CRNA Salary Virginia 2026
What Inova, Sentara, VCU Health, and UVA CRNAs actually earn—and how Virginia's opt-out status positions independent CRNA practice against the DC metro labor market.
Virginia CRNAs earn a BLS OEWS May 2025 state mean of $243,259 per year — approximately 2% below the national CRNA mean of $248,320. That near-parity with the national average makes sense once you understand Virginia's structural position: the state is a CRNA opt-out state, which removes the physician-supervision cost drag that pushes states like Arizona and Pennsylvania below the national mean, and the Northern Virginia DC-metro market pulls the statewide average up through the Inova system's competitive pay.
Virginia opted out of the CMS physician supervision requirement in 2015. Since then, Virginia CRNAs have had independent practice authority in Medicare-certified facilities — they can administer anesthesia, select drug protocols, and manage cases without a physician anesthesiologist present. This is the same opt-out status held by 26 other states (27 total as of 2026 per AANA). For individual CRNAs, opt-out status matters most at rural critical-access hospitals, where CRNA-only anesthesia departments run leaner and can pay locum premiums that supervision states cannot justify.
Employer-by-Employer Pay: Inova, Sentara, VCU Health & More
Virginia's CRNA market is anchored by four major health systems — Inova in Northern Virginia, Sentara in Hampton Roads, VCU Health in Richmond, and UVA Health in Charlottesville — plus a spread of community hospitals and rural critical-access facilities across the Appalachian corridor. Here is how employer pay compares.
| Employer | Type / Location | Base Salary Range |
|---|---|---|
| Inova Health System (NoVa) | Large academic system, Level I trauma | $245,000–$275,000 |
| Sentara Norfolk General | Level I trauma, Hampton Roads | $230,000–$260,000 |
| VCU Health (Richmond) | Academic Level I trauma, state medical center | $225,000–$258,000 |
| UVA Health (Charlottesville) | Academic Level I, university system | $230,000–$262,000 |
| Carilion Health (Roanoke) | Regional system, SW Virginia | $220,000–$248,000 |
| HCA Virginia (multiple) | Community / regional hospitals | $215,000–$245,000 |
| Ballad Health (Bristol / Kingsport border) | Rural Appalachian corridor | $210,000–$240,000 |
| Rural critical-access (locum / sole-provider) | Independent practice CRNA-only | $195–$225/hr |
Inova's NoVa footprint is the defining factor in Virginia's statewide CRNA mean sitting so close to the national average. Fairfax County's labor market is essentially the DC labor market — federal employee compensation benchmarks, defense contractor wages, and a well-educated workforce competing for complex healthcare roles all push Inova to pay above regional Mid-Atlantic norms. A lead CRNA at Inova Fairfax Medical Campus managing a complex cardiac or neurotrauma anesthesia rotation can clear $280,000–$300,000 including bonus and benefit contributions.
Sentara runs the dominant CRNA program in Hampton Roads, covering Norfolk General (Level I trauma), Sentara Leigh, and Sentara Virginia Beach. The Hampton Roads market pays less than NoVa but more than the Appalachian corridor — reflecting military base proximity, retiree surgical volume, and the Sentara system's regional scale. VCU Health offers the most specialized case mix in Richmond: as an academic trauma center serving Virginia's urban safety-net population, VCU's CRNA team handles neurotrauma, burn, and complex obstetric anesthesia that supports the upper range of its pay band.
Virginia's Opt-Out Status: What Independent Practice Means for Pay
Virginia's opt-out from the CMS federal supervision requirement (42 CFR 482.52(c)) took effect in 2015 when Governor Terry McAuliffe signed the opt-out letter. The practical effect: CRNAs at Virginia's Medicare-certified hospitals can administer anesthesia without a physician anesthesiologist present, structured under a CRNA-only or CRNA-led anesthesia model. Facilities can still implement collaborative agreements or physician medical direction as a matter of internal policy, but the federal mandate no longer compels it.
The pay implication is real at the right facilities. Rural critical-access hospitals in the Appalachian corridor — southwest Virginia, the Shenandoah Valley, the Northern Neck — often operate CRNA-only anesthesia departments under a remote medical director model. With no physician anesthesiologist salary on the departmental budget, the hospital can afford to pay the CRNA more. The locum market in rural Virginia reflects this: sole-provider rates of $195–$225/hr are achievable at rural facilities, compared to $180–$200/hr at suburban community hospitals.
The opt-out also opens the path to independent CRNA practice. Under Virginia law, CRNAs can establish independent practice entities, contract directly with ambulatory surgery centers, and accept direct-pay anesthesia arrangements without a physician supervising the business entity. For experienced CRNAs in the NoVa or Richmond market, the independent practice option is a meaningful career and income ceiling raiser that supervision states cannot offer.
Opt-out summary: Virginia is one of the 27 states that opted out of CMS physician supervision for CRNAs. This means Virginia CRNAs can practice independently in Medicare-certified hospitals, establish independent CRNA practices, and contract directly with ASCs — without a physician anesthesiologist in the coverage chain.
Locum CRNA Market: $180–$225/hr and the Rural Virginia Opportunity
Virginia's locum CRNA market offers two distinct tiers. The urban and suburban tier — Inova, Sentara, VCU, community hospitals — runs $180–$200/hr for standard placements, reflecting strong hospital systems that rarely need to pay crisis-level locum rates because they maintain competitive full-time CRNA pay. The rural and critical-access tier is different: facilities in the Allegheny Highlands, the Northern Neck, far southwest Virginia, and the Eastern Shore regularly use locum CRNAs for coverage gaps, and sole-provider rates range $195–$225/hr.
