How Much Do Hospitals Pay Anesthesia Groups? Stipends per Anesthetizing Location

The short answer: there is no current public benchmark for what hospitals pay anesthesia groups per anesthetizing location. The figure most often quoted, about $160,000 per location a year, comes from a 2012 survey. One consulting firm’s database put contracts signed in roughly 2019 to 2022 at about $185,000. Since then CRNA pay has risen by more than a third and Medicare’s anesthesia rate has fallen, so those numbers are now low. At today’s pay, a staffed location costs roughly $650,000 to $850,000 a year to cover, depending on the staffing model. The stipend is whatever part of that the location’s cases do not collect, which can be anything from zero to more than $400,000 per location. Your own number depends mostly on three things: how many cases each location runs, your payer mix, and the coverage the hospital requires outside the daytime schedule.

What the published figures say

The older per-location surveys are cited mostly second hand, and the current commercial benchmarks are sold by subscription, so a hospital comparing its stipend against a single national figure is usually comparing it with a number from another decade.

Why the number has grown

• Pay. The Bureau of Labor Statistics mean wage for nurse anesthetists rose from $181,040 in 2019 to $248,320 in 2025, about 37%. In our own index of job postings, the median posted CRNA salary was $300,000 in September 2026 and the anesthesiologist median $550,000 (pay by state).
• Medicare’s rate. The national anesthesia conversion factor for most clinicians fell from $22.27 in 2019 to $20.50 in 2026, and CMS has proposed $20.21 for 2027 (the 2027 conversion factor).
• Commercial payers. The No Surprises Act ended surprise out-of-network bills for care at in-network facilities, which consultants say shifted leverage toward plans in rate negotiations, and UnitedHealthcare (in most states), Anthem in some states and Cigna now pay CRNA claims billed without medical direction at 85% (the 85% rule). The California study found a sizable increase in stipends after the state’s 2017 law ended surprise billing by out-of-network clinicians at in-network facilities.
• Locums and coverage. Open shifts filled through locums cost more than employed staff (what locums cost), and hospitals have added sites outside the operating room, later evenings and weekend rooms.
• Group instability. Envision’s 2023 bankruptcy, contract terminations by national companies and local groups losing staff have left hospitals negotiating with fewer alternatives (private equity and national groups).

The arithmetic for one location

Every staffed location has to be covered on every day it runs, whether it does two cases or six. At September 2026 median pay plus 20% for benefits, with 1.25 full-time clinicians needed per location to cover 250 days a year with relief, one location costs about $825,000 a year with an anesthesiologist alone, about $725,000 in a 1:3 care team and about $656,000 at 1:4 (what each ratio costs).

What it collects depends on volume and payer mix. With four cases a day of 12 units each and a 35% Medicare, 15% Medicaid, 45% commercial and 5% self-pay mix at a $75 commercial rate, a location collects about $500,000 a year. The gap per location then looks like this for a 1:3 care team:

Annual gap per location, six locations, 1:3 care team, before call, obstetrics and management overhead. The commercial share is traded against Medicare; Medicaid and self-pay are held at 15% and 5%. From the anesthesia subsidy calculator, where every input can be changed.

The same staffing cost produces anything from a surplus to more than $400,000 per location. That is why a per-location figure from another hospital says little about yours unless the volume and payer mix are similar. One more case a day at each location moves the gap more than most renewal negotiations do.

What public contracts show

Public hospitals approve anesthesia contracts in open session, and their board packets show what full coverage costs today. These figures are the total paid for a defined coverage schedule, in some cases net of an offset for the group’s collections, and they include leadership, teaching or clinic time as well as coverage; some are ceilings rather than base payments. They are not directly comparable with a top-up stipend.

