Lumexa Imaging (LMRI) 2026 年第二季法說會：高階影像產品組合創新高，財測指引收窄

重點摘要

• 2026 財年第二季合併營收年增 5.1% 至 2.642 億美元，全系統營收則成長 6.0%。
• 全系統高階造影檢查量成長 6.3%，占總檢查量比重達創紀錄的 37.4%，年增 111 個基點。正子斷層造影 (PET) 檢查量成長 23.2%。
• 調整後 EBITDA 為 5,640 萬美元，與去年同期的 5,630 萬美元大致持平。調整後 EBITDA 利潤率由 22.4% 降至 21.4%，部分反映上市公司相關成本增加及新設據點的投資。
• 淨利改善至 270 萬美元，擺脫去年同期 720 萬美元的淨虧損。GAAP 每股盈餘 (EPS) 為 0.03 美元，調整後 EPS 為 0.20 美元。
• 自由現金流達創紀錄的 2,310 萬美元，相比 2025 財年第二季為負 250 萬美元。淨槓桿率由 5.7 倍降至 3.6 倍。
• 管理層將全年調整後 EBITDA 預測區間收窄至 2.35 億至 2.41 億美元，中位數維持於 2.38 億美元。營收與調整後 EPS 預測則重申不變。

核心財務數據

業務與營運表現

全系統門診檢查量成長 3.1%。高階造影檢查量在全系統成長 6.3%，在合併基礎上成長 6.8%。這類檢查的報銷給付率通常為常規檢查的 3 至 4 倍。

全系統磁振造影 (MRI) 檢查量成長 7.2%，正子斷層造影 (PET) 檢查量則成長 23.2%。Lumexa 於 7 月在南卡羅來納州與亞利桑那州新增了預計引進的三台 PET 設備中的兩台，使裝機量從 8 台朝 2026 財年 11 台的目標邁進。管理層預期在新增這些設備後，第 3 季 PET 的成長動能將進一步增強。

乳房攝影檢查量在年初表現較疲軟後有所改善，年增 2.6%，每日平均檢查量較第 1 季成長超過 6%。

Lumexa 在上半年開設了兩家新設中心，並完成了兩項收購，其中包括與 UPMC 合資企業旗下的首個據點。該公司仍按計畫推進 2026 財年開設 8 至 10 家新設中心的目標，其餘多數據點預計將於今年稍晚開幕。

該公司還與特別外科醫院 (Hospital for Special Surgery) 成立了第九個醫療系統合資企業。該合作夥伴關係最初將在大紐約地區開發新設據點，不過醫療需求證明 (CON) 的核准要求可能會延長開發時程。管理層表示，其市場評估已確定近 100 個醫療系統可藉由 Lumexa 的模式來滿足門診造影需求。

Lumexa Imaging Connect 作為該公司的整合營運平台，支援患者預約就診、醫師連線、放射科醫師工作流程及醫療系統整合。該公司仍按計畫於年底前在三分之二的中心導入 FastScan，並正在擴展虛擬 MRI 及 AI 輔助報告工具。

管理層展望

管理層繼續預期政府給付金額將與去年同期持平，商業保險支付率則增加 1%。聯邦醫療保險優勢計畫 (Medicare Advantage) 與按服務付費的 Medicare 約占營收的 20%。

受季節性因素及新設中心營運步入正軌影響，該公司預計全年獲利的 45% 來自上半年，55% 來自下半年。上半年調整後 EBITDA 占全年預測中位數的 45.3%。

全年上市公司相關成本預計總計約 700 萬美元。2026 財年股權獎勵支出預計約為 5,000 萬美元，隨後因過往獎勵攤銷完畢，2027 財年將降至約 2,000 萬至 2,800 萬美元。

風險與關注領域

• 調整後 EBITDA 利潤率較去年同期下滑，主因公司吸收了較高的上市公司相關成本以及對新中心的既定投資。
• 第二季自由現金流得益於有利的營運資金變動及合資公司利潤分紅的時間點。管理層警告，切勿將本季 41% 的轉換率視為常態運作率 (run rate)。
• 商業保險支付方的占比維持在約 59%，僅比去年同期微幅下滑。管理層認為近期市場層面的變化並不具持久性，但保險支付方結構仍是影響每次掃描平均營收的變數。
• 預計於 2027 年推出的美國衛生福利部 CMS「跨地點給付一致化」(site-neutral payment) 擬議改革仍有待公眾評論及最終定案。管理層將其視為潛在的多年度催化劑，而非即刻帶動獲利的驅動因素。
• 放射技術師與放射科醫師的人力短缺仍是全行業的瓶頸。Lumexa 正透過培訓計畫、虛擬 MRI、遠距放射線診斷及合作醫師團隊來支援產能。
• 公開揭露的資料外洩事件涉及的是第三方供應商而非 Lumexa 的系統。管理層表示，該事件對業務的影響及相關成本極小，預期不會產生重大影響。

分析師問答重點

管理層表示，下半年的 EBITDA 成長動能將受到常態性季節檢查量回升、高階造影佔比提升，以及 2024 年和 2025 年新設中心獲利能力改善的支撐。新設中心通常在大約一年內達到損益兩平。

關於跨地點給付一致化的報銷問題，管理層表示 Lumexa 並不依賴醫院門診的溢價給付。若擬議法規最終確定，公司預期這將促使醫療系統更有緊迫感去尋求低成本的門診造影合作夥伴關係，隨時間推移，進一步帶動據點增加與擴大合作關係。

在現金流方面，儘管第二季創下歷史新高，管理層仍維持全年轉換率預測。營運資金撥付時程以及早於預期的合資公司分紅，將數百萬美元的現金流從第三季提前至第二季。

在產能方面，管理層強調 FastScan、虛擬 MRI 以及 Connexia 的遠距放射線診斷能力均為提升吞吐量並緩解人力限制的工具。Connexia 在與醫療系統洽談合資企業時也被視為一項競爭優勢，因為它能提供額外的放射科判讀產能。

電話會議完整逐字稿

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完整財報電話會議逐字稿

管理層陳述

Operator

Thank you for standing by, and welcome to the Lumexa Imaging Second Quarter 2026 Earnings Conference Call. [Operator Instructions] As a reminder, today's program is being recorded.

