Lumexa Imaging Q2 2026 Earnings Call Transcript

Key Takeaways

  • Positive Sentiment: Q2 showed continued operating momentum, with system-wide revenue up 6% and same-center revenue growth of 4.4%. Advanced modalities reached a record 37.4% of volume, supported by 6.3% growth in advanced imaging and strong PET growth of 23.2%.
  • Positive Sentiment: Lumexa reiterated its full-year consolidated revenue guidance of $1.045 billion-$1.097 billion and adjusted EPS guidance of $0.71-$0.77, while narrