Florida is one of three states with more than 700 ASCs, along with California and Texas, according to an October white paper from Medicus Healthcare Solutions.
Florida also led the nation in new ASC developments, with at least 10 announced, approved or under construction through early June, according to Becker’s state-by-state tally. California had at least four.
Medicus counted about 10,900 ASCs nationwide as of October 2026, based on its proprietary data. It calculated per-capita figures using U.S. Census Bureau population estimates.
Seven things to know about where ASC density and development meet:
1. The highest-density states drew few new projects. Maryland has eight ASCs per 100,000 residents, Georgia six, and Idaho and Arizona five each, per Medicus. Maryland, Georgia and Idaho each logged one new development in Becker’s tally. Arizona logged two.
2 .The lowest-density states saw almost no new projects. Vermont has fewer than one ASC per 100,000 residents, Iowa has one, and Maine and Rhode Island have two each. Iowa logged one new development in Becker’s tally. Vermont, Maine and Rhode Island logged none.
3. Certificate-of-need laws don’t fully explain the map. All four of the lowest-density states have certificate-of-need laws, according to the National Academy for State Health Policy database. So do two of the highest-density states, Maryland and Georgia. Idaho and Arizona do not. Georgia’s 2024 reforms exempt certain single-specialty ASCs owned by one physician or practice, as long as they stay under capital spending and operating room thresholds.
4. Hospitals without ASCs point to regulation. Among hospitals and health systems without an ASC, 35% cite regulatory obstacles such as certificate-of-need laws as the main reason, according to the 7th Hospital Leadership ASC Survey from Avanza + MedHQ. Another 24% already operate a hospital outpatient department or short-stay hospital, and 24% have an ASC in progress.
5. Demand is outpacing supply in Sun Belt markets. In Orlando, Fla., outpatient visits are projected to grow 16.4% through 2029, while construction is projected to grow 3.8%, according to a March JLL report.
6. New York may be nearing saturation. The state logged at least six new ASC developments in 2026. Manhattan was the only market in JLL’s analysis where outpatient construction outpaced visit growth.
7. Real estate is tightening everywhere. About 93% of medical office building space nationwide is occupied, according to JLL. ASC rents rose more than 8%, the largest increase of any outpatient facility type, according to CBRE.
8. Operators are adjusting. Solara Surgical Partners plans to focus on the Southeast over the next five years, with acquisitions likely to make up part of that growth.
“There may be consolidation opportunities,” Chief Development Officer Steve Hockert told Becker’s in January.
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.
