The sealed envelope with the medical exam for AOS must be submitted along with all required filings in the above. Research the local medical practitioners certified by the U.S. Surgeon General to give such medical exams and select a doctor of your choosing. In my professional experience, such exam does not involve extensive treatment and should not be more than several hundred dollars.
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You need to mail the medical exam with the rest of your I-130/I-485 application. Call around and talk to other civil surgeons - they are allowed to set their own prices and perhaps you can find one with more reasonable prices.
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The I-485 must be filed with the medical exam.
J Charles Ferrari Eng & Nishimura 213.622.2255 The statement above is general in nature and does not constitute legal advice, as not all the facts are known. You should retain an attorney to review all the facts specific to your case in order to receive advise specific to your case. The statement above does not create an attorney/client relationship. Answers on Avvo can only be general ones, as specific answers would require knowledge of all the facts. As such, they may or may not apply to the question.