Surgical nurse practitioner salary: what surgical NPs earn

LS
By Lindsay Smith, AGPCNP
Updated August 18, 2026

Reviewed for clinical accuracy · Methodology: NIH, NCBI, AANP guidelines

Surgical nurse practitioners earn a meaningful premium above the general NP median, driven primarily by whether they hold first-assist surgical privileges and which subspecialty they practice in. The BLS May 2025 national median for all nurse practitioners (SOC 29-1171) is $132,300, with a 10th percentile of $101,340 and a 90th percentile of $174,420. Surgical NPs – especially those first-assisting in high-acuity subspecialties like cardiothoracic surgery and neurosurgery – routinely earn $145,000–$195,000+. Outpatient surgical clinic NPs who manage pre-op and post-op patients without OR first-assist privileges earn closer to $115,000–$135,000.

There is no BLS occupational code specific to surgical nurse practitioners, and no national body publishes a surgical-NP-specific wage. SOC 29-1171 covers all NP specialties as a single category, so every surgical-specific figure below is an estimate rather than a measured national statistic. The two verifiable anchors are the BLS OEWS percentile spread for SOC 29-1171 and the AANP Nurse Practitioner Compensation Report, which surveyed NPs on 2023 earnings and found a full-time median base salary of $120,000 and a median total income of $126,000 across all NP specialties. The same survey puts the corresponding means at $125,269 base and $132,248 total, which is worth holding onto when you compare pages: a guide quoting roughly $132,000 as an AANP “median” has silently swapped in the mean, and the two are not interchangeable. Those two anchors disagree, and the gap is instructive rather than an error in either. AANP’s median base of $120,000 sits about $12,000 under the BLS median of $132,300 because they measure different things: BLS OEWS surveys employers about total wages paid, while AANP surveys NPs about base salary, and base excludes the production bonuses, call stipends and differentials that make up a real share of surgical NP pay in particular. Expect employer-reported figures to run above self-reported base figures for any specialty where production pay is common. Ranges in this guide are built by positioning surgical roles against the BLS percentile spread using job posting analysis; treat them as planning estimates and verify against local postings before negotiating.

For the full career pathway – NP track selection, facility credentialing, RNFA background, and fellowship programs – see how to become a surgical nurse practitioner.

National salary snapshot:

Surgical NP salary – national percentile estimates (2025)
Percentile Annual salary Typical profile
10th ~$110,000 New surgical NP; outpatient clinic only; no OR first-assist privileges yet
25th ~$122,000 1–3 years experience; outpatient surgical clinic with limited inpatient coverage
50th (median) ~$138,000 3–6 years; credentialed for OR first-assist; general surgery or orthopedics
75th ~$158,000 6–10 years; high-acuity subspecialty (trauma, CT surgery); regular OR first-assist
90th ~$190,000+ 10+ years; cardiothoracic or neurosurgery; academic AMC with wRVU production bonus

Methodology note: BLS does not publish surgical-NP-specific salary data, so the percentiles above are estimates rather than survey results. They are positioned against the published BLS OEWS SOC 29-1171 spread for May 2025 (P10 $101,340, median $132,300, P90 $174,420) and adjusted upward for the surgical first-assist premium using job posting ranges. The AANP Nurse Practitioner Compensation Report is the closest thing to a primary survey for NP pay, but it does not break out surgical first-assist roles as a category.

How surgical NP salaries are calculated

Surgical NP compensation structures vary more than most NP specialties because the OR first-assist component creates a distinct production variable that most NP roles lack.

Base salary model

Most surgical NPs at hospitals and academic medical centers receive a base salary plus benefits. The base reflects the non-OR components of the role: inpatient floor rounding, outpatient clinic time, call coverage, and administrative duties. At community hospitals without strong wRVU tracking, this base is often the entire compensation.

wRVU production model

At academic medical centers and larger surgical programs, surgical NPs – particularly those with significant OR first-assist volume – are increasingly paid on a work relative value unit (wRVU) model. wRVUs are CMS’s measure of physician and APP work intensity for each billable procedure or service. A production bonus is paid when the NP’s total wRVU generation in a quarter or year exceeds a threshold.

