How to Value Your Ambulatory Surgery Center (ASC) in 2026

Ambulatory surgery centers (ASCs) are a hot commodity, attracting increased interest from hospital and health systems, surgical facility operators (e.g., United Surgical Partners International, Surgery Partners, SCA Health), private equity firms, and commercial payers. Given this increased interest from strategic and financial buyers, it's not surprising that we are hearing from a growing number of ASC owners wondering about the value of their facilities. According to IBISWorld, the pace of consolidation reflects this demand: corporate-owned ASCs now account for roughly one-third of all centers, up from about one in five just five years ago.

Before we dive into the factors influencing ASC value and discuss surgery center valuations, it's helpful to get a lay of the ASC land. As IBISWorld notes, the ASC industry generated $54.3 billion in revenue in 2025 and is projected to grow at a 3.7% annual rate through 2030. The massive changes in ASC scale and scope in recent years continue to propel growth but also bring challenges. A larger number of ASCs are performing a broader set of procedures than ever, including the likes of total joint replacements, more complex spine surgeries, and a variety of cardiovascular treatments, but labor shortages, inflation, and reimbursement pressures are hurting their ability to increase profitability.

Outpatient care will continue shifting away from inpatient (e.g., hospital) settings toward ASCs. Evolving medical and technology advances will further accelerate the transition as patients seek safe, affordable care and payers look to reel in rising healthcare costs. The rise in the number of ASCs to the point where the number of Medicare-certified surgery centers (~6,600) has surpassed the number of hospitals (~6,100) is in part due to the significant cost savings of procedures performed in ASCs compared to onsite hospital surgeries, which allows for lower reimbursement rates and patient expenses. 

The migration of care into ASCs, fueled by payer pressures, is one the reasons many hospitals and health systems are seeking to develop or partner with ASCs. Advisory firm Avanza Strategies notes that roughly 9 out of 10 hospitals and health systems intend to continue investing in and affiliating with ASCs. The trend is up significantly in recent years, with the firm attributing the shift to many factors, including the ongoing shift of non-urgent surgical procedures into the outpatient setting, consumer demand, the need to decrease costs, and growing competition for surgical cases. Physicians remain interested in starting ASCs or becoming minority or majority owners to allow them to obtain distributions.

Key Risk Drivers for the Value of an Ambulatory Surgery Center

Similar to most investable assets, the value of ASCs is a function of risks versus rewards. Key risk drivers include:

• Location: Being located in a certificate of need (CON) state and/or being located near key suppliers, solid referral sources, ample labor supply, low concentration of other ASCs, and good patient demographics are all positives.
• Payers: Having low reliance on out-of-network payers is preferable.
• Reimbursement: Having low dependence on procedures with low reimbursement rates helps reduce risk. Centers with significant Medicaid exposure or heavy pain management concentration generally trade at a discount.
• Specialty mix: Higher-acuity specialties — e.g., orthopedics, spine, ophthalmology, GI — typically command premium valuations due to strong commercial reimbursement and procedural volume.
• Operational dependence: Having high reliance on one physician, one referral source, or one senior executive who would cause a dramatic decline in revenue if they were to leave the ASC raises risk. Diversified physician alignment — with no single provider representing an outsized share of case volume — is a meaningful driver of premium valuations.
• Non-competition/non-solicitation agreements: Having little concern that employees or independent contractors would leave the ASC and immediately become a competitor or would steal away key employees reduces risk.
• Multi-specialty vs. single-specialty ASCs: Multi-specialty ASCs that have a low concentration of services/procedures provided relative to total revenue are considered less risky than single-specialty ASCs.

Other issues impacting the riskiness of a particular ASC include:

• Performance: The overall performance of an ASC relative to its peers/competitors. An ASC that historically underperforms its peers will be viewed as riskier than one that at least performs as well as like facilities.
• Historical legal issues: Legal fees will impact valuations via lower profitability, while a history of numerous legal issues (e.g., malpractice claims) will increase buyers' perception of riskiness. 
• Turnover: An ASC with relatively high employee, patient, and/or referral source turnover will be looked at as riskier than otherwise.
• Collections issues: An ASC with a history of billing/collections issues, high claims denials, longer than normal collection periods, and higher than normal write-offs for uncollectable accounts receivable (A/R) will be deemed riskier than normal.
• Patient readmissions: An ASC with an above-average hospital admission rate will increase buyers' perception of riskiness.
• Compliance: An ASC with a history of regulatory compliance, accreditation, and/or licensure issues will be deemed riskier.

