And you need a full time manager who does nothing but keeps up with the regulations and insures that everything is running to code - CMS, AAAHC, etc.
Then you need someone who can insure everyone is credentialed correctly - all staff that has access to the ASC has been properly credentialed, background checks, licenses, insurance.
Then the ASC needs it's own malpractice insurance, not to mention business insurance, as it needs to be run as a separate corporation from your clinic. Then if they occupy the same space, the IRS may deny the incorporation.
Our ASC has 2 surgical rooms and a procedure room (no anesthesia in that room). We have 8 pre- and post-op bays. Ours is a Certificate of Necessity state, so it took a lot of money and time to get that. We have about 12 surgeons and 2 physiatrists actively using it, with full time staff of about 10 nurses, and 6-8 part-time nurses, plus a supply clerk, housekeeping who does sterilization also, front desk, schedulers and the manager. Operational costs probably exceed $1M per year. It cost $4-5M to build 5 years ago.
It is an incredible amount of work and money and unlikely that a small office can effectively run one on their own.