Lumexa Imaging Holdings, Inc. Common Stock (LMRI) Q4 2025 Earnings Report, Transcript and Summary

Good morning, and welcome to Lumexa Imaging's Fourth Quarter and Full Year 2025 Earnings Call. [Operator Instructions] Please note that this conference is being recorded. I would now like to introduce Sue Dooley, Lumexa Imaging's Head of Investor Relations. Sue, please go ahead.

Thank you, and good morning, everyone. We appreciate you joining us today. Leading today's call are our Chief Executive Officer, Caitlin Zulla; and Tony Martin, our Chief Financial Officer. Before we begin, I want to note that we will be discussing non-GAAP financial measures that we consider helpful in evaluating Lumexa Imaging's performance. You can find details on how these relate to our GAAP measures, along with reconciliations in the press release that is available on our website. We will also be making forward-looking statements based on our current expectations and assumptions, which are subject to risks and uncertainties, including factors listed in our press release and in our various SEC filings. Actual results could differ materially, and we assume no obligation to update these forward-looking statements. With that, I'd like to now turn the call over to Caitlin. Caitlin, please go ahead.

Thanks, Sue. Good morning, and thank you all for joining us today on our first earnings call as a public company. The fourth quarter of 2025 marked a strong close to an important year for Lumexa Imaging, and we delivered steady and consistent growth in revenue and EBITDA that exceeds our preliminary earnings announcement. We generated consolidated revenue of $267.7 million, up 7.9% over Q4 of last year. Adjusted EBITDA of $63.8 million represented an 18.6% increase over Q4 of last year and delivered a 23.8% adjusted EBITDA margin. We completed 1.4 million advanced imaging exams system-wide in the quarter, which is a 7.7% increase year-over-year. 2025 was a year marked by several meaningful achievements for Lumexa Imaging. Here are a few of the highlights. We advanced our growth plans, achieving a record number of de novo openings and driving strong same-center growth. We launched a successful rebrand of the company, rolling out our new name, Lumexa Imaging to better represent our shared purpose, our innovative spirit and our commitment to bringing greater access and exceptional care to more patients and more communities. We completed our IPO, bringing greater awareness of our company to the investment community, broadening access to our value creation opportunity and by using proceeds to reduce our leverage profile, freeing up more cash to support our plans for profitable growth. I'd like to take a moment to reflect on the fundamentals of our business and the reason I believe we have a strong runway for continued growth. Our straightforward value proposition continues to resonate with patients, providers and payers as demonstrated by our high patient Net Promoter Scores, which are consistently over 90. We provide enhanced access to high-quality imaging that helps move patients through treatment in more convenient settings and at meaningfully lower cost than hospital outpatient department or HOPD sites of care. We benefit from several long-term demand tailwinds, including aging populations with complex and chronic conditions, new treatment paradigms that require advanced imaging, increasing rates of preventative screening and an ongoing migration from hospital and inpatient settings to outpatient imaging amidst a fragmented and capacity-constrained industry landscape. Our commercial efforts are directed at higher growth and higher reimbursing advanced imaging modalities, including MRI, CT and PET scans. We also offer routine modalities like X-ray and ultrasound, which are strategic and position us as a convenient and comprehensive solution for patients, even though those modalities are a less meaningful driver of our financial results. We are deploying a focused and disciplined profitable growth algorithm grounded in same-center growth, geographic expansion, strategic service line expansion and delivering efficiencies across our company, including select AI-enabled solutions. And by leveraging technology, including our existing tech stack as well as innovations being developed in coming months and years, we are well positioned to drive better outcomes and efficiencies. We turn the page to 2026 with confidence fueled by strong execution and a sense that at Lumexa Imaging, we are in the early innings of capitalizing on the opportunities ahead of us. We are inspired by our mission to expand access to high-quality imaging through elevated compassionate care, improving lives and advancing health care across the country. Next, I would like to take a moment to review the key strategic initiatives we have in our sights for 2026. First, driving same-center growth is our primary strategic focus. As a reminder, increased procedure volume generally accounts for approximately 2/3 of our revenue growth and the remaining 1/3 is attributed to rates, driven by both increases in both rate per unit and acuity mix or percentage of advanced modalities. Our commercial team is laser-focused on driving same-center growth. To bring this to life, I'll share a couple of examples from the fourth quarter. In Orthopedic, we launched a targeted marketing and sales outreach campaign, which drove incremental growth from one of our highest referring specialty provider categories during their peak surgical season. Another area where our teams are driving momentum is mammography. Approximately 85% of our screening volume comes from existing patients who returned for their annual exam, reflecting high levels of patient trust and retention. Leveraging our CRM capabilities and proactive scheduling during patient visits, we were able to meaningfully increase our annual screening compliance rate. We also initiated marketing efforts to drive a healthy increase in new mammography patients in 2025. When annual compliance rates increase, more instances of breast cancer are detected and treated early, saving lives and lowering the cost of health care. As we drive more demand within our existing centers, we are also taking steps to become more efficient to meet this growing outpatient imaging volume. Here are a few examples. With the benefit of an AI-enabled faster scanning