Healthcare Services M&A Valuation Multiples, 2023–2026: Benchmarks by Segment, Size and Year
Key findings
Across 187 control transactions announced from January 2023 through October 2026, U.S. healthcare services businesses sold at a median of 0.88x revenue and 9.6x EBITDA (68 deals with positive EBITDA). Excluding bankruptcy and other distressed sales, the medians rise to 0.98x revenue and 10.1x EBITDA.
Multiples held in a band, not a trend. Median EBITDA multiples ran 11.4x (2023), 9.7x (2024), 6.5x (2025) and 9.1x (2026 year to date). The 2025 dip reflects a smaller, more mid-market mix rather than a broad repricing.
Scale is the largest single driver. Deals above $200 million traded at a median 11.2x EBITDA and 1.34x revenue; deals below $10 million at 2.8x EBITDA and 0.27x revenue.
Segment spread is wide. Outsourced services (2.8x revenue, 11.6x EBITDA) and ambulatory surgery centers (1.24x revenue, 12.4x EBITDA) sit at the top; hospitals (0.41x revenue, 9.5x EBITDA) and primary care practices (0.11x revenue) at the bottom.
Distress compresses value sharply. The 22 distressed sales with reported revenue traded at a median 0.15x revenue, most of them hospitals sold out of the Steward, Prospect and other bankruptcies.
Small practice acquisitions price near asset value. Hospital purchases of individual primary care practices, largely in West Virginia, cluster at 0.05x to 0.15x revenue, consistent with equipment and records rather than goodwill.
Data and methodology
The benchmarks draw on BuckheadFMV's transaction research database of 215 U.S. healthcare transactions announced between 2023 and 2026, of which 187 meet the screens below.
Sources. Every transaction has a disclosed or court-approved price and target financials from a primary source:
SEC filings (8-Ks, 10-Qs, 10-Ks, merger proxies) of public buyers and sellers.
State certificate-of-need and transaction-notice filings (New York, Illinois, Connecticut, Oregon, California, Massachusetts, Rhode Island, Maine, Michigan, Kentucky, West Virginia, New Jersey).
Bankruptcy court sale approvals.
Medicare cost reports for hospital revenue and EBITDA.
Screens.
Announced (or application filed) January 1, 2023 through October 31, 2026.
Control transactions only, including deals that moved a buyer into majority control. Minority and physician-syndication stakes are excluded.
Distressed and bankruptcy sales are included and flagged; medians excluding them are shown where they differ materially.
Transactions whose target revenue was estimated rather than disclosed are excluded.
Definitions.
Enterprise value (EV) is the disclosed price, grossed up to 100% where a majority stake was sold.
Revenue is net revenue for the latest full fiscal year before announcement, or the run-rate disclosed with the deal.
EBITDA is as reported by the parties or computed from cost reports and filed financial worksheets as net income plus interest, taxes, depreciation and amortization. EV/EBITDA is shown only where EBITDA is positive.
Statistics are medians with the interquartile range (25th to 75th percentile). Cells with fewer than three observations are noted.
Limitations. Disclosure is uneven: large and public-company deals report EBITDA far more often than small private ones, so EBITDA medians lean toward larger transactions. Prices may include real estate in some deals and exclude it in others. Many state-filing prices reflect partial interests or negotiated terms that are not market tests of full enterprise value.
Market overview by year
Disclosed deal flow was steady at roughly 40 to 60 control transactions a year. Median multiples moved within a band rather than along a clear trend. The low 2024 revenue median reflects the Steward and CarePoint bankruptcy hospital sales; excluding distressed deals, the 2024 medians are 0.97x revenue and 11.3x EBITDA. The 2025 EBITDA median rests on 15 transactions weighted toward mid-market home-based and hospital deals.
Year | Deals | EV/Revenue median (IQR) [n] | EV/EBITDA median (IQR) [n] | EV/EBITDA excl. distressed |
2023 | 46 | 1.06x (0.40x–2.26x) [45] | 11.4x (7.8x–14.6x) [12] | 11.5x |
2024 | 58 | 0.63x (0.20x–1.54x) [55] | 9.7x (5.7x–13.9x) [28] | 11.3x |
2025 | 44 | 0.77x (0.20x–1.71x) [42] | 6.5x (3.6x–11.2x) [15] | 6.5x |
2026 (through October) | 39 | 0.93x (0.19x–1.70x) [38] | 9.1x (7.9x–10.8x) [13] | 9.1x |
All years | 187 | 0.88x (0.20x–1.68x) [180] | 9.6x (4.6x–13.6x) [68] | 10.1x |
By transaction size. Enterprise value is the clearest single predictor of the multiple paid. Transactions below $10 million are mostly single practices and small facilities priced close to tangible asset value.
