Nurse Staffing Agency Costs: What the Bill Rate Pays For, and the States That Cap It
A nurse staffing agency bills a per diem RN at a 35–50% markup on the wage (AMN Healthcare), a travel nurse at 40–70% above staff rates (DirectShifts), and a direct hire at 18–25% of first-year salary. Hospitals surveyed by NSI in 2026 reported an average travel nurse fee of $91.23 an hour against $59.46 for a staff RN with benefits. Two states publish legal maximums — Minnesota's 2026 RN cap is $78.51 an hour — and this page shows what is inside the rate, what the contract adds, and the arithmetic of a 78-day vacancy.
A note on who's writing this
Boostpoint is not a nurse staffing agency. We run social media job advertising for healthcare employers, which means we compete with agencies for the same budget, and you should read our framing with that in mind. What we can do that a neutral page usually can't is show our own numbers: the RN row of our 2026 Social Job Advertising Benchmark is on this page, with the methodology at the bottom. Every agency figure here is third-party and attributed, and where a public record exists — a state rate cap, a state labor department report, a public company's filing — we used it in preference to anyone's marketing. This page covers the nursing agency bill only. For the sector-wide comparison of agency fees against advertising, read healthcare staffing costs; for cost per applicant by clinical role, RN vs LPN vs CNA recruiting cost; for the float-pool alternative to per diem, PRN and per diem staffing costs.
Nurse staffing agency rates: the four ways you'll be billed
Nursing agency fees come in four shapes, and the first job is to know which one is on the quote. A per diem agency bills an hourly rate that is the nurse's wage plus a markup. A travel agency bills a weekly rate for a fixed contract, usually 13 weeks at 36 hours. A direct-hire or permanent-placement agency charges a one-time percentage of first-year salary. And nearly every temp arrangement carries a conversion fee if you hire the nurse permanently — except in Illinois, where that fee is now illegal, and in Minnesota, where every administrative charge has to fit inside the state cap.
| Arrangement | Typical charge | How it's billed | Source |
|---|---|---|---|
| Per diem RN | 35–50% markup on the hourly wage | Per hour, per shift, invoiced weekly or bi-weekly | AMN Healthcare |
| Travel nurse | 40–70% above staff nurse rates | Weekly bill rate for a fixed contract, typically 13 weeks × 36 hours | DirectShifts |
| Travel nurse, hospital-reported average | $91.23 per hour · $189,758 per year | What 527 surveyed hospitals said they actually pay, 2026 | NSI Nursing Solutions |
| Direct hire (permanent placement) | 18–25% of first-year salary | One-time fee, due when the nurse starts | AMN Healthcare |
| Conversion (temp to permanent) | Varies by contract; prohibited in Illinois for agreements on or after July 1, 2022 | One-time fee when you hire the agency nurse | Illinois HB 4666 |
On the BLS median RN wage of $93,600 (May 2024), a direct-hire fee runs $16,848 at 18% and $23,400 at 25%. On a 13-week travel contract at the NSI hospital average, the bill is 468 hours × $91.23 = $42,695.64; the same 468 hours at $59.46 of loaded staff pay would be $27,827.28, so the premium on one contract is $14,868.36. That premium buys real things — a credentialed nurse who starts Monday, payroll, liability, housing logistics — and the rest of this page is about seeing exactly what.
What is inside a nurse agency bill rate
Most pages stop at "the markup covers overhead." Three public records let you see the actual split. AMN Healthcare, the largest US healthcare staffing company, reported a gross margin of 23.0% in its Nurse and Allied Solutions segment for 2025 on $1,647.3 million of revenue. That means 77 cents of every billed dollar in that segment was cost of revenue — the clinician's pay, benefits, payroll taxes, stipends, and insurance — and 23 cents was left for the agency's own sales, recruiting, operations, and profit. Illinois requires nurse agencies to report what they charge and what they pay; for Cook County, the state's June 2024–May 2025 annual report shows an average RN charge of $110.89 an hour against an average RN wage paid of $78.79, so the wage was 71.05% of the bill and the agency's gross share was $32.10 an hour, a 40.74% markup. And NSI's 2026 hospital survey puts the average travel nurse fee at $91.23 against $59.46 of staff RN pay including 25.8% for benefits — a difference of $31.77 an hour, or $66,081 a year at 2,080 hours.