How wRVU calculations work for OR first-assist:

When an NP first-assists in surgery, the assistant’s services are billed separately from the primary surgeon’s, using modifier AS on the surgeon’s procedure code. Medicare applies two reductions in sequence: the assistant-at-surgery reduction of 16%, then the non-physician practitioner reduction of 85%. The combined payment is therefore 13.6% of the Medicare Physician Fee Schedule amount for the procedure (MPFS × 0.16 × 0.85). On a procedure carrying 20 work RVUs, the assistant billing works out to 20 × 0.16 × 0.85 = approximately 2.72 credited units. In high-volume OR roles, those units accumulate meaningfully across a year.

Two caveats matter before you build a compensation expectation on this. Not every procedure permits an assistant at surgery – CMS assigns each code an assistant-at-surgery payment indicator, and codes marked as not payable generate nothing regardless of who scrubbed in. And how a hospital credits assistant billing back to the NP’s personal wRVU total is an internal accounting decision that varies by employer; some credit the full assistant units, some credit none, and the arrangement is worth confirming in writing before you accept a production-based offer.

Illustrative wRVU examples for common first-assist procedures:

First-assist billing units for selected surgical procedures (CY 2026 work RVUs)
Procedure CPT code Surgeon work RVU (CY 2026) Assistant billing at 13.6%
Laparoscopic cholecystectomy 47562 10.21 ~1.39
Total knee arthroplasty 27447 19.11 ~2.60
Aortic valve replacement, open with bypass 33405 40.29 ~5.48

Work RVU values are revised annually in the Medicare Physician Fee Schedule final rule, so any table like this one has a shelf life. For CY 2026 CMS finalized a negative 2.5% “efficiency adjustment” to the work RVUs of roughly 7,700 non-time-based codes, which reduced most surgical values relative to CY 2025 – total knee arthroplasty fell from 20.02 to 19.11 on that basis. Look up the current value for the specific codes your service performs in Addendum B of the current final rule rather than relying on a figure quoted in any guide, including this one.

An NP first-assisting on several OR cases per day at a high-volume surgical program accumulates assistant billing units that can support a production bonus, but the size of that bonus depends on your employer’s conversion rate and on whether the institution credits assistant units to the NP at all. Published per-wRVU conversion rates for APP production bonuses are employer-specific and no national body compiles them, so treat any single dollar-per-wRVU figure you encounter online as one employer’s arrangement rather than a market rate.

Salary by practice setting

Work setting is the strongest salary determinant for surgical NPs. The difference between an outpatient surgical clinic role and an OR first-assist role at a cardiothoracic surgery program can exceed $60,000 in annual compensation.

Surgical NP salary by practice setting
Practice setting Typical salary range First-assist in OR? Notes
Outpatient surgical clinic (general surgery) $115,000–$135,000 Rarely Pre-op assessments, wound care, post-op follow-up; FNP credential most common; predictable M–F hours
Academic medical center – inpatient surgical floor $130,000–$155,000 Sometimes Daily rounding on post-op patients; AGACNP or ACNPC-AG credential preferred; call coverage adds $8,000–$15,000
Academic medical center – OR first-assist (general surgery) $138,000–$165,000 Yes – primary role Facility credentialing required; wRVU production bonus at most AMCs; AGACNP-BC preferred
Trauma surgery center (Level I/II) $145,000–$175,000 Yes 24-hour coverage model; night and weekend differentials significant; highest demand for surgical NPs nationally; AGACNP-BC required at most Level I centers
Cardiothoracic surgery program $155,000–$195,000+ Yes – highest OR involvement Open-chest and VATS cases; CT surgery NPs have highest earning ceiling of any surgical subspecialty; wRVU values for cardiac cases are among the highest in medicine
Neurosurgery program $148,000–$185,000 Yes Complex cases (spinal fusion, craniotomy); high wRVU values; AGACNP-BC typical credential; academic center programs pay at top of range
Orthopedic surgery (joint replacement focus) $135,000–$165,000 Yes – routine High-volume first-assist in arthroplasty; implant-company relationships can add consulting income for experienced NPs; ambulatory surgery center roles common
Bariatric surgery program $125,000–$155,000 Yes Pre-op behavioral evaluation + OR first-assist + post-op metabolic management; full longitudinal patient relationship; bariatric NPs with bariatric medicine board certification earn at upper end
Plastics and reconstruction $120,000–$148,000 Sometimes Strong wound care and flap monitoring component; academic reconstructive surgery pays more than private aesthetic surgery; aesthetic practice may include non-NP revenue lines
Locum tenens surgical NP $95–$130/hour ($197k–$270k annualized) Depends on assignment Highest gross income ceiling; credentialing complexity per facility; no employer benefits; most valuable in trauma and CT surgery subspecialties

