Highest Paying States for CRNAs (2026): Where Nurse Anesthetists Earn the Most
The highest paying state for CRNAs is New York at $327,882 average median salary in 2026, based on BLS OEWS data across 51 states and 1664+ metro areas. CRNA pay varies from Alabama ($197,314) to New York ($327,882) — driven by opt-out state independent practice, locum tenens premium, ASC mix, and rural shortage.
Best States for CRNA Salary: 2026 Rankings
CRNA pay variance is driven by opt-out state independent practice (24 states + Guam), locum tenens premium ($200-$300/hour), rural shortage HRSA NHSC + IHS loan repayment, ASC partnership equity, ACT (Anesthesia Care Team) state restrictions, COL, and state income tax. New York leads at $327,882, Alabama sits at $197,314.
Top-Tier States (Opt-Out + Rural Premium)
- Wyoming ($265,000-$320,000) — opt-out state + rural shortage + no state income tax.
- Montana ($245,000-$300,000) — opt-out state + rural shortage + no IHS region.
- North Dakota ($240,000-$290,000) — opt-out state + rural + no state income tax.
- South Dakota ($235,000-$285,000) — opt-out state + rural + no state income tax.
- Alaska ($235,000-$285,000) — opt-out + chronic shortage + no state income tax + IHS.
- Iowa ($230,000-$280,000) — opt-out state + rural premium.
Mid-Tier Markets
- California ($220,000-$275,000) — ACT state but Bay Area / LA / San Diego HCOL premium.
- Nevada ($215,000-$270,000) — opt-out + Las Vegas + no state income tax.
- New Hampshire ($210,000-$265,000) — opt-out + Boston commuter premium.
- Oregon ($205,000-$255,000) — opt-out + Portland.
- Washington ($205,000-$255,000) — opt-out + Seattle + no state income tax.
- Tennessee ($200,000-$250,000) — opt-out + no state income tax.
- Kentucky ($195,000-$245,000) — opt-out + rural.
- Mississippi ($190,000-$240,000) — opt-out + rural shortage + low COL.
Specialty Premium Markets
- Locum tenens CRNA — premium $200-$300/hour + travel.
- Independent practice / 1099 (opt-out state) — premium 1099 income.
- ASC partnership / surgicenter ownership — equity premium.
- Pain clinic CRNA subspecialty — premium specialty.
- Rural shortage (HRSA NHSC + IHS LRP stack) — premium federal forgiveness.
- VA / DoD federal CRNA — pension + PSLF.
- Academic medical center (UAB, Penn, Duke, Mayo) — premium + PSLF.
- Military CRNA — premium signing + military pay.
2026 State Ranking Methodology
Rankings reflect 2026 projected median from BLS OEWS 2025. Opt-out state independent practice + locum + ASC equity materially shift ceiling. Top CRNAs in opt-out + locum exceed median substantially.
2019 BLS
$174,790
2025 BLS
$236,590
2026 Current Est.
$248,893
2019–2027 Growth
+49.8%
National Average for Context
2019–2025: BLS OEWS actual data. 2026+: CAGR 5.20% projection.
| Year | Median Annual Salary | Status |
|---|---|---|
| 2019 | $174,790 | Actual |
| 2020 | $183,580 | Actual |
| 2021 | $195,610 | Actual |
| 2022 | $203,090 | Actual |
| 2023 | $212,650 | Actual |
| 2024 | $223,210 | Actual |
| 2025 | $236,590 | Actual |
| 2026(current) | $248,893 | Estimated |
| 2027 | $261,835 | Projected |
Understanding the national salary trend helps contextualize state-level differences. The national median provides a baseline for comparing how each state's nurse anesthetist pay stacks up.
Note: BLS actual data is sourced from the Bureau of Labor Statistics Occupational Employment and Wage Statistics (OEWS) survey. Estimated and projected values are calculated using a 5.20% historical CAGR. Actual compensation may vary based on employer, experience, certifications, and local market conditions.
Top 10 Highest Paying States for Nurse Anesthetists
What Drives State-Level CRNA Pay Differences
Five primary factors explain CRNA state-level pay variance.
1. Opt-Out State Independent Practice (30-40%)
- Opt-out states (24 + Guam): WY, MT, ND, SD, AK, IA, NV, NH, OR, WA, TN, KY, MS, MN, NE, NM, KS, CO, WI, MI, OK, ID, CA (limited), AL — independent practice + premier scope.
- ACT (Anesthesia Care Team) states (CA, NY, NJ, IL, MA) — MD supervision model.
- Independent billing — premium opt-out states.
- 1099 / independent contractor — premium opt-out.
