First regarding budget and medical school: There are currently a few universities in the USA that cost over $90,000 per year. The cost of attending university tends to go up faster than inflation. With price increases you could very well spend an average of $100,000 or slightly more per year for the four years that you are an undergraduate student, and could spend perhaps another $125,000 per year in medical school. If you go on to medical school, the total cost of eight years of university could come to something like $900,000 by the time that they call you “Doctor Seiren”. You do not want to borrow even half of this. Even doctors do not make enough money to make it easy to pay this off. Budget matters for anyone who is considering a medical future and whose parents do not have close to a million dollars to pay for it.
However, there are a huge number of universities that are very good for premed students. I do not know what state you are from, but it is very highly likely that your in-state public university, or several of your in-state public universities, are very good for premed students. Also, there are universities that have various types of financial aid that are very good for premed students. You do not need to attend a top 20 university to get accepted to a very good medical school (and in most cases top 20 schools have very good need based financial aid).
Your ACT score is very good. It is definitely way over what you would need to get accepted to a university that is very good for premed (even ignoring the fact that there are some very good universities that are either test-optional or test-blind).
Most students who start university intending to be premed end up never applying to medical school. Some are not able to maintain a “medical school worthy” GPA in their premed classes. Some just decide that they want to do something else. Some choose some other medical-related career path (such as biotech research). Some just decide they want to do something very different (law school, software engineering, or whatever). Also, some students apply to medical school and do not get accepted anywhere.
This is of course very good. This will make you competitive for the highest ranked universities. However, the vast majority of applicants to the highest ranked universities have similarly very strong credentials, and most are rejected. Probably much more importantly, the highest ranked universities (let’s say top 20) are not a good fit for all very strong students. Some students will be happier at a smaller school such as a liberal arts college. Some students would be happier at their in-state public university. Some students would be happier somewhere else. Finding a good fit is important, but is unfortunately often more difficult compared to just looking at university rankings.
This really depends where you apply. Some schools care about ECs and use them to pick between a long list of very strong applicants. Some don’t care as much. Some do not even look at them. One daughter only applied to universities in Canada (we live in the northeast of the US so Canada is not all that far away) and none of the schools she applied to even asked about ECs.
Reading a bit further down this thread, I see your list of ECs. This is a very good list. You do not need a long list of ECs. Showing commitment to a few ECs and doing well with them is the point. Having the longest list is not the point.
I think that you might want to read the “applying sideways” blog on the MIT admissions web site. As I understand it, this recommends that you do whatever is right for you, and whatever you do, do it well. This is the approach that my wife, my two daughters, and I have all taken and it has worked out well for us. However, what each of us did was very different. This also helped us attend 8 different universities (one each for a bachelor’s degree, and a different one each for graduate school). Perhaps part of the point is that if you do what is right for you, then you are likely to do it well. Also, if you do what is right for you, this is likely to look genuine and fit well with whatever college or university is likely to be a good fit for you.
Finally, keep in mind that there are hundreds of very good colleges and universities in the US. You do not need to attend a top 20 university to do well in life. Also, if you look at top 20 graduate programs, the students in these programs will have gotten their bachelor’s degree at a very wide range of different colleges and universities. Given your excellent academic performance up to now, assuming that you keep up the good work, there will be plenty of very good universities where you can be accepted. You will want to try to find one that is affordable and that is a good fit for you.