TL;DR
For healthcare practices in 2026, Helcim is the cheapest option in our cost engine at $10K and $50K a month, with interchange-plus rates, no monthly fee and a Business Associate Agreement on request. Stax overtakes it above about $60K a month of steady volume and is the cheapest at $250K, where its $199+ monthly subscription is small next to the markup it removes. Stripe takes the edge for practices running custom patient portals or telehealth platforms that need API access. Square fits solo practitioners who collect copays at the front desk and value simple setup over the lowest rate (prices checked Oct 2026).
How we ranked
We weighted six criteria using each provider's published pricing and terms. We read pricing pages and terms; we did not open accounts.
- Effective rate at $250K monthly volume (35% weight): the all-in cost after interchange, assessments, and processor markup.
- Business Associate Agreement availability and cost (20%): does the processor sign a BAA, and on which plan tier.
- Contract length and early termination fee (10%): we penalize three-year terms and ETFs above $250.
- Settlement speed (10%): same-day or next-day deposits matter for practice cash flow.
- Recurring billing and payment plan support (15%): patient balance billing, HSA/FSA card handling, ACH for high-deductible plans.
- EHR and practice management integration (10%): native connectors to Epic, Athenahealth, Kareo, AdvancedMD, DrChrono, or Open Dental.
Interchange data is pulled from Visa's published Interchange Schedules and Mastercard Interchange Rates and Criteria. Pricing comes from each processor's public page. Effective rates use our published method: a $50 average sale and a 60% credit, 40% debit mix (prices checked Oct 2026).
At a glance
Six processors made the shortlist. Worldpay was excluded because it publishes no price list; pricing is negotiated.
| Provider | Headline pricing | Contract | Settlement | Best for | Watch out for |
|---|---|---|---|---|---|
| Helcim | IC + 0.40% + $0.08 in-person; IC + 0.50% + $0.25 online (lower above $50K) | No contract | Next business morning | Up to about $60K monthly | No instant payout option |
| Stripe | 2.9% + $0.30 online; 2.7% + $0.05 in-person | Month-to-month | 2 business days | Custom portals, telehealth | Flat rate costs more than interchange-plus at every volume we price |
| Square | 2.6% + $0.15 in-person; 3.3% + $0.30 online on Free (2.9% + $0.30 on paid plans); 3.5% + $0.15 keyed | No contract | Next business day | Solo practitioners under $25K monthly | Keyed copays jump to 3.5% + $0.15 |
| Stax | $99 to $199+/mo by annual volume + IC + $0.08 in-person; + $0.15 online | No cancellation fee stated; length not published | Next business day | Steady volume, cheapest at $250K+ monthly | Monthly fee applies in slow months |
| Payment Depot | Interchange-plus by quote; no prices listed | No cancellation fees; $0 setup | Not published | Practices that get a written quote | Full cost not public |
| Clover | 2.6% + $0.10 (Starter, $0 software) to 2.3% + $0.10 (Growth bundles, $84.95+/mo) | 36-month hardware subscription | 1 to 3 days | Front-desk POS, single location | Hardware subscriptions cannot be canceled |
Helcim
Helcim publishes interchange-plus rates of IC + 0.40% + $0.08 in-person and IC + 0.50% + $0.25 for card-not-present, with automatic volume discounts that compress the markup as you scale.
Pricing structure: no monthly fee, no setup fee, no PCI fee. The markup steps down at $50K, $100K, $500K, and $1M monthly volume. In our engine, Helcim works out to about 1.94% in person and 2.45% online at $250K a month, or $4,850 and $6,125 (prices checked Oct 2026). Your card mix moves the real number.
Contract: no contract, no cancellation fee. Deposits arrive the next business morning at no cost.
Hardware: Helcim Card Reader at $199, or the Smart Terminal at $349 or $32 a month for a year.
Who it's for: independent practices, dental groups, specialty clinics, behavioral health, and physical therapy practices processing up to about $60K per month. Helcim's HIPAA guide says it "always provides BAA to healthcare clinics upon request." Get the signed BAA and its scope in writing.
Who should avoid it: practices that need instant payouts, which Helcim does not offer, or that want one fixed rate per sale. In our engine Helcim is cheaper than Square's free plan even at $10K a month ($211 against $290 in person).
Stripe
Stripe charges 2.9% + $0.30 for online cards and 2.7% + $0.05 for in-person tap-and-dip, with the Reader M2 at $59, the S700 and S710 at $299, and the T600 at $329.
Pricing structure: flat-rate by default, with custom pricing for large volume and no published threshold. Stripe's healthcare guides mention HIPAA only in general terms; we found no page where Stripe says whether it signs a BAA. Ask Stripe in writing before you send it any patient data.
Contract: pay as you go, no monthly fee. Payouts take 2 business days; Instant Payouts cost 1.5%.
Recurring billing: Stripe Billing supports patient payment plans, balance billing, and dunning, for 0.7% of Billing volume on pay-as-you-go pricing. Card-on-file storage is included; ACH costs 0.8% capped at $5 per transaction.
Who it's for: practices running a custom patient portal, telehealth software, mental health platforms, or any clinic where engineering owns the checkout flow. Stripe's API access can matter more than its cost gap: in our engine Stripe costs $1,400 a month at $50K in person against $1,020 on Helcim.
Who should avoid it: practices with no engineering resources processing high in-person volume. The 2.7% + $0.05 card-present rate works out to 2.80% in our engine at $50K a month, against 2.04% on Helcim.
