As a shortage of physician anesthesiologists persists across the country and the demand for outpatient surgical services continues to rise, many ASCs have shifted increasingly towards anesthesia models that depend on certified-registered nurse anesthetists.
“Most of the ASCs in my area are also becoming CRNA-only,” Jesse Johnson, CRNA at Springdale, Ark.-based Chief Anesthesia Services, told Becker’s in 2025. “This helps keep costs down for anesthesia services.”
While this model has become commonplace in the industry, new questions about its sustainability are being raised as the CRNA role has become more highly in-demand and their salaries inch towards that of physician anesthesiologists.
CRNA salaries grew 59% from 2019 to 2026, rising from $181,000 to $288,000, according to Marit Health and data from the American Association of Nurse Anesthetists, which is nearly twice the 29% growth rate for anesthesiologists over the same period.
Pay also varies by setting, with CRNAs working in outpatient settings earning an average of $263,960 annually — more than their colleagues both hospitals and physicians offices.
The premium reflects strong demand for anesthesia coverage in ASCs, where orthopedic and cardiac cases continue to migrate from inpatient settings. For surgery centers competing for CRNA coverage, that outpatient premium functions simultaneously as a recruiting advantage and a cost pressure.
Geography stretches the range further. The average advertised CRNA salary reaches $400,000 in Alaska, the highest of any state, with at least $350,000 average compensation in eight states as of the first quarter of 2026, according to a report from BagMask.com. Alabama sits at the opposite end at $216,364. New Hampshire saw the largest single-quarter increase between the fourth quarter of 2025 and the first quarter of 2026, jumping more than $50,000.
While CRNAs demand higher pay, ASCs may be increasingly less able to meet that demand as their reimbursements from both Medicare and commercial payers continue to fall.
In October 2025, UnitedHealthcare cut CRNA reimbursement by 15% for QZ-billed services in selected states and eliminated payments tied to several add-on and qualifying circumstances codes. Because QZ billing reflects CRNA services delivered without physician medical direction, the reduction directly lowers compensation for independent CRNAs and may eliminate pay for higher-acuity cases entirely.
ASCs are already stretched on anesthesia costs. The share of ASCs expecting to pay anesthesia stipends rose from 28% in 2024 to 44% in 2025, driven by staffing shortages, rising anesthesia salaries and stagnant reimbursement.
The sum of these factors is a difficult reality for ASCs, who must either meet market demand or risk losing revenue by delaying or passing on cases due to staffing shortages. In a June 16 LinkedIn poll, Becker’s asked ASC leaders what the biggest expense eating into their margins was. Out of 285 responses 58% identified labor as their biggest cost center — more than all other responses combined.
For some, the problem represents more of a distribution issue than a supply one — and solutions should reflect that.
“Ever since the pandemic, we’ve had an exodus from the hospital with surgeons and anesthesia providers, and there are unintended consequences. I also think it’s maldistribution when you have seven surgeons that all want a 7 a.m. start, but this one’s done at 10 a.m., this one’s done at 11 a.m., this one’s done at 1 p.m. and this one’s done at 3 p.m,” Brett Maxfield, CRNA, director of surgical and anesthesia services at Madison Avenue Surgery Center in Idaho Falls told Becker’s. “That’s a waste of resources. If you have talented providers that could be in a chair doing that and instead they’re, you know, maybe doing preoperative testing or something like that, take that provider and move them back into a chair where they are needed.”