Toast fees for medical practices, next to Payzium's published rate.

Medical, dental and veterinary practices have card costs that are shaped by how patients pay rather than by what they buy. Tickets vary from a small copayment to a large elective procedure, so the per-transaction fee and the percentage both matter and neither dominates. Most payments are card-present at the front desk, but a growing share arrives through patient portals, statements paid online and cards kept on file for payment plans, all of which are card-not-present and priced at higher interchange.

Health savings and flexible spending cards are the second factor. They are debit-type cards with their own acceptance rules and interchange, and a practice that sees many of them should confirm how a processor prices them rather than assume they fall under the in-person rate.

Third, the point-of-sale is often the practice management system, and those systems commonly bundle a processor at a rate set by the software vendor. As with salons, the two can be separated, and the comparison above assumes the practice chooses its processor on price rather than accepting the bundled default.

A note on what this page does not do. Nothing here is a statement about patient data or about compliance obligations that apply to a practice; those are between the practice, its software vendor and its advisers. The comparison is about processing cost only.

The table above uses a typical practice ticket and a card-present share that assumes most payments happen at the desk, with a meaningful keyed and online share for statements and payment plans. A practice that bills mostly through a portal should expect the keyed share, and the gap between plans, to be larger.