Remote Sql Performance Issue Code Time and Sql Profile times are not matching up

I have a local application (Web Application but reproducible in console app) that is accessing a remote SQL server hosted on AWS. We are having a performance issue that I am trying to debug but am having difficulty. I ran the Visual Studio 2013 performance tool and all indications that I have a bad query (cmd.ExecuteReader is 99% of the sample data and about 9 seconds of time). Next logical thing to do is to run a Query profiler on the sql server hosted at AWS. This is where it gets weird, the query profiler reports the query takes 20ms.

So I cannot resolve the difference in time here, in my code it is taking 9 seconds to execute a query but sql profiler reports the same query is take 20ms. Is there something else I can look at from the sql side (maybe connection time, waiting time, sending time)?