Read those three together and the shape is consistent: roughly seven dollars in ten go to the nurse and the costs of employing her, and the agency's gross share is somewhere between a fifth and a third of the bill depending on how the wage is counted. The Cook County figure is one county's self-reported average and other Illinois counties in the same report swing widely, so treat it as an illustration, not a national rate. The point is that the markup is not mostly margin. It is mostly the cost of carrying a licensed employee you don't have to carry — which is exactly why an agency is worth paying when you need coverage on Monday, and exactly why it gets expensive when Monday turns into a quarter.
The states that publish a maximum nurse agency rate
Two states set a legal ceiling on what a nurse staffing agency can bill long-term care facilities, and both publish the numbers. Minnesota's supplemental nursing services agency cap is statewide, set annually by the Department of Health at 150% of the weighted average wage plus a payroll-tax factor under Minn. Stat. 144A.74, and it explicitly includes "all charges for administrative fees, contract fees, or other special charges." Massachusetts sets maximum per-hour prices for temporary nursing services under 101 CMR 345.00 by health service area and shift, with holidays capped at 150% of the maximum and a 19.7% travel-nurse factor above the limits.
| Jurisdiction and setting | RN | LPN | CNA | Source |
|---|---|---|---|---|
| Minnesota nursing facilities — standard, Jan 1–Dec 31, 2026 | $78.51 | $62.97 | $43.83 | MDH SNSA maximum charges; Minn. Stat. 144A.74 |
| Minnesota nursing facilities — holiday, 2026 | $135.03 | $110.82 | $76.26 | MDH SNSA maximum charges |
| Massachusetts nursing facilities — weekday day shift, range across six HSAs | $68.84 – $71.37 | $58.77 – $63.24 | $32.43 – $34.00 | 101 CMR 345.03(2) |
| Massachusetts hospitals — weekday day shift, range across six HSAs | $96.76 – $105.00 | $61.66 – $65.47 | $35.31 – $37.26 | 101 CMR 345.03(3) |
The Massachusetts regulation includes its own worked example for a 12-hour shift: an RN in HSA 1 at a nursing facility from 7 a.m. to 7 p.m. bills eight hours at $71.03 and four at $75.29, so $869.40 ÷ 12 = $72.45 an hour. Run the same arithmetic for Greater Boston (HSA 4) and the day-shift RN ceiling is 8 × $71.37 + 4 × $75.63 = $873.48, or $72.79 an hour; at a Boston hospital it is 8 × $105.00 + 4 × $115.05 = $1,300.20, or $108.35 an hour. Minnesota's flat RN cap makes a 12-hour nursing-home shift $942.12 on a normal day and $1,620.36 on a holiday. Put those ceilings next to the NSI national hospital average of $91.23 and the Cook County average of $110.89 and you can see what a cap does: it holds nursing-home rates well under what hospitals report paying, and it does not touch hospitals at all in Minnesota.
Check the legal maximum for a shift
If you run a facility in Massachusetts or Minnesota, the number below is the most an agency may charge you per hour for that role on that shift, straight from the published tables. Everywhere else, use it as a reference point for what two states decided a fair ceiling looks like.
Nothing is stored or sent — this runs in your browser. Figures are the published maximums; agencies may charge less.
Sources: Minnesota Department of Health, SNSA Maximum Charges for Nursing Facilities effective January 1–December 31, 2026 (RN $78.51, LPN $62.97, CNA $43.83; holiday $135.03, $110.82, $76.26), under Minn. Stat. 144A.74; Massachusetts 101 CMR 345.03(2)–(3), effective October 1, 2021 and still the posted regulation on August 25, 2026, with holidays capped at 150% of the maximum and a 19.7% travel-nurse factor not applied here. Massachusetts 12-hour figures use the regulation's own method: eight hours at the day rate plus four at the next shift's rate, or eight at the night rate plus four at the day rate, weighted. Fixed-term employees are exempt in Massachusetts. Verify the current table before relying on it.
