the cost includes pre op consultation, surgery at a surgery center as opposed to a hospital. My daughter had plastic surgery in one and they are not that uncommon. Fee includes anesthesiologist, dr's fees, operating room fees, etc. When you go back for fills it's $15.00 a fill. I can understand your anxiety, but the dr. was very frank about getting little business when doing it at hospital and that he had negotiated a package deal with the surgery center etc. I looked at his diplomas and he graduated from very good schools--I've read other threads about him and people seem very happy. One of my reluctances about doing Mexico is that American drs. don't want to deal with you afterwords. Had I not been able to get this price I probably would have done the Mexico thing, but to be honest, I haven't flown since I got really fat and don't want to deal with the whole hassle of fitting into an airplane seat, etc. I realize that if you are in another state you'd probably fly anyway. I think, although I've not done so, that there is some state agency which collects complaints about drs. GOOD LUCK!