USMLE and ECFMG Fees for IMGs: Every Cost from Registration to Residency (2027)

If you’re an international medical graduate (IMG) planning for the 2027 Match, the USMLE and ECFMG fees for IMGs are only the beginning. There are several other costs along the way, from certification and applications to US clinical experience, interviews, and your eventual move to the U.S.

This guide breaks down the total cost of USMLE for IMGs, stage by stage, using the latest official fees for 2026–2027. We’ll separate the costs you can plan for upfront from expenses that vary depending on your situation, so you know what’s coming before the next bill arrives.

The table below outlines the total USMLE and ECFMG costs, organized chronologically by when fees are due. Published fees are relatively predictable, conditional costs depend on your route, and variable costs depend on your choices and location. Costs reflect official rates as of October 10, 2026.

Step 3 is administered only in the U.S. and its territories.

Before you pay anything, confirm that your medical school is listed in the World Directory of Medical Schools with an ECFMG sponsor note. The check is free, and without the note you cannot apply (our guide to the Intealth accreditation policy explains the rules).

Your first payment is the $110 MyIntealth account fee, which already includes the $50 NotaryCam charge for notarizing your identification form online. You then apply for ECFMG Certification and pay ECFMG to verify your final diploma and final transcript with your school.

Two additional costs may apply. Your medical school may charge its own administrative or verification fee, and ECFMG-arranged English translation is currently $52 per page when applicable.

It also helps to know who is billing you. Since January 12, 2026, FSMB has handled USMLE Step exam services for IMGs, including registration and score-report delivery. ECFMG continues to handle certification, credentials, Pathways and other ECFMG services.

Step 1 costs $695 for eligibility periods ending in 2026 or 2027, paid to FSMB. Testing outside the United States and Canada adds a $210 testing-region fee, bringing the Step 1 cost to $905 before any applicable taxes. If FSMB can’t find you in its database when you create your account, you pay a $75 processing fee, which is credited toward your next FSMB service, such as your Step 1 application.

If you test in India, 18% GST is added and shown on your payment summary before you pay.

Our Step 1 registration guide walks through each screen of the FSMB application.

Prometric does not run USMLE centres in every country, so check the testing-region list before you register. If your country does not have a suitable test center, you may also need to budget for travel and accommodation. Those costs vary by location, so it is best to price your route separately from the exam fee.

Short on time for Step 1? Synapse QBank (the only qbank with a daily live tutor) gives you high-yield Step 1 questions written by physicians who scored 260+, and our 7-day Step 1 high-yield bootcamp condenses the most-tested concepts into one week. If one subject keeps pulling your scores down, a few sessions of targeted tutoring cost less than another full resource.

Step 2 CK also costs $695, but the testing-region fee abroad is higher at $235, so you pay $930 outside the United States and Canada (plus 18% GST in India).

With Step 1 now reported as pass/fail, Step 2 CK remains an important scored part of the residency application, so many applicants choose to prioritize their preparation here.

Aiming for a competitive Step 2 CK score? Synapse covers Step 2 CK too, so you stay on one platform from Step 1 onward. Our 7-day Step 2 CK bootcamp and one-on-one tutoring are there if your practice scores stall below your target.

US clinical experience (USCE) does not have a fixed cost. What you spend depends on the type of rotation, the provider, the city, and how long you stay. Your budget may include the rotation fee, housing, transportation, health insurance, malpractice coverage, food, and flights.

Some rotations also have additional application or onboarding costs. Because these expenses vary so much, it is better to treat USCE as a separate variable cost rather than add one standard figure to your USMLE and ECFMG fees.

Our USCE guide for IMGs explains what to consider before choosing one.

For the 2027 Match, ECFMG Certification requires Step 1, Step 2 CK and one of the 2027 Pathways, which cover clinical and communication skills.

Unless you are already certified or passed the retired Step 2 CS, you need a Pathway, and every Pathway requires OET Medicine.

