I think you will find that your DAME does a lot more than just give you a medical. He has to go through your whole medical history basically from day one, write it up in explanatory letters to AvMed, basically negotiate for you to ascertain what he and they are both happy with. Then he probably has follow up correspondence as well. I would say that $450 probably would not even go close to his real cost in these days of total bureaucracy.. If you don't believe this, try finding a DAME in a country town, they are few and far between because it is not worth their time or the hassle of dealing with the authority..I would think that you are being ripped of a lot more in a lot of aviation business's, ie ASIC, flight reviews, try getting an AOC. And don't let us talk of Part 61