USMLE Fees 2026 and 2027: US Students vs International Graduates

Written by Julian. Checked on October 4, 2026.

USMLE fees for 2026 and 2027 are USD 695 for Step 1, USD 695 for Step 2 CK and USD 955 for Step 3, the same for US students applying through NBME and for international students and graduates applying through FSMB, from the USMLE Apply for Exams page, checked on October 4, 2026. A test outside the United States and Canada adds a region fee of USD 210 for Step 1 and USD 235 for Step 2 CK. One attempt at each Step comes to USD 2,345 at US test centers and USD 2,790 with both region fees, before any ECFMG fees.

USMLE fees for 2026 and 2027 by Step

The application fee is the same in 2026 and in 2027, and the same on both application routes, on the USMLE Apply for Exams page, checked on October 4, 2026. What moves the total is where you take the exam.

USMLE Step	Application fee, 2026 and 2027	Region fee, test outside the US and Canada	Total outside the US and Canada (computed)
Step 1	USD 695	USD 210	USD 905
Step 2 CK	USD 695	USD 235	USD 930
Step 3	USD 955	None listed	USD 955

Source: USMLE, Apply for Exams, and NBME, USMLE fees, checked on October 4, 2026. The totals are this article's arithmetic.

The NBME fee page prints the same three fees in its 2026 table and in its 2027 table. A footnote there sends a US student who wants to take Step 1 or Step 2 CK at an international center to NBME registration for the regional surcharge.

Which fee year applies: your eligibility period decides

The fee year follows your eligibility period, not the day you pay. NBME prices registrations by three month eligibility period, on its USMLE fees page, checked on October 4, 2026:

2026 fees: eligibility periods from the one starting November 1, 2025 (ending January 31, 2026) to the one ending December 31, 2026.
2027 fees: eligibility periods from the one starting November 1, 2026 (ending January 31, 2027) to the one ending December 31, 2027.

Both years carry the same numbers, so a student choosing between a late 2026 window and an early 2027 window pays USD 695 for Step 1 either way. The page printed no 2028 fees on October 4, 2026.

The region fee and the India tax

Step 1 carries a USD 210 region fee and Step 2 CK a USD 235 region fee for exams taken outside the United States and Canada, on the Apply for Exams page, checked on October 4, 2026. The page lists no region fee for Step 3. A test in Canada costs the same as a test in the United States.

Testing in India adds a tax. The same page says that under Notification No. 28/2023-Central Tax the USMLE program must collect goods and services tax on online information database access and retrieval services provided in India, which include Steps 1 and 2 taken in India. Effective December 4, 2024, that 18 percent tax is collected and remitted directly to India, and no amount is retained by the USMLE program. The page does not say which amount the 18 percent is charged on, so this article does not compute an India total.

An older ECFMG address for the USMLE surcharge, iome.ecfmg.org/fees/usmle-surcharge.html, returned a server error when this article tried it on October 4, 2026, so no figure from it is printed here. A surcharge quoted elsewhere may come from that older page. For a 2026 or 2027 test, use the region fees on usmle.org.

Who applies through NBME and who through FSMB

The Apply for Exams page splits applicants into two routes for every Step, checked on October 4, 2026:

NBME, for students and graduates of LCME or COCA accredited medical programs in the US. That covers US MD and DO students. The application starts at myusmle.org.
FSMB, for students and graduates of medical schools located outside the US. That covers international medical students and graduates, for Step 1, Step 2 CK and Step 3. The application starts at usmle.fsmb.org.

ECFMG is not the application processor on that page. It appears there for certification: all international medical graduates need ECFMG Certification to be eligible for Step 3. The USMLE eligibility page, checked on October 4, 2026, sets the full Step 3 condition for an international graduate: passing scores on Step 1 and Step 2 CK, the equivalent of the MD degree from a school listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements, ECFMG Certification, and a valid and unexpired ECFMG Certificate.

The Apply page also names the USMLE Fee Assistance Program, through which co-sponsor NBME supports medical students and residents with demonstrated financial need to help cover Step exam fees. It does not print who qualifies or how much is covered; its link leads to the program terms.

Fees international graduates pay on top

The USMLE fee table does not include ECFMG Certification, which an international graduate needs before Step 3. ECFMG publishes its own fees.

This article prints no ECFMG figure. The ECFMG fees page and the Intealth fees page both refused an automated read on October 4, 2026 (HTTP 403), and this site does not copy a fee from a prep site or from memory. Read the current certification and Pathways amounts on the ECFMG site before you budget, and add them to the totals below.

Rescheduling and extension fees

Prometric charges for moving a USMLE appointment inside 45 days of the test, and nothing earlier. The table took effect July 1, 2026 and is the same in all testing regions, on the USMLE reschedule page, checked on October 4, 2026.

When you change the appointment	Step 1	Step 2 CK	Step 3
46 or more days before the test date	No fee	No fee	No fee
31 to 45 days before	USD 35	USD 35	USD 35
6 to 30 days before	USD 100	USD 100	USD 100
5 or fewer days before	USD 158	USD 178	USD 317

Source: USMLE, Reschedule Exam, fee schedule effective July 1, 2026, checked on October 4, 2026. Days count back from the first day of the scheduled test, not including it.

The Bulletin page on applying and scheduling, checked on October 4, 2026, gives the rule behind the table: you may reschedule within your eligibility period, and a change during the 45 calendar days before the appointment carries a fee.

