When an ASC administrator looks at the average certified registered nurse anesthetist salary, it is often only part of the picture.
The fully loaded cost of employing a CRNA in an ASC is often substantially higher, and the gap between the compensation figure and the actual budget impact is a consistently underestimated number in ASC finance.
The salary math
As of July 2026, the average annual CRNA total compensation is $291,396, according to Marit Health’s compilation of 559 peer-reported salaries. However, the loaded cost of employing a CRNA often includes components that do not appear in the compensation figure but are real expenditures for every employer:
Employer Federal Insurance Contributions Act contributions at the statutory rate of 7.65% add approximately $22,292 on a $291,396 salary, per IRS payroll tax guidelines.
Malpractice insurance for CRNAs averaged $5,968 in 2024, nearly 50% higher than the average for other non-physician providers, according to a VMG Health report on CRNA compensation trends.
Malpractice insurance for CRNAs averaged $5,968 in 2024, nearly 50% higher than the average for other non-physician providers, according to a VMG Health report on CRNA compensation trends.
Health, dental and vision benefits for a single employee typically run $7,000 to $10,000 annually for employer-sponsored coverage, according to KFF’s “2025 Employer Health Benefits Survey.”
A standard employer retirement match, typically 3% to 5% of salary based on common plan designs, adds roughly $8,700 to $14,570 annually.
Continuing education, licensing and professional dues add $2,000 to $4,000 more annually.
When added up — $291,396 in base compensation, $22,292 in payroll taxes, $5,968 in malpractice insurance, $8,500 in health benefits, $3,000 in continuing education and licensing and $11,656 for a retirement match where one’s offered — and the subtotal comes to $342,812 before any stipend.
That $342,812 figure, a roughly $51,000 gap over the base salary most administrators budget from, doesn’t yet include paid-time off backfill or stipend payments, both of which add real cost but vary too much by market to fold into a single number.
The share of ASCs expecting to pay anesthesia stipends jumped from 28% in 2024 to 44% in 2025, according to VMG Health. For centers now paying a stipend, which is close to the majority, the actual cost of CRNA coverage is higher still. The stipend amount varies by market and is not consistently published in publicly available benchmarking data, but any stipend payment adds directly to the loaded cost above.
Why the number keeps climbing
The pressure isn’t uniform. CRNAs in Alaska earn the highest average salary in the country, $311,110 a year, while California CRNAs average $283,780, according to 2026 Bureau of Labor Statistics data. Nationally, wages have risen across nearly every market as demand for anesthesia providers outpaces the supply of clinicians willing to fill the role.
Ben Childers, MD, a plastic surgeon and president of Premier Outpatient Surgery Center in Colton, Calif., told Becker’s the pressure has intensified sharply over roughly the last year. The center relies heavily on CRNAs, who can practice independently in California, with one anesthesiologist covering a handful of shifts each month. Additionally, nearby hospital systems, including Kaiser Permanente, can outbid Premier for the same small pool of providers.
“It’s supply and demand,” Dr. Childers said. “The price of nurse anesthetists has gone up because they can demand it — because there’s not as many. We can get $1,600 down the street. So you’ve got to raise your rate.”
Reimbursement hasn’t followed. About 30% of Premier’s volume comes through Inland Empire Health Plan, a Medicaid managed care plan covering roughly 2 million people in the region. IEHP pays Premier a reasonable facility fee, Dr. Childers said, but reimburses anesthesia providers less for the same cases. This gap has widened, he said, as more commercial-insurance patients have shifted onto Medicaid managed care since the Affordable Care Act.
“What’s happened is they’re now putting it on the hospitals, and they’re putting it on the surgery centers, to subsidize their payments,” he said.
Rather than out-bid hospitals dollar for dollar, Dr. Childers said Premier competes on culture and case mix: a lower-acuity caseload (plastic surgery, hand surgery, pain management, rather than hospital traumas), and small retention gestures like feeding anesthesia staff lunch daily.
No consensus on the fix
Faced with the same math, ASC leaders are landing in different places — the VMG survey leaders found that 44% planning contractor arrangements with stipends and another 36% using contractors without them, leaving employed and traditional group-coverage models a shrinking minority.
Scott Freer, clinical administrator of ASC Bala Cynwyd, Pa., told Becker’s he thinks centers should stop treating the stipend as a “ransom payment” and start negotiating it like any other contract — tied to coverage guarantees, on-time starts and turnover metrics, benchmarked against regional data, with exit clauses if a group can’t staff the schedule.
“The math points in one direction: fewer physician-heavy models, more CRNAs,” Mr. Freer said. “Physician-only coverage is becoming a luxury most ASCs can’t justify for routine ambulatory cases. CRNA-only and hybrid care team models fit the ASC setting well since the acuity is lower and the case volume rewards efficiency.”
Others are moving the opposite direction, back toward direct employment.
Paul Lynch, MD, founder and CEO of US Pain Care, called employment “the answer” to a shortage that has worsened since the pandemic.
His team has found success in “bringing it in-house — full-time employment with your own CRNAs or anesthesiologists rather than subsidizing an outside group,” typically on a base-salary-plus-productivity-bonus structure.
Andrew Lovewell, CEO of Columbia (Mo.) Orthopaedic Group, made that move more than two years ago and expects more practices to follow “if CRNA wage inflation doesn’t cool off.”
But many leaders feel employment doesn’t make the cost disappear, but rather relocates it.
Aaron Hayes, administrative director of North Pointe Surgery Center in Lancaster, Pa., directly employs the center’s anesthesiologist and CRNAs, and said the model buys control over staffing and coverage reliability, but “does not make anesthesia inexpensive.”
“We are still carrying wages, benefits, CME, malpractice, recruitment risk and the operational burden of maintaining coverage,” Mr. Hayes said. “ASCs need anesthesia to generate facility revenue, but the anesthesia service line itself may not be financially self-sustaining.”
Why it matters
“Anesthesia is now a cost for many ASCs that previously did not have to subsidize their providers,” Traci Albers, CEO of Sioux Falls, S.D.-based Surgical Management Professionals, told Becker’s. “With increasing anesthesia shortages, increasing salaries and stagnant reimbursement, ASCs are now subsidizing anesthesia.”
The reimbursement side has not kept pace. Average professional anesthesia reimbursement fell 5.5% from 2019 to 2023, and UnitedHealthcare’s 15% CRNA reimbursement cut in select states arrived on top of that.
Many ASC leaders predict that as the anesthesia coverage crisis continues, centers will pivot toward more flexible models.
“Over the next five years, I expect ASCs to rely more heavily on flexible, partnership-based anesthesia models rather than a single traditional staffing approach,” Julie Jackson, NP, chief administrative officer of Milwaukee-based GI Associates, told Becker’s. “The anesthesia market continues to be challenged by workforce shortages, rising compensation expectations, increased malpractice and operating costs, and the need to safely manage higher-acuity patients in outpatient settings.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.