If you are applying for adjustment of status (Form I‑485) or an immigrant visa, the medical examination with a USCIS‑designated civil surgeon is mandatory—and the cost can vary wildly from one state to another, and even between clinics in the same city. Some applicants pay $200 for a complete exam, while others receive a bill for $800 or more. The difference is not arbitrary; it reflects a combination of state‑specific overhead, the scope of services bundled into the base fee, and whether the clinic includes laboratory work and vaccinations. Understanding these cost drivers is the first step to avoiding overpaying, because unlike many other immigration fees, civil surgeon charges are not fixed by the government and are entirely market‑driven.
Critical Rule: As of August 2026, the average cost for a U.S. immigration medical exam (civil surgeon fee) ranges from $250 to $550, but this base fee rarely includes lab tests, X‑rays, or vaccines. When you add mandatory blood tests, tuberculin skin tests, and missing vaccinations, the total out‑of‑pocket cost typically lands between $400 and $900, with urban coastal areas averaging 30‑50% higher than rural or Midwestern regions. The civil surgeon must be designated by USCIS—you cannot use a regular doctor—and the fee is not covered by most health insurance plans, so you will pay the full amount yourself.
Why Civil Surgeon Costs Can Range from $200 to $800
No single factor determines the price. Instead, a combination of geographic, operational, and regulatory elements creates a wide spectrum of fees. The most influential drivers include:
- State and local cost of living: Clinics in high‑cost states like California, New York, and Massachusetts pay more for rent, staff salaries, and medical supplies, and they pass those costs on to patients. A civil surgeon in San Francisco may charge $600 for the base exam, while a similar clinic in Oklahoma City charges $250.
- Clinic type and size: Large multi‑specialty practices often have higher overhead and charge more than solo practitioners or community health centers. However, they may also offer on‑site labs and X‑ray services, which can be more convenient.
- Whether the clinic includes laboratory work in the base fee: Some civil surgeons bundle the physical exam, blood tests, and urine test into one flat fee, while others charge separately for each component. This makes upfront comparison essential.
- Vaccination administration: If you need vaccines, the civil surgeon can administer them on site, but they will add the cost of the vaccine itself plus an administration fee. Some clinics charge per vaccine, others offer package deals.
- Expedited processing: If you need your Form I‑693 completed quickly (e.g., within 2‑3 business days), many clinics charge a rush fee of $50 to $150.
⚠️ Important: The civil surgeon’s fee is separate from the USCIS filing fee for Form I‑485. Do not confuse the two. The medical exam fee is paid directly to the clinic, and you must ensure you receive a properly completed Form I‑693 in a sealed envelope.
What's Actually Included in the Civil Surgeon's Base Fee?
To compare quotes accurately, you need to know exactly what the base fee covers. Most civil surgeons break down their charges as follows:
| Service | Typically Included? | Typical Cost (if separate) |
|---|---|---|
| Physical examination (history and physical) | Yes – included in base fee | $150 – $400 |
| Review of vaccination records and completion of Form I‑693 | Yes – included | (part of base fee) |
| Syphilis blood test (RPR/VDRL) | Often included, but not always | $30 – $80 |
| Tuberculosis test (IGRA blood test or PPD skin test) | Rarely included – usually separate | $30 – $150 |
| Chest X‑ray (if required, e.g., positive PPD) | Not included – must be added | $50 – $200 |
| Gonorrhea test (urine or swab) | Usually separate | $40 – $100 |
| Vaccinations (each) | Not included – you pay per dose | $20 – $120 per vaccine |
| Titers (blood tests for immunity) | Not included | $25 – $100 each |
Before scheduling, ask the clinic for a detailed written estimate that lists every possible charge. This way, you can compare total expected costs across different providers.
Average Cost by U.S. Region – A State‑by‑State Comparison
To give you a realistic picture, we have compiled average base fees (excluding lab work and vaccines) and estimated total costs (including mandatory tests) for five representative states, based on 2026 data from multiple civil surgeon offices. These are averages, and individual clinics may charge more or less.
| State / Region | Average Base Fee (Exam + Form I‑693) | Estimated Additional Lab + X‑Ray | Estimated Total (no missing vaccines) |
|---|---|---|---|
| California (Los Angeles) | $450 – $600 | $200 – $300 | $650 – $900 |
| Texas (Houston) | $250 – $380 | $150 – $250 | $400 – $630 |
| Florida (Miami) | $300 – $450 | $180 – $260 | $480 – $710 |
| New York (NYC) | $500 – $700 | $220 – $320 | $720 – $1,020 |
| Illinois (Chicago) | $350 – $500 | $170 – $270 | $520 – $770 |
If you need additional vaccines, add $20‑$120 per dose. Many applicants need 2‑3 vaccines, which can add $100‑$300 to the total. The wide ranges reflect differences in clinic pricing and the specific tests required (e.g., some states have higher rates for certain lab work).
✅ Pro Tip: If you are flexible with location, consider traveling to a lower‑cost area within your state. For example, clinics in suburban or rural areas often charge 20‑30% less than those in downtown metropolitan centers. Even a short drive can save you hundreds of dollars.
