Professional Fee

The professional fee is the doctor's own bill for the work they did: the surgeon who operated, the anesthesiologist who kept you asleep, the radiologist who read your scan. It is billed under the physician's own name and NPI number, using the same CPT code the facility uses, and it is separate from the facility fee for the building and the staff.

This is why one procedure can produce three or four bills. A knee replacement generates a facility bill from the hospital, a professional bill from the orthopedic surgeon, a professional bill from the anesthesia group, and sometimes one more from a physician assistant. In the BCBS Texas carrier file, the surgeon's negotiated professional fee for a total knee (CPT 27447) commonly runs $1,800 to $3,200, while the hospital's facility rate for the same code runs $18,000 to $45,000. People see the surgeon's number and think they know the price. They know about 8 percent of it. The flip side is the bundled cash price from a surgery center: one number that already has the facility, the surgeon and the anesthesia inside it, so there is no second or third bill waiting in the mailbox.

The takeaway: when you get a price for a procedure, ask whether it is the professional fee, the facility fee, or both. A total that does not say which one it is, is not a total. Ask for the bundled all-in number, or for each part in writing.