Most CRNAs know their hourly rate. Fewer know what that same hour bills.
That gap matters most when you work for yourself. If you’re a 1099 CRNA pricing cash work with a plastic surgeon, an outpatient ortho group or a dental office, the number you quote is the number you live with. This guide shows how anesthesia is priced, what an hour is worth under insurance and cash pay, and how to bring those numbers into the conversation with confidence.
The short version
- Formula: Every case is priced the same way: units for the procedure, plus units for time, multiplied by a dollar amount per unit.
- Hourly rate: An hour of anesthesia bills about $330 at the average commercial insurance rate. Posted cash rates for office-based work sit around $800 for the first hour, paid up front with no claims to be cut or denied.
- Settings: Cash work is mostly in cosmetic surgery, cash-price orthopedic centers and dental offices.
- Benchmarks: Practices that post their prices charge about $575 to $1,000 for the first hour. Dental and oral surgery sedation can run higher.
- Cases: In all three examples, the posted cash price beat the insurance average, and it’s paid before surgery.
- Calculator: Enter your own case and rates to see what your time is worth.
- Negotiation: Know your numbers and your costs, keep your price simple, and lead with what the surgeon or dentist gains. A full guide to negotiating, including the best books on it, is coming soon.
- Caveats: Check your state’s rules first. This work runs on relationships, and you carry the costs and the risk.
How anesthesia is priced
Every case is priced the same way: units for the procedure, plus units for time, multiplied by a dollar amount per unit.
Anesthesia uses a simple formula: (base units + time units) × conversion factor.
- Base units are set for each anesthesia code and reflect how complex the procedure is. They don’t change with time. CMS publishes them free in its anesthesia base unit file.
- Time units count your anesthesia time, usually one unit per 15 minutes.
- The conversion factor is the dollar value of one unit. This is where payers differ most.
A 60-minute knee arthroscopy, for example, carries 3 base units plus 4 time units: 7 units total (WA L&I fee schedule).
Anesthesia hourly rate
An hour of anesthesia bills about $330 at the average commercial insurance rate. Posted cash rates for office-based work sit around $800 for the first hour, paid up front with no claims to be cut or denied.
The units stay the same. The value of each unit is what changes.
| Who pays | Value per unit | One hour of time units (4 units) |
|---|---|---|
| Commercial insurance (national average) | $82.43 | about $330 |
| Cash pay | Set by you | See examples below |
The ASA’s 2025 survey of commercial contracts found a national average of $82.43 per unit and a median of $76.00 (Coronis Health). Those are group contracts, so a solo CRNA may see less.
Insurance is also shifting under CRNAs who bill without medical direction. UnitedHealthcare cut QZ claims to 85% of the allowable in most states (Coronis Health), and Premera Blue Cross followed in March 2026 (Zotec). Cash work sidesteps those rules entirely: no claims, no denials, no modifier cuts.
Where cash anesthesia lives
Cash work is mostly in cosmetic surgery, cash-price orthopedic centers and dental offices.
Three outpatient areas run largely on self-pay or bundled cash prices.
Plastics and cosmetic surgery. Cosmetic cases aren’t covered by insurance, so anesthesia is quoted up front, usually as a first-hour fee plus time increments.
Outpatient orthopedics. Cash-price surgery centers sell bundles. Surgery Center of Oklahoma’s $4,458 knee arthroscopy includes the surgeon, facility, anesthesia and routine follow-up (Surgery Center of Oklahoma). The anesthesia share is built in, which means someone negotiated it.
Dental. Office-based dental anesthesia is often cash only, especially for sedation and general anesthesia for anxious adults, special-needs patients and children.
Benchmarks
Practices that post their prices charge about $575 to $1,000 for the first hour. Dental and oral surgery sedation can run higher.
These are real posted prices from individual practices. They’re examples, not market averages: no national cash-price database exists.
| Practice / setting | Published cash pricing |
|---|---|
| Bright Line Anesthesiology (CRNA-led, office-based) | $400 up to 30 min · $800 up to 1 hr · $1,400 up to 2 hrs · $2,000 up to 3 hrs · $2,500 up to 4 hrs · $125 per 15 min after |
| Bright Line (nerve blocks) | $400 single injection · $800 catheter |
| Bright Line (ASC-based) | $100 per ASA unit |
| Virginia facial plastics practice (by facility) | $576–$1,000 for 1 hr · $1,088–$2,000 for 3 hrs |
| Georgia plastics practice | $400 first 30 min + $150 per added 15 min |
| Office-based dental anesthesia practice | $2,595 minimum covering up to 4 hrs · $163 per added 15 min |
| Indianapolis oral surgery group (IV sedation) | $375 per 15 min, 30-min minimum |
Sources: Bright Line, Virginia Facial Plastic Surgery, Georgia Plastic, Advanced Dental Anesthesia, Oral Surgeons of Indianapolis.
