Short answer: among providers that publish prices, a standard nexus letter in 2026 runs from about $500 to $1,600. Complex cases, prior denials, and appeal work run $1,500 to $2,500. Several well-known companies do not publish a price at all. Below is what each provider actually lists, what drives the number, and the honest test for whether paying is worth it in your case.
I write nexus letters for a living, so read this knowing that. Every price here comes from the provider's own site or from a comparison that cites it, and each one is linked so you can check it yourself.
Published Nexus Letter Prices, September 2026
| Provider | Published price | What comes first | Who writes it |
|---|---|---|---|
| XTerra Health | $500 | Eligibility check before payment | Not stated on the pricing page |
| Prestige Veteran Medical Consulting | $600 letter + $200 screening | Paid screening | "Licensed medical professionals" |
| Valor Psychology | $600 (mental health only) | Intake | Psychologist |
| Sworn Medical | $995 flat, or $395 records analysis + $600 letter | Free 15-minute screening call | One board-certified physician, named, who also signs |
| VetNexusMD | $1,000 per condition + $500 record review | Paid record review | Board-certified psychiatrist (psychiatric conditions only) |
| Valor 4 Vet | $1,200 letter + $300 record review | Paid record review, required | Varies |
| Patriot Path | $1,500 flat, up to 5 conditions | Free consultation | Licensed MD, PsyD, or PhD; the individual is not named publicly |
| Mednick Associates | $1,500 fixed (attorney-facing) | Free pre-screening | Assigned expert |
| Telemedica | $1,595 standard + $325 eligibility review ($620 for eligible members) | Paid eligibility review | Network providers |
| REE Medical | Not published. Third-party reports of $2,500 to $4,000+ | Consultation | Network providers |
Prices as listed on each provider's public pages on September 12, 2026, or as reported by Claim Raven's comparison (checked by them August 13, 2026, updated September 6) and VA Claim Strategy's May 2026 review. Where a provider requires a paid review before the letter, the true starting cost is the sum. Prices change; confirm before paying anyone, including me.
What Drives the Price
- Who writes it. A board-certified physician costs more than a nurse practitioner or physician assistant, and both cost more than a "medical professional" whose credentials are not stated. The VA weighs the author's qualifications when it weighs the opinion, so this is not just a cost question.
- How much of your record they read. A letter based on your full service treatment records, VA records, and private records takes hours. A letter based on a summary you fill out takes minutes, and the VA can tell the difference.
- Screening fees. Some providers charge $200 to $325 before they decide whether they can help. Others screen free. Add the screening fee to the letter price to compare honestly.
- Per condition or flat. A $1,000 per condition price and a $1,500 flat price for five conditions are very different numbers for a veteran claiming three things.
- Complexity. A prior denial, a negative C&P exam to rebut, or an appeal means more record work and a longer, more defended opinion. Expect the higher tier from most providers. Some also charge the higher tier for any secondary claim; ask.
- Rush. Twenty-four to forty-eight hour turnaround is advertised by some companies at a premium. A physician cannot read a thousand-page file well in a day. Be skeptical of speed.
What the Price Does Not Buy
No nexus letter guarantees an outcome. Any provider who suggests otherwise is selling something other than a medical opinion. The VA gives weight to a private opinion based on the author's qualifications, whether the records were actually reviewed, and whether the reasoning is explained. A $2,000 letter with a conclusion and no rationale is worth less to an adjudicator than a $500 letter that walks through the evidence. Price is a poor proxy for quality in this market, in both directions.
Is a Nexus Letter Worth Paying For?
The VA needs three things for direct service connection: a current diagnosis, an in-service event or injury or exposure, and a medical link between the two. A nexus letter addresses only the third. So the test is simple: is the missing piece in your claim the medical link?
Paying is likely worth it when:
- You have a documented current diagnosis and documented in-service event, and no doctor has yet connected them in writing.
- The VA denied your claim specifically for lack of a nexus, or a C&P examiner gave an unfavorable opinion you need to rebut.
- You are claiming a condition secondary to a service-connected condition, and the causal chain needs a physician to explain it.
- Your treating physician will not write one. Many will not, for time or liability reasons, and that is not a reflection on your claim.
Paying is probably not worth it when:
- Your condition is presumptive for your service, for example under the PACT Act. The VA presumes the link; you do not need to prove it.
- You have no current diagnosis. A nexus letter cannot substitute for one. Get diagnosed first.
- There is no evidence of the in-service event anywhere in your records or lay statements. The letter has nothing to connect to.
- Your treating physician is willing to write a reasoned opinion. That letter is free, and a treating physician's opinion carries real weight.
Questions to Ask Before You Pay Anyone
- Who, by name, will write and sign my letter, and what are their credentials? Can I verify them with a state medical board?
- Will they read my complete records, or a summary?
- Is the price in writing before I pay, and what changes it?
- If they review my records and conclude they cannot support my claim, what do I owe?
- Is there a contingency fee or a percentage of back pay? (There should not be.)
- Can I see a sample, with the veteran's details removed?
What Sworn Medical Charges, and Why
The screening call is free and takes fifteen minutes. On it I tell you whether a nexus opinion is likely to help, and if it is not, you owe nothing and I will say so. A standard letter is $995, which includes the full records review. If you want the records analysis first, before deciding on the letter, that is $395, and the letter is $600 after it, so the total is the same. Complex work, meaning a prior denial, a rebuttal to an adverse exam, or an appeal, is $1,495 and is confirmed in writing on the call before you pay anything. A secondary claim on its own is standard. Each additional condition on the same records is $500. There is no contingency fee, no percentage of back pay, and no charge if I cannot take your case. A portion of my caseload is reserved at reduced fee or pro bono for veterans in financial hardship.
I set the price where I did because I read every page of every record myself and write every opinion myself. It is not the cheapest letter on this page and it is not the most expensive. It is the price of a physician's time.
Sources
- Claim Raven, Nexus Letter Companies and Costs: 2026 Price Comparison (prices checked August 13, 2026; updated September 6, 2026)
- VA Claim Strategy, Best Nexus Letter Companies (2026) (May 8, 2026)
- Patriot Path pricing
- VetNexusMD nexus letter cost
- Mednick Associates, veteran disability cases
- Sworn Medical pricing