Nurse Anesthetist Salary by State (2026): CRNA Pay Compared Across All 50 States

Nurse anesthetist salary by state reflects one of the highest-paid nursing roles in U.S. healthcare. The national median for Nurse Anesthetists sits at $248,893, but state-by-state pay across the 51 states tracked here ranges widely — from $197,314 in Alabama to $327,882 in New York. That spread reflects state-level cost of living, Medicare CRNA opt-out status (states that have opted out of physician supervision requirement for CRNAs in Medicare reimbursement), state-level CRNA independent practice authority, the regional concentration of CRNA-only / rural critical access anesthesia coverage, locum tenens and per-diem markets, and structural CRNA shortage in many states.

This page compares the average certified registered nurse anesthetist salary by state across 1664+ metropolitan and non-metropolitan areas — drawing on the Bureau of Labor Statistics Occupational Employment and Wage Statistics (OEWS) survey for SOC 29-1151. If you're a working CRNA evaluating relocation or 1099 locum, a DNP / DNAP graduate planning your first position, or an anesthesia department director benchmarking pay across states, the state-level comparison below is the central reference point.

How CRNA Salary by State Is Measured

The BLS reports state-level CRNA salary through three numbers:

• Annual median (50th percentile) — used to rank state-level pay in the table below.
• Annual mean (average) — typically runs 6–12% above median; states with strong locum / 1099 / independent practice and CRNA-only practice models show wider mean-median spreads.
• Percentile distribution (P10 / P25 / P75 / P90) — P10 reflects entry-level CRNAs at academic medical centers (lower base but strong benefits / PSLF); P90 reflects 1099 locum CRNAs at rural critical access markets, CRNAs at independent CRNA-only practice in opt-out states, senior W-2 CRNAs at high-paying hospital systems and ASC chains, lead / chief CRNAs with administrative supplements, and CRNAs in high-cost / high-demand markets with sign-on bonuses ($30,000–$80,000+). Top locum CRNAs at rural critical access in opt-out states earn $300,000–$500,000+ annually.

The state-comparison table below applies BEA Regional Price Parity (RPP) adjustment so both nominal pay and real purchasing power are visible.

1. State Medicare CRNA Opt-Out Status and Independent Practice

The single largest non-cost-of-living driver of state-level CRNA pay is Medicare CRNA opt-out status. Under CMS rules, states can opt out of the physician supervision requirement for CRNAs in Medicare reimbursement — enabling broader independent CRNA practice:

• Opt-out states (no physician supervision required for Medicare billing) — Iowa (first to opt out, 2001), Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, Wisconsin, California (opt-out 2009), Colorado (limited opt-out), Kentucky. ~17 states total. Opt-out states support broader independent CRNA practice and rural CRNA-only anesthesia coverage. CRNA pay in opt-out states often higher especially for rural critical access work.
• Non-opt-out states — most large urban / academic medical center states (New York, Texas, Florida, Pennsylvania, Ohio, Massachusetts, Illinois, Michigan, Georgia, North Carolina) retain physician supervision. Strong ACT (Anesthesia Care Team) model with anesthesiologist-CRNA collaboration.
• State CRNA independent practice authority — beyond Medicare opt-out, state-level scope-of-practice laws shape independent practice. Strong independent practice states allow CRNAs to function autonomously per state law.
• VA system national CRNA practice — the VA has expanded CRNA full practice authority across all VA facilities regardless of state opt-out status, supporting strong federal CRNA employment in every state.

2. State CRNA-Only Practice and Rural Critical Access Markets

Rural critical access markets in opt-out states drive top-of-distribution CRNA pay:

• Rural CRNA-only markets — Iowa, Nebraska, Kansas, South Dakota, North Dakota, Montana, Wyoming, Idaho, Minnesota, Wisconsin, New Mexico (rural) often staff critical-access hospital anesthesia coverage with CRNA-only models. Locum tenens CRNAs travel to these markets for short-term coverage at $200–$400+/hour.
• Locum tenens CRNA market — major agencies: Trinity Health, AMN Healthcare, CHG (CompHealth, Weatherby), Aya Locums, Cross Country, LocumTenens.com. 1099 CRNAs at locum work command premium with travel, housing, malpractice covered.
• State ASC density — Texas, Florida, Arizona, Tennessee, North Carolina have rapidly growing ASC concentration. ASC CRNA pay competitive with hospital but with no-call schedules.
• State pain medicine CRNA practice — CRNAs in interventional pain management practice cluster at scope-supportive states.

