TL;DR
For healthcare practices in 2026, Helcim wins on price for clinics processing $50K to $500K per month, with interchange-plus rates and a free Business Associate Agreement. Stripe takes the edge for practices running custom patient portals or telehealth platforms that need API access. Square fits solo practitioners under $25K monthly volume who collect copays at the front desk. Stax wins above $500K monthly card volume, where the $99 subscription beats percentage markups on average tickets above $80.
How we ranked
We weighted six criteria against actual statements from healthcare practices billing $25K to $5M per month in card volume.
- 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.
At a glance
Six processors made the shortlist. Sales-only quotes from Worldpay were excluded; practices under $5M monthly volume rarely receive their best pricing without competitive bids.
| Provider | Headline pricing | Contract | Settlement | Best for | Watch out for |
|---|---|---|---|---|---|
| Helcim | IC + 0.40% + $0.08 in-person; IC + 0.50% + $0.25 online | Month-to-month | 2 business days | $50K to $500K monthly | Phone support business hours only |
| 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 past $100K monthly |
| Square | 2.6% + $0.10 in-person; 2.9% + $0.30 online; 3.5% + $0.15 keyed | Month-to-month | Next day | Solo practitioners under $25K monthly | Keyed copays jump to 3.5% + $0.15 |
| Stax | $99/mo + IC + $0.08 in-person; + $0.18 online | Month-to-month | 2 business days | $80K+ monthly volume | $99 fixed cost in low-volume months |
| Payment Depot | $79 to $199/mo + IC + $0.05 to $0.15 | 1 to 3 years | 2 business days | $100K+ monthly | Tiered membership, long contracts |
| Clover | $14.95 to $54.95/mo + 2.3% to 2.6% + $0.10 | Varies by reseller | Next day | Front-desk POS, single location | Hardware locked to Fiserv processing |
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 $25K, $50K, $100K, and $250K monthly volume tiers. A practice running $200K monthly in mixed in-office and online billing typically lands at an effective rate of 2.3% to 2.5% all-in, depending on card mix and average ticket.
Contract: month-to-month, no early termination fee.
Hardware: Helcim Card Reader at $99 one-time. Works as a standalone terminal or via app. No proprietary hardware lock-in.
Who it's for: independent practices, dental groups, specialty clinics, behavioral health, and physical therapy practices processing $50K to $500K per month. Helcim signs a Business Associate Agreement on any account that requests one.
Who should avoid it: practices that need 24/7 phone support, or anyone running below $20K monthly where Square's free plan costs less in absolute dollars.
Stripe
Stripe charges 2.9% + $0.30 for online cards and 2.7% + $0.05 for in-person tap-and-dip, with the Stripe Terminal Reader at $59 and the BBPOS WisePOS E at $349.
Pricing structure: flat-rate by default, with interchange-plus pricing available on custom plans for practices processing roughly $80K+ monthly. Stripe signs a BAA for HIPAA compliance only on Custom Volume contracts; the standard self-serve account does not include a BAA.
Contract: month-to-month, no minimums on flat-rate.
Recurring billing: Stripe Billing supports patient payment plans, balance billing, and dunning. 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 matters more than the 0.30% to 0.55% markup over interchange-plus competitors at most volume tiers.
Who should avoid it: practices with no engineering resources processing high in-person volume. The 2.7% + $0.05 card-present rate runs roughly 0.30% above what Helcim charges on the same card mix.
Square
Square charges 2.6% + $0.10 for in-person, 2.9% + $0.30 for online, and 3.5% + $0.15 for keyed-in transactions. Square offers a free Square Reader and a free Square POS app.
Pricing structure: flat-rate, no monthly fee on the free plan. Square for Healthcare is a separate vertical product with a BAA included on paid Plus plans starting at $29 per location per month.
Contract: month-to-month.
Settlement: next-day deposit at no extra cost, or instant deposit at 1.75% of the transfer amount.
Recurring billing: Square Invoices and Square Subscriptions handle patient balances and copay plans. ACH transfers run at 1% per transaction.
