A comprehensive metabolic panel costs an average of about $48 in the United States. Through some direct primary care practices, the cash price is closer to $3.31.[1]
Green Imaging advertises MRIs starting at $390.[2] C.A.R.E.S. Direct Primary Care in Alabama tells members it can help them get one for around $350.
Many DPC practices also dispense common generic medications at or near their wholesale cost. A prescription that costs $15, $30, or more at the pharmacy may cost only a few dollars through the practice.[4]
The obvious question is: how?
The MRI machine is not cheaper. The blood test is not lower quality. The medication is not a different drug.
The difference is everything surrounding the medical service.
Direct primary care doctors remove insurance billing from routine primary care, buy some products at wholesale, negotiate directly with outside providers, and often pass the price to patients with little or no markup.
The monthly membership makes that possible.
The Membership Pays for the Doctor, Not Everything Else
A direct primary care (DPC) membership usually costs $50 to $200 a month. The fee covers the primary care relationship: office visits, longer appointments, messaging, preventive care, chronic-condition management, and certain procedures performed in the office.
It does not usually include every lab test, bottle of medication, X-ray, CT scan, or MRI.
Those items may cost extra. The difference is that the practice can often tell you the price before you buy them.
Think of the model in two parts:
The membership pays for access to the doctor. You are not charged for every visit, message, or follow-up included in the agreement.
Outside products and services are sold separately. The practice may offer them at wholesale, at cost, or through a negotiated cash-price partner.
This is why a $70-a-month DPC practice can help a patient get a $350 MRI. The practice is not absorbing the cost of the scan. It is connecting the patient to a less expensive place to buy it.
DPC Removes the Cost of Fighting With Insurance
A traditional medical practice spends a surprising amount of money getting paid.
It needs people and software to submit claims, assign billing codes, request prior authorization, appeal denials, collect copays, and figure out why an insurer paid less than expected. One Health Affairs study estimated that American physician practices spent $82,975 per doctor each year interacting with health plans.[3]
Patients rarely see that work. They still pay for it.
DPC removes most of it from primary care. The practice charges the same membership fee each month. There is no insurance claim for an included office visit and no separate bill based on how many problems the patient discussed.
That gives the practice two advantages:
It can operate with fewer billing and administrative employees.
It has predictable monthly revenue without scheduling as many short visits as possible.
This is the basic reason DPC can charge less while giving patients more time with the doctor. It is not trying to make a $100 office visit cost $20. It is using a different way to pay for primary care.
NextMD's guide to what DPC actually costs to run explains the full practice economics.
How a $48 Lab Test Becomes a $3 Lab Test
Laboratory pricing may be the clearest example.
A DPC practice can contract directly with a laboratory and pay a negotiated cash rate. The office draws the blood or sends the patient to a partner location. The lab does not have to submit a claim to the patient's insurer, wait for payment, or send the patient a bill weeks later.
The practice can then pass that contracted price to the member.
Hint Health reports that a comprehensive metabolic panel averaging about $48 nationally can cost approximately $3.31 through a DPC practice.[1] That panel commonly measures glucose, electrolytes, kidney function, liver-related markers, and proteins in the blood.
Not every DPC office has the same contract. One practice may include basic labs in the membership. Another may charge the negotiated price. A third may send the patient to an outside lab that bills insurance.
Ask to see the practice's current lab-price sheet. A statement such as “discounted labs available” is not the same as a price.
How DPC Doctors Sell Generic Medications for a Few Dollars
Many DPC doctors buy commonly used generic medications from a wholesaler and dispense them directly from the office.
The practice may keep a limited supply of medications used frequently in primary care, such as certain antibiotics, blood-pressure drugs, diabetes medications, thyroid medication, or cholesterol medication. When a patient needs one of those drugs, the doctor can sell it at or near the practice's acquisition cost.
There is no pharmacy benefit manager setting a formulary. There is no insurance claim. There may be no retail pharmacy markup.
That does not mean the medication is free or included in the membership. It usually appears as a separate charge.