- CRNA-MD pay ratio — opt-out closes gap.
2. Rural Shortage + Federal LRP (20-30%)
- HRSA NHSC loan repayment (up to $100,000 HPSA) — premium.
- IHS (Indian Health Service) loan repayment (up to $40,000 per 2-year) — premium federal.
- VA EDRP (Education Debt Reduction) — premium federal.
- Critical access hospital sign-on — major.
- Rural housing assistance — premium.
- Federal pension + PSLF stack — long-term.
3. State Income Tax (5-10% take-home)
- No state income tax — AK, WA, TX, FL, TN, NV, SD, WY, NH. Substantial on CRNA $200K+.
- High state income tax — CA (13.3%), NY (10.9%), OR (9.9%), HI (11%), NJ (10.75%) — major bite.
- NYC + Philadelphia local — additional.
- Self-employment SE tax (independent / 1099) — 15.3%.
- Property + sales tax — TX tradeoff.
4. Locum Tenens Premium (10-15%)
- Locum daily rate — $200-$300/hour for established CRNAs.
- Critical access hospital coverage — premium rural locum.
- Multi-state license + Compact (eNLC) — premium.
- 1099 / IC structure — premium.
- Travel + per-diem (untaxed) — major supplemental.
- Premium during shortage spikes — major.
5. ASC + Setting Mix (10-15%)
- ASC (Ambulatory Surgery Center) partnership / ownership — equity premium.
- Pain clinic CRNA — premium subspecialty.
- Hospital W-2 (broadest entry) — base + benefits.
- Academic medical center — premium + PSLF.
- Surgicenter / specialty hospital — premium.
- Federal VA / DoD / IHS — pension + PSLF.
- Independent practice / 1099 (opt-out) — premium.
Where Do Nurse Anesthetists Get Paid the Most?
Complete ranking of all 51 states by average nurse anesthetist salary. Click any state to see city-level breakdowns and detailed data.
| Rank | State | Avg Salary |
|---|---|---|
| 1 | New York | $327,882 |
| 2 | New Jersey | $292,054 |
| 3 | California | $289,361 |
| 4 | West Virginia | $284,165 |
| 5 | Wisconsin | $283,853 |
| 6 | Washington | $275,205 |
| 7 | Massachusetts | $272,220 |
| 8 | Nebraska | $268,955 |
| 9 | Illinois | $265,352 |
| 10 | Minnesota | $265,021 |
| 11 | Nevada | $264,747 |
| 12 | South Carolina | $263,059 |
| 13 | Maine | $261,635 |
| 14 | North Carolina | $261,325 |
| 15 | New Hampshire | $260,748 |
| 16 | Michigan | $254,475 |
| 17 | Connecticut | $253,786 |
| 18 | Alaska | $250,868 |
| 19 | Arizona | $250,755 |
| 20 | North Dakota | $250,064 |
| 21 | Virginia | $249,776 |
| 22 | Texas | $249,640 |
| 23 | Oregon | $249,297 |
| 24 | Colorado | $249,083 |
| 25 | South Dakota | $249,077 |
| 26 | Idaho | $247,766 |
| 27 | Maryland | $243,000 |
| 28 | Florida | $241,839 |
| 29 | Georgia | $241,776 |
| 30 | Louisiana | $240,633 |
| 31 | Pennsylvania | $239,086 |
| 32 | Kentucky | $238,321 |
| 33 | Ohio | $238,135 |
| 34 | Utah | $238,130 |
| 35 | Missouri | $236,536 |
| 36 | Rhode Island | $235,830 |
| 37 | District of Columbia | $234,754 |
| 38 | Montana | $229,536 |
| 39 | Iowa | $228,919 |
| 40 | Delaware | $228,347 |
| 41 | Indiana | $227,552 |
| 42 | Tennessee | $226,474 |
| 43 | Hawaii | $226,393 |
| 44 | Wyoming | $224,850 |
| 45 | New Mexico | $223,018 |
| 46 | Vermont | $221,745 |
| 47 | Kansas | $220,533 |
| 48 | Oklahoma | $219,861 |
| 49 | Mississippi | $218,013 |
| 50 | Arkansas | $216,620 |
| 51 | Alabama | $197,314 |
Lowest Paying States for Nurse Anesthetists
Even the lowest-paying states offer nurse anesthetist salaries well above the national average for all occupations. Here are the 5 lowest-paying states:
Top Earner Potential by State
The 90th percentile represents what experienced, highly-skilled nurse anesthetists earn in each state. These are the 10 states with the highest earning ceilings:
| # | State | Top Earner (P90) |
|---|---|---|
| 1 | Illinois | $424,300 |
| 2 | California | $420,934 |
| 3 | Missouri | $409,654 |
| 4 | New Jersey | $403,152 |
| 5 | Nevada | $400,252 |
| 6 | Massachusetts | $395,705 |
| 7 | Washington | $392,820 |
| 8 | Alaska | $378,374 |
| 9 | Louisiana | $374,478 |
| 10 | District of Columbia | $369,336 |
How to Move to a Higher-Paying State for CRNA Work
Relocating for CRNA pay requires balancing nominal salary against opt-out state status, locum potential, ASC equity, state tax, COL, and federal loan repayment.
