2026 ASC Rate Benchmarks

Intro

Our earlier guide covered how to compare your surgery center's rates: which lenses matter, what the CY2026 rules changed, and where benchmark data comes from.

This post supplies the numbers.

We analyzed 358.9 million negotiated-rate records covering 7,427 ambulatory surgery centers across all 50 states, and pulled national facility rate benchmarks for five of the most common ASC procedures. We also cover what had to be stripped out before those numbers meant anything, because the cleanup is where most benchmarking efforts quietly fail.

What Are ASCs Actually Paid? National Facility Rate Benchmarks

Short answer: commercial ASC facility rates for common procedures run from roughly $600 to roughly $2,000 nationally, depending on the procedure, with payer-to-payer variation of up to about 1.5x on the same code.

The table below shows national median facility rates. These are facility fees, meaning what the surgery center is paid for the room, staff, supplies, and equipment. They do not include the surgeon's professional fee, which is negotiated separately.

How these were calculated. Each payer's median is computed first, then the median is taken across payers. This keeps a payer that publishes more rows from dominating the result. Rates are restricted to fixed-dollar negotiated amounts on the institutional billing class, and payers whose published values behaved as flat defaults rather than negotiated prices were excluded.

What the pattern shows

Two things stand out.

Payer variation is real but uneven. The GI procedures show the widest spread, with the highest-paying national payer around 1.5x the lowest for the same code. Orthopedic and pain procedures cluster much more tightly, closer to 1.1x. If you negotiate every code with the same energy, you are spending it in the wrong places. Endoscopy is where payer selection moves the number most.

These are national medians, not your benchmark. A national median tells you the order of magnitude. It does not tell you whether your rate is competitive, because your comparison set is local: the surgery centers in your market, under your ownership model, with your payer mix. A center at the national median can sit in the bottom quartile of its own metro. That gap between national context and local position is the entire point of benchmarking.

Why These Numbers Are Hard to Produce

Everything above came out of public payer files. So why can't a surgery center pull it themselves?

Because a machine-readable file, or MRF, is a publishing artifact, not a price list. It contains genuine negotiated rates, placeholder values, several different pricing methods, and two different kinds of fee, all in the same column, with nothing marking which is which.

Four traps account for most of the damage. Each one produces a benchmark that looks reasonable while being wrong by a wide margin.

Trap 1: Flat Default Rates That Look Like Negotiated Prices

The most damaging trap, and the least visible.

One national payer in our dataset publishes a single identical dollar amount across 4,523 distinct procedure codes. Another repeats one amount across 650 codes, including Category III codes, which cover emerging procedures that often have no established payment at all.

These are defaults, filler populating rows where a real rate does not exist or was not published. They sit in the same column as genuine rates, formatted identically.

The effect on a benchmark is direct. For one payer, its default value was the single most frequent number in its colonoscopy distribution, enough to pull that payer's median onto the default exactly. That payer was excluded from the table above for this reason.

How to spot it: take a value and count how many distinct billing codes carry it. A real negotiated rate appears on a handful of clinically related codes. A default appears on hundreds or thousands, usually with an identical row count on every one. That repeated row count is the tell, and it is invisible if you only look at one code at a time.

Why it survives normal cleanup: defaults are not extreme values. They sit in plausible mid-ranges, which means interquartile filtering and outlier screening leave them untouched and drop them straight into your median.

One nuance worth knowing. Not every repeated value is filler. Payers do apply a single grouper rate across a bundle of clinically related codes, which is legitimate contracting. The distinction is scale and shape: a real grouper covers dozens of related codes across many facilities, while a default sprays one number across thousands of unrelated codes with a uniform, low row count on each.

Trap 2: Facility Fees and Professional Fees in the Same Column

A surgery generates two bills. The facility fee covers the center. The professional fee covers the surgeon and anesthesiologist. They are negotiated separately, paid separately, and are not comparable.

Both can appear under the same ASC identifier in payer files. Billing class distinguishes them, and it is the field most people skip.

The gap is not small. For diagnostic colonoscopy, the professional rate runs roughly half the facility rate. For cataract surgery, roughly two thirds.

