Surgical Technologist Salary by State (2026): CST Pay Compared Across All 50 States

Surgical technologist salary by state varies meaningfully across the U.S. The national median for Surgical Technologists sits at $68,141, but state-by-state pay across the 52 states tracked here ranges widely — from $31,933 in Puerto Rico to $88,941 in Hawaii. That spread reflects state-level cost of living, state CST credential mandates (nine states currently require NBSTSA certification for new OR hires), the regional density of academic medical centers and ambulatory surgery centers, hospital union representation, and the local mix of cardiovascular, neuro, and orthopedic surgical subspecialty practice.

This page compares the average surgical technologist salary by state across 1677+ metropolitan and non-metropolitan areas — drawing on the Bureau of Labor Statistics Occupational Employment and Wage Statistics (OEWS) survey for SOC 29-2055. If you're a working CST evaluating relocation, a new graduate of a CAAHEP-accredited program planning your first OR job, or a surgical services director benchmarking pay across states, the state-level comparison below is the central reference point.

How Surgical Tech Salary by State Is Measured

The BLS reports state-level surgical technologist salary through three numbers:

• Annual median (50th percentile) — used to rank state-level pay in the table below.
• Annual mean (average) — typically runs 3–6% above median; states with strong CVOR and neurosurgery specialty premiums show wider mean-median spreads.
• Percentile distribution (P10 / P25 / P75 / P90) — P10 reflects new CSTs working general OR cases at community hospitals; P90 reflects senior CSTs at academic medical centers, cardiovascular OR (CVOR) and neurosurgery specialty scrubs, surgical first assistants (CSFA / CSA), and lead/scheduling technologists at major surgical hospitals.

The state-comparison table below applies BEA Regional Price Parity (RPP) adjustment so both nominal pay and real purchasing power are visible.

1. State CST Certification Mandates

The single largest non-cost-of-living driver of state-level surgical tech pay is state CST certification mandate status. Nine states currently mandate NBSTSA (National Board of Surgical Technology and Surgical Assisting) CST credentialing for new OR hires, raising the entry bar and supporting higher pay floors:

• CST-mandate states — Tennessee, Indiana, Massachusetts, Nevada, New Jersey, New York, Oregon, South Carolina, Texas, Washington require CST credentialing for new OR hires. These states reliably support higher state-level surgical tech pay because the certification barrier limits supply.
• Non-mandate states — other states accept on-the-job-trained surgical technologists without national certification. These states have more competitive labor markets but show wider pay distributions because credentialed CSTs earn meaningful premiums regardless of state mandate.
• State CAAHEP / ABHES-accredited program density — states with multiple Commission on Accreditation of Allied Health Education Programs (CAAHEP) or Accrediting Bureau of Health Education Schools (ABHES) accredited programs (Texas, Florida, California, Pennsylvania, Ohio, North Carolina) have larger CST graduate pipelines.

2. State Cost of Living: Nominal vs Real Pay

Cost of living drives nominal state-level surgical tech salary. California, Alaska, Washington, Oregon, Massachusetts, Connecticut, Hawaii, New York, New Jersey lead the nominal pay rankings. After BEA RPP adjustment, the real-purchasing-power gap narrows. Texas, Florida, and Tennessee — no-state-income-tax states — deliver strong real-dollar take-home for surg techs.

3. State Demand-Supply Dynamics for Surgical Techs

State-level surg tech pay reflects the demand-supply balance:

• State academic medical center and Level-1 trauma center concentration — Massachusetts, Maryland, Pennsylvania, Texas, North Carolina, California, Ohio concentrate Level-1 trauma centers and academic medical centers requiring senior CVOR, neuro, and pediatric specialty scrubs. These states drive upper-percentile surg tech pay.
• State ASC (ambulatory surgery center) density — Texas, Florida, Arizona, Tennessee, North Carolina, Indiana, Ohio have rapidly expanding ASC concentration. Physician-owned and corporate ASC chains (Surgery Partners, USPI, AmSurg, SCA Health, NovaMed) compete for CST talent.
• State cardiac surgery program density — Texas (Texas Heart Institute, Methodist DeBakey), Ohio (Cleveland Clinic), Massachusetts (Mass General), New York (NYU, Mt Sinai), California (Cedars-Sinai, Stanford), Minnesota (Mayo), Pennsylvania (HUP, Penn State) drive CVOR-specialty pay above general OR rates.
• State orthopedic specialty hospital density — Indiana, Tennessee, Florida, Texas have strong orthopedic specialty hospital concentration (Hospital for Special Surgery — NY, Andrews Sports Medicine — AL, OrthoIndy, Texas Orthopedic Hospital). These markets support upper-percentile ortho-specialty surg tech pay.
• State hospital union density — California (SEIU-UHW), New York (1199SEIU, NYSNA hospital units), Massachusetts (1199SEIU), Illinois (SEIU HCII), Oregon (ONA hospital units) deliver union-supported surg tech pay floors above non-union states.
• State HPSA concentration — rural and underserved states routinely offer sign-on bonuses for surg techs willing to anchor community hospital surgical services.

4. NBSTSA CST and CSFA Specialty Distribution by State

The NBSTSA issues CST and CSFA (Certified Surgical First Assistant) credentials. CSFA distribution by state shapes upper-percentile state surg tech pay because surgical first assistants typically earn $5,000–$25,000+ above bench CST pay:

• CSFA-credentialed surg techs — concentrate in states with strong private surgical group practice (Texas, Florida, Ohio, Indiana, North Carolina, Tennessee, California). CSFAs at independent surgical groups can bill professionally alongside the surgeon in some states, supporting upper-percentile pay.
• CVOR specialty scrubs — cluster at cardiac-center-strong markets (Texas, Ohio, Massachusetts, California, New York, Minnesota, Pennsylvania).
• Neurosurgery specialty scrubs — cluster at academic medical center markets.
• Robotics (da Vinci) certified scrubs — distribute across urology, gynecology, general, and thoracic surgery markets. States with rapid robotic surgery adoption (Florida, Texas, California, New York, Pennsylvania) support modest robotics premium pay.
• OB / L&D scrub specialty — dedicated C-section scrub roles at hospital labor & delivery units; uniform demand across states.

How to Compare Surgical Tech Salary by State Effectively

When comparing the average surgical technologist salary by state, work through this checklist:

• Verify state CST mandate status — TN, IN, MA, NV, NJ, NY, OR, SC, TX, WA require CST certification for new hires. Plan for NBSTSA exam pass before relocating.
• Compare nominal and real (cost-adjusted) pay together — a state with the highest nominal median can have lower real purchasing power if its cost of living is higher.
• Check state income tax — surg techs in Texas, Florida, Tennessee, Nevada, Washington, Wyoming, South Dakota, Alaska, and New Hampshire keep more of every dollar.
• Compare percentile distribution, not just median — states with strong specialty subspecialty premiums show wide P75–P90 spreads.
• Factor in employer mix — academic medical center states (MA, MD, PA, MN, TX, NC, CA, OH) support upper-percentile specialty pay; ASC-heavy states (TX, FL, AZ, TN, NC, IN, OH) offer dense outpatient employment with no-call schedules.
• Consider CSFA credentialing path — if you plan to credential as surgical first assistant, target states with strong private surgical group practice density.

2026 State-Level Surgical Tech Salary Outlook

Surgical tech pay has grown at a compound annual rate of 5.40% nationally over the past five years — driven by chronic OR staffing shortages, rapid ASC expansion, growing elective orthopedic and cardiac case volume, and post-pandemic surgical backlog clearance. States with rapid ASC growth (Texas, Florida, Arizona, Tennessee, North Carolina), states with state-mandated CST credentialing and strong academic medical center density (Massachusetts, New York, New Jersey), and rural shortage states using sign-on bonuses to recruit are seeing the fastest state-level pay growth through 2026. The BLS projects Surgical Technologists employment growth at 6% through 2033, keeping upward pressure on state-level wages, especially for CVOR, neuro, and ortho specialty CSTs and CSFAs.

Browse the state-by-state comparison table below to see the $68,141-baseline state ranking, top 10 and bottom 10 states by projected median, regional groupings (Northeast / Midwest / South / West), and direct links to per-state pages for deeper city-level breakdown.