Nursing agency fees the rate sheet doesn't show
The hourly rate is the number you negotiate; the contract terms are where the total moves. Illinois made most of them visible by law. Under HB 4666, for agreements executed on or after July 1, 2022, a nurse agency contract with an Illinois facility must include a schedule of all hourly bill rates per employee category and a full description of administrative charges, agencies may not sign non-competes with nurses or CNAs, and they may not charge liquidated damages, conversion fees, employment fees, buy-out fees, placement fees, or other compensation if you hire the nurse permanently. Agencies also report their average charges and average wages paid to the Department of Labor quarterly, which is where the Cook County figures above come from. Whether or not your state requires it, ask for the same five things in writing:
- The bill-rate schedule by role and shift, with evening, night, weekend, and holiday multipliers stated as numbers, not "premium applies." Massachusetts caps holidays at 150%; Minnesota's 2026 holiday RN rate is $135.03 against $78.51 standard — a 71.99% premium. Your contract's multiplier is whatever it says.
- The conversion fee and its schedule. Many contracts step the fee down with hours worked; some waive it after a threshold. If you are in Illinois it should be zero. If it is a flat percentage of salary with no step-down, that is the term to negotiate first, because it is the one you pay when things go well.
- Overtime and cancellation. Who pays time-and-a-half when a 12-hour shift runs to 13, and how many hours' notice you have to cancel a shift without being billed for it. Two hours and twenty-four hours are both common; the difference on a census that drops is the whole margin.
- Guaranteed hours on travel contracts. A 36-hour guarantee means you pay 36 hours whether or not you use them. Ask whether the guarantee survives a low census, a float to another unit, or a facility-initiated cancellation.
- What is inside the rate. Credentialing, background checks, liability coverage, and housing stipends are either inside the bill rate or invoiced separately. Minnesota's cap forces them inside; elsewhere, an "administrative fee" line can add several dollars an hour to a rate that looked competitive.
When a nurse staffing agency is the right call
Before the case against the bill, the case for it, because it is real. You have a shift going unfilled this week: nothing beats a roster of credentialed nurses who can start tomorrow, and per diem staffing exists for census spikes, leave, and departures. The role is a specialty: an ICU, OR, or cath-lab nurse for one opening is a search an agency runs all day and you run once. Credentialing is your bottleneck: license verification across states, background checks, and health screenings are real work that an agency amortizes across hundreds of placements. Nobody on your team can work applicants: an applicant who waits two days goes cold, and paying an agency to screen is buying a service, not wasting money. And the survey data says hospitals know all of this — NSI found 70.7% of hospitals intend to decrease travel and agency use in 2026, and reports they still reach for it whenever a shortage bites. Wanting to use less agency and being able to are different things, and the gap between them is filled by whether you have a way of producing your own candidates.
Where the arithmetic turns: the vacancy that becomes a quarter
The agency premium is a per-hour number, so the cost of coverage is the premium times the hours, and the hours are set by how long the position stays open. NSI's 2026 report puts the average RN time-to-fill at 78 days, ranging from 56 to 102 by specialty, with an average of 43 unfilled RN FTEs per hospital and an 8.6% vacancy rate. Cover one vacant RN position with agency for those 78 days at 36 hours a week and you buy 78 ÷ 7 × 36 = 401.14 hours; at the NSI difference of $31.77 an hour between the travel fee and loaded staff pay, the premium on that one vacancy is $12,744.31 — before the position is filled, and with the hours not rounded before multiplying. That is the cost of the days, not the cost of the agency. The agency is charging what it charges; the 78 days are yours.
Nothing is stored or sent — this runs in your browser. Defaults are the NSI 2026 hospital averages; replace them with your own rates.
This is the premium above your own loaded cost, not the whole bill — you would have paid the staff wage either way. It excludes the agency's separately invoiced fees, overtime, and any conversion fee. Hours are days ÷ 7 × weekly hours, not rounded before multiplying.