An American Academy of Family Physicians practice guide reported that 61% of the DPC practices in its underlying survey dispensed medication.[4] The exact rules vary by state, and a small practice cannot stock every drug.
This works best for inexpensive generics. It usually does not solve the price of brand-name medications, specialty drugs, biologics, or medications that require complex storage and monitoring. Those prescriptions still tend to run through a pharmacy and, when available, insurance.
Before buying from the practice, compare three numbers:
The DPC office price
Your insurance price at the pharmacy
The pharmacy's cash or discount-card price
The DPC option can be cheaper. It will not win every time.
How a DPC Doctor Finds a $400 MRI
Imaging works differently because the DPC doctor does not own the machine.
The practice builds relationships with independent imaging centers or cash-pay networks that publish a price for the scan. When the doctor orders an MRI, the patient can compare that cash quote with the price available through insurance.
The reason the cash price can be lower is fairly simple. Hospital imaging carries the cost structure of a hospital. An independent center performs a narrower set of scheduled services. A cash transaction also avoids much of the claims, denial, and collection process.
Green Imaging is one company in this part of the DPC ecosystem. It arranges MRIs, CT scans, mammograms, and other studies through a national network of independent facilities. The company says MRI prices start at $390 in some markets and that its quoted cash price includes the radiologist who reads the scan.[2]
That last detail matters. A $400 facility fee followed by a separate radiologist bill is not a $400 MRI.
Green Imaging founder and radiologist Dr. Cristin Dickerson says the company also reviews some orders before the appointment. She described cases in which a radiologist changed the type of scan or removed contrast when it was unnecessary.[5]
Green Imaging reports substantial savings for its clients, but those are company-reported results. The only comparison that matters to an individual patient is the complete cash quote versus their personal insurance estimate.
Cash Can Be Cheaper Even When You Have Insurance
Suppose your insurer's negotiated price for an MRI is $1,500. You have a $3,000 deductible and have spent almost none of it.
You may owe the full $1,500.
If an independent center offers the scan for $400, paying cash saves $1,100 today.
But there is a catch. That $400 may not count toward your deductible or annual out-of-pocket maximum. If you expect surgery or another major expense later in the year, the insurance route could still make more sense.
Use this rule: compare the two real prices, not the hospital's list price and not your deductible by itself.
Ask your insurer for your personalized out-of-pocket estimate. Most health plans must provide an online price-comparison tool for covered services.[6] Then ask the cash-pay center for a complete written quote.
For imaging, confirm:
The exact body part and type of scan
Whether the scan uses contrast
Whether the facility fee is included
Whether the radiologist's interpretation is included
Whether sedation or another service costs extra
Whether the cash payment can be submitted to insurance
If you are not using insurance, federal rules generally allow you to request a written good faith estimate. You may qualify for the federal dispute process if a provider's final bill is at least $400 above its estimate.[7]
The Doctor Still Has to Decide What You Need
Lower prices are useful only when the care itself makes sense.
A $3 lab test is still a waste if the result will not change anything. A $400 MRI is still expensive if the patient never needed the scan. A cheap prescription is not a good deal if it is the wrong medication.
The DPC doctor's job is to connect price with clinical judgment.
That means deciding whether testing is necessary, ordering the correct study, choosing an appropriate medication, checking for interactions, and reviewing the result afterward.
It also means knowing when a low cash price is not the best option. A patient who has met their deductible may pay less through insurance. A brand-name drug may have a manufacturer assistance program. A hospital may be the appropriate place for imaging when the patient needs specialized equipment, sedation, or immediate access to other medical care.
Cheap care and good care are not the same thing. The value of DPC is having a doctor who can help you get both.
What to Ask Before You Join a DPC Practice
Every practice handles outside services differently. Before joining, ask:
Which lab tests are included in the membership?
Can I see the cash-price list for labs that cost extra?
Does the practice dispense medications in the office?
Which medications does it stock, and what do they cost?