Virginia's opt-out status makes rural locum positioning cleaner. A locum CRNA sole-provider at a rural Virginia critical-access hospital is not navigating the supervision patchwork — they own the anesthesia department for that coverage period, which simplifies contracting, credentialing, and risk allocation relative to supervision states where the hospital must also credential the medical director relationship.
Travel CRNAs targeting Virginia should note the eNLC compact status (Virginia joined January 19, 2018). The NLC RN compact applies to RN licenses, not specifically to CRNA/APRN practice; CRNA practice in Virginia still requires meeting Virginia Board of Nursing APRN requirements. The NLC APRN Compact, when implemented, would extend multistate licensure to APRNs including CRNAs — verify current Virginia APRN Compact status with the NCSBN before accepting Virginia CRNA assignments based on compact coverage.
How to Push Your Virginia CRNA Pay Past $270,000
Virginia CRNAs have several realistic levers for pushing beyond the statewide mean. Understanding which combinations are feasible in your market segment matters more than any single tactic.
NoVa positioning: The largest single pay lever is geographic. A CRNA in Fairfax or Loudoun at an Inova facility earns $25,000–$35,000 more per year than the same CRNA in Roanoke. If Northern Virginia's cost of living is workable, the income differential outpaces the housing cost increase within two to three years for most CRNAs.
Subspecialty mix: Cardiac, neurotrauma, pediatric, and obstetric anesthesia all carry premium pay bands at Level I trauma centers. At VCU Health and UVA, CRNAs specializing in cardiac or neurotrauma are positioned for the upper third of each system's pay band. The case mix volume at both systems is sufficient to maintain subspecialty competency without the burnout risk of a narrower subspecialty position.
Independent practice (locum or entity): Virginia's opt-out enables full independent CRNA practice. A NoVa or Richmond CRNA with a professional entity can contract with free-standing ASCs, dental and oral surgery offices, pain practices, and GI endoscopy centers — markets where per-case billing rates translate to annualized income well above $270,000 for full-time coverage. The administrative overhead is real but manageable; many Virginia CRNAs use this as a one-to-two day per week supplement to a hospital base rather than a replacement.
On-call and call-back pay: Level I trauma centers in Virginia pay on-call and call-back at 1.5x–2x the base CRNA rate. A CRNA at VCU Health taking significant neurotrauma call adds $15,000–$25,000 per year to base pay through call-back activations. The income gain is real; the lifestyle trade-off is equally real. Model the actual call-back frequency from contract data before committing to a high-call position.
Frequently Asked Questions
What is the average CRNA salary in Virginia?
Virginia CRNAs earn a BLS OEWS May 2025 state mean of $243,259 per year — approximately 2% below the national CRNA mean of $248,320. Northern Virginia CRNAs in the Inova system typically earn $245,000–$275,000, while Richmond and Hampton Roads run $225,000–$258,000. Rural Virginia critical-access sole-provider CRNAs can reach $230,000–$265,000 with locum stipends included.
Do CRNAs need physician supervision in Virginia?
No. Virginia opted out of the federal CMS physician supervision requirement in 2015. CRNAs can practice independently in Medicare-certified Virginia hospitals. Virginia is among 27 opt-out states per AANA as of 2026. Facilities may still require collaborative agreements by internal policy, but federal supervision is not mandated.
How much do Inova Health System CRNAs earn?
Inova Health System in Northern Virginia pays CRNAs $245,000–$275,000 for experienced staff, with lead CRNA and director roles reaching $280,000–$300,000. Inova competes in the DC labor market, driving compensation above most of the Virginia statewide mean.
What do locum CRNA rates look like in Virginia?
Locum CRNA rates run $180–$200/hr at Virginia urban hospitals and $195–$225/hr at rural critical-access and sole-provider settings. Virginia's opt-out status simplifies rural locum CRNA contracting compared to supervision states. NoVa and DC-metro placements command $200–$215/hr given labor market competition.
Can CRNAs practice independently in Virginia?
Yes. Virginia's opt-out status enables full independent CRNA practice. Virginia CRNAs can establish professional entities, contract directly with ASCs, dental/oral surgery offices, pain practices, and endoscopy centers without physician supervision. This opens a path to annualized income well above $270,000 for CRNAs who supplement hospital employment with independent practice days.
Sources
- Bureau of Labor Statistics OEWS May 2025 — Nurse Anesthetists (29-1151) — Virginia CRNA mean $243,259, national mean $248,320
- American Association of Nurse Anesthesiology (AANA) — opt-out state list and independent practice guidance
- Virginia Department of Health Professions — Virginia Board of Nursing APRN practice requirements
- Inova Health System Careers — CRNA job postings and pay band data
Sources and method
Last updated
Where this page quotes a Bureau of Labor Statistics (BLS) figure, it is from the Occupational Employment and Wage Statistics (OEWS) May 2025 release, published May 15, 2026. BLS does not publish separate wages for nursing specialties such as ICU, ER or travel nursing, so figures for those come from private publishers that build estimates from job postings or self-reported pay rather than employer payroll records. Treat them as ranges, not exact salaries.
- BLS Occupational Employment and Wage Statistics, May 2025: wage estimates by occupation and state, released May 15, 2026.
- BLS OEWS: registered nurses (29-1141): registered nurse wages, national and by state.