The prospect of carrying out a several-million-dollar surgical construction project can be overwhelming. But breaking your start-up costs into bite-sized chunks can help make it more manageable. Plus, the budgeting process impels you to think through your plan in a step-by-step fashion. There are six major fixed expenses involved in building an ambulatory surgical center from scratch: land acquisition, site development, design, construction, equipment and furnishings. Here are some guidelines for figuring your costs.