Almost everyone filing Form I-485 to adjust status has to be examined by a civil surgeon, a doctor USCIS has designated to perform the immigration medical exam and sign Form I-693. The surprise for most applicants is that USCIS charges nothing for the form and sets no price for the exam. On its Finding a Medical Doctor page, last updated July 8, 2025, USCIS states it plainly: “We do not regulate the fees that civil surgeons charge to perform an immigration medical examination.”
That one sentence explains why two quotes for the identical exam in the same city can differ by hundreds of dollars. It also sets up the second surprise, which is that the required vaccinations are almost never inside the exam fee. They are billed on top, dose by dose, and an applicant walking in with no vaccination records can end up paying more for shots than for the exam. This guide covers what civil surgeons and health departments actually publish as of September 2026, what the fee does and does not buy, and where the savings are.
What Does the Immigration Medical Exam Cost Without Insurance?
Because no agency publishes a national fee schedule, the only honest way to price this is to read what individual civil surgeons post. County health departments are the most useful comparison point because they are civil surgeons too and they publish flat rates. The figures below come from published price lists checked September 4, 2026, plus a 2025 peer-reviewed study of the private market in Sacramento County.
| Line item | Low | Average | High |
|---|---|---|---|
| Base exam, county health department | $340 (Weber-Morgan, Utah, labs included) | $345 | $350 (Polk County, Iowa, labs extra) |
| Base exam, private civil surgeon | $400 (Sacramento County study) | $650 | $900 (Sacramento County study) |
| Exam at a student-run free clinic | $0 (residents of served cities) | $250 | $250 (all other patients) |
| TB screening, IGRA blood test | Included at Weber-Morgan | $130 (Polk County) | Billed by the civil surgeon |
| Syphilis and gonorrhea testing | Included at Weber-Morgan | $30 (Polk County) | Billed by the civil surgeon |
| Vaccine-only follow-up visit | $65 (Polk County) | $65 | Vaccine cost is additional |
| Typical all-in, county health department | $340 | $425 | $510 |
Read that top block carefully, because the two health department prices are not measuring the same thing. Weber-Morgan Health Department in Utah charges $340 for a “Complete Immigration Exam, All Ages” that includes the first-visit lab work for tuberculosis, syphilis and gonorrhea, but the page states the fee “does not include immunization or radiology fees, if needed.”
Polk County Health Department in Des Moines itemizes instead: $350 for the physical exam, $130 for tuberculosis screening, and $30 for the syphilis and gonorrhea tests. Add those together and Polk County lands at $510, about 50% above Weber-Morgan for a comparable package. Neither is wrong. That spread is what an unregulated fee looks like.
The private market runs higher. A 2025 paper in the Journal of Community Health describing an immigration medical exam program at a University of California, Davis student-run free clinic reported that exams in Sacramento County run $400 to $900 each, and that the clinic charged $250 to patients outside the communities it serves and nothing to residents of those communities.
So the defensible cross-source range for the exam alone is roughly $340 to $900, and there is no single “correct” number in between. USCIS says as much on its Find a Civil Surgeon tool: “The cost of an immigration medical examination can vary significantly.”
What Drives the Price
The fee is set by the doctor, not by any agency
USCIS lists three things applicants should be aware of: rates vary by civil surgeon, many civil surgeons do not accept insurance, and insurance may not cover many portions of the exam. There is no cap, no benchmark, and no appeal. The only lever you have is which office you call.
What is bundled versus itemized
Some offices quote one flat price covering the physical, the labs and the sealed envelope. Others quote a low base fee and then bill each lab. When you compare two quotes, ask specifically whether the number includes the tuberculosis blood test, the syphilis blood test and the gonorrhea urine test, because that single question is worth about $160 at Polk County’s published rates.
Vaccines are a separate bill and the biggest variable
The CDC’s vaccination technical instructions for civil surgeons, updated March 11, 2025, require age-appropriate proof of vaccination against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, rotavirus, Haemophilus influenzae type b, hepatitis A, hepatitis B, meningococcal disease, varicella, pneumococcal disease and influenza. COVID-19 is not on that list. If your records are complete, no vaccine charges appear. If they are missing, the civil surgeon must administer at least one dose of every age-appropriate vaccine you are behind on, and each dose is priced separately. Our guide to vaccine costs without insurance has current per-dose cash prices.
Whether follow-up testing is triggered
Under the CDC’s tuberculosis technical instructions for civil surgeons, every applicant age 2 and older must have an interferon gamma release assay, the IGRA blood test, rather than a skin test, and a chest radiograph is required if that test is positive. Most applicants stop at the blood test. If yours is positive, add the cost of a chest X-ray and, in some cases, a health department referral. Our TB test cost guide covers the standalone prices for both the IGRA and the skin test.
Where you live
The same forces that make a physical exam without insurance cost more in San Francisco than in Des Moines apply here. High cost metros run at the top of the range, and rural county health departments run at the bottom.
Cash Price vs. Insurance
This is one of the few medical services where cash is not just competitive, it is often the only option. USCIS warns that many civil surgeons do not accept insurance at all, and the health departments say the same thing in their own words. Weber-Morgan states it “is unable to bill insurance for immigration exams.” Polk County says “we do not bill private insurance” and offers an itemized receipt instead.
There is a real split, though. The exam is generally not covered. The vaccines often are, because they are ordinary preventive care that most plans must cover at no cost sharing when delivered in network. Weber-Morgan notes that “some insurance plans may cover required vaccines,” and Polk County lets applicants come back for a vaccine-only visit.
The practical consequence is that if you have any coverage at all, the smart split is to pay cash for the exam and route the shots through your plan or a low-cost clinic. Ask for an itemized receipt either way so you can submit it yourself. Our guide to reading an itemized bill explains what to look for.
How to Pay Less
Call three civil surgeons before you book. USCIS itself suggests this on the Find a Civil Surgeon page: “It may be helpful to call a few civil surgeons to find out how much they charge.” Ask each one for the base fee, whether TB, syphilis and gonorrhea testing is included, and what each vaccine costs. The published spread between $340 and $900 is not a fiction, and the search tool at uscis.gov is free.
Check your county health department first. The two lowest published prices in this guide are both county health departments. They are USCIS-designated civil surgeons like anyone else, they issue the same sealed envelope, and they typically post their fees online instead of quoting over the phone. Our guide to free and sliding-scale clinics covers how to find the public health options near you.
Get your vaccine records before you get vaccines. Every dose you can document is a dose you do not pay for. Most state immunization registries will release your record for free, and many childhood records held by a school district or a former employer are retrievable. If a record is genuinely lost, a blood test proving immunity is sometimes cheaper than repeating the series, which is why the CDC instructions allow laboratory confirmation of immunity. Compare against our titer test cost guide before you decide.
Buy the shots somewhere other than the civil surgeon’s office. Nothing in the CDC instructions says the civil surgeon has to be the one who administers them, only that the doses are documented on Form I-693. Local health departments frequently run federally funded adult immunization programs with a nominal administration fee, and pharmacies price routine adult vaccines competitively. Polk County’s $65 vaccine-only visit fee exists specifically for people in this situation.
Do not pay twice for STI testing. The syphilis and gonorrhea tests are part of the exam. If you were about to book them separately, cancel. If your civil surgeon quotes an unusually high lab fee, our STD testing cost guide shows what those same tests cost on the open market, and the fair price tool will tell you whether a quote is out of line.
Dispute a surprise add-on in writing. If you were quoted a flat fee and then billed for extras that were not disclosed, that is a billing dispute like any other. Our guide to negotiating medical bills has the script.
Timing, Validity, and What to Do Before You Book
The exam has a paperwork rule worth knowing because getting it wrong costs a full second exam. Per the USCIS Policy Manual, last updated June 11, 2025, a properly completed Form I-693 signed by a civil surgeon on or after November 1, 2023 can be used as evidence for the entire period the benefit application is pending. There is no two-year clock anymore for those forms. Forms signed before November 1, 2023 retain evidentiary value for two years from the signature date.
The catch is that the form belongs to one application. If that application is withdrawn or denied, you need a new Form I-693 for any future filing, and you pay for the exam again. Officers can also request updated documentation if they have reason to believe your medical situation changed.
One more procedural point that protects your money: the civil surgeon must seal the completed form in an envelope, and USCIS will not accept it if the envelope is unsealed or altered. Do not open it, no matter how curious you are. Ask the office for a copy of your vaccination record separately, which the CDC instructions require them to give you.
If you are also budgeting for travel or work-related medical paperwork this year, the same call-around logic applies to a DOT physical, a pre-employment drug test and travel shots like the yellow fever vaccine, all of which are cash-pay services with no published national price.