Blend them and you get the midpoint of two unrelated things, well below what a surgery center should be measuring against. Every figure in the benchmark table above is institutional billing class only. If a comparison set does not say which class it used, assume it is blended.

Trap 3: Rates That Are Not Dollar Amounts

Not every published rate is a price. Across our ASC records:

• 54% are negotiated fixed-dollar amounts
• 33% are fee schedule amounts
• 13% are something else: a percentage of billed charges, a per diem, a derived value, or another method

Roughly one in eight ASC rate records is not a dollar figure for a single procedure.

A percentage of charges is a formula whose real value depends on your chargemaster. A per diem is a daily amount that may cover several services. A case rate bundles an episode. Average these together and the result describes nothing.

This is the most mechanical trap and the easiest to fix, and also the most commonly skipped, because the column looks numeric and averages without complaint.

Trap 4: Assuming Your Center Has One Rate Per Code

Most ASC leaders describe contracts in the singular. The colonoscopy rate. The cataract rate.

The data disagrees. Across 5,592 surgery centers publishing a colonoscopy facility rate, most carry more than one distinct published price for that single code. Some carry a handful. At least one carries twelve.

The reasons are ordinary. A payer contract covers multiple plan products, and commercial, exchange, and administrative-services lines can each carry different terms under the same agreement.

The consequence is not. Benchmark using one rate from one contract and you are measuring a fraction of your own position. Your effective rate depends on payer mix across those plans, and a center can hold a strong headline rate while most of its volume prices well below it.

A Note on Percent of Medicare

Percent of Medicare is the most quoted figure in ASC benchmarking and the easiest to get wrong.

Medicare pays surgery centers from the ASC payment system, a different fee schedule from the Physician Fee Schedule that pays surgeons. Both exist for the same procedure codes and produce very different numbers.

Compare a facility rate against the physician schedule and the percentage is meaningless, and meaningless in a specific direction: it inflates how many rates appear to fall below Medicare, because the denominator is too small.

If a report quotes a percent-of-Medicare figure for facility rates, ask which schedule sits underneath it. If nobody can answer, the number is not usable.

What Clean ASC Benchmarking Requires

Skip any step and you will still get a number. It will look like a benchmark.

How Gigasheet Produces ASC Benchmarks

Every trap above is a normalization problem, and normalization is the work.

Gigasheet resolves billing class, standardizes pricing methods, screens repeated values that behave like defaults rather than negotiated rates, and applies the correct Medicare reference for the setting. What comes out is a comparable rate with a Provider Rate Score showing where it sits against the market, and percentile bands showing the full distribution rather than a single midpoint.

The national medians in this post are the starting point. Your position against local peers, payer by payer, is the part that changes negotiations.

Frequently Asked Questions

What is the average ASC rate for a colonoscopy?

The national median facility rate for diagnostic colonoscopy (code 45378) is roughly $820. This is the facility fee only and does not include the physician's professional fee. Individual rates vary meaningfully by payer, market, and ownership type.

How much do surgery centers get paid for cataract surgery?

The national median facility rate for cataract removal with lens insertion (code 66984) is roughly $1,640, with national payer medians varying by about 1.2x.

How much does ASC reimbursement vary between payers?

It depends on the procedure. GI procedures such as colonoscopy and upper endoscopy show the widest variation, with the highest-paying national payer around 1.5x the lowest. Orthopedic and pain management procedures cluster more tightly, closer to 1.1x.

What is the difference between an ASC facility rate and a professional rate?

The facility rate pays the surgery center for the room, staff, supplies, and equipment. The professional rate pays the surgeon and anesthesiologist. For colonoscopy the professional rate runs roughly half the facility rate, so blending them produces a misleading benchmark.

Why can't I benchmark ASC rates directly from payer machine-readable files?

Payer files mix genuine negotiated rates with flat default values, combine facility and professional fees in one column, and include pricing methods that are not dollar amounts. Without normalization, calculated benchmarks reflect the mixture rather than real market rates.

Which Medicare schedule should ASC rates be compared against?

Facility rates should be compared against the Medicare ASC payment system, and professional rates against the Physician Fee Schedule. Using the physician schedule for facility rates overstates how many rates fall below Medicare.