The application costs $945, is non-refundable, and is due by January 31, 2027 (ET). Our Pathways guide explains which Pathway fits your situation.

You book and pay for OET directly with OET, not through ECFMG. The full Medicine test costs AU$587 in most countries and US$455 in the United States. For ECFMG, OET@Home counts only if your country has no OET test venue, so most applicants must take it at a venue.

You do not need Step 3 to apply to residency or participate in the Match. Step 3 is generally required for physicians seeking H-1B sponsorship, and some IMGs choose to take it before residency for immigration or application-related reasons.

The fee is $955.

Step 3 is given only in the United States and its territories, so living abroad means adding a US trip, and you must hold ECFMG Certification before you apply. Our Step 3 registration guide covers the FSMB process.

Preparing for USMLE Step 3 but short on time? Synapse QBank features just 800 carefully selected, high-yield questions, designed for busy residents and residency applicants who want to focus on what matters without getting overwhelmed by thousands of questions. Want a comprehensive, high-yield review of Step 3 topics in just one week? Check out our 7-Day Live USMLE Step 3 Course to review the most important concepts efficiently.

The rescheduling fee structure changed on July 1, 2026. Moving or cancelling an appointment 46 or more days before the scheduled test date is free, while shorter notice carries higher fees.

If you cannot test within your three-month eligibility period, FSMB offers a one-time, three-month extension for a non-refundable $70 fee, which you must request no later than 25 days after the period ends.

A score recheck costs $80 and must be requested within 90 days of your score release.

Retaking a Step costs the full exam fee again, testing-region fee included, and you may take the same Step no more than four times, with no more than three attempts at it in any 12-month period.

Before you can submit applications, you buy an ERAS token from ECFMG for $185 (up from $165 last season). It is valid for one season, covers every specialty you apply to, includes ECFMG's transmission of your certification status, and is non-refundable.

Your USMLE transcript is ordered through FSMB. For the 2026–2027 application cycle, the transcript fee is $70 once per residency application cycle, covering up to five recipients.

For budgeting, it is easier to calculate your own ERAS cost based on the number of programs you plan to apply to. In one specialty, the first 30 programs cost $11 each, and every program after 30 costs $30.

Need expert one-on-one help perfecting your ERAS application? Check out our Match Application Packages.

Registration for the 2027 Main Residency Match opened on September 15, 2026 and costs $85, which covers up to 20 programs on your rank order list.

Each program beyond 20 adds $30, and registering after January 29, 2027 adds a $50 late fee. Couples pay $45 per partner, and no NRMP fee is refundable.

Rank order lists with 100 or more ranks incur an additional length-of-rank-list fee ranging from $50 to $200, depending on the number of ranks. SOAP itself does not have an NRMP registration fee.

For the 2027 Main Residency Match, the Rank Order List Certification deadline is March 3, 2027, and Match Day is March 19, 2027.

If you do not match, our guide on what to do if you don't match covers your next steps.

For virtual interviews you mainly need a reliable connection, a decent webcam and microphone, and a quiet room, and scheduling platforms such as Thalamus are free for applicants. In-person visits and second looks are optional; if you do them, travel is the main cost.

Want every interview to count? Get our free interview preparation resources.

Most IMGs train on a J-1 visa sponsored by ECFMG. Before you start, you pay ECFMG's sponsorship fee, the SEVIS fee for your first sponsorship, and the State Department's visa application fee.

H-1B sponsorship has different eligibility and immigration requirements. For physician applicants, a passing Step 3 result is generally required before H-1B-sponsored clinical training begins.

Match Day is not the end of your expenses. Once you know where you will train, you may need to pay a state training or postgraduate license fee before you can start. The requirements and fees vary by state, and some programs cover or reimburse these costs, so check with your program before paying anything.

Housing will usually be one of your biggest upfront expenses. You may need to pay a security deposit and your first month’s rent before your first paycheck arrives. The U.S. Department of Housing and Urban Development’s Fiscal Year 2027 Fair Market Rents can give you a rough idea of housing costs in different cities, but actual rents and deposit requirements vary by property.