And now I'd like to introduce your host for today's program, Sue Dooley, Investor Relations. Please go ahead, ma'am.

Sue Dooley

Thank you, and hello, 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 today's discussion will include forward-looking statements, including statements regarding our 2026 guidance, expected operating performance, growth initiatives, reimbursement assumptions, capital expenditures and other future events. These statements reflect our current expectations and assumptions, which are subject to risks and uncertainties that could cause actual results to differ materially. Please refer to the forward-looking statements and risk factors described in today's earnings release and our most recent SEC filings for additional information. We undertake no obligation to update these statements.

We will also discuss certain non-GAAP financial measures. Definitions and reconciliations to the most directly comparable GAAP measures are included in today's earnings release.

With that, I will now turn the call over to Caitlin. Caitlin, please go ahead.

Caitlin Zulla

Thanks, Sue. Thank you all for joining us today. Q2 was a quarter of substantial progress as we continue to execute against the strategic priorities, which support our ambition to build the premier platform for high-quality, lower-cost outpatient imaging serving health systems, physicians and patients. These include driving strong same-center growth with an expanding mix of advanced modalities, new de novo openings and ensuring the successful ramp of new centers, accelerating high-impact strategic service lines and expanding our geographic footprint through disciplined, capital-efficient growth. I'm eager to share our progress tonight.

A few highlights from the quarter. In Q2, we demonstrated continued strength of our core business. We delivered healthy growth in total same-center volumes, sustained momentum in advanced modalities, continued maturation of our de novo cohorts and important progress in expanding our health system partnerships. Advanced modalities grew to 37.4% of total volume, a record high for our company and 111 basis points higher than a year ago. Our advanced modality mix shift continues to build, driving higher reimbursement and margin for the business.

In May, we announced 4 new centers. So far this year, we've opened 2 de novos against our ongoing goal of 8 to 10 annually. We also completed 2 acquisitions, including our first site with the UPMC joint venture. And as we've previously indicated, the balance of this year's openings will be later in the year, and we remain on track to hit our full year de novo target.

In June, we achieved a significant milestone, a joint venture with Hospital for Special Surgery, a globally recognized leader in musculoskeletal health, expanding our presence in the New York City metro area. And all quarter, we are actively ramping de novo centers and our 2024 and 2025 cohorts are tracking in line with our expectations, layering in a healthy mix of advanced volumes while making meaningful strides towards our objectives around long-term growth and profit expansion.

These accomplishments provide us with a strong foundation heading into the second half of the year. Our performance through Q2, together with the continued progress across our key growth initiatives, supports our continued confidence in our ability to deliver our full-year commitments and the updated guidance we are providing today. Tony will speak more to this in a moment.

We remain inspired by our mission to expand access to high-quality and lower-cost imaging through elevated compassionate care. I'm proud of the progress our team is making and the energy they bring to their work at Lumexa every day. In fact, we recently completed our annual employee engagement survey and achieved record scores, a reflection of a team that is aligned and energized by our vision to be the partner of choice for leading health systems and radiologists. That spirit of engagement and shared purpose is the foundation from which we continue to grow.

It's early days for our market opportunity and yet our value proposition resonates strongly with patients, providers, health systems and payors. Whether through our wholly owned or joint venture centers, we are successfully delivering high-quality imaging in more convenient settings on a more timely basis and at a meaningfully lower cost than hospital outpatient departments. We helped health systems solve important operational challenges and achieve their patient care and market expansion goals. And patients love the care they receive, which is reflected in our Net Promoter Scores that consistently exceed 90.

In fact, Kaufman Hall just published an article titled Radiology strategy was never about radiology, which states, Imaging is not simply a department. It's a critical infrastructure for health systems growth in oncology, cardiovascular, neuroscience and orthopedics. We could not agree more. Our value proposition at Lumexa is bigger than operating imaging centers. We help health systems improve access, retain patients and improve their bottom line. We view imaging access as the front door to a health system's most valuable service line, and we helped health systems own that front door at a lower cost in the right convenient locations for their patients and with an operating model that drives value to all stakeholders.

As you know, CMS released its 2027 Hospital Outpatient Prospective Payment System proposed rule in early July. We believe the proposed OPPS rule provides further validation of the direction health care is moving. High-quality imaging should be delivered in the most appropriate cost-effective setting. If finalized as proposed, the site-neutral provisions would reduce the reimbursement advantage associated with hospital outpatient departments and further strengthen the rationale for health systems to expand lower-cost freestanding imaging capacity.

Lumexa is built for this environment. Our model enables health systems to improve access, expand strategically and participate in outpatient imaging growth with a lower cost structure that does not depend on a hospital-based reimbursement premium. While the proposal remains subject to comment and finalization, we view the shift towards outpatient imaging as a structural growth driver that will benefit us across the years, not quarters.