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. The flat 2.6% to 2.9% covers high-margin rewards card interchange the practice never has to pay on interchange-plus pricing. The keyed rate of 3.5% + $0.15 makes phone-order copays expensive.
Stax
Stax charges $99 per month plus interchange plus $0.08 per transaction in-person and $0.18 per transaction card-not-present. No percentage markup above interchange.
Pricing structure: subscription. Above roughly $80K to $100K in monthly card volume, the $99 fixed cost beats interchange-plus percentage models. Below that, Helcim wins on absolute dollars.
Contract: month-to-month available; longer-term contracts negotiated separately.
Hardware: works with Dejavoo terminals, mobile readers, and the Stax virtual terminal.
Recurring billing: native recurring billing module, card-on-file, ACH. Stax signs BAAs for healthcare accounts on request.
Who it's for: surgery centers, multi-provider group practices, ambulatory care, and orthodontic practices processing $80K to $5M per month. The fixed subscription makes per-transaction costs predictable for finance teams.
Who should avoid it: practices below $50K monthly. The $99 monthly base, plus the $0.18 per-transaction fee on card-not-present, can push effective rates above what Helcim or Square charge on the same volume. Practices with average tickets under $30 also lose ground on the per-transaction structure.
Payment Depot
Payment Depot offers wholesale rates with a tiered monthly membership: roughly $79 for the entry plan up to $199 for higher-volume plans, plus interchange plus $0.05 to $0.15 per transaction depending on plan.
Pricing structure: membership. Like Stax, the model wins above a break-even monthly volume. Payment Depot publishes plan tiers, but pricing varies by reseller and account manager.
Contract: historically one to three-year terms, with month-to-month available on negotiation.
Hardware: works with standard terminals and gateways including Authorize.Net and NMI.
Recurring billing: supported via gateway add-ons. BAA available on request for healthcare accounts.
Who it's for: practices processing $100K to $1M per month that want a known per-transaction floor and U.S.-based phone support during business hours. Strong fit for dental, optometry, and primary care groups with predictable card mix.
Who should avoid it: practices that want a single public price card. Payment Depot quotes vary, and the entry-level plan may not include the $0.05 floor without volume commitments. Read the contract for ETFs and PCI fees billed separately.
Clover
Clover sells POS bundles at monthly plan prices from $14.95 to $54.95, with card-present rates of 2.3% to 2.6% plus $0.10 depending on plan, and 3.5% plus $0.10 for keyed transactions.
Pricing structure: subscription plus card rate, but the catch is reseller pricing. Clover hardware works only on Fiserv (formerly First Data) processing. Switching processors means replacing every terminal in the practice.
Contract: depends on reseller. Many Clover deals come from independent sales organizations with three-year terms and early termination fees in the $250 to $500 range.
Hardware: Clover Mini at $799, Clover Flex at $599, Clover Station at $1,649. Locked to Fiserv.
Recurring billing: third-party apps via the Clover App Market. BAA support varies by reseller.
Who it's for: single-location front-desk POS where staff prefers a touchscreen. Some dental and veterinary offices use Clover for the integrated cash drawer and receipt printer.
Verdict
For most healthcare practices processing $50K to $500K per month, Helcim wins on math: interchange-plus pricing with automatic volume discounts beats every flat-rate plan once the practice crosses $35K in monthly card volume. Solo practitioners under $25K monthly stay on Square's free plan and add the Square for Healthcare Plus tier when they need the BAA. Group practices, ambulatory surgery centers, and multi-provider clinics above $80K monthly should price-shop Stax's $99 subscription against Helcim's volume-tiered rate; the break-even sits around $80K to $100K monthly depending on average ticket. Stripe wins for telehealth or any practice running a custom patient portal where API control matters more than 0.20% in markup. Skip PayPal Standard for patient billing: the 3.49% + $0.49 card-not-present rate, per PayPal's published fees, costs roughly $3,000 more per $100K in card volume than interchange-plus pricing.