3. State Cost of Living and Tax

State cost of living and income tax dramatically affect CRNA take-home at this income level:

• State cost of living — California, Hawaii, New York, Massachusetts, New Jersey, Washington, Connecticut lead nominal CRNA pay rankings.
• State income tax variation — CRNAs in Texas, Florida, Tennessee, Nevada, Washington, Wyoming, South Dakota, Alaska, and New Hampshire keep more of every dollar. At CRNA income levels ($200,000–$400,000+ for W-2; higher for 1099 locum), state income tax savings can reach $20,000–$60,000+ annually vs California / New York.
• State cost-of-living-adjusted leaders — Texas (no tax + high pay + locum opportunities), Tennessee (no tax + Vanderbilt / HCA), Florida (no tax + high pay + retiree-driven surgical volume), Washington (no tax + Seattle market + opt-out), Wyoming (no tax + rural critical access opt-out + premium locum). These states deliver outstanding real purchasing power for CRNAs.
• 1099 locum tax structure — 1099 CRNAs can structure income through S-corp or LLC for tax efficiency. SEP-IRA / Solo 401(k) contribution capacity higher than W-2.

4. State CRNA Shortage and Educational Programs

State CRNA shortage and educational program distribution shape state pay:

• CRNA shortage states — most rural states (Mountain West, Plains, Deep South) report severe CRNA shortage with aggressive sign-on bonuses ($30,000–$80,000+), paid relocation, student-loan repayment, and 4-day workweeks.
• State COA-accredited CRNA programs — Council on Accreditation programs in Pennsylvania, New York, Texas, Ohio, Tennessee, Florida, North Carolina, Virginia, Michigan, California, Illinois, Massachusetts, Minnesota, Iowa, Missouri, Pennsylvania, Wisconsin, Colorado, Washington, and others. ~130+ accredited programs.
• 2025 DNP / DNAP mandate — COA mandates all new CRNA programs at doctoral level (DNP or DNAP) effective 2025. Pipeline supply transitioning; supply pressure supports continued upward pay.
• NBCRNA NCE certification — National Board of Certification and Recertification for Nurse Anesthetists. Required nationally.
• State CRNA fellowship programs — pain management, regional anesthesia, ultrasound-guided nerve block fellowships add premium specialization.

How to Compare CRNA Salary by State Effectively

When comparing the average nurse anesthetist salary by state, work through this checklist:

• Verify Medicare opt-out status — 17 states have opted out (Iowa, Nebraska, Idaho, Minnesota, NH, NM, Kansas, ND, Washington, Alaska, Oregon, Montana, SD, Wisconsin, California, Colorado limited, Kentucky). Opt-out states support broader independent practice.
• Compare nominal and real (cost-adjusted) pay together — a state with the highest nominal median can have lower real purchasing power if its cost of living is higher.
• Check state income tax — at CRNA income levels, no-tax states (TX, FL, TN, NV, WA, WY, SD, AK, NH) deliver $20,000–$60,000+ annual savings vs California / New York.
• Compare percentile distribution, not just median — opt-out states with rural critical access markets show very wide P75–P90 spreads driven by 1099 locum CRNAs.
• Factor in practice model — W-2 hospital employed (broad); CRNA-only independent practice (opt-out states); ACT model with anesthesiologists (non-opt-out and major urban opt-out states); 1099 locum (premium pay, travel-intensive); ASC CRNA (no-call lifestyle); VA federal CRNA (PSLF + pension).
• Track sign-on bonuses — shortage states offer $30,000–$80,000+ sign-on bonuses for W-2 positions.
• Consider locum tenens path — 1099 locum CRNA work supports premium pay in rural opt-out states.
• Plan for DNP / DNAP doctoral requirement — 2025 doctoral mandate affects new entrants.

2026 State-Level CRNA Salary Outlook

CRNA pay has grown at a compound annual rate of 5.20% nationally over the past five years — driven by sustained CRNA shortage, expanding ASC anesthesia volume, growing pain management and interventional CRNA scope, rural critical access shortage requiring locum coverage, VA full practice authority implementation, 2025 DNP / DNAP doctoral mandate compressing pipeline supply, and aggressive shortage-driven sign-on bonus competition. States with rural critical access opt-out markets (Iowa, Nebraska, Kansas, South Dakota, North Dakota, Montana, Wyoming, Idaho, Minnesota, Wisconsin), no-state-income-tax states with strong CRNA markets (Texas, Florida, Tennessee, Washington), and high-CRNA-shortage states with aggressive sign-on bonuses are seeing the fastest state-level pay growth through 2026. The BLS projects Nurse Anesthetists employment growth at 38% through 2033 (combined with NP / CNM in the OEWS APRN category) — among the fastest-growing occupations in the U.S. — keeping very strong upward pressure on state-level wages.

Browse the state-by-state comparison table below to see the $248,893-baseline state ranking, top 10 and bottom 10 states by projected median, regional groupings (Northeast / Midwest / South / West), and direct links to per-state pages for deeper city-level breakdown.