If you cannot test inside your eligibility period, the organization that registered you can grant a one time contiguous extension, for a fee. NBME lists that fee as USD 70 for Step 1 and Step 2 CK in both 2026 and 2027. FSMB registrants should check FSMB's own fee page, which refused an automated read on October 4, 2026. Let the period run out instead and you apply again, because the Bulletin says fees are non-refundable and non-transferable.

What Step 1 to Step 3 costs in total

One attempt at each Step costs a US student USD 2,345. An international graduate pays the same USD 2,345 at US or Canadian test centers, and USD 2,790 when Step 1 and Step 2 CK are taken outside the US and Canada. These sums are this article's arithmetic on the usmle.org fees checked on October 4, 2026.

Path through the USMLE	Step 1	Step 2 CK	Step 3	Total (computed)
US MD or DO student, NBME	USD 695	USD 695	USD 955	USD 2,345
International graduate, FSMB, US or Canada test centers	USD 695	USD 695	USD 955	USD 2,345, plus ECFMG fees
International graduate, FSMB, Step 1 and Step 2 CK outside the US and Canada	USD 905	USD 930	USD 955	USD 2,790, plus ECFMG fees

The gap between the first and last rows is USD 445, the two region fees. A test in India adds the 18 percent tax on top, on a base the USMLE page does not state.

A retake is a new application with its own fee. The USMLE eligibility page, checked on October 4, 2026, makes you ineligible for any Step once you have attempted a Step four or more times without passing, incomplete attempts included. You may not take the same Step more than three times within 12 months, and a fourth attempt must be at least 12 months after the first and at least six months after your most recent attempt. Attempt limits for other exams are in the post on how many times you can take Step 1, the NCLEX, the MCAT and PLAB 1, and Step 1 pass rates in the post on the Step 1 passing score.

Pay each fee once: practice from your own notes

The cheapest attempt is the one you do not repeat. One way to work toward that is to practice from the material you were taught. Upload your lecture slides or notes here and the generator writes practice questions from them, each printed with the verbatim sentence it came from and its page number, checked against the stored text of that page before you see it. The pricing page lists the free monthly allowance and the one time options, a 90 day Exam Pass at USD 19.99 and a 500 question pack at USD 5.99, neither of which renews. The sample exam shows a checked question, and the format numbers sit on the Step 1 page and the Step 2 CK page.

Questions people ask

How much does USMLE Step 1 cost in 2026?

USD 695 for the application, the same in 2026 and 2027, whether a US MD or DO student applies through NBME or an international student or graduate applies through FSMB. A test outside the United States and Canada adds a USD 210 region fee, for USD 905 in all. USMLE Apply for Exams page, checked on October 4, 2026.

How much does Step 2 CK cost?

USD 695 for the application in 2026 and 2027 on both the NBME and the FSMB route. A test outside the United States and Canada adds a USD 235 region fee, for USD 930 in all. USMLE Apply for Exams page, checked on October 4, 2026.

How much is USMLE Step 3?

USD 955 in 2026 and 2027, through NBME for graduates of LCME or COCA accredited US programs and through FSMB for graduates of schools outside the US. The Apply for Exams page lists no region fee for Step 3. An international graduate needs ECFMG Certification and a valid, unexpired ECFMG Certificate to be eligible. USMLE Apply for Exams and eligibility pages, checked on October 4, 2026.

What does it cost to take all three USMLE Steps?

USD 2,345 for one attempt at Step 1, Step 2 CK and Step 3 at US test centers (695 plus 695 plus 955). An international graduate who takes Step 1 and Step 2 CK outside the United States and Canada pays USD 2,790, the extra USD 445 being the two region fees, plus ECFMG fees not included here. Arithmetic on the usmle.org fees checked on October 4, 2026.

Do international medical graduates apply for the USMLE through ECFMG?

Not according to the USMLE Apply for Exams page checked on October 4, 2026. It sends students and graduates of medical schools outside the US to FSMB for Step 1, Step 2 CK and Step 3, and students and graduates of LCME or COCA accredited US programs to NBME. ECFMG appears on the page for certification, which every international medical graduate needs to be eligible for Step 3.

How much does it cost to reschedule a USMLE exam?

Nothing 46 or more days before the test date. Prometric charges USD 35 from 31 to 45 days before and USD 100 from 6 to 30 days before, for every Step. Inside 5 days it is USD 158 for Step 1, USD 178 for Step 2 CK and USD 317 for Step 3, in all testing regions. USMLE reschedule page, fee schedule effective July 1, 2026, checked on October 4, 2026.

Is there a tax on the USMLE in India?

Yes. Effective December 4, 2024, the USMLE program collects an 18 percent goods and services tax on Steps 1 and 2 taken in India, under Notification No. 28/2023-Central Tax, and remits it directly to India, keeping none of it. The page does not state which amount the tax is charged on. USMLE Apply for Exams page, checked on October 4, 2026.

How much is the USMLE eligibility period extension?

USD 70 for Step 1 and Step 2 CK registered through NBME, in both 2026 and 2027, for a one time contiguous extension of the three month eligibility period. FSMB registrants ask FSMB. NBME USMLE fees page and the USMLE Bulletin applying and scheduling page, checked on October 4, 2026.

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Published October 4, 2026.