads Benchmarks. Independent industry analysis of Google Ads trends + Smart Bidding adoption. searchenginejournal.com
- US Google Ads & PPC Statistics 2026 (MIS Services). Our own compilation of 60+ US PPC statistics. /google-ads-ppc-statistics-2026
Frequently Asked Questions
Ready for Honest Google Ads Management?
Free 30-minute Google Ads audit. We review your account structure, wasted spend, conversion tracking, and the highest-ROI 90-day actions. Healthcare? We also audit HIPAA compliance posture.