Hidden Costs That Inflate Your Final Bill
The base fee is rarely the final amount you pay. Many applicants are surprised by additional charges that crop up during the process. Watch out for these common extras:
- Vaccination titers: If you cannot prove immunity for MMR, varicella, or hepatitis B, the civil surgeon will order blood tests (titérs) to check immunity. These can cost $25‑$100 per test.
- Missing vaccine doses: Even if you have records, you may need a Tdap booster or an influenza shot. The clinic will charge for the vaccine and administration.
- Interpretation/translation services: If you need an interpreter during the exam, some clinics charge an additional fee, typically $25‑$50.
- Expedited completion: If you need the Form I‑693 completed in less than 5 business days, expect a rush fee.
- Extra copies: You may need an extra copy of the medical report for your records. Some clinics charge $10‑$20 per additional copy.
- Lab processing fees: If the clinic sends your blood work to an outside lab, you may receive a separate bill from the lab – sometimes significantly higher than the clinic’s estimate. Ask if the clinic uses a preferred lab and what the typical out‑of‑pocket costs are.
How to Find the Most Affordable Civil Surgeon Near You
Price shopping for a civil surgeon is allowed and encouraged, as long as you ensure the physician is currently designated by USCIS. Follow these steps to get the best value:
- Use the USCIS Find a Doctor tool – The official USCIS website maintains a list of designated civil surgeons by zip code. Start there to find eligible providers.
- Call at least three clinics – Ask each for a detailed price breakdown over the phone. Inquire whether the base fee includes the syphilis and gonorrhea tests (they are mandatory for applicants 18 and older). Ask about the IGRA test (blood test for TB) vs. PPD skin test – some clinics prefer the blood test, which is more expensive but may be required for certain applicants.
- Ask about package deals – Some clinics offer a “complete immigration exam package” that includes the physical, all required labs, and up to a certain number of vaccines for a flat fee. This can be cheaper than paying a la carte.
- Check with community health centers – Federally Qualified Health Centers (FQHCs) and some non‑profit clinics may offer the exam at a sliding scale based on income. However, they may not have a civil surgeon on staff, so verify first.
- Inquire about insurance coverage – While most health insurance plans do not cover the immigration medical exam itself, they may cover the lab tests and vaccines if they are considered preventive care. Check with your insurance provider to see if you can get reimbursed for those portions.
- Plan ahead – Rush fees are entirely avoidable if you schedule the exam at least 2‑3 weeks before you need the completed Form I‑693. Give yourself time to avoid the extra cost.
Common Mistakes That Cost You More Than Necessary
Even with a budget‑conscious approach, simple missteps can drive up your total bill. Avoid these costly errors:
- Not bringing your complete vaccination records – If you fail to provide records of prior vaccines, the civil surgeon will order titers or give you the vaccines again, both of which add significant cost.
- Assuming all clinics charge the same – Many applicants go to the first clinic they find, assuming the price is regulated. It is not – and prices can vary by hundreds of dollars within the same city.
- Not asking about the IGRA test cost – The blood test for TB is more expensive than the skin test. If you are not at high risk for TB and have no known exposure, ask if the clinic offers the PPD skin test as a cheaper option.
- Forgetting about the flu vaccine – During flu season (October–May), the flu shot is required. If you show up without it, you will have to pay for it at the clinic, often at a higher price than at a pharmacy.
- Paying for unnecessary tests – Some clinics may order tests that are not required by CDC guidelines (e.g., additional STD panels). Politely ask if each test is mandatory for the immigration exam.
- Waiting until the last minute – When you are under time pressure, you are more likely to accept the first available appointment and pay rush fees. Schedule early to give yourself bargaining power.
Frequently Asked Questions
Q: Why do civil surgeons in different states charge such different prices?
A: The primary reasons are regional cost of living, clinic overhead, competition, and whether the clinic bundles services. Coastal cities with high rents and staff salaries tend to have higher fees, while rural and Midwestern areas often have lower costs.
Q: Can I use my regular doctor for the immigration medical exam?
A: No – only a USCIS‑designated civil surgeon can perform the exam and complete Form I‑693. Your regular doctor cannot be substituted, even if they are a board‑certified physician.
Q: Will my health insurance cover the civil surgeon exam?
A: Most health insurance plans do not cover the immigration physical exam because it is not medically necessary for treatment. However, some plans may cover the laboratory tests and vaccinations if they are considered preventive services. Check with your insurer.
Q: How can I get a lower price from a civil surgeon?
A: Call multiple clinics, ask for a detailed quote, and compare. Inquire about package deals and whether they offer discounts for payment in cash. Also, consider traveling to a less expensive suburb or rural clinic nearby.
Q: What is the average total cost for the entire medical exam including all tests?
A: Depending on your vaccination status and location, the total out‑of‑pocket cost typically ranges from $400 to $900. In high‑cost areas with missing vaccines, it can exceed $1,000. In low‑cost regions with complete records, you may pay under $400.
Q: Do I have to get the exam in the state where I live?
A: No – you can use any USCIS‑designated civil surgeon in any state. There is no residency requirement. If you find a significantly cheaper clinic in a neighboring state, you are allowed to travel there for the exam. Just make sure to factor in travel costs.