What producing your own RN applicants costs — and what it doesn't buy
The alternative to covering a vacancy is shortening it, and that means a pipeline of your own applicants. Our 2026 benchmark, 173 registered-nurse campaign-months of social media job advertising, shows a median cost per applicant for RNs of $19.08, a middle 50% of $12.76–$34.84, and an 11% apply rate — the lowest apply rate of the nursing roles we track (CNAs convert at 18%, LPNs at 21%), because an RN clicks less readily and completes fewer applications. Twenty RN applicants at the median cost $381.60; at the upper quartile, 20 × $34.84 = $696.80. Those are applicants, not hires, and we don't publish a cost per hire because we don't track hires — how many of twenty RN applicants become one start depends on your screening, your offer, and your unit, and we would be inventing a number if we told you. What we can say is that the applicant budget for a position is a fraction of the agency premium on the same position's vacancy — $12,744.31 is 33.40 times $381.60, which is why the comparison worth running is not "agency versus advertising" but "how many days does each approach take off the 78."
One caution that matters more for nursing than for any other role: in an earlier analysis of 478 healthcare campaigns across 30 employers (campaign-level, a different methodology from the benchmark), hospital application flows completed at 6.0% against 22.1% in senior living and 21.6% in home care, because hospitals mostly route candidates into long ATS applications after the click. If your RN application takes 25 minutes, you will pay for the click and lose the nurse, and the advertising will look expensive for a reason that has nothing to do with the advertising. Fix the form before you fund the campaign. The RN, LPN and CNA cost page goes through what the form does to each role.
Seven dollars in ten of a nurse agency bill pay for the nurse. The premium pays for the days — and the days are the only part of the bill that a facility with its own applicant pipeline gets to shorten.
Frequently asked questions
How much does a nurse staffing agency charge?
By arrangement: per diem RNs at a 35–50% markup on the hourly wage and direct hires at 18–25% of first-year salary, per AMN Healthcare; travel nurses at 40–70% above staff nurse rates, per DirectShifts. Hospitals surveyed by NSI Nursing Solutions in 2026 reported an average travel nurse fee of $91.23 an hour, or $189,758 a year. Where a state caps the rate, the ceiling is public: Minnesota's 2026 nursing-facility RN maximum is $78.51 an hour, and Massachusetts nursing facilities' weekday day-shift RN maximum runs $68.84–$71.37 depending on region.
What is a typical nurse staffing agency markup?
For per diem nursing, 35–50% on the wage is the range AMN Healthcare publishes. Public records show the split in practice: Illinois' Cook County reported an average RN charge of $110.89 an hour against an average wage paid of $78.79, a 40.74% markup, and AMN's own Nurse and Allied Solutions segment ran a 23.0% gross margin in 2025, meaning 77% of billings were the cost of employing the clinician. Minnesota's statutory cap is 150% of the weighted average wage plus a payroll-tax factor, with all administrative fees inside it.
How much of the bill rate does the nurse actually get?
Roughly seven dollars in ten, by the three public records on this page. Illinois' Cook County report shows the wage at 71.05% of the average RN charge; AMN Healthcare's 2025 segment results put cost of revenue — pay, benefits, payroll taxes, stipends, insurance — at 77% of billings; NSI's hospital survey shows $59.46 of loaded staff pay against a $91.23 travel fee. The agency's gross share covers recruiting, credentialing, sales, and profit, and in Illinois the contract must state administrative charges separately.
Do any states cap nurse staffing agency rates?
Minnesota and Massachusetts publish legal maximums for nursing facilities. Minnesota's Department of Health sets a statewide cap each year under Minn. Stat. 144A.74 — for 2026, RN $78.51, LPN $62.97, CNA $43.83, with holiday rates of $135.03, $110.82, and $76.26. Massachusetts' 101 CMR 345.00 sets maximum per-hour prices by health service area and shift for nursing facilities and hospitals, with holidays capped at 150% and a 19.7% travel-nurse factor. Illinois does not cap rates but requires licensed agencies to disclose them and report quarterly. The lookup on this page returns the published figure for a given role and shift.
What is a nurse agency conversion or buy-out fee, and can we avoid it?
It is the fee an agency charges when you hire one of its nurses permanently, usually a percentage of salary that steps down with hours worked. In Illinois it is prohibited: for agreements executed on or after July 1, 2022, HB 4666 bars nurse agencies from charging liquidated damages, conversion, employment, buy-out, or placement fees when a facility hires the nurse, and from signing non-competes with nurses or CNAs. Elsewhere, negotiate the schedule before the first shift — it is the fee you pay when the placement goes well.
How much does a travel nurse cost a hospital?