The first-assist premium

The single largest salary lever in surgical NP careers is OR first-assist credentialing. NPs with active first-assist surgical privileges earn $15,000–$40,000 more annually than surgical clinic NPs who manage pre-op and post-op patients without entering the OR. The premium exists because:

  1. First-assist credentialing is facility-specific and requires proctored case validation – it takes effort and time to acquire
  2. Surgical programs have genuine staffing need for credentialed NP first-assistants that exceeds the supply of qualified candidates in many markets
  3. OR first-assist generates billable wRVUs in a way that clinic visits often do not, making the credentialed surgical NP a more direct revenue contributor to the surgical program

The premium is highest in cardiothoracic and neurosurgery, where the technical demands of the cases create the narrowest pool of NPs qualified to first-assist. It is somewhat lower in orthopedic arthroplasty – high-volume joint replacement programs have historically recruited more efficiently into first-assist roles, increasing local supply.

Surgical NP salary by state

Geographic variation in surgical NP pay is driven by cost of living, local NP supply and demand, scope-of-practice laws (full practice authority states typically offer higher compensation), and the density of academic medical centers and Level I trauma centers.

Surgical NP estimated salary by state
State Estimated annual salary (median) Practice authority
California$162,000Restricted
District of Columbia$160,000Full
Massachusetts$158,000Full
Washington$156,000Full
Oregon$154,000Full
Connecticut$152,000Full
New York$150,000Full (sunset extended to 2030 – see below)
Minnesota$149,000Full
Colorado$148,000Full
Maryland$147,000Full
New Jersey$146,000Reduced
Nevada$145,000Full
Illinois$143,000Reduced
Pennsylvania$142,000Reduced
Michigan$141,000Restricted
Ohio$140,000Reduced
Wisconsin$139,000Reduced
Virginia$139,000Restricted
North Carolina$138,000Restricted
Georgia$137,000Restricted
Tennessee$136,000Restricted
Indiana$135,000Reduced
Arizona$135,000Full
Utah$134,000Full
Missouri$133,000Restricted
Kentucky$132,000Reduced
Texas$131,000Restricted
Florida$130,000Restricted
Alabama$126,000Reduced
Mississippi$122,000Reduced

State salary figures are estimated medians for surgical NPs with OR first-assist experience, modeled from BLS SOC 29-1171 state data and job posting ranges – BLS does not publish surgical-NP-specific state wages, so these are planning estimates. Practice authority classification follows the AANP State Practice Environment (May 2026 edition), which currently places 27 states plus the District of Columbia in the full practice category, 12 in reduced, and 11 in restricted. States not listed had insufficient posting volume for surgical NP salary modeling.

Practice authority and pay do not correlate, and the table above makes that visible. California is a restricted practice state and also the highest-paying surgical NP market in the country. Several full practice authority states – Utah, Arizona, Nevada – sit in the middle or lower half of the range. Guides that place the two columns side by side often imply that independent practice drives higher pay; the wage data does not support that reading. What full practice authority changes is the administrative structure you work within and your ability to practice without a career-long supervisory or collaborative agreement, which matters for autonomy and for anyone considering independent practice. It is a separate consideration from the salary number, not a driver of it. Verify your target state’s current classification against the AANP map and your state board before relying on it – several states moved between categories during 2025 and 2026, including Oklahoma and New Jersey.

New York deserves a specific note, and its status is now settled through the end of the decade. Its full practice authority classification rests on the 2022 NP Modernization Act, which waived the collaborative-relationship requirement for NPs holding 3,600 or more practice hours but carried a sunset date of July 1, 2026. The standalone renewal bill (S2360) never left the Senate Higher Education Committee, but the waiver was extended through the budget: Governor Hochul signed A10007C, the FY2027 budget legislation, on May 28, 2026, moving the sunset to July 1, 2030. Surgical NPs in New York with 3,600+ practice hours continue to practice without a written collaborative agreement through that date. If you are weighing a New York surgical NP role, confirm the current collaborative-agreement requirement directly with the New York State Education Department Office of the Professions.