technology, we increased schedule throughput by nearly 40% while also improving image clarity since introduction. Our FastScan integration and rollout was approximately 50% complete across all of our centers by the end of 2025, and we expect to reach about 2/3 adoption by the end of 2026. Another innovation we are integrating is virtual cockpit for remote MRI scanning. This technology allows us to minimize the impact of machine downtime, flex our staffing schedules and extend hours to serve our patients. Our next strategic priority for 2026 involves geographic expansion. We aim to achieve this through new de novo openings, JV partnerships and carefully selected M&A. We view de novo openings as foundational to driving future growth. In 2025, we opened nine new centers, a record for our company. As a reminder, our typical de novo ramps and reaches breakeven in about one year, and our 2024 and 2025 cohorts of centers are tracking right in line with those expectations. Looking ahead, we plan to open 8 to 10 de novos annually and are agnostic as to whether those are in wholly owned or joint venture structures. We opened our first de novo of the year in February and currently have very good line of sight to reaching our 2026 goal for new sites. We look forward to providing you with more details as the year unfolds. Joint ventures represent the next area of our strategic focus for 2026. Joint ventures are a key differentiator, aligning health system priorities with our expansion strategy. Health systems are increasingly seeking ways to participate in the rapid site of care shift to outpatient imaging and opportunities to grow their outpatient ambulatory footprint. Our JV model provides a highly effective entry point. Through the clinical, commercial and operational excellence we demonstrate, particularly in de novo development, Lumexa Imaging is well positioned to help systems execute against these ambitions while remaining focused on their broader enterprise priorities. In return, these partnerships accelerate our presence in any given market. We are cultivating a robust pipeline of potential partners with multiple ongoing conversations at various stages. I'd like to highlight a recent example that illustrates the power of our approach to joint ventures. In the back half of last year, we entered into a new partnership with the University of Pittsburgh Medical Center. Through this, we're working with UPMC to help them achieve their goals of providing access to lower cost, high-quality and more convenient imaging. At the same time, we are broadening our own footprint to include Pennsylvania, expanding our reach to 14 states. It's early on in our partnership, but we are actively advancing site location planning. We are energized to have been chosen as a partner by this results-oriented and forward-thinking health system. When it comes to M&A tuck-ins, we are continuously evaluating accretive opportunities and will remain very disciplined in our approach. At the end of the fourth quarter, we completed one small tuck-in acquisition of a new facility in North Carolina, an extension of our strong partnership with Atrium. Another strategic priority for 2026 involves offering new strategic service lines to drive acuity mix and achieve efficiencies through innovation. Two areas I'd like to highlight as examples are mammography with cardiac screening known as breast arterial calcification and PET. We recently launched breast arterial calcification or BAC screenings as a cash add-on assessment for cardiac health at our mammography locations in South Jersey. Cardiovascular disease is one of the leading causes of death for women with over 60 million women in the U.S. living with some form of heart disease. As noted in a study published in the Journal of the American College of Cardiology, BAC can be used as a biomarker to evaluate calcium buildup in the breast arteries, which may indicate increased cardiovascular risk. Acceptance of this add-on has been strong since inception. PET is another strategic area of focus for us and was a contributor to our growth and increase in acuity mix in 2025. Our Lumexa Alzheimer's Center of Excellence helps identify patients who may benefit from emerging onset dementia therapies with amyloid PET exams. Patients who receive this therapy need up to five MRIs for side effects monitoring. Improved pet access is a valuable way we can enable their care. Our full year PET volumes increased mid-teens on both a consolidated and system-wide basis. BAC and PET drive both volume and rate for us, and we're in the process of expanding these strategic service lines to other geographies. I'd like to take a moment to speak about our approach to innovation. At Lumexa, we take a partnering approach to leveraging technology and incorporating artificial intelligence across our business. We believe this approach allows us to accelerate adoption, benefit from reduced capital intensity and enjoy the flexibility to leverage the best proven solutions as they rapidly come to market. In the fourth quarter, we reached an agreement to partner with Ferrum Health, a leading AI convener. Simply put, Ferrum acts as an AI clinical imaging app store, providing us access to FDA-cleared apps through a single integrated pathway. Through this partnership, we can quickly turn on, evaluate and measure the effectiveness of hundreds of AI applications that we can implement across modalities and workflows while protecting our data and our insights. We're driving best-of-breed technology across our entire company. Our centralized back-office teams are also participating in this push for innovation as well, using emerging agentic and generative AI functions to increase efficiencies. Wrapping up, I'm pleased with our Q4 results, and our team is energized by the success to deliver on our strategic priorities for the year to come. We believe we're in the early stages of capitalizing on the significant opportunity ahead of us and that Lumexa is well positioned to deliver profitable growth this year and beyond. I want to say a huge thank you to our dedicated team members and our radiologists. Our accomplishments are a direct result of their hard work and commitment to providing the highest quality imaging experience for our patients who rely on us. I'll now turn the call over to Tony to review our fourth quarter in more detail. Tony?