In other government matters, we reviewed CMS' 2027 Medicare Physician Fee Schedule proposed rule released in July. As a reminder, this is relevant to our current rate assumptions of approximately flat year-over-year government reimbursement rates and a 1% increase in commercial payor rates. If finalized as proposed, we believe the CMS rule will be consistent with our planning assumption for government payor rates. Medicare Advantage and fee-for-service stands at around 20% of our revenue. Regarding our commercial payers, the majority of the mix, we're fortunate to have a diverse set of payers who renew across staggered years. And so far this year, commercial negotiations also support our assumptions as we look ahead.

At Lumexa, we're addressing a large and growing market opportunity, and the market is moving towards us. We benefit from durable long-term tailwinds that we believe are just taking shape, aging populations with more complex and chronic conditions, new treatment paradigms requiring advanced imaging, rising preventative screening rates and a sustained shift from hospital-based to outpatient sites of care in a fragmented capacity-constrained industry.

In a real highlight of Q2, we announced our ninth health system joint venture, a strategic partnership with Hospital for Special Surgery, the world-renowned leader in musculoskeletal health. I would like to speak to this prestigious partnership in a bit more detail, which we think represents a significant validation of our joint venture approach. HSS is ranked #1 in orthopedics in the U.S. and is recognized globally for clinical excellence. Their decision to partner with Lumexa involves a rigorous evaluation of our clinical quality and operational capabilities.

HSS is an exciting amplifier of our vision to build a broad network of imaging centers in some of the nation's most attractive markets. Imagine New Yorkers who can visit their specialists in Manhattan and obtain timely and convenient imaging in surrounding communities. The New York metro area is one of the largest health care markets in the country, and we are excited to serve patients and referring providers in the strategic MSA. We are honored that HSS chose to partner with Lumexa. This partnership is our second new health system collaboration in the last 12 months following UPMC and reflects the growing pipeline of health systems actively seeking to expand hospital outpatient imaging access.

In fact, our recent market review identified a substantial universe of health systems, close to 100, where our model can address a demonstrated outpatient imaging need, giving us the confidence in the depth and duration of our partnership pipeline. The market in front of us is promising and vast and our offering is compelling.

In addition to the long-term market forces supporting our growth plans, our operations and commercial teams have partnered with clinical leaders to implement important programs to enhance care and drive growth. Specifically, our team is busy with programs to drive same-center growth and expand access with discipline and an emphasis on advanced modalities. Here's a little more on that. PET was a particular highlight in Q2 with 23.2% growth. We continue to advance our strategy here, adding 2 of our 3 targeted new PET machines in July. We are also expanding into new tracers, unlocking our valuable PET offering for more patients, including the tracer, FES, fluoroestradiol for estrogen-positive breast cancer patients.

On the DAC front, our AI-powered breast arterial calcification program continues to see strong uptake in New York and New Jersey, and we are advancing our expansion plans for other geographies. We recently launched our lung cancer screening initiative. This involves programs to drive patient engagement around one of the most impactful screening opportunities in our patient population. By increasing awareness and access, we can help more patients get screened, diagnosed earlier and connected to life-saving care.

Lung cancer remains the leading cause of cancer-related deaths in the U.S. and only about 18% of eligible individuals currently receive the screening, a striking gap when compared to the 72% screening rate for colorectal cancer. Targeted clinical outreach efforts like these remain a strength for our company. In Q2, we continue to advance our capital-light best-of-breed technology strategy. Today, we are giving that integrated capability a name, Lumexa Imaging Connect.

Lumexa Connect is the operating platform that connects patients, referring physicians, radiologists and health system partners across the imaging journey. Built on leading technologies, our platform allows us to rapidly integrate emerging innovations rather than require us to develop every solution ourselves. Lumexa Connect is foundational to our strategy, and it's designed to help us move faster, onboard new partners efficiently, improve access, increase capacity and scale efficiently as we grow.

We're already seeing this strategy deliver results.

We remain on track to deploy FastScan across 2/3 of our centers by year-end, helping shorten MRI scan times and expand capacity. We're also advancing virtual MRI capabilities and rolling out AI-powered dictation and reporting tools designed to improve radiologist efficiency, reduce physician burnout and accelerate report turnaround time. Lumexa Connect is not a new strategy. It is the name for the scalable operating platform that already supports our centers, our partners and our continued growth. New name, still capital-light, still best of breed. And we'll continue to evolve this platform with the best technologies to support improved service and operating performance for our patients, referring physicians, radiologists and health system partners.

In that regard, I would like to take a moment to highlight another differentiating aspect of our company, investments that enable the goals of our own technologists. I'm delighted to share that in Q2, we graduated our 100th technologist from Lumexa's Technologist Advancement Academy, spanning advanced modalities and mammography, including technologists from across all of our geographies. I'm proud of our team to support this important initiative, helping make Lumexa a great place for our clinical team members to call home.

Wrapping up, I'm pleased with the gains we're achieving as we proceed with good momentum into the second half of the year. De novos are ramping, advanced modalities are growing as a percentage of our mix. Our JV pipeline is robust, and we're expanding into important new markets with exceptional health system partners. I remain confident in our ability to execute on our strategic priorities and deliver on our full year commitments, and I believe we are just getting started.

Before I turn the call over to Tony, I will pause as I do every quarter to say a huge thank you to our dedicated team members and radiologists. Your commitment to our patients and to our mission is the foundation of everything we do. With that, Tony, please continue.