Salary levers – what moves the number most

OR first-assist credentialing is the highest-impact lever, worth $15,000–$40,000 annually compared to clinic-only practice. The earlier in your career you obtain surgical privileges, the longer you benefit from the premium.

Subspecialty selection is the second most powerful lever. Cardiothoracic surgery and neurosurgery are consistently the highest-paying surgical subspecialties for NPs. Trauma surgery is close behind and offers more positions due to 24-hour coverage requirements. Plastics and outpatient general surgery sit at the lower end.

Academic vs. community setting shapes base salary structure. Academic medical centers pay higher bases and more frequently use wRVU production models with bonus potential. Community hospitals and ambulatory surgery centers pay more conservatively but may offer better hours and call load.

Call and shift coverage adds $8,000–$25,000 in many surgical NP roles. Trauma surgery positions at Level I centers frequently include mandatory on-call – the on-call stipend is a meaningful compensation component. Negotiate call structure and pay explicitly when evaluating offers.

Locum tenens and travel assignments generate the highest gross income ceiling – $95–$130/hour for credentialed surgical NPs in shortage markets. The trade-off is the absence of employer benefits and the administrative overhead of maintaining or establishing privileges at multiple facilities.

Full practice authority shapes how you work rather than what you are paid. In full practice states an NP evaluates, diagnoses, orders and interprets tests, and prescribes under the exclusive licensure authority of the state board of nursing, with no career-long collaborative or supervisory agreement required. Texas, California, Florida, Georgia, Tennessee, Virginia, North Carolina and Missouri are among the restricted practice states where a supervisory or delegation arrangement remains mandatory, and Texas additionally requires a prescriptive authority agreement with a supervising physician. That constrains autonomy and adds administrative overhead, but the state salary table above shows it does not translate into lower pay: California is restricted and pays the most in the country. Weigh practice authority as a working-conditions and career-optionality question, not as a proxy for compensation.

wRVU model negotiation: if you are entering a role where wRVU production is measurable (an OR first-assist role at an AMC), negotiate for a wRVU bonus structure rather than a pure base salary. Surgical cases generate high wRVU values per unit time – a well-structured production bonus can add more than an additional month’s salary to annual compensation.

Surgical NP vs. comparable roles

Understanding where surgical NPs sit relative to adjacent roles helps frame the earning ceiling and the career decision.

Surgical NP salary comparison to adjacent roles (national median estimates)
Role Median annual salary Education Scope notes
Surgical NP (OR first-assist, cardiothoracic) $155,000–$195,000+ BSN + MSN/DNP (6–8 years) First-assist under facility surgical privileges; NP prescribing and ordering authority
Surgical NP (outpatient clinic, no OR) $115,000–$135,000 BSN + MSN/DNP (6–8 years) Pre-op / post-op management; no OR first-assist
CRNA (Certified Registered Nurse Anesthetist) $236,590 (BLS median) BSN + DNP CRNA program (10–12 years) Administers anesthesia; highest-paid nursing role nationally
Physician assistant – surgical subspecialty $130,000–$160,000 Bachelor's + PA master's (6–7 years) Similar scope to surgical NP in most settings; no independent prescribing in some states
RNFA (Registered Nurse First Assistant) $80,000–$100,000 BSN + AORN-standard RNFA program (5–6 years) OR first-assist only; no NP scope; no prescribing; ceiling lower than surgical NP. The CRNFA credential is issued by National Assistant at Surgery Certification (NASC), not by CCI, which issues CNOR
OR RN (circulator or scrub) $75,000–$100,000 BSN (4 years) Perioperative nursing care; no prescribing; no diagnosis; no first-assist (unless RNFA-trained)
Surgical attending (MD/DO) $350,000–$600,000+ MD/DO + residency + fellowship (13–16 years) Full surgical scope; leads operative team; no restriction on procedure privileges

The comparison table is useful for framing the career trajectory. Surgical NPs earn meaningfully more than RNFAs and OR nurses, sit close to surgical PAs (with some variation by state and setting), fall below CRNAs, and well below surgical attendings. For someone coming from an OR nursing background, the surgical NP pathway offers the best income ceiling without completing medical school.