Thank you, Caitlin, and thank you all for joining us today to discuss our results. On today's call, I'll review the financial results and speak to some key drivers of our performance in the quarter. I will then provide our outlook for full year 2026. To supplement my review of our GAAP financials on today's call, I will cite some system-wide metrics to help you better understand our overall performance and the breadth of our business. System-wide metrics include all centers that we operate, including the 102 that we wholly own as well as the 86 centers that we operate in our eight joint ventures with health systems. Our health system JV centers' revenues and expenses are not included in our GAAP revenues and expenses due to our minority ownership position, but they are important drivers of our performance because we do record our pro rata ownership share of their net income and their cash flows in ours, and we pick up our pro rata share of their EBITDA and our adjusted EBITDA. Details of our JV financial performance are included in our quarterly financial statement disclosures. We ended 2025 with a strong Q4 performance, one that exemplified our long-term growth algorithm and our focus on advanced modalities, including MRI, CT and PET. Consolidated revenues for the full year of $1.023 billion increased 7.8% compared to 2024. System-wide revenues increased 8.2% compared to 2024. We also delivered adjusted EBITDA of $230.2 million, which increased 14.6% compared to 2024, representing an adjusted EBITDA margin of 22.5%. Our cash flows were strong and delivered a more than half turn reduction in leverage ratio during a year in which we opened a record 9 new centers, with leverage coming down an additional 2 turns to 3.5x levered in December as a result of our IPO and related debt refinancing. Turning to our fourth quarter financials, starting with revenues. In the fourth quarter, consolidated revenues came in at $267.7 million, an increase of 7.9% compared to the same period last year. This growth was most heavily driven by our return in network with a large payer in New Jersey. We also saw an increase in the volume of procedures in other locations and a continued mix shift toward advanced imaging, which has higher rates. We experienced strong system-wide performance across all of our outpatient sites, both wholly owned and in JVs. As shown in our financial tables, system-wide revenue growth was 10.6% in the quarter. Revenue per unit, which includes both scan and read revenue, also benefited from modest increases in contracted rates with payers who appreciate our lower price point compared to hospital-based services. Our outpatient revenues also grew as we ramped four sites added in 2024 and the nine new sites we opened across 2025. Additionally, our professional fee revenues, which comprise our second operating segment, were $66.8 million, reflecting growth of 10.6%. Finally, management fee and other revenues were $57.2 million. These revenues consist of two primary components. First, we're paid a management fee by each of our health system JVs to operate the outpatient centers in those JV structures. Second, we employ center employees and directly pay for certain IT and other services on behalf of the JV sites and essentially lease them back to the JV without an associated margin. We call these pass-through revenues. We disclosed the amount of pass-through revenues in a table accompanying our quarterly earnings release. Expenses related to the refinancing of our debt and other transaction costs in our IPO year resulted in a GAAP net loss of $28.7 million for the quarter compared to a net loss of $25.1 million in the fourth quarter of last year. Adjusted EBITDA for the fourth quarter was $63.8 million compared to $53.7 million in the same period last year, representing an increase of 18.6%. Adjusted EBITDA margin was a healthy 23.8%, up 150 basis points from the prior year fourth quarter, underscoring the scalability of our operating model and strong execution of margin expansion initiatives. I'll remind everyone that adjusted EBITDA reflects our pro rata ownership share of EBITDA of all our centers, both the ones we wholly own and those in health system JVs. A quick note on stock-based compensation. Our stock-based comp can be viewed in two components. First is the expensing of shares that were issued as part of the purchase price for some businesses we acquired during 2020 and 2021. These costs will be fully amortized during 2026. Second is the expensing of equity instruments granted to management and employees, which is expected to continue to be part of stock comp beyond 2026. Turning to the balance sheet. We ended the quarter with $58.8 million of cash and cash equivalents compared to $26.1 million at the end of 2024. We've materially strengthened our balance sheet. As I described earlier, we delevered over half a turn simply through the operation of the business during 2025 despite opening a record nine de novos. Then in December, we used $406 million of