J. Martin

Thank you, Caitlin, and thank you all for joining us. Tonight, I'll review the financial results and speak to key drivers of our performance for the quarter. I will then provide our outlook for the full year. To supplement my review of our GAAP financials, I will discuss certain system-wide financial and operating metrics that provide additional perspective on our overall performance and the breadth of our business. We use these metrics in managing the business because they reflect activity across all of the centers we operate, both wholly owned as well as the centers we operate in our joint ventures with health systems.

Turning to our second quarter financials. Consolidated revenues came in at $264.2 million, an increase of 5.1% compared to the same period last year. System-wide revenue growth, which includes all sites we operate, was 6% in the quarter, powered by strong growth in advanced modalities. Revenue per scan in our outpatient segment increased 2.2%. This is a system-wide metric we use because it provides useful perspective on outpatient economics by capturing both the technical scan revenue where applicable, the associated professional read revenue. The year-over-year increase was driven by advanced modalities representing a larger share of our business, together with modest increases in contracted payor rates, partially offset by payer mix shifts in a few markets.

I would like to review some important volume metrics before going into more detail on our financials. We experienced strong system-wide volume performance across our outpatient sites during Q2, both wholly owned and in JVs. System-wide volume growth was 3.1%, with strength in advanced imaging being somewhat tempered by routine scans, although we did see improvement in mammography volumes that started the year slower than expected. While routine scans impact our earnings less than advanced, we were glad to see them improve during the quarter.

Advanced modality volumes, which generally reimbursed 3x to 4x higher than routine modalities were a highlight and grew 6.3% system-wide versus prior year and 6.8% on a consolidated basis. As Caitlin already highlighted, this quarter, advanced modalities represented 37.4% of our volumes, a 111 basis point increase over the prior year period. We're encouraged that these procedures have continued to steadily grow and represent a higher mix of our system-wide volumes.

Now for a bit more detail on our consolidated revenues. Outpatient net patient service revenues at $143.7 million grew 3.5% on healthy same-site growth. Professional fee net patient service revenues, our second operating segment, were $60.0 million (sic) [ $64.2 million ] reflecting growth of 5%, in line with our model. Finally, management fee and other revenues grew $7.2 million and were $60.4 million for the quarter. Within that management fee line, roughly $26 million primarily represents management fees we earn from operating the sites in our health system JVs, which saw particular strength this quarter.

The remaining $34 million in this category represents zero-margin pass-through of employee, IT and site level costs that we pay on behalf of our joint ventures. When you're modeling us, it's important to understand these 2 components in terms of impact to margin. G&A for the quarter was $24.4 million, up $5.7 million from the second quarter of 2025. This increase was expected and driven by $5.9 million higher expenses from the 2 primary components we talked about last quarter and that will continue to impact year-over-year comparisons throughout 2026. They are as follows: first, our pubco costs, which are ongoing expenses related to being a public company. These were $1.5 million in the quarter, and we continue to expect approximately $7 million of these costs for full year 2026.

Second, and also similar to last quarter is an increase in stock-based compensation from $8.3 million in Q2 of '25 to $12.7 million in Q2 of '26. This reflects the onetime resetting of legacy equity comp plans as part of our IPO. We expect full year stock-based comp for 2026 to be approximately $50 million. About half of that relates to historic M&A and will be fully amortized by the end of 2026. As a result, we anticipate ongoing stock-based compensation of approximately $20 million to $28 million for full year 2027.

Below operating expenses, we include our equity and earnings of unconsolidated affiliates. This is our pro rata ownership share of the net income of our JV sites, the line item in our financials that reflects contributions from these important partnerships. At $18.6 million, this was $2.1 million higher than Q2 of '25, reflecting particular strength this quarter in the sites we operate with health system partners.

Below the operating line, interest expense was $16.2 million in Q2. This new run rate is $14 million less than Q2 '25, reflecting our use of IPO proceeds to pay down debt last December, freeing up more than $50 million in cash interest expense savings on an annualized basis and increasing our flexibility to invest in growth.

In addition, we repriced our debt in June 2026, further reducing our go-forward run rate for interest expense by $1 million per quarter starting in Q3. Pretax income was $5.8 million for Q2 compared to a pretax loss of $2.4 million in Q2 '25. After a tax provision of about $3 million in the quarter, net income was $2.7 million in Q2 compared to a net loss of $7.2 million in the prior year period. Our GAAP EPS was $0.03 per share in Q2 and adjusted EPS was $0.20.

Turning now to adjusted EBITDA, which is an important supplemental measure we use to evaluate operating performance across our entire network. It includes adjusted EBITDA from our wholly owned centers as well as our pro rata share from the centers we operate through our health system joint ventures. Adjusted EBITDA was $56.4 million in the quarter compared with $56.3 million a year ago.

Underlying performance benefited from healthy overall volumes and strong growth in advanced modalities, while our reported growth absorbed incremental public company costs and planned investments associated with ramping our de novo centers. The year-over-year comparison also reflects a tougher prior year baseline than we saw in Q1 as the volume recovery following the resolution of an out-of-network situation was largely resolved by the second quarter of 2025.

Our adjusted EBITDA margin was 21.4% in Q2 '26 compared to 22.4% in Q2 '25, partly due to the $1.5 million step-up in public company costs. Sequentially, adjusted EBITDA margin increased 110 basis points from Q1. On the cash flow front, cash flows from operating activities were $32.8 million in Q2 '26. This is $31 million higher than Q2 '25, reflective of our lower senior credit facility debt and related interest payments. Free cash flow, which we define as cash flows from operating activities less CapEx, was $23.1 million for Q2 '26, a record high for the company compared to negative $2.5 million in Q2 '25. This is a $25.6 million improvement and resulted in a conversion in Q2 of roughly 41% of adjusted EBITDA, which is another record.