• Kern Medical (Bakersfield, California), October 2025: $9.25 million in the first year of a three-year amendment, rising 4% a year, plus a capped 5% fund for extra hours, for a coverage grid of about 47,500 hours a year. The grid includes a CRNA-staffed operating room and obstetric post and an in-house trauma anesthesiologist around the clock, and medical director time. That is roughly $195 per hour of coverage, and the payment already reflects an offset of $1.3 million a year for the group’s collections. Under the 2022 amendment the hospital paid $7.6 million a year for about 41,100 hours: the annual cost has risen about 22%, mostly because the hospital bought more hours, although the two contracts are not built quite the same way.
• Riverside University Health System (California), approved October 2025, effective March 2025: up to $21.2 million a year to Loma Linda University’s faculty medical group, up 7.5% as a market adjustment toward local salaries, with authority for up to $2.1 million a year more. It is priced on 37.5 full-time positions and covers about 15 weekday locations, round-the-clock trauma and obstetric rooms, a pain service, a pre-operative clinic and the anesthesia residency. The group’s collections, less a billing fee, are offset against it.
• Arrowhead Regional Medical Center (San Bernardino, California), August 2024: a new agreement worth up to $33.4 million over 40 months, about $10 million a year at its ceiling ($9.6 million base, stepping up with quality targets), against $9.1 million a year under the 2022–2024 contract. The posted contract describes coverage of up to 11 operating rooms, including obstetrics, around the clock, plus cardiac, non-operating-room, pain and pre-operative clinic hours.

How stipends are structured

• Fixed stipend. A set monthly payment based on projected cost minus projected collections. The group carries the collection risk.
• Collections or income guarantee. The hospital tops the group up to an agreed amount after actual collections, usually with audits and a year-end reconciliation. The hospital carries the revenue risk, and the group has less reason to collect well.
• Cost-based deficit funding. The hospital funds the group’s actual cost of coverage less its actual collections.
• Hourly add-ons. Extra rooms or hours at contracted rates; Kern pays $195 an hour for a CRNA and $280 for an anesthesiologist from a capped fund on top of its base.
• Performance terms. A share of the payment tied to on-time starts, cancellations, turnover or quality reporting.

Whatever the structure, the payment has to be fair market value and commercially reasonable, set in advance and not tied to the volume or value of referrals, to fit the exceptions under the physician self-referral law and the safe harbor under the anti-kickback statute. The HHS Inspector General has noted that arrangements with hospital-based physicians such as anesthesiologists raise different concerns from other physician contracts, chiefly a hospital paying less than fair market value or requiring free services in exchange for the exclusive contract.

How to benchmark your own stipend

1. Write down the coverage you are buying. Locations by hour and day, call, obstetrics, trauma and sites outside the operating room. The coverage grid is the cost.
2. Measure it four ways: stipend per staffed location, per hour of coverage, per case and per anesthesia unit billed.
3. Ask for the group’s collections. Units billed, payer mix, collections per unit and commercial conversion factors. A collections problem often arrives looking like a staffing problem.
4. Check the staffing model and pay against your market, not the national median: in our job-posting index, state CRNA medians differ by up to 60%.
5. Look for coverage you do not use. A location staffed every day that runs two cases costs nearly as much as one that runs five.

Our explainer on anesthesia subsidies covers what the payment is and is not; why subsidies keep growing covers the budget-season questions.

Sources

• Duffy, Green and Trish, Health Affairs, June 2025, on California hospital stipends to anesthesiology groups, 2002–2021, as summarized by the USC Schaeffer Center.
• ECG Management Consultants, key findings from MD Ranger’s 2024 benchmarks.
• Enhance Healthcare, Anesthesia subsidies: putting it all on the table.
• MGMA cost survey (2009 report, 2008 data), as summarized by Anesthesia Business Consultants (December 2009).
• Healthcare Performance Strategies, Anesthesia Subsidy Survey 2012, as cited in testimony to the Massachusetts Health Policy Commission (March 2025).
• Kern County Hospital Authority, board packets of October 15, 2025 and October 19, 2022; Riverside County Board of Supervisors, October 21, 2025; San Bernardino County, August 20, 2024.
• U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, nurse anesthetists (29-1151), May 2019 and May 2025.
• 42 CFR 411.357 (physician self-referral exceptions) and 1001.952(d) (personal services safe harbor); HHS OIG, Supplemental Compliance Program Guidance for Hospitals, 70 FR 4858 (2005).