Your best injector wants 20% of what she brings in. She has an offer from the practice across town, she knows roughly what her schedule produces, and a percentage feels fair to her. It may also be the one pay plan your state treats as a violation.

Start with what the job pays elsewhere. The Bureau of Labor Statistics put the national median wage for registered nurses at $46.90 an hour in its 2025 estimates, and for nurse practitioners at $63.61. Those figures cover every industry, hospitals included, and say nothing specific about aesthetics. But they are the floor an injector can walk back to, and any plan you build sits on top of them.

The short version

Pay a wage or a salary. Add a bonus that is tied to how the employee and the practice performed, in amounts you set in advance. Keep commission for retail products and non-medical services. Then have a health care attorney in your state read the plan before anyone signs it.

That is close to the advice the American Med Spa Association has published twice. In 2018 its founder, Alex R. Thiersch, wrote that in most states giving a non-physician a percentage of the payment for a medical treatment is fee-splitting, and that physicians "can establish structured bonus plans" instead. In 2020 Renee E. Coover, an attorney with Advanced Medaesthetic Partners writing on AmSpa's site, recommended bonuses "structured to reward employees based on both employee performance and the overall performance of the medical spa," and added that commission on retail products and non-medical services is legal.

Both articles are several years old and both speak in general terms about "most states" and "many states." Neither is a substitute for the statute where you operate.

What the statutes say

Coover listed three places to look in any state: fee-splitting statutes, anti-kickback laws and medical board opinions. We read three statutes on October 8, 2026. They are not interchangeable.

StateSectionWhat the text covers
Illinois225 ILCS 60/22.2A licensee "may not directly or indirectly divide, share or split any professional fee or other form of compensation for professional services with anyone in exchange for a referral or otherwise," outside the exceptions the section lists
CaliforniaBusiness and Professions Code 650Makes it unlawful for a licensee to offer or accept a commission or other consideration "as compensation or inducement for referring patients"
FloridaSection 458.331(1)(i)Lists "paying or receiving any commission, bonus, kickback, or rebate, or engaging in any split-fee arrangement in any form whatsoever" for referred patients as a ground for discipline

Illinois is the broad one. "Or otherwise" reaches past referrals, and the section goes on to spell out which kinds of entity may pool and divide professional fees.

California's section is written around referrals, and it has a carve-out worth knowing. Subdivision (b) says payment "based on a percentage of gross revenue" for services other than referring patients is not unlawful if it is "commensurate with the value of the services furnished." The penalty is real, though: a first conviction carries up to a year in county jail, a fine of up to $50,000, or both (the subdivision also allows a sentence under Penal Code section 1170). Whether a particular injector plan falls on the right side of subdivision (b), or runs into some other California rule, is a question for a California attorney. It is not one a pay-plan template can answer.

Florida's language sits in the medical practice chapter's list of grounds for discipline. It is a licensing rule, enforced by the board through discipline.

A worked example

Everything in this example is an illustration. The wage, the hours, the goals and the revenue are assumptions, not benchmarks.

Say you employ a registered nurse injector for 1,800 paid hours a year at $58 an hour. Base pay is 1,800 x $58 = $104,400.

Each quarter you post three goals with a fixed dollar amount beside each: $1,500 if the practice hits its revenue goal, $1,000 if the practice hits its rebooking goal, and $1,000 for her own scorecard (charting done on time, protocols followed, patient feedback). The most she can earn is $3,500 a quarter, or $14,000 a year. Total pay at the top of the plan is $104,400 + $14,000 = $118,400.

Now the owner's question. What does that cost against what she produces? If her schedule brings in $600,000 of treatment revenue, $118,400 / $600,000 = 19.7%. If it brings in $450,000, the same pay is 26.3%.

Compare a straight 20% commission, the plan you are trying to avoid. On $600,000 it pays $120,000. On $450,000 it pays $90,000.

The totals are close in a good year. The difference is who carries a slow one. Commission pushes that onto the employee, and the fixed plan leaves it with you. That is the price of not tying her pay to medical fees, and it is why the practice-wide goals matter: they are the part of the plan that moves with the business. If your revenue goal leans on recurring income, the membership pricing arithmetic feeds straight into it.

I prefer fixed dollar amounts to a percentage of anything, profit included. My reason is plain: when nothing is being divided, there is less to argue about. That is a preference, not a legal opinion.

Where it goes wrong

The first mistake is renaming. A "bonus" calculated as a percentage of the treatments one injector performed is a commission with a different label, and a new label does not change the arithmetic.

Then there is the cross-sell payment. Coover wrote that in a state with anti-kickback laws, "paying a commission for upselling a patient to a different provider for a different treatment can be considered a kickback." A $25 payment to an aesthetician for walking a facial patient over to the injector (a hypothetical, but a familiar one) is the kind of arrangement she was describing.

Mixed commission bases cause quieter trouble. Retail commission is the piece Coover called legal, but only if the base is retail. If your point-of-sale report lumps skincare, memberships and treatments into one "sales" line, you cannot show what the commission was paid on.

And remember who else is exposed. Thiersch wrote that in a state where fee-splitting is illegal, staff who receive the commission "are also subject to a fine." An injector who asks for a percentage is asking to share the risk as well as the revenue. Say so in the pay conversation.

What depends on your state

All of it, in the end. Whether your state has a fee-splitting statute, how broadly it is worded, whether nurse practitioners or physician assistants who own practices are treated differently from employees, and what the medical or nursing board has said in its opinions are all state questions. This guide is general information. Take the plan document, not a summary of it, to a health care attorney in your state, and have your accountant check the payroll treatment of the bonus while you are at it.

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