The improvement was largely attributable to our reduced debt and related interest expense that demonstrates the ability of our business to continue to generate strong cash flow. Recall that we used the full IPO proceeds to pay down debt in order to free up cash to pursue our market opportunity, grow the company and delever. We would not read a single quarter as a new run rate. But as we have said previously, we continue to expect 2026 free cash flow conversion to be approximately 25% to 30% of adjusted EBITDA on a full year basis. While free cash flow conversion can vary, we believe this conversion range will improve as we scale our business.

And now for a moment on CapEx. We continue to see the opportunity to accelerate our growth plans in our fragmented industry and to target meaningful returns by investing in de novos, adding new and upgraded equipment and capabilities at our existing sites and through targeted M&A. Our $9.7 million capital spend in Q2 '26 reflects a busy quarter of investment activity and is not a change in our underlying spending plan. We continue to anticipate approximately $5 million to $7 million in cash CapEx per quarter.

Shifting to the balance sheet. Our capital position is strong, and we ended the quarter with $69.7 million in cash and cash equivalents, up from $51.2 million (sic) [ $58.8 million ] at the start of the quarter. As of June 30, net leverage was 3.6x compared to 5.7x a year ago. Further, we're committed to managing our capital structure strategically. And at the end of Q2, we repriced our term loan to a rate of SOFR plus 250 basis points. This reduction generates an additional annual cash interest savings of $4 million per year starting in Q3.

Wrapping up with our outlook, we're pleased with our accomplishments in Q2, including progress across key growth initiatives. And so with half the year complete, we're narrowing our adjusted EBITDA guidance range to $235 million to $241 million versus the previous range of $234 million to $242 million, while maintaining the midpoint at $238 million. The narrower range reflects our first half results, our view of the business and continued confidence in the underlying assumptions supporting our guidance.

Adjusted EBITDA reflects our full system-wide footprint, including our pro rata share of JV performance, while our consolidated revenue guidance reflects only our majority-owned centers. That scope difference, not a change in our view of either business is why we're narrowing adjusted EBITDA guidance while our revenue guidance remains unchanged.

And so tonight, we're reiterating our consolidated revenue guidance of $1.045 billion to $1.097 billion and our adjusted EPS guidance of $0.71 to $0.77 per share. As we move into Q3 and continue executing on our goals, we're energized by the opportunities in front of us and the progress we've made so far this year.

So with that, let's turn to your questions. Operator, would you please open the call?

Operator

[Operator Instructions] And our first question comes from the line of Brian Tanquilut from Jefferies.

分析師問答

Brett Grulkowsk

This is Brett Grulkowsk on for Brian Tanquilut with Jefferies. As we think about the second half of the year, can you talk about the expectations for the seasonality in the business? And then if there's any other incremental drivers to point out as we think about the sequential ramp?

Caitlin Zulla

Thanks so much, Brett. Appreciate the question. Maybe I'll kick it off, and then I'll turn it over to Tony to talk a little bit more about second half pacing. So we are very excited by the progress we've been able to demonstrate this year. Advanced imaging continues to be strong, really thrilled by our new company record of the 37.4% of volumes coming from advanced imaging.

And as you'll remember, last year, we did a record number of de novos. We opened up 9, pacing of those were 3 in the first quarter, 3 in the second, 0 in the third and then 3 in the fourth. And so excited by the progress we've been able to see in the ramping of our 2024 and 2025 de novo cohorts. And so what you see is really a compounding of all of these trends as we enter in the second half of the year, which is why we were confident in reaffirming our guidance and narrowing the range.

But Tony, I'll let you maybe talk a little bit more about specific pacing.

J. Martin

Sure, sure. Yes, the momentum is what we expected as the year would unfold. There is a natural seasonality to the business, and we're seeing that happen. And as we reported last quarter, we expected 45% of our earnings in the first half of the year and 55% in the back half, and we're right on that. That comes from the seasonal ramping of volume and the ramping of our de novos. We had so many of them come out of the ground in 2025.

So right on target for the 45% in the first half and the ramping that we expect to continue kind of sequentially in Q3 and Q4. And actually at 45.3%, if we want to take it out to a decimal point. So we're actually a little bit ahead of that.

Brett Grulkowsk

Great. Okay. Yes, that's helpful. And then for a follow-up, could you maybe provide some additional color on the recent HSS JV, maybe on how it's progressed in the early stages? And then if there's any future expansion opportunity there? And then maybe more broadly, what the pipeline as a whole for new JV opportunities looks like?

Caitlin Zulla

Yes. Happy to talk about HSS. It was a very exciting milestone for the company. HSS, obviously, world-renowned institution and so focused on musculoskeletal, which obviously requires imaging in every part of the diagnosis and treatment. With HSS, similar to UPMC, we are focusing on a de novo approach. We've already targeted markets in the New York metropolitan area and actively advancing site plan. New York does have CON requirements that will require a little bit longer of an extended time line, but excited to talk a little bit more about this as we go into 2027.

And then we think about kind of the second part of your question about hospital engagement and hospital pipeline. One of the reasons I'm the most excited to be in this role at Lumexa is the early days around opportunities to continue to grow to serve outpatient needs in the industry. Starting first, radiology demand continues to grow for all the reasons we talked about, right, novel treatment paradigms, increased screening mandates, technological advances and there's continued unmet demand.