net IPO proceeds to pay down debt, which reduced our leverage ratio by 2 more turns. In December, we also received improved credit ratings from both S&P and Moody's to B+ and B2, respectively, and we refinanced our term loan at a more favorable interest rate. The result of this balance sheet strengthening activity is an anticipated annual cash savings of more than $50 million. Sometimes people ask about the debt of our unconsolidated health system JVs. We'll always disclose that figure in our quarterly reporting. But I'll note here that the total at year-end was $69 million, attributed mainly to financing of equipment purchases at the centers. That number is not included in our balance sheet or our computation of leverage ratios for lenders. But if we were to include our pro rata ownership share of this debt, our leverage ratio would only increase by about 0.15x. We consider our JVs to be capital-efficient business models that support our growth objectives and generate significant cash flows for us and our health system partners. Our business continues to generate strong cash flow. Before moving to guidance, I want to reiterate our three capital allocation priorities. First, we plan to fund de novo facility growth, equipment upgrades and investments in strategic service lines. Second, we may make carefully chosen strategic tuck-in acquisitions. While these are part of our growth matrix, our 2026 guidance is not dependent on future M&A. And third, over the longer term, we aim to reduce our leverage profile to below 3x. Given the durable cash generation of our business, we believe we're well positioned to execute on these three priorities. Put another way, we believe our business provides the flexibility to naturally delever even while fully funding our ongoing capital needs and growth strategy. Now turning to our outlook for full year 2026. Unchanged from our pre-announcement earlier this month, we continue to expect revenue to be in the range of $1.045 billion to $1.097 billion and adjusted EBITDA to be in the range of $234 million to $242 million, which includes approximately $7 million of public company costs that were not incurred in 2025. At the midpoint, the adjusted EBITDA growth rate, excluding the addition of these costs in our first full year of operations as a public company would be 7%. And today, we're adding guidance for adjusted EPS, which we expect to be between $0.71 and $0.77 per share. We expect continued growth in volumes with advanced modalities growing faster and representing an increasing share of the mix. This is important as advanced imaging drives higher revenue per procedure and higher margins. Other modalities impact our profits, but some drive profit more than others, and our marketing efforts reflect that. For example, X-ray volumes were 15% of our system-wide volumes in 2025, but only 5% of our revenues. We do not provide quarterly guidance, but as we think about Q1, I want to share some additional color that may be helpful in framing expectations. From a seasonality perspective, the first quarter is typically our lowest for revenue and adjusted EBITDA. And then our results ramp throughout the year with the fourth quarter consistently being our strongest, driven by patients seeking care ahead of annual deductible resets. With Q1 2026 largely behind us, we want to note some atypical timing dynamics. First, we believe our strong Q4 performance was in part due to some pull forward of volumes from January into December. Second, New Jersey, Texas and three other Southern states were impacted in Q1 by storms, causing some impact to volumes. While we were able to recover a portion of these volumes within the quarter, we anticipate these dynamics to result in Q1 adjusted EBITDA being approximately flat compared to Q1 of 2025. We believe we can make up the remaining lost volume throughout the course of 2026, and we remain confident in our full year guidance. As we set our sights on the longer term, in alignment with the discussions we had at the time of our IPO, we believe we're building a durable growth engine fueled by de novo growth, same-center sales expansion and expanding strategic service lines. We're in the early days of implementing our growth initiatives. And as new centers ramp and acuity mix shifts with industry tailwinds supporting our growth, we believe we can consistently deliver revenue growth at least in line with that of the market. Further, our attractive unit economics give us confidence we can consistently grow our adjusted EBITDA at a rate higher than our revenue growth. Wrapping up my review of our financials. 2025 was an exciting year of milestones and profitable growth, and we put the building blocks in place for long-term shareholder value creation. Echoing Caitlin, I'm pleased with our performance in the quarter, ending the year on strong footing. I also want to recognize that none of it would have been possible without the hard work of our dedicated team. Operator, would you please open the call to questions.