Enterprise value | Deals | EV/Revenue median (IQR) | EV/EBITDA median [n] |
Under $10 million | 70 | 0.27x (0.07x–0.86x) | 2.8x [11] |
$10 million to $50 million | 33 | 1.32x (0.59x–2.55x) | 3.7x [7] |
$50 million to $200 million | 25 | 0.96x (0.37x–2.33x) | 10.6x [11] |
Over $200 million | 59 | 1.34x (0.69x–2.62x) | 11.2x [39] |
Multiples by segment
Outsourced services and laboratories command the highest revenue multiples; hospitals and professional services the lowest, with hospital EBITDA multiples near 10x once distressed sales are set aside.
Segment | Deals | EV/Revenue median (IQR) | EV/EBITDA median (IQR) [n] | Distressed deals | EV/EBITDA excl. distressed [n] |
Professional Services | 49 | 0.25x (0.09x–1.35x) | 2.8x (1.4x–12.4x) [9] | 3 | 2.8x [9] |
Hospitals | 43 | 0.41x (0.14x–1.09x) | 9.5x (4.8x–13.1x) [26] | 16 | 10.4x [22] |
Specialty Outpatient Facilities | 30 | 0.99x (0.61x–1.79x) | 12.4x (9.6x–16.3x) [4] | 2 | 12.4x [4] |
Home-Based Services | 25 | 1.11x (0.79x–1.28x) | 7.3x (5.1x–11.2x) [10] | 0 | 7.3x [10] |
Outsourced Services | 11 | 2.80x (1.52x–3.74x) | 11.6x (9.3x–15.9x) [8] | 0 | 11.6x [8] |
Laboratories | 8 | 1.99x (1.33x–5.45x) | — | 2 | — |
Managed Care | 7 | 0.28x (0.25x–0.62x) | 9.6x (7.9x–23.8x) [4] | 2 | 10.0x [3] |
HealthTech | 6 | 2.66x (2.27x–2.82x) | 31.4x (23.8x–42.2x) [3] | 0 | 31.4x [3] |
Behavioral Health | 4 | 0.63x (0.47x–1.39x) | 4.4x [2]* | 0 | 4.4x [2]* |
Other (pharmacy, post-acute, optical) | 4 | —* | —* | 1 | —* |
* Fewer than three observations; shown for completeness, not as a benchmark. IQR = interquartile range (25th–75th percentile). Professional services EBITDA multiples are drawn mostly from small practice transactions and are not representative of platform-scale physician groups.
Segment commentary
Hospitals. Hospital values split on scale and financial health. Non-distressed hospital deals above $200 million traded at a median 11.2x EBITDA and 1.16x revenue; smaller non-distressed deals at 6.1x EBITDA and 0.28x revenue. Sixteen of the 43 hospital transactions were distressed, mostly Steward, Prospect and Community Health Systems divestitures, and many sold for nominal prices against substantial revenue.
Ambulatory surgery centers. ASCs are the most consistently valued facility type at a median 1.24x revenue. The few transactions with reported EBITDA cluster at 10x to 16x, in line with health system and national operator buy-ins. Partial-interest physician buy-ins, excluded here, often price well below these levels.
Professional services. Physician practice transactions with disclosed financials are mostly small, hospital-acquired practices priced near asset value (median 0.11x revenue for primary care). Physical therapy acquisitions by public consolidators are a clear exception at a median 1.65x revenue.
Home-based services. Home health, hospice, personal care and durable medical equipment traded in a narrow band of roughly 1.0x to 1.3x revenue, with EBITDA multiples of 5x to 12x depending on payer mix and scale.
Outsourced services, laboratories and HealthTech. These non-provider segments carry the highest revenue multiples (2.0x to 5.5x medians), reflecting higher margins, recurring contracts and scalability. Distressed genetics laboratory sales (Invitae, 23andMe) pull the laboratory range down.
Using these benchmarks
Market multiples are a starting point, not a conclusion of value. Where a business falls within a range depends on its size, growth, payer mix, margins, regulatory position and the buyer pool. The same multiple can also mean different things depending on whether real estate, working capital or debt is included in the price.
BuckheadFMV provides fair market value opinions, business valuations and transaction support for hospitals, physician groups, ambulatory surgery centers, home-based care providers and other healthcare organizations. To discuss how these benchmarks apply to your organization, contact us at buckheadfmv.com.
These benchmarks summarize publicly disclosed transactions for general information only. They are not a valuation opinion or an opinion of fair market value for any specific transaction.
This transaction data is one source of market information among many. In its valuation engagements, BuckheadFMV relies on multiple sources of market data, including transaction databases purchased from third-party providers, and selects the data appropriate to each engagement based on its facts and circumstances. BuckheadFMV is not bound to use any of the transactions presented here in any engagement, and does not rely on them exclusively or to any particular degree. These benchmarks are published to make additional market information available to the healthcare industry.
Transaction detail
The transaction data behind these benchmarks is available for purchase and download in the BuckheadFMV store for $250. The Excel workbook lists the 187 transactions used in the statistics, plus 28 minority-interest and estimated-financials transactions for reference, with the date, target, acquirer, state, segment and facility type, enterprise value, revenue, EBITDA, valuation multiples, distressed-sale flag and source for each.