And then it is also an incredibly fragmented landscape and very early days for health systems to really begin to formalize what is their outpatient imaging strategy. And so we've got an exciting pipeline of health systems we're talking to. We look forward to giving more updates across upcoming quarters. But there's a lot of growth and opportunity in this space. Thanks so much, Brett.

Operator

And our next question comes from the line of Andrew Cooper from Raymond James.

Andrew Cooper

Maybe first, we've heard a lot from different players in the space through the quarter or through the earnings reports already. I guess, I think, Tony, you mentioned some payor mix shifts in a few markets. Could you touch on that a little bit more? And anything you're seeing from a procedure mix perspective, whether it's changes in ortho-related imaging versus more kind of acute-oriented procedures? Just would love your observations and kind of underlying some of the volume changes.

J. Martin

Sure. I'll ask that Caitlin add some color after I give you a couple of numbers here. But really, yes, we saw just a little bit of shift in payor mix, nothing significant. It was in a couple of markets, and it was kind of different than what we had in Q1. We had different parts of the business experience some ebbs and flows in this stuff. So really nothing of note or anything that will be a long-term trend, just kind of a modest shift. And you could see we came in where we expected. So it wasn't -- obviously, it wasn't significant. And Caitlin, can you take...

Caitlin Zulla

Yes, I can really take the acuity piece, Andrew. So as we see acuity, as we look across the book, we continue to see real strength in MRI. MRI growth on a system-wide basis was 7.2% quarter-over-quarter. So continuing to drive our focus on supporting MRI and then PET, so 23.2% growth, as we highlighted in the script. Throughout our journey, we've been talking about the opportunity we have at Lumexa to deepen our PET profile.

So thrilled that we're able to say that 2 of the 3 machines that we had talked about this year are live in South Carolina and Arizona. And then we continue to see advancements in the radiotracers. We referenced our new estrogen-positive breast imaging radiotracer, FES. We continue to see strong demand for amyloid, PYLARIFY, also working on Ga-68 and [FDG ]. So continued focus on expanding PET as a strategic service line based on the strong acuity demand there.

Operator

And our next question comes from the line of Andrew Mok from Barclays.

Andrew Mok

We don't have the Q yet. So I was hoping you could share the same-store system-wide revenue growth metric in the quarter and talk through the underlying components of that between volume and price.

J. Martin

Sure. The same-site volume growth, was that...

Andrew Mok

Yes, same-store system-wide revenue. What did that come in, in the quarter and then maybe break that down into the components of price and volume?

J. Martin

Yes. Yes. So same-site system-wide basis was 4.4% revenue and 2.2% volume, 2.2% rate.

Andrew Mok

Got it. That's helpful. And then on the commercial mix side, can I just revisit that for a second. It was a little bit unclear to me what exactly you're seeing on the commercial mix. So, one, can you help us understand where that finished in the quarter? What was that down year-over-year? And to the extent that you did see some pressure in some of your markets, can you just elaborate on what exactly you saw?

J. Martin

Sure. Yes. When we get to the Q published, it will show 59% consolidated commercial mix, which is the same as it was last year. There was a very slight downward tick but nothing significant, right? We have heard some of the other health care providers, particularly the hospitals talk about a more significant payor mix shift. We didn't really see that.

And in Q2, it was in a few markets that we consolidate. And in Q1, we had a little bit of degradation more on the JV side, and they just kind of -- neither one seems to be a sign of anything durable that we could tell. And like I said, really fractional because it just is kind of a rounding error on our payor mix percentages.

Operator

And our next question comes from the line of Whit Mayo from Leerink Partners.

Benjamin Mayo

Looking at the first quarter, you guys had some weather related disruption. Do you think you recovered any of that volume in the second quarter? Or is that just all lost at this point?

Caitlin Zulla

Yes. Whit, thank you for the question. Maybe I'll start. We saw strength of advanced in Q1, and we're really proud of how it ended. And so our thinking was there would be very little carryover of advanced into Q2. Talking about advanced performance in Q2, again, performed well. You can see the impact of our new facilities are having on our overall enterprise growth rate.

And one of the areas that we were focused on, on the recovery front was mammography. And so we had talked about that lagging at the end of Q1. Excited to see mammography growth this quarter. Mammo is up 2.6% year-over-year and continue to grow north of 6% on a per day basis over Q1. So the one area where we did see a little bit of opportunity and pull-through is in mammo. Again, we focus on advanced because they reimburse at a significantly higher rate than routine, but nice to see the recovery within the mammo book.

Benjamin Mayo

Okay. I was curious if there was any cost that you'd care to call out related to the data breach?

Caitlin Zulla

Yes. Thanks, Whit. When we think about data breach, we disclosed it in our Q, one, to create clarity that the breach was related to a vendor and not our systems. And then second, to highlight the fact we've seen minimal impact on the business. We have not seen any costs that require us to say that we think it will be impacting the business or have a material impact. And we want to continue to be transparent about the journey we are on and make sure that we're answering any of your questions.

Operator

And our next question comes from the line of Stephen Baxter from Wells Fargo.

Stephen Baxter

I just wanted to ask a follow-up on the cadence. I get that we're on track in terms of the 45% versus 55% allocation. When we think about the first half EBITDA growth needing to improve a good amount in the back half, should we be thinking that, that's primarily going to be driven by better growth or maybe improved margin profile versus what you delivered in the first half of the year? And then I have a follow-up.

