The five largest ASC operators have accelerated growth through acquisitions, partnerships and de novo development. While independents still dominate the market, these chains now account for nearly one-third of all ASCs, reshaping outpatient surgery nationwide.
Here’s where the five biggest ASC chains stand today:
1. USPI: The nation’s largest ASC network
United Surgical Partners International, backed by Dallas-based Tenet Healthcare Corp., operates more than 518 ASCs and surgical hospitals across 37 states with over 11,000 affiliated physicians. In Q1 2024, USPI reported $995 million in revenue and allocated $250 million for M&A and de novo investments. Over the past decade, its ASC portfolio has grown by 139%.
2. SCA Health: Optum’s outpatient engine
Deerfield, Ill.-based SCA Health, part of UnitedHealth’s Optum, manages more than 320 ASCs in 35 states with about 9,200 affiliated physicians, serving more than 1.43 million patients annually. The company holds just over 5% of ASC market share. Optum reported $253 billion in revenue in 2024, underscoring the financial scale behind its ASC operations.
3. AmSurg: Reemerging after restructuring
Nashville, Tenn.-based AmSurg operates more than 250 ASCs across 34 states, collaborating with nearly 2,000 physicians. In 2022, the company performed over 2 million outpatient surgery cases, including more than 1 million colonoscopies.
Since splitting from Envision Healthcare following its Chapter 11 filing in 2023, AmSurg has reestablished itself as a standalone operator. In June 2025, St. Louis-based Ascension announced a definitive agreement to acquire AmSurg, which would expand its ambulatory center footprint significantly.
4. HCA Surgery Ventures: Embedding ASCs into hospital strategy
HCA Healthcare’s Surgery Ventures division runs about 125 centers as of Q1 2025, up from 121 in 2024. These centers performed more than 1 million surgical cases in 2023 and helped outpatient procedures account for 37.3% of HCA’s total patient revenue, up from 36.9% the prior year.
5. Surgery Partners: Growth through partnerships
Brentwood, Tenn.–based Surgery Partners is expanding rapidly — adding five new surgical facilities and recruiting 150 physicians in Q1 2025 alone. Its recent rejection of Bain Capital’s $3.2 billion acquisition offer underscores its commitment to independence and confidence in its growth trajectory. The chain is also boosting orthopedic volume — handling over 29,000 joint cases in Q1 2025, signaling a strategic focus on high-acuity specialties.