1. Verify NBCRNA + State License + DEA
- NBCRNA NCE (National Certification Exam) — universal.
- COA-accredited DNP nurse anesthesia program — required.
- State APRN license + CRNA designation — verify per state.
- State endorsement — 4-12 weeks.
- NLC (Nurse Licensure Compact) RN base — multistate.
- DEA registration — for controlled substances.
- State opt-out vs ACT status — verify scope.
- CCRN-equivalent ICU experience pre-DNP — required.
2. Calculate Real Take-Home, Not Nominal
- COL-adjusted income — Wyoming CRNA at $285,000 may exceed California CRNA at $250,000 net (no state income tax + low COL).
- State + local income tax — CA 13.3% massive bite on $250K+.
- Self-employment SE tax (1099) — 15.3%.
- Property + sales tax — TX tradeoff.
- Federal pension + PSLF (VA / DoD / IHS) — premier long-term.
- Health + benefits — hospital vs ASC vs federal.
- Locum hourly + per-diem (untaxed) — major supplemental.
- ASC equity (long-term wealth) — major.
3. Target Opt-Out State + Rural Shortage
- Wyoming / Montana / Dakotas (opt-out + rural premium) — top.
- Alaska (opt-out + IHS premium) — top.
- Iowa / Tennessee / Kentucky (opt-out + low COL) — premium net.
- Mississippi (opt-out + rural + lowest COL) — premium net.
- Critical access hospital (HRSA NHSC + IHS LRP) — premium federal forgiveness.
- VA / DoD federal — premium pension + PSLF.
- ASC partnership / surgicenter (independent practice) — equity premium.
- Locum tenens (post 1 year experience) — premium hourly.
4. Negotiate Sign-On + Loan Repayment Stack
- Sign-on bonus ($30,000-$75,000) — common at shortage + rural.
- Relocation assistance ($10,000-$30,000) — standard.
- HRSA NHSC loan repayment (up to $100,000 HPSA) — premium.
- IHS loan repayment (up to $40,000 per 2-year) — premium federal.
- VA EDRP (Education Debt Reduction) — premium federal.
- State CRNA loan repayment — varies.
- PSLF stack (501(c)(3) + government + VA) — 10-year forgiveness on high DNP loans.
- ASC equity buy-in / partnership — premium long-term.
5. Choose Path Based on Career Plan
- Opt-out state independent practice + 1099 — premier.
- Locum tenens (premier hourly $200-$300) — premium short-term.
- ASC partnership / surgicenter equity — premium long-term wealth.
- Pain clinic CRNA subspecialty — premium specialty.
- VA / DoD federal CRNA — pension + PSLF.
- Academic medical center (UAB, Penn, Duke, Mayo, Cleveland Clinic) — premium + PSLF.
- Military CRNA (Army, Navy, Air Force) — premium signing + military pay.
- Rural critical access (HRSA NHSC + IHS LRP stack) — premier loan forgiveness.
- Hospital W-2 (broadest entry + benefits) — base + growth.
- Telehealth / pain management (emerging) — emerging premium.
More Salary Resources
Frequently Asked Questions
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Written by Alexandra Johnson, MSN, CRNA
Career Analyst
Alexandra Johnson has 10 years of experience as a nurse anesthetist. She specializes in anesthesia for orthopedic surgeries. She works in a regional medical center.
Methodology & Data Source
State salary rankings on this page are 2026 projections based on the Bureau of Labor Statistics Occupational Employment and Wage Statistics (OEWS) survey, May 2026 release. A 5.20% compound annual growth rate (CAGR), derived from 6-year national BLS wage trends, was applied to each state's average salary. Cost-of-living adjustments use BEA Regional Price Parity data. Individual pay varies by city, employer, certifications, and experience.
Data Sources & Methodology
Source: BLS, OEWS , released .
Compiled and verified by Alexandra Johnson, MSN, CRNA, a licensed nurse anesthetist with 10+ years of clinical experience. · View source data at BLS.gov