Bright Line stands out because nurse anesthesiologists run it, and it has posted cash rates openly since its founding in 2011. Its dental services are cash only.
Three cases, side by side
In all three examples, the posted cash price beat the insurance average, and it’s paid before surgery.
Same units, two price tags. The insurance column shows what those units would bring if billed to a payer; cosmetic and most dental cases are self-pay, so they’re there for perspective.
| Case | Units | Commercial avg | Example cash price |
|---|---|---|---|
| Knee arthroscopy, 60 min (01382) | 3 + 4 = 7 | $577 | $700 at $100/unit (ASC) |
| Abdominoplasty, 2 hrs (00802) | 5 + 8 = 13 | $1,072 | $1,400 (office-based, up to 2 hrs) |
| Dental case, 90 min (00170) | 5 + 6 = 11 | $907 | $1,400 (office-based, up to 2 hrs) |
Example cash prices use Bright Line’s posted schedule. Base units: WA L&I.
The takeaway: cash pricing for the same time can land at or above the commercial insurance average, paid before the case, with nothing to collect later.
Calculator
Enter your own case and rates to see what your time is worth.
Coming soon: the GasRate app by The Gas Locker. Every case, its base units and your own rates, on your phone. Follow The Gas Locker for the launch.
What does your case bill?
Pick a case and its anesthesia time. See what those units bring at the commercial insurance average, next to your own cash price.
Posted first-hour or hourly anesthesia fees from individual practices. Examples, not averages; most don’t say whether an anesthesiologist or CRNA provides care. Tap “Use” to try one.
| Market | Setting | Posted fee | |
|---|---|---|---|
| DC / N. Virginia | Plastics | $576–$1,000 first hour (most $600–$630) | |
| New York City | Plastics | $600–$1,000 per hour | |
| Maryland | Dental | IV sedation $500–$1,000/hr; general anesthesia ~$1,200+/hr | |
| New Jersey | Dental | General anesthesia $800–$1,500/hr | |
| Boston | Plastics | Usually bundled into the surgery price, not posted |
Illustrative estimates only, not a quote or billing advice. The commercial figure is a national average of group contracts; your contracts, region, modifiers and payer policies (including QZ reductions) will differ. Time units are minutes ÷ 15, rounded to one decimal. Cash price rounds added time up to the next 15 minutes. Cosmetic and most dental cases are self-pay; the insurance figure is there for perspective. East Coast examples: Virginia Facial Plastic Surgery, Neinstein Plastic Surgery, Maryland Sedation Dentist, Dental Sedation Services (NJ), JL Plastic Surgery. Rates checked October 2026.
The negotiation playbook: pitching cash rates to surgeons and dentists
Know your numbers and your costs, keep your price simple, and lead with what the surgeon or dentist gains.
Negotiating isn’t about squeezing anyone. It’s about walking in with numbers instead of guesses.
1. Know what your time generates
Run your most common cases through the calculator. Know the commercial average and your proposed cash price for each. When a surgeon says your rate is high, you can show where it sits.
2. Know your costs and your walk-away number
Your cash price has to cover more than your time:
- Drugs, supplies and any equipment you bring
- Malpractice insurance
- Travel and setup time
- Paperwork, including Good Faith Estimates (more below)
- Cancellations and slow days
Add those up, then decide the lowest rate you’ll accept before the conversation starts. That’s your walk-away number. You don’t share it.
3. Make your price easy to quote
Surgeons and dentists sell surgery to patients. A simple, time-tiered schedule (a first-hour fee plus a set amount per 15 minutes) lets their staff quote anesthesia on the spot. Bright Line’s posted schedule is a good model.
It also helps with the law. Providers must give uninsured or self-pay patients a written Good Faith Estimate before scheduled care, and patients can dispute a bill that comes in at least $400 above it (CMS). A clear schedule makes accurate estimates easy.
4. Lead with what they gain
Talk about their practice, not your bills:
- Cases stay in their office or surgery center, on their schedule
- One predictable anesthesia price they can quote patients
- Payment collected before surgery, so nobody chases balances
- A reliable provider who shows up and keeps the day moving
5. Short scripts
Use these as starting points and put them in your own words.
- Opening: “My anesthesia fee is $X for the first hour and $Y for each 15 minutes after. Most of your cases would fall around $Z, and patients pay it before surgery.”