[Operator Instructions] Our first question comes from the line of John Ransom with Raymond James.

So as we think about 2026, how do we think about the growth in advanced imaging versus routine? Does it look like 2025? I know there was a distortion from the Blue Cross tuck-in. And then as you think about the rhythm of opening your new centers, how do we think about the quarterly rhythm of that as we move through the year?

Thank you so much, John. Yes. So we remain focused on continuing the growth of our advanced imaging. We are incredibly proud of the strength that we were able to show in fourth quarter and throughout the year. As we said in our prepared remarks, throughout the year, advanced imaging grew 8% on a same-center basis, 7.1% on -- excuse me, on a consolidated basis and 7.1% system-wide. We will continue to see that growth at a rate higher than our routine. When we think about routine, it really is combined of three different modalities. You have your ultrasound, your mammography and your X-ray. X-ray, just by the nature of the speed and the accessibility, it is the largest end. It's the biggest number. It's the biggest piece. And obviously, we provide that for strategic reasons. But as Tony shared in his prepared remarks, it is not correlated to the overall performance of the business, and you saw that in Q4. So we'll continue to focus on the strength of advanced and excited to see that continue to grow. And then answer your questions about de novos, thrilled to say that we've already opened up this year, on track to deliver that 8 to 10. We've got really good visibility in terms of pacing, expect it to be more second half of the year weighted with more of the openings, but we will have some additional openings in the first half as well.

Our next question comes from the line of Whit Mayo with Leerink Partners.

Tony, any help on cash flow and CapEx for the year? And then how much of the CapEx is expected to be the equipment upgrades? Just any thoughts would be helpful.

Sure, Whit. Yes, as I've discussed in the prepared remarks and previously, it's a strong cash-generating business, thankfully. We're able to carry out all of our growth initiatives while delevering each year. And that really sets us up, especially after the IPO, bringing down our debt and generating even more cash to be used in the future to kind of continue that delevering. As to how that's played out in 2025, we will be filing our 10-K not later than March 31, which will have more details on how -- what the spend consists of. But we do remain heavily focused on the de novos as a huge chunk of that spend, investing in the existing centers for growth. And then there is a maintenance component that is kind of the minority of the spend, but is necessary to ensure that we continue to have what we need at the existing sites.

Okay. Well, just back on the cash flow this year, just trying to think about the bridge from '25 to '26. Would it be just simplistically easy to look at just the EBITDA growth and then adding back the $50 million of interest savings to get to a reasonable number? Or are there any other variables or considerations that we should think about?