One credential detail is worth getting right, because it is widely muddled. The CRNFA (Certified Registered Nurse First Assistant) is issued by National Assistant at Surgery Certification (NASC), which took over administration of the credential from the Competency and Credentialing Institute. CCI issues CNOR, the perioperative nursing certification, along with CNAMB, CFPN and CSSL. The two bodies are frequently conflated, and the practical consequence is that CNOR and CRNFA now recertify separately through their respective organizations rather than as a dual process. For an RN pathway, CRNFA eligibility requires a bachelor’s degree or higher, current unrestricted RN licensure, completion of an RNFA program meeting AORN standards, current CNOR certification, and 2,000 documented RNFA practice hours within the preceding five years; certification is assessed through a professional portfolio rather than an examination. APRNs applying with a master’s or doctoral advanced practice credential may have the CNOR requirement and experience hours waived.

Specialty comparison

Surgical NP salary vs. other NP specialties (national median estimates, 2025)
NP specialty Estimated median salary Earning ceiling
Surgical NP (OR first-assist, AMC) ~$148,000 $195,000+
Cardiology NP ~$145,000 $185,000+
Emergency NP ~$131,000 $165,000+
Neurology NP ~$130,000 $175,000+
Palliative care NP ~$123,000 $150,000
Family NP ~$132,000 $174,000+
Psychiatric-mental health NP ~$137,000 $180,000+ (private practice)
Women's health NP ~$132,000 $174,000

Specialty-level NP medians are estimates. BLS reports a single median for all nurse practitioners (SOC 29-1171, $132,300 for May 2025) and does not break the occupation out by clinical specialty, so no official specialty median exists for any row in this table. The figures are modeled from job posting ranges anchored on that BLS median and its 90th percentile of $174,420, and should be read as relative positioning rather than as measured national statistics. Note that the largest-supply generalist specialties – family and women’s health – sit at the all-NP median by construction rather than below it, because they make up the bulk of the workforce the median is computed from. A specialty table that places FNP or WHNP well under $132,300 is asserting that the typical NP earns less than the measured typical NP, which cannot be right.

Surgical NPs with OR first-assist privileges in cardiothoracic and neurosurgery settings represent one of the highest-paying NP specialty paths. The ceiling is exceeded only by CRNA and, within the NP category, by a narrow subset of private-practice or industry-linked psychiatric NP roles.

Career ceiling and advancement trajectory

Surgical NP career progression and compensation stages
Career stage Typical timeline Salary range Notes
Staff surgical NP – clinic only 0–3 years post-certification $110,000–$132,000 Pre-op / post-op management; OR privileges pending or not yet applied
Staff surgical NP – OR first-assist credentialed 1–5 years post-credentialing $135,000–$165,000 Active surgical privileges; production bonus eligible; subspecialty building
Senior surgical NP – subspecialty focused 5–10 years experience $155,000–$190,000 Recognized subspecialty expertise (CT surgery, trauma, neuro); wRVU production optimized; may precept junior NPs
Lead NP / surgical APP program director 10+ years $160,000–$195,000 Administrative role leading surgical APP team; hiring, onboarding, quality oversight; academic medical center role typically
Independent practice (FPA states) Any experience level in FPA state $140,000–$185,000+ Solo or group surgical NP practice; pre-op assessments, minor procedures, post-op management; not applicable to OR first-assist as independent provider
Industry / medtech consulting 8+ years surgical NP experience $160,000–$220,000+ Medical device and surgical robotics companies (Intuitive Surgical, Stryker, Medtronic, Zimmer Biomet) hire surgical NPs as clinical specialists, application specialists, and regional sales support; income combines base + commission + equity in some cases

The medtech / surgical industry pathway is an underappreciated income ceiling for surgical NPs. Companies that manufacture surgical implants, robotic surgical systems, and operating room equipment actively recruit clinical professionals with OR experience to serve as product educators, clinical application specialists, and territory managers. A surgical NP with 8–10 years of first-assist experience across orthopedic, spinal, or robotic cases is highly valuable to these companies – total compensation packages in clinical specialist and territory management roles frequently reach $160,000–$220,000 when base, commission, and benefits are combined.