Some people might argue that the above-listed risk drivers are qualitative matters rather than quantitative. In reality, these risk drivers ultimately impact overall performance and are therefore quantitative relative to creating cash flow for the owners/investors of the ASC. Factors that most commonly reduce ASC valuations include physician concentration, reimbursement pressure, declining case volume, heavy Medicaid exposure, and operational inefficiencies.

Relative size also matters regarding the market value of ASCs. There is higher demand from buyers for ASCs with higher revenue and organizations with multiple locations. Higher demand will lead to higher valuations.

2026 Ambulatory Surgery Center Valuations

How much is your surgery center worth? Below is a breakdown of the current estimated ASC market values based on multiples of EBITDA (earnings before interest, taxes, depreciation, and amortization) by size and perceived riskiness. Before diving into the numbers, it's worth noting that revenue size is one lens, but it's not the primary one. ASC valuations are driven more by EBITDA quality, specialty mix, commercial payor exposure, physician alignment, and growth capacity than by top-line revenue alone. A $12 million revenue ASC generating strong EBITDA with significant commercial orthopedic volume can command a higher valuation than a $30 million revenue center with compressed margins and a Medicaid-heavy payor mix. The chart below uses revenue as an organizing framework for accessibility, but the multiples within each tier reflect these deeper quality factors:

ASC Market Multiples by Risk Level*

For example, a low-risk ASC with $9.0 million in annual revenue and an EBITDA of $1.8 million (20.0% EBITDA margin) will have a market value in the range of $9.0 million to $12.6 million. Note that the industry's average profit margin currently sits around 15.9%, according to IBISWorld, meaning an ASC generating a 20% EBITDA margin is outperforming its peers — a factor that buyers will recognize and that supports stronger valuations.

ASC Market Multiples by Profile Type*

While the chart above organizes valuations by revenue size and risk level, buyers also evaluate ASCs through the lens of overall profile and platform potential. The following reflects current market multiples by ASC type:

Here's a look at value ranges for moderate risk levels.

Estimated Market Values for Moderate-Risk ASCs*

*Actual market value is also a function of (1) quality of offering memorandum and reporting, (2) quality of intermediary representation, (3) historical performance of the company, (4) future growth prospects of the company, (5) quality, type, and number of potential buyers, (6) current and projected macroeconomy, (7) current and projected industry stability and growth, (8) and numerous other factors.

Note that acquisitions of ASCs are typically stock purchases, as opposed to asset purchases, and are done on a cash-free/debt-free basis. The seller(s) normally distribute their cash balances before closing the sale/purchase and after paying off all indebtedness.

How a Quality of Earnings (QoE) Analysis Can Put Your ASC Ahead of the Game

Buyers typically undertake a quality of earnings (QoE) analysis. A QoE is a comprehensive examination of a company's financial performance, detailed revenue analysis, review of accounting policies, assessment of company management, examination of company operations, and reliability of financial reporting. We often recommend that ASC owners undertake a seller's QoE before going to market. By doing so, owners can take steps to mitigate issues uncovered during the QoE process, thereby reducing perceived riskiness.

Moreover, the QoE process helps sellers and their mergers and acquisitions (M&A) advisor (e.g., VERTESS) to better identify discretionary and non-recurring expenses that are add-backs to EBITDA to best reflect the cash flows generated by the ASC to potential buyers.

What Is Your ASC Worth? Receive a Market Valuation From VERTESS 

Whether or not you're considering selling your ASC, knowing the current market valuation can provide you insight into deciding where to go. You might be trying to determine where you want your ASC to be five years from now. A good roadmap begins by knowing where you stand today. A market valuation of your ASC is a great start to knowing where you are now.

As a healthcare-focused M&A firm, we at VERTESS help owners understand the expected value of their business if they are to bring their company to market. We'd be more than happy to provide you with a current market valuation of your ASC.

About the Author

Blake has extensive and diverse career in healthcare for more than 20 years including serving as CEO for multiple hospitals of Fortune 500 companies and several large ambulatory surgery centers. His operations and business development knowledge has allowed him to experience the entire M&A process from start to finish, focusing primarily on private equity transactions. His experience as both a CEO and clinician provides a unique perspective based on years of experience and empathy when working with business owners seeking M&A advice. His expertise is in ambulatory surgery centers, physician practices and independent hospital businesses. He enjoys supporting healthcare business owners who select the M&A direction, as one who has walked in their shoes. 

Full bio | LinkedIn