J. Martin

Sure. Yes. I mean kind of a good starting point is just what tends to happen sequentially from Q1 all the way through Q4. As we've talked about in past calls, it's a sequential ramp from when the deductibles reset, as you know. So from Q1 to Q2 sequentially, our adjusted EBITDA grew nearly 11%. And so that's an example of what tends to happen with the seasonality of the business. You see some meaningful step-ups just from the pure seasonality component. So we believe that undergirds everything that happens at all the sites from year-to-year, and that's a big part of it.

In addition, you've seen, as Caitlin described, more and more of our volumes are coming from advanced and that too provides more momentum sequentially as the quarters unfold. And then, of course, the de novos, we opened a few towards the end of 2024, a lot more in 2025. So with our typical ramp of those, they tend to get to breakeven in a year or so. So the ones we opened in 2024, it's only 4 compared to more than double that 10 -- I mean, 9 last year.

Those are ramping to profitability this year and already are earlier in our reported numbers. There's not very many of them, but those '24 ones are right on target, and that means they're making some money. The 2025 ones are going to gain a lot more momentum in the second half of the year. They are doing very well against expectations.

We map out our path to when they'll reach breakeven and where they'll go from there. We did a deep dive recently on all of them and feel great about where they're headed. And so that, too, is meaningful in terms of sequential growth in the second half of the year compared to what we reported in the first half.

Stephen Baxter

Got it. Okay. And then just to come back to the policy, I obviously appreciate you touching on the proposed changes for hospital reimbursement. Just as we think about the types of opportunities this could potentially open up for you, I guess, how should we think about that? Is it just an acceleration of the same type of growth that you've seen in JV partnering opportunities that you've seen? Or do you think there's any opportunity for some of these growth opportunities to maybe develop differently than they have in the past for you?

Caitlin Zulla

Yes. Thanks, Stephen. We are optimistic and excited about the site neutrality proposed rule. Certainly, it depends on how it is finalized. I think first, importantly, so as a point of clarification, Lumexa does not rely on hospital outpatient reimbursement premiums. So the proposal really does improve the relative attractiveness of our IDTF model. I see this as a multiyear catalyst versus something that's going to change our results immediately.

What I do think it does is it -- today, it reinforces the conversations that are already happening that hospitals need more imaging capacity and building that capacity in a high-cost hospital setting is becoming increasingly difficult to justify. And then our model allows them to expand access, retain patients within their network, participate economically, obviously, without relying on that hospital outpatient reimbursement premium.

So we do expect the first impact will be an increased urgency and activity in our partnership pipeline and then followed over time by new centers and expanded relationships. And I just also want to clarify, obviously, our strategy doesn't depend on this rule being finalized, but the -- our underlying value proposition already works, but I do think site neutrality would simply strengthen it.

Operator

And our next question comes from the line of Pito Chickering from Deutsche Bank.

Pito Chickering

I guess focusing on cash flow from ops this quarter looked pretty good. I think a lot of it came from increase of accrued expenses. So can you talk about sort of cash flow in the second quarter, how we should be thinking about cash flow from ops and CapEx in the back half of the year?

J. Martin

Sure. Yes, we feel real good about what Q2 means for the guidance range we provided of 25% to 30% conversion rate. That translates to something like $60 million to $70 million of free cash flow for the year. It's very much about timing quarter-to-quarter. As you pointed out, there are working capital swings that are natural in the business. And those were -- those tend to mean that the second half of the year is better than the first. But sometimes you have some swings that work in your favor that hit in the same quarter.

And so for Q2, that was true in our -- just in our day-to-day working capital and also the timing of distributions from our JVs was favorable. We got a few extra million of that. And really both of those just kind of happen in Q2 rather than Q3. And so we don't really view the year any differently. But we definitely see the performance in Q2 is indicative of why we guided to that 25% to 30% on a full year basis anyway.

And your question about the CapEx, yes, I mean, $5 million to $7 million a quarter is what we expect to spend. I'd say we had more than that in the second quarter because we've just been busy in investing in our growth opportunities. And we really will continue to do that where the return is there. That may cause us to kind of be at the high end of the range.

It wouldn't surprise me if that annual number is kind of more driven by a $7 million a quarter run rate as we get later in the year because if we have opportunities to grow, whether it's getting more de novos out of the ground or other spend that we don't want to tie ourselves too much to some sort of artificial number because we're going to grow and deploy that capital. But all that said, within the balance of the free cash flow guidance we've given, we feel very good about that for the year.

Pito Chickering

Okay. Then a follow-up, I think you talked about PET in the script. Can you just remind us how many machines you guys have in your centers? And what percent of revenues PET is these days? And how we should think about the role in the next 12 months? And are you taking share from hospitals? And is it mostly the JVs or fully owned facilities that you're investing in and you're taking share out of?

Caitlin Zulla

Yes. So we are very excited by the growth of PET. We have shared that we have 8 PET machines and the goal was to get to 11 this year. So we already have 2 open well on our way. We have focused on there's so much opportunity within MRI and CT, and that's what the business has prioritized over the year, but we do see significant growth opportunity in PET. We expect to see significant growth rate. The 23.2% that we highlighted was before the 2 machines opened in July. So you should expect in Q3, that growth rate will continue to go higher. As we think about where are we taking share, I mean, PET is one of -- it is one of the more heartbreaking backlogs in so many communities that we are entering into, where we're hearing that patients are waiting weeks, if not months, for their PET exams.

And when you think about what PET does, is it helps diagnose? Oftentimes life-threatening diseases and show whether or not treatment is progressing -- treatment is stopping the progression of the disease, waiting weeks and months is unacceptable. So we are often going into markets where there is a significant backlog, primarily, obviously, patients being seen at hospitals that can't keep up with the demand.