At this point, we're not really guiding on cash flow. And so I'll caveat whatever I say about that, at least for the moment in our young, early journey as a public company. But yes, high level, the company is experiencing the EBITDA growth you described, a lot of interest savings. 2026 will continue to be kind of a high capital spend year just because of the continuation of what we did in 2025 in terms of the growth CapEx and ensuring that the fleet is fully up to current needs for us. So we've spent a little more on maintenance than usual, and we'll probably continue to do that in 2026. But directionally, you're thinking about it the right way.

Our next question comes from the line of Benjamin Rossi with JPMorgan.

Just on the rate side within your 2026 guidance, what are you factoring for pricing in 2026? And how are you thinking about expectations for rate growth across your main books for commercial, Medicare and Medicaid payers this year?

Thank you so much, Ben. Yes, Tony, maybe I'll let you talk a little bit about how we assume our growth algorithm.

Sure. Sure. Over time, our growth is driven about 2/3 by volume and 1/3 by rate. And that kind of drives the 7%-ish same-site growth that we have in the outpatient segment. If you look at our consolidated financials, we show top line revenue growth a little bit less than that because we do have a second segment, which is a lot smaller than the outpatient segment, and it grows a little bit less, more like 5%. And we've talked about how that fits into our overall strategy to drive that business. So that creates a kind of a blended growth rate of more like 6% -- 5% to 6% top line. But that outpatient business is more like 7%, 2/3 of it by volume, heavily by growth in advanced modalities. So the growth in the advanced kind of -- it represents about half of what we experienced in terms of rate increase because those just reimburse higher, 3x to 4x higher. So as we have more business in that, it generates some rate growth. And then the kind of the remaining half of what we call rate growth is driven just by escalators in contracted rates in the commercial book. And that's -- we believe we're actually kind of thinking of that very conservatively at this point.

Our next question comes from the line of Andrew Mok with Barclays.

Just wanted to follow up on the cash flow and CapEx. Can you give us a sense for total system-wide CapEx expected for 2026? And help us understand how that's expected to flow through the P&L and cash flow statement, especially on the nonconsolidated portion.

Sure. We're not, at this point, putting a number out there in terms of how much that's going to be numerically. I think it does flow through a combination of ways on our cash flow statement. For our consolidated sites, it's in our investing activities to the degree we use our own cash. There's also a supplemental disclosure that talks about CapEx that we fund just by capital leasing those assets, which involves no cash outlay. So you'll see that in our 10-K when we file in terms of what the 2025 numbers are. The amounts we spend on the health system JVs are burden the cash distribution that we get from them. So that's something we'll talk about more as we get a little bit more mature as a company. We're keeping our guidance metrics pretty limited at the moment, but we're going to be happy to show more about that in the future.

If you're not giving 2026, can you share where total system-wide CapEx landed for 2025?

I believe -- I don't know that that's going to be in our 10-K explicitly. But I think in our talks during the -- during our going public process, system-wide, we were spending something north of $100 million with our pro rata share of that being significantly less because for the part we spend in the health system JVs, we split it pro rata with our health system partner.

Our next question comes from the line of Ryan Daniels with William Blair.

This is Matthew Mardula on for Ryan. So, in your prepared remarks, you touched up on this regarding Q4 results. But since a majority of patients come from referring physicians, how is the team positioned for this year to increase patient referrals to your imaging centers? And are you planning to do any more initiatives or changes to build as well as increase physician relationships for this year?

Yes, Matt, thank you so much. So we have a strong engagement strategy with our referring physicians. We have over 120 sales reps that are embedded in our markets that engage with over 100,000 referring physicians. So incredibly engaged. When we think about -- we first focus on our highest referring specialties, your ortho, your neuro, your ENT, your pain, your urology and your gastro. We highlighted a specific campaign we did on orthopedics in Q4 in our prepared remarks, very much because that is their busy season as well. And so orthopedics need imaging, and we were able to provide that for them. We also have marketing efforts, specifically as we think through women who canceled their mammograms during the snow days in Q1. And so a very targeted outreach to make sure that we are rescheduling and getting our patients back on the schedule to get their mammograms. So we'll continue to have a high level of engagement with our referring physicians and making sure we've got targeted messaging and strategies to meet their needs.