The 527 hospitals in NSI's 2026 survey reported an average travel nurse fee of $91.23 an hour, $189,758 a year, against $59.46 an hour for a staff RN including 25.8% for benefits — a difference of $31.77 an hour or $66,081 a year. On a standard 13-week, 36-hour contract that is 468 hours × $91.23 = $42,695.64 billed and a premium of $14,868.36 over the same hours at staff cost. DirectShifts describes travel bill rates as 40–70% above staff rates; the NSI averages sit inside that range at 53.4% above loaded staff pay.
Are per diem nursing apps cheaper than a staffing agency?
We can't say from their websites. Marketplace apps such as ShiftKey and Nursa describe facility rates as transparent or set by the facility, but neither shows a facility price or fee on the pages we reached on August 25, 2026, so we won't quote one. The questions are the same as for an agency: what the facility pays per hour, what fee sits on top, who employs the clinician, and who carries credentialing and liability. In Minnesota the answer has to fit under the same cap; in Illinois the same disclosure rules apply to licensed agencies.
When should a facility use a nurse staffing agency instead of recruiting directly?
Use an agency when the shift is this week, the role is a specialty you fill once, credentialing is your bottleneck, or nobody can work applicants the same day. Recruit directly when the same position keeps reopening, because the agency premium is priced per hour and the hours are set by the vacancy: on NSI's 2026 averages, 78 days of coverage costs $12,744.31 in premium alone, while 20 RN applicants at our benchmark median of $19.08 cost $381.60 — applicants, not hires. The honest comparison is which approach takes more days off the vacancy.
See what your own RN applicants cost before the next contract renews
We'll show you the healthcare campaigns closest to yours from 173 RN campaign-months and 553 in the sector — with the management fee inside the number and no cost-per-hire claim we can't back.
Book a DemoBoostpoint figures come from the 2026 Social Job Advertising Benchmark — 891 campaigns and 1,334 campaign-months, costs inclusive of campaign management: registered nurse median cost per applicant $19.08, middle 50% $12.76–$34.84, 11% apply rate, 173 campaigns; healthcare and senior living sector 553 campaign-months. Cost per applicant is not cost per hire; we do not track hires and publish no cost-per-hire figure. The hospital application-completion figures (6.0% hospital, 22.1% senior living, 21.6% home care) come from an earlier campaign-level analysis of 478 healthcare campaigns across 30 employers and use a different methodology from the benchmark. Third-party figures are attributed in-page: AMN Healthcare (direct hire 18–25%, per diem RN markup 35–50%); DirectShifts (travel nurse bill rates 40–70% above staff rates); NSI Nursing Solutions, 2026 National Health Care Retention & RN Staffing Report, 527 hospitals in 40 states (travel nurse fee $91.23/$189,758; staff RN pay $59.46/$123,676 including 25.8% benefits; difference $31.77/$66,081; RN time-to-fill 78 days, 56–102 by specialty; RN vacancy rate 8.6%; 43 unfilled RN FTEs per hospital; 70.7% anticipating decreased travel/agency use); AMN Healthcare fourth-quarter and full-year 2025 results, February 2026 (Nurse and Allied Solutions revenue $1,647.3 million, gross margin 23.0%); Illinois Department of Labor, Annual Nurse Agency Licensing Act Report, June 1, 2024–May 31, 2025 (Cook County average RN charge $110.89, average wage paid $78.79); Illinois HB 4666, Public Act 102-0946, for agreements on or after July 1, 2022; Massachusetts 101 CMR 345.00, effective October 1, 2021, the posted regulation as of August 25, 2026; Minnesota Department of Health, SNSA Maximum Charges for Nursing Facilities effective January 1–December 31, 2026, and Minn. Stat. 144A.74; BLS Occupational Outlook Handbook, registered nurses, median annual wage $93,600 (May 2024). Worked figures: 468 hours = 36 hours × 13 weeks; 401.14 hours = 78 days ÷ 7 × 36, multiplied unrounded; $12,744.31 = 401.142857 × $31.77; $16,848 and $23,400 = 18% and 25% of $93,600. State caps and agency rates change; verify the current tables before budgeting. This is a sample of Boostpoint campaigns, not an industry-wide study.