For the complete pathway to becoming a surgical NP, including NP track selection and facility credentialing details, see how to become a surgical nurse practitioner. For CRNA salary comparison, see CRNA salary.

Frequently asked questions

Do surgical NPs earn more than other NP specialties?

Surgical NPs with OR first-assist credentials in high-acuity subspecialties (cardiothoracic surgery, neurosurgery, trauma) sit at or near the top of the NP compensation range. The key variable is whether you hold active first-assist surgical privileges – without OR involvement, surgical clinic NPs earn closer to the FNP median.

What is the biggest salary mistake surgical NPs make?

Taking clinic-only roles indefinitely without pursuing OR first-assist credentialing. The first-assist premium is $15,000–$40,000 annually – a difference that compounds across a career. NPs who spend their first 5 years in outpatient surgical clinic without pursuing OR credentialing often find it harder to transition later because their application of surgical skills has atrophied and they lack recent case volume to credential against.

Can surgical NPs earn consulting income?

Yes. Two main channels exist. First, medtech companies – particularly surgical robotics (Intuitive Surgical for da Vinci cases), orthopedic implant manufacturers (Stryker, Zimmer Biomet, DePuy), and spinal implant companies – hire surgical NPs as clinical specialists and proctors. Second, surgical NPs with specific subspecialty expertise sometimes consult for plaintiffs or defendants in medical malpractice cases involving surgical care. Neither income channel replaces primary practice income at early career stages, but both become accessible with 5–8 years of subspecialty experience.

How does locum tenens work for surgical NPs?

Locum surgical NPs contract through staffing agencies to cover surgical programs that have open NP positions or short-term coverage gaps. The hourly rate is $95–$130/hour for credentialed surgical NPs in high-demand specialties. The complication is that surgical privileges are facility-specific – locum surgical NPs must complete the credentialing process at each new facility, which typically takes 60–120 days. Most locum surgical NPs work a core set of facilities where they maintain standing privileges and take locum assignments at those sites repeatedly, rather than rotating to new hospitals continuously.

References

  1. U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, “Nurse Practitioners (SOC 29-1171),” May 2025 estimates. National median annual wage $132,300; 10th percentile $101,340; 90th percentile $174,420. Accessed via O*NET OnLine, onetonline.org/link/summary/29-1171.00.
  2. U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, “Nurse Anesthetists (SOC 29-1151),” May 2025 estimates. National median annual wage $236,590. Accessed via O*NET OnLine, onetonline.org/link/summary/29-1151.00.
  3. American Association of Nurse Practitioners, Nurse Practitioner Compensation Report, 2024 edition (2023 calendar year data). Full-time median base salary $120,000; median total income $126,000.
  4. American Association of Nurse Practitioners, State Practice Environment, State Government Affairs, May 2026 edition. Definitions of full, reduced, and restricted practice categories and current state classifications.
  5. Centers for Medicare and Medicaid Services, Medicare Claims Processing Manual, Publication 100-04, on assistant-at-surgery services. Payment for non-physician practitioners assisting at surgery is calculated as the Medicare Physician Fee Schedule amount multiplied by the 16% assistant-at-surgery reduction and the 85% non-physician practitioner reduction, yielding 13.6% of the physician amount; modifier AS applies.
  6. Centers for Medicare and Medicaid Services, Revisions to Payment Policies Under the Physician Fee Schedule, CY 2026 Final Rule, published 31 October 2025, including the negative 2.5% efficiency adjustment to work RVUs for approximately 7,700 non-time-based codes, and Addendum B relative value units.
  7. National Assistant at Surgery Certification, “CRNFA Certification: Application and Candidate Handbook.” Eligibility requirements including bachelor’s degree, current CNOR certification, completion of an RNFA program meeting AORN standards, and 2,000 documented RNFA practice hours within the preceding five years.
  8. Competency and Credentialing Institute, “CNOR and CRNFA Dual Certification Changes.” Confirms CRNFA is administered by NASC and that CNOR and CRNFA now recertify separately.
  9. Association of periOperative Registered Nurses, AORN Standards for RN First Assistant Education Programs, on the education standard referenced in CRNFA eligibility.