Our next question comes from the line of Stephen Baxter with Wells Fargo.

Thanks for the color on Q1. That's helpful. It would be great to potentially understand how you're thinking about it on potential volume impact or maybe same-store revenue impact from the weather and kind of pull-forward dynamics. And then as you're thinking about the balance of the year outside of Q1, any sense of how much you're assuming of the volumes that you haven't recovered yet that you might actually get versus what kind of just leaks out and doesn't ultimately occur?

Yes. Thanks so much, Stephen. I appreciate the question. As we said a bit in the prepared remarks and obviously saw at SCA and USPI, Q4 was always our highest quarter related to deductible reset. And so really proud of the efforts that the team put in to drive strength in Q4. And obviously, we'll be replicating that as we think about 2026. We think about kind of the impact in Q1, about 50-50 kind of 50% acceleration in Q4 and then about 50% of it being about weather impact. Team is actively engaging. Certainly, we know any patients that had scans on the schedule and we're -- our call center -- centralized call center is reaching out to reschedule them. And then we have our sales team engaging with referring physicians who also had a backlog. So we feel really confident that we'll be able to continue to drive the volume growth. We're seeing strength post storm, especially in the advanced no growth. And the combination of our strong sales efforts as well as just the operational strength of our team, feel confident in the full year guidance.

Great. Yes, that's very helpful. And then maybe also if you could potentially provide a comment on maybe some of the current macro conditions. Obviously, people are watching closely when it comes to things like oil prices and gas prices and things of that nature. I guess how are you thinking about that? Like is there any exposure within your own P&L that we need to be mindful of? And then as you think about the money you're spending on capital, I guess, how are you thinking about potential downstream impacts to the capital projects that you might have?

Yes. Thank you so much, Stephen. We are very much keeping an eye on all things macro and all things within our supply chain. And right now, we see no risk at all to Lumexa Imaging. We've specifically received some questions regarding helium. Just as an example, helium has actually been in shortage for several years, and we have strong service contracts with our original equipment manufacturers that give us fair pricing. We also have a number of secondary sources and all of those have fixed rates, same with gadolinium. And just in terms of context, some of the newer MRs require actually less helium than older models. And so the equipment refreshes that we've been doing intentionally over the last few years provide us further security. So no concerns at this time that you need to be thinking of.

[Operator Instructions] Our next question comes from the line of Brian Tanquilut with Jefferies.

You got Jack Slevin on for Brian. Caitlin, I wanted to ask some really interesting commentary around your rollout of FastScan and other throughput initiatives. Can you maybe talk a little bit about -- I heard the progression of we're going to get to 2/3 by the end of this year. But can you -- are there any early reads on sort of what that means from an efficiency standpoint or sort of the volume inflection you've been able to see as you've rolled that out across the first half of the portfolio?

Yes. Thanks so much, Jack. Appreciate the question. So we are very excited about FastScan. It's an initiative that we have been working on over years, proud to be at 50% of our MRI fleet with FastScan at the end of last year. Very simply, FastScan truncates the amount of time it takes to do an exam. So, for an ankle MRI on a Siemens, it takes it from 22 minutes down to 8. It is better for the radiologist because the image is higher quality. And then it is better for the patient because they have to spend less time in the claustrophobic MRI tube. And then, of course, it's better for us because it opens up additional scheduling capacity, typically about 40%. We are very measured in all capital deployment and including FastScan, we can get FastScan capabilities either by acquiring a new machine or by providing bolt-on software. It's about $150,000. So obviously, a meaningfully lower price point. And we always want to make sure that we will be able to drive a strong IRR that will meet our investment thresholds. So we make sure we have that business case approved before we roll it out. So excited for the continued growth, and that's a big part of giving us the confidence that we'll be able to drive the insight growth in 2026 and beyond that we've shared in our growth algorithm.

Our next question comes from the line of Pito Chickering with Deutsche Bank.