And so we expect to see continued growth in both our individual consolidated markets, which Arizona is, and that's where one of the additions came and then also within our joint ventures, the site in South Carolina is in partnership with Atrium. So exciting growth in PET for certainly the quarters to come.

Operator

[Operator Instructions] Our next question comes from the line of Matt Mardula from William Blair.

Matthew Mardula

This is Matthew on for Ryan Daniels. And with advanced imaging being 37.4% of volume, a record for the company, I know one of the company's goals is to increase advanced imaging volume. But how should we think about the growth in advanced imaging as a percentage of volume for the rest of the year and maybe into 2027 or longer term?

And then just when I'm kind of thinking and when we're all thinking about the drivers of advanced imaging, it sounds like it's just a good mix of industry trends and company initiatives. But is it more weighted towards one?

Caitlin Zulla

Thanks, Matt. Appreciate the question. So yes, excited that we were able to have 37.4% of total volume come from advanced. Notably, that's 111 basis point improvement over Q2 2025. We aren't setting a specific target number. We want to grow all parts of our business. But when we have advanced growing more rapidly than routine, obviously, the contribution in terms of revenue, advanced is 3x to 4x revenue premium and then that flows through to margin, it's a significant driver of our success and growth.

And then when you think about what is driving advance, I mean, certainly, you've got the secular drivers that is radiology, aging population, increasing chronic conditions, you have novel treatment paradigms. And so there's just an increased demand. So we are doing everything we can to make sure we are capturing our fair share and growing at a pace exceeding the industry. And so that starts with how we're positioning our sales team.

We've highlighted that we have over 120 representatives in the market selling to our value proposition all day, every day. And then it also goes to how we're structuring our operations to continue to add capacity, things like FastScan that we're on track to get to 2/3 of our MRI fleet is equipped with FastScan or virtual MRI that we're continuing to roll out to help make sure that if tech happen to call out, we're able to continue to run the machine.

So continuing to focus on the capacity. And then, of course, really targeting where do we open our new de novo sites, all based on where we see supply demand mismatch in the geography and the opportunity to serve a population that does not have ample access to advanced imaging. So certainly, it's exciting to be in an industry that's got strong tailwinds, and we're doing everything we can on a sales and operations perspective to position ourselves for outsized growth.

Operator

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

Benjamin Rossi

In context of the broader labor tightness for radiologists and techs, as you've been working to leverage some of those technologies you mentioned to expand capacity, are you finding this online capacity allows for enough of a backfill to make up for any labor-related capacity limitations? Or are these constraints resulting in backlogs in certain facilities? Just curious how the capacity trends during 2Q and how you're managing levels to meet demand.

J. Martin

Yes, yes. Something we think about all the time. I think I can go first and throw a number or 2 out there, then Caitlin can kind of expand broader context on this. Yes, we look at our expense for this as like it's up 5% year-over-year. Our operating expenses from '25 to '26. And so in this kind of inflationary environment that we're in generally in the economy, that feels pretty good. And it is kind of -- has kind of been an inflationary type of item for us. That said, there's certainly opportunities to improve that. And Caitlin, I know we do a lot to retain and recruit.

Caitlin Zulla

Yes. Yes. Yes. So Ben, when you're thinking about the 5%, that includes obviously pre ramp-up costs for de novos. And so comparing against our revenue, there's expansion upon it and opportunities to as revenue continues to grow alongside the expenses, it will grow at a higher rate. And then what are we doing to continue to support. Obviously, I highlighted the Technologist Advancement Academy, continuing to grow our own. We have the advantage of being an environment that technologists like to work in compared to hospitals.

And we are continuing to roll out our virtual MRI solution that allows us to have one tech run multiple machines at one time, which allows us to have increased capacity, especially as we've got -- we're recruiting a tech or somebody is calling out to take care of their family [indiscernible].

And then on the radiologist side, this is why we love kind of our 3-pronged model. We have Connexia, our telerad group, where we continue to recruit and build out the capacity within that entity, our third-party radiologists that we work with in the markets that we serve and then our affiliated physician groups. So between all of that, we're able to come up with the right solutions to support the continued growth.

Benjamin Rossi

Great. And I guess as a follow-up, I want to spend a moment there on Connexia. I guess, with that broader commentary regarding industry demand and in read turnaround, could you give us an update on how you're thinking about that segment? I know you're finding that partners are leaning into this segment more? Or if it's maybe resonating more with your prospective partners?

Caitlin Zulla

Yes. Ben, often, when we're having conversations with our health system partners the fact that we are bringing an option for the [ rad read ] to support the outpatient strategy is seen as very attractive and a differentiator in our approach. There are certainly health systems that have a preference around rad read groups. And so if they do, we will support what is the most right for the partnership in the local market, but the fact that we are able to provide incremental capacity for our outpatient centers is certainly seen as a positive in the joint venture discussions.

Operator

This does conclude the question-and-answer session of today's program. I'd like to hand the program back to Caitlin for any further remarks.

Caitlin Zulla

Thank you. I want to close by thanking our team members and radiologists whose commitment to our mission and to our patients and communities we serve remains the foundation of everything we do.

Thank you for your questions today. We enter the second half of 2026 with strong momentum, a growing network of health system partners and deep confidence in our strategy and our team's ability to execute. We look forward to updating you on our progress in the future. Have a good night.

Operator

Thank you, ladies and gentlemen, for your participation in today's conference. This does conclude the program. You may now disconnect. Good day.