Does the practice have negotiated rates for X-rays, CT scans, and MRIs?
Does an imaging quote include the radiologist's fee?
Can I compare the cash price with my insurance price before deciding?
Who reviews outside test results and handles the next step?
The membership price tells you what it costs to reach the doctor. These questions tell you what the relationship may save after you join.
Patients can compare listed membership prices and physician-led practices through NextMD's Alabama directory or search nationwide.
The Bottom Line
DPC doctors are not buying lower-quality tests or special versions of generic drugs.
They are removing layers.
The membership removes insurance billing from routine primary care. Direct lab contracts remove the retail price of testing. In-office dispensing can remove the pharmacy and insurance middlemen for common generics. Independent imaging centers can remove the hospital price from a scheduled scan.
That is how a patient can end up with a $3 lab test, a prescription that costs a few dollars, or an MRI near $400.
The savings are not automatic, and they are not identical at every practice. But they are real enough that patients should ask about them before choosing a DPC doctor.
Frequently Asked Questions
Are labs and medications included in a DPC membership?
Sometimes, but often they cost extra. Many practices offer labs and generic medications at a negotiated or wholesale price instead of including them in the monthly fee. Read the agreement and ask for the current price list.
Can a DPC doctor really sell medication from the office?
Many can. State laws and practice policies vary, and offices usually stock only a limited selection of common generic medications. Brand-name and specialty drugs generally still come from a pharmacy.
Do I still need health insurance with DPC?
Yes. DPC covers primary care, not hospitalization, surgery, specialty care, or most major imaging. Patients generally keep insurance for larger and less predictable medical expenses. NextMD's DPC versus traditional primary care comparison explains how the two fit together.
Does a cash MRI count toward my deductible?
It may not. Ask the insurer before paying whether it accepts patient-submitted claims and whether the expense will count toward your deductible or out-of-pocket maximum.
Is a cash-pay MRI lower quality?
The payment method does not determine the quality of the scan. Ask whether the facility can perform the exact ordered study, whether it meets your equipment and safety needs, and who will interpret the images. MRI does not use ionizing radiation, but its powerful magnetic field creates specific safety concerns for certain implants and metal objects.[8]
NextMD helps patients find physician-led concierge and direct primary care practices, compare listed prices, and review doctor credentials. Search practices near you.
Sources
Hint Health. (2025). Employer Trends in Direct Primary Care. Reports direct-contracting examples, including an approximately $3.31 DPC price for a comprehensive metabolic panel. Read the Hint Health report
Green Imaging. (2026). Affordable MRI, CT, Mammography, and Diagnostic Imaging. Company pricing page; MRI prices advertised from $390 depending on region, with the radiologist fee included in the quoted cash price. Review Green Imaging pricing
Morra, D., Nicholson, S., Levinson, W., Gans, D. N., Hammons, T., and Casalino, L. P. (2011). US Physician Practices Versus Canadians: Spending Nearly Four Times As Much Money Interacting With Payers. Health Affairs, 30(8), 1443-1450. Read the study
Rowe, K., and Rowe, W. (2020). Transitioning to Direct Primary Care. Family Practice Management, 27(4), 29-34. Reports medication dispensing among surveyed DPC practices and explains common practice operations. Read in Family Practice Management
Richter, S., and Dickerson, C. (2026, August 19). PMPM vs FFS: The Perverse Incentives Plan Sponsors Sometimes Miss. Relentless Health Value, Episode 525. Listen and read the transcript
Centers for Medicare & Medicaid Services. (2025). How to Get the Most Out of Transparency in Coverage. Explains health-plan price-comparison tools for covered services. Read the consumer guide
Centers for Medicare & Medicaid Services. (2024). Know Your Rights When You Aren't Using Insurance. Explains good faith estimates and the $400 patient-provider dispute threshold. Read the CMS self-pay guide
U.S. Food and Drug Administration. (2017). MRI Benefits and Risks. Explains the absence of ionizing radiation and the safety risks created by the magnetic environment. Read the FDA patient guidance