I guess going back to sort of 1Q, you guided sort of flat EBITDA year-over-year, but your guidance was maintained for the year. So, originally, we're modeling quarterly guidance -- quarterly EBITDA growth of about 6.7% at the midpoint of the range, excluding the $7 million of public costs for every quarter this year. Now first quarter is flat. So just mathematically, we should be modeling sort of 9% quarterly EBITDA growth from 2Q to 4Q. I'm just sort of curious what you -- it seems like a big step up for the rest of the year with a flat first quarter. I guess what gives you guys conviction EBITDA growing at 9% for the rest of the year?

Sure. I think, Pito, thank you for the question. I think broadly, we have great momentum in the business. So we have strength of our advanced mods. We have the record year of de novo openings in 2025 that are ramping well. The pacing of last year was more first weighted than second half, and we already have the one open in 2026. We also have multiple ongoing JV conversations at various stages. It gives us confidence in the broader need for our service and our model. And then we have the tuck-in acquisition that we shared in December, and we're building a pipeline of acquisition opportunities. And then on top of that, we've got conviction and proof points in advancing our strategic service lines like our breast arterial calcification, great uptake in New Jersey and great clinical results for our patients, first and foremost. And so we'll be thinking about how we expand that as well. Tony, anything else you'd add about how we think about pacing throughout the quarters?

Yes. As we discussed, it is a seasonal business and ramps, and it happens in kind of different rates year-to-year depending on things like weather and depending on how significant deductible reset driven behavior is. So that will change, but we do ramp up every year quarter-by-quarter. And weather events and other disruptions in individual sites happen with referring physicians being closed down for a couple of days or us being closed down for a couple of days. So we have a playbook that we use to get that volume back. It's part of doing business in this space. All health care services providers have those playbooks, and we certainly do and have put them to work. So we do expect to kind of pull that rest of that volume in at some point, and that adds to our conviction in our annual guidance.

Our last question is a follow-up from the line of John Ransom with Raymond James.

Just a couple more for me. What was the professional fee revenue in the fourth quarter and for the full year?

For the fourth quarter, it was $66.8 million.

Okay.

And the full year figure, I think I put in my prepared remarks, but I certainly have it.

I can get that. I mean I can get that offline.

Yes, and that will certainly be in our 10-K. We're going to be filing that not later than the 31st. But yes, we can certainly get that.

And then my other -- and then what was the professional fee -- last year, fourth quarter professional fee?

Yes. It -- the growth rate was 10.6% year-over-year. So I'll answer your question that way.

Does professional grew that much?

Yes.

Okay. All right. And then secondly, we've kind of been back and forth on how to manage -- or excuse me, how to model management fee plus pass-through. So, in your disclosure, we had thought about management fees as being 10% of the revenue of your unconsolidated. So it looks like management fees are higher than that, and that probably includes some stuff in your other revenue segments. But how do we think about managing -- modeling management fees? And what kind of margin does that business generate? Because I know you don't break out the costs, but just help us model that versus the pass-through in 2026.

Yes. Good question. And I'm glad we're able to highlight the pass-throughs because that's a big chunk of revenues that doesn't really drive anything in an EBITDA standpoint. So your question about what to focus on in terms of modeling it makes a lot of sense to me. I think what you've seen in the recent trend is the best indicator of the future on that. It is from a pure management fee standpoint, driven by a percentage of the revenues of the underlying JVs, which you can see the growth rates that are happening at that level. It is -- there is a little bit of other revenue in that as well for some other services we provide. So I think that combination is not likely to change a whole lot in terms of how it's growing and how you're looking at it.

So grow it sort of in line with consolidated revenue growth -- or I'm sorry, with system-wide revenue growth?

I think, generally speaking, that's how we look at it, yes.

I would now like to hand the call back over to Caitlin Zulla for closing remarks.

Thank you for the questions today, and thank you for your continued interest in Lumexa Imaging. As you've heard throughout the call, we are entering 2026 with strong momentum, a clear strategy and deep confidence in our ability to execute. Our team remains focused on delivering exceptional patient care, expanding access to high-quality imaging and driving disciplined, profitable growth. I want to close once again by thanking our dedicated team members and our radiologists. Their commitment to our mission and to the patients and the communities we serve continues to be the foundation of our success. We appreciate your time today and look forward to updating you on our progress in the quarters ahead. Thank you.

This concludes today's conference. Thank you for your participation. You may now disconnect.