ASC valuations remain healthy on paper, but many leaders say the problem is the gap between what a center is worth today and what it could have fetched two years ago.
ASC EBITDA multiples range from 2.7x to 12.0x, with a median of 10.1x, according to DealStats transaction data. Large, lower-risk centers command closer to 8-10x multiples; smaller centers typically land closer to 6-7x.
Despite the headwinds, strong assets are still transacting well. The median total invested capital-to-EBITDA multiple for ASC transactions reached 7.9 times in 2025, the highest level in at least eight years and best-in-class assets with strong physician alignment, favorable specialty mix and clean financials have commanded double-digit multiples in select cases, according to VMG Health’s 2026 Healthcare M&A Report.
Here are the factors affecting ASC valuations in 2026:
1. Reimbursement erosion is compressing EBITDA
Lower EBITDA means a lower absolute sale price, even at the same multiple. The ASC conversion factor for 2026 is $56.322, compared with $91.415 for hospital outpatient departments — a gap ASC leaders say continues to underscore longstanding structural payment challenges.
2. Anesthesia costs are eating margins
The share of ASCs expecting to pay anesthesia stipends rose from 28% in 2024 to 44% in 2025, according to a VMG Health report, with 67% of surveyed leaders citing anesthesia as a significant financial challenge for 2026.
“ASCs require anesthesia services to deliver most of the care they provide. Increasing competition and decreased reimbursement for anesthesia services have made it a significant cost center for many ASC,” Jon Van Valkenburg, executive director of Upstate Orthopedics Ambulatory Surgery Center in East Syracuse, N.Y., and ASCA board member, told Becker’s.”Several years ago, that was not the case. The relatively lower reimbursement rates for ASCs, combined with these increasing costs, have made the business model much more challenging.”
3. Physician concentration risk
Facilities that rely heavily on one or two surgeons for case volume face higher risk, which can reduce valuation multiples, according to McGuireWoods and transaction data compiled by Focus Bankers. Conversely, centers with a broad physician ownership base and stable referral patterns typically achieve stronger pricing in transactions. Buyers closely evaluate whether case volume is concentrated among a few individuals or supported by a broader, stable physician base, VMG Health said in an April 2026 analysis. In a market where surgeon recruitment is difficult and noncompetes are under pressure, buyer confidence in volume stability is harder to establish: 61 percent of ASCs identified recruiting new surgeons as their biggest physician-related risk for 2026, according to VMG Health, driven in part by hospital employment contracts with explicit no-leakage clauses that have become standard in markets where health systems hold leverage.
4. Site-neutral payment uncertainty
ASCs are at risk of changes in Medicare reimbursement policies. Site neutrality policies in Medicare payment would reduce differences in reimbursement between lower-cost settings like ASCs and hospital outpatient departments, and removing those site differences may alter competitive dynamics and lower margins for certain procedures.
5. Supply costs are still rising
Medical supply chain costs are projected to increase 2.41% in 2026, according to Vizient’s Summer 2025 Spend Management Outlook. Medical and surgical supply costs rose 82% per full-time employee between 2013 and 2022, and leaders say the trend has only accelerated post-pandemic.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.