Square
Square charges 2.6% + $0.15 for in-person on its Free plan, 3.3% + $0.30 for online on Free (2.9% + $0.30 on paid plans), and 3.5% + $0.15 for keyed-in transactions. The Square POS app is free and hardware starts at $59.
Pricing structure: flat-rate, no monthly fee on the Free plan; Plus is $49 and Premium $149 per location a month, with lower in-person rates. Square's HIPAA help page says that if you are subject to HIPAA and your use of Square has Square handle protected health information for you, "then you agree to the HIPAA Business Associate Agreement." The page names no plan or price; confirm with Square which features are covered.
Contract: no contract.
Settlement: next-business-day deposit at no extra cost, or instant or same-day transfer at 1.95% of the amount.
Recurring billing: Square Invoices and Square Subscriptions handle patient balances and copay plans. ACH runs at 1% per transaction with a $1 minimum.
Who it's for: solo practitioners, single-provider clinics, and front-desk POS use cases under $25K monthly volume. Strong fit for practices where the staff already knows Square from a prior business.
Who should avoid it: any practice processing more than $40K monthly. In our engine Square costs $1,450 a month at $50K in person, against $1,020 on Helcim. The keyed rate of 3.5% + $0.15 makes phone-order copays expensive.
Stax
Stax charges $99 a month up to $150,000 a year in volume, $139 from $150,000 to $250,000 and $199 or more above that, plus interchange plus $0.08 per transaction in-person and $0.15 per transaction card-not-present. No percentage markup above interchange.
Pricing structure: subscription. In our engine Helcim is cheaper at $50K a month ($1,020 against $1,055 in person) and Stax is cheaper at $250K ($4,475 against $4,850), so the crossover sits at about $60K a month in person, where the $199 fee equals Helcim's 0.35% margin (at $100K Stax is still cheaper, 1.91% against 1.94%).
Contract: Stax states no cancellation fees but does not publish the contract length. Deposits arrive the next business day.
Hardware: SwipeSimple reader $125, Dejavoo QD4 countertop $310, QD2 wireless $495, plus the Stax virtual terminal.
Recurring billing: native recurring billing module, card-on-file, ACH. We could not confirm a BAA policy on Stax's own pages, which blocked our checks; ask Stax in writing.
Who it's for: surgery centers, multi-provider group practices, ambulatory care, and orthodontic practices with steady volume in the low six figures a month and up. The subscription makes costs predictable for finance teams.
Who should avoid it: practices below $50K monthly. The $99 to $199+ monthly fee, plus $0.15 per card-not-present transaction, can push effective rates above Helcim's on the same volume. Practices with average tickets under $30 also lose ground on the per-transaction structure.
Payment Depot
Payment Depot sells interchange-plus pricing by quote. Its pricing page (archived Oct 2025) lists no monthly or per-transaction price; it says $0 setup and no cancellation fees.
Pricing structure: interchange plus a quoted markup. Without published prices we cannot compute its full cost, so it is not in our cost ranking.
Contract: no cancellation fees per its pricing page; ask for the agreement length in writing.
Hardware: ask which terminals and gateways it supports before you buy equipment.
Recurring billing: its pricing page lists recurring and scheduled payments; ask what they cost. We could not confirm a BAA policy on its own pages; ask in writing.
Who it's for: practices that want interchange-plus pricing and will get the full quote in writing before signing.
Who should avoid it: practices that want a single public price card. Read the agreement for any monthly fee, PCI fee and terms.
Clover
Clover sells POS bundles with software from $0 (Starter) to $84.95 or more a month (Growth bundles), with card-present rates of 2.6% plus $0.10 on Starter, 2.5% plus $0.10 on Essentials and 2.3% plus $0.10 on Growth, and 3.5% plus $0.10 for keyed transactions.
Pricing structure: software plan plus card rate. In our engine Clover costs $1,335 a month at $50K in person on a Growth bundle. Clover is also sold through banks and resellers, whose rates and terms can differ from Clover.com.
Contract: Clover's hardware subscriptions run 36 months and cannot be canceled. A bank or reseller may add its own terms; read the full agreement.
Hardware: Clover Go $199, Clover Compact $349 or $16 a month for 36 months, Station Solo bundles from $1,799. Ask whether the device can be used with another processor before you buy.
Recurring billing: third-party apps via the Clover App Market. We found no BAA policy on Clover's pricing page; ask Clover or the reseller in writing.
Who it's for: single-location front-desk POS where staff prefers a touchscreen. Clover suits a front desk that wants a cash drawer and receipt printer in one system.
Verdict
For most healthcare practices processing up to about $60K per month, Helcim wins on cost: interchange-plus pricing with automatic volume discounts costs less than every flat-rate plan in our engine at $10K, $50K, $250K and $1M a month. Solo practitioners who value simplicity can stay on Square's Free plan, accepting a higher rate, and should read Square's HIPAA terms. Group practices, ambulatory surgery centers, and multi-provider clinics should price Stax's subscription ($199 or more a month at these volumes) against Helcim's volume-tiered rate; by our engine's formula Stax becomes cheaper above about $60K a month in person and is cheaper at $250K ($4,475 against $4,850), while Helcim is cheaper at $50K. Stripe wins for telehealth or any practice running a custom patient portal where API control matters more than the rate. Skip PayPal Checkout for patient billing: at 3.49% + $0.49, per PayPal's published fees, $50K a month in $50 online payments costs about $2,235, against about $1,275 on Helcim in our engine (prices checked Oct 2026).