- “That’s higher than I expected”: “For perspective, the same case bills about $A at the national commercial average. My price is set so your patients get one clear number with nothing billed later.”
- “Someone else is cheaper”: “That’s fair to check. Ask what’s included: blocks, overtime, cancellations and who handles the estimate paperwork. I’m happy to walk through mine.”
- “Can you do a flat fee per case?”: “For cases that run predictably, yes. I’d set it from your average case time, with a time limit and a per-15-minute rate past it.”
- Holding firm: “I’d rather keep my rate where it is and make sure the day runs smoothly. If volume grows, I’m open to revisiting it.”
6. Negotiate more than the rate
When the hourly number stalls, other terms often move:
- Daily minimum for a booked day, even if cases cancel
- Late-cancellation fee for cases dropped within a set window
- Overtime increments past the quoted time
- Blocks priced separately (as Bright Line does)
- Who supplies drugs, monitors and airway equipment
- Payment timing: collected before the day of surgery
- Who collects from the patient: you, or the practice on your behalf
7. Put it in writing
A short written agreement covers your schedule, what’s included, cancellation terms and how payment works. A healthcare attorney in your state can review it once and save you trouble later.
Coming soon: a full guide to negotiating, with the best negotiation books.
Set your rate on your own. Share ideas with colleagues, but don’t agree with other CRNAs on what to charge. The FTC has taken action against independent physicians for agreeing on prices (FTC). Also, never pay a surgeon or dentist for sending you cases; referral payments can create kickback problems. Ask a healthcare attorney about your state’s rules.
Caveats
Check your state’s rules first. This work runs on relationships, and you carry the costs and the risk.
- Scope and supervision rules vary by state. Check your state’s rules for office-based anesthesia and CRNA practice before you price anything.
- Office-based settings carry their own standards. Facility requirements, equipment and emergency readiness are part of the job, and part of your costs.
- It’s a local, relationship business. Volume depends on a few surgeons or dentists who trust you.
- You carry the overhead and the risk. Cash work pays up front, but the costs are yours.
Bottom line
Your time has a price, and now you can see it. At the commercial insurance average, an hour of anesthesia time is worth about $330; published cash schedules for office-based work start around $800 for the first hour. Know your numbers, know your costs, make your price easy to quote, and you can walk into any surgeon’s or dentist’s office with confidence.
Where is the market heading? Too Many CRNAs? The Early Signs Are Already Here looks at the numbers behind a possible CRNA oversupply, and why knowing your number matters more every year. Just starting as a contractor? See the 1099 CRNA starter guide.
FAQ
Can a CRNA charge patients cash directly?
In many settings, yes, especially for cosmetic and dental cases that insurance doesn’t cover. State practice rules and the setting’s requirements decide the details, so check yours first.
Do I need to give self-pay patients an estimate?
Yes. Providers must give uninsured or self-pay patients a written Good Faith Estimate before scheduled care, and patients can dispute bills at least $400 above it (CMS).
Where do I find base units for other cases?
CMS publishes them free on its Anesthesiologists Center page. The base units are unchanged for 2026 (California DWC).
Is the commercial average what I’d get from insurers?
Not necessarily. It’s a national average of group contracts from the ASA survey. Solo CRNAs, different regions and QZ reductions can all mean less.
Sources
- Coronis Health: ASA commercial conversion factor survey
- Coronis Health: UnitedHealthcare policy update
- Zotec: Premera QZ change
- CMS: Anesthesiologists Center
- Washington L&I: Anesthesia fee schedule
- California DWC: 2026 fee schedule notes
- Bright Line Anesthesiology: Fees
- Surgery Center of Oklahoma: Knee arthroscopy
- Virginia Facial Plastic Surgery: Fees
- Georgia Plastic: Anesthesia cost
- Advanced Dental Anesthesia: Financial policy
- Oral Surgeons of Indianapolis: IV sedation
- Neinstein Plastic Surgery: Liposuction costs NYC & NJ
- Maryland Sedation Dentist: Sedation costs
- Dental Sedation Services: Costs in New Jersey
- JL Plastic Surgery: Prices (Boston)
- CMS: Good Faith Estimate
- FTC: Advocate Health Partners
This is educational content. There are no affiliate links, and nobody paid to be mentioned. It is not legal, tax or billing advice. Educational content only, not legal, tax, billing or financial advice. Prices and rates were checked in October 2026 and change often; confirm current figures and your state’s rules before relying on them. Cover image: AI-generated via Google Gemini. Image credits: Image: AI-generated via Google Gemini.