You should also budget for your flight to the U.S., temporary accommodation if needed, utilities, phone service, transportation, and basic living expenses until your residency salary starts. Depending on where your program is located, you may also need a car and car insurance.

The exact amount you need will depend heavily on your residency location and what your program covers, so it is better to build a personal relocation budget than rely on one national estimate.

To see how the numbers add up, consider an IMG who takes Step 1 and Step 2 CK outside the United States and Canada, passes both on the first attempt, needs the 2027 ECFMG Pathway, takes OET in a location where the test is priced in Australian dollars, applies to 86 Internal Medicine programs, and ranks 20 programs.

So, in this example, the official costs come to $6,040 plus AU$587 for OET. This does not include applicable GST in India, US clinical experience, interview expenses, travel, visa costs, relocation, or preparation resources.

This is an example rather than a universal total cost of the USMLE for IMGs. Your final amount will change depending on where you take the exams, whether you need a Pathway, how many programs you apply to and rank, and the other costs you incur along the way.

For an IMG testing outside the United States and Canada, Step 1 costs $905 before applicable taxes and Step 2 CK costs $930 before applicable taxes. In the worked example in this guide, the official fees before OET total $6,040, plus the AU$587 OET fee. Your actual total will vary depending on your Pathway status, number of applications, testing location, USCE, interviews, visa and relocation costs.

IMGs pay for the USMLE through FSMB, which took over USMLE registration for IMGs on January 12, 2026. ECFMG fees, including certification, credentials, the Pathway and the ERAS token, are still paid in MyIntealth.

IMGs pay the same $695 USMLE exam fee as US students. You pay more because of the testing-region fee when you test abroad and the ECFMG fees US graduates never pay, which come to $1,855 with the Pathway.

The $185 ERAS token is non-refundable, and ERAS does not refund program fees for any reason.

In one specialty, ERAS program fees come to $2,430, plus the $185 token and the $70 transcript, for $2,685 in total.

Most IMGs can’t get a USMLE or ERAS fee waiver. The AAMC Fee Assistance Program is open only to US citizens, nationals, permanent residents, refugees, asylees and DACA recipients, and its ERAS discount goes only to people approved for fee assistance when they applied to medical school. NBME's USMLE fee assistance is limited to US citizens, permanent residents and DACA recipients enrolled at LCME- or COCA-accredited schools or designated Caribbean schools.

You do not need Step 3 for the Match itself. Step 3 is generally required before starting H-1B-sponsored physician training, but it is not required for J-1 sponsorship.

The cost of the USMLE journey is more than the price of the exams themselves. Once you add ECFMG certification cost, OET, the Pathway, ERAS, the Match, US clinical experience, interviews, and eventually your visa and move to the U.S., the expenses can add up quickly.

The good news is that you can plan for most of them. Know which fees are fixed, give yourself enough time to avoid unnecessary rescheduling or repeat exams, and decide carefully how many programs and how much USCE you actually need. A little planning early on can save you from some very expensive surprises later.

Whether you’re preparing for USMLE Step 1, Step 2 CK, Step 3, or the Match we’re here to help you succeed!

If you’re looking for a more efficient way to study, Synapse QBank offers high-yield practice questions, daily live tutoring sessions, and a 24/7 AI Tutor to help you focus on what matters most.

Prefer a live review? Our 7-Day Live USMLE Courses cover the most high-yield concepts for Step 1, Step 2 CK, and Step 3 to help you prepare efficiently and confidently.

If you prefer personalized guidance, our one-on-one USMLE tutoring is completely risk-free! You can start with a free demo session to meet your tutor and see if it’s the right fit before committing to any package.

We wish you the very best on your USMLE and residency Match journey! Don’t hesitate to reach out if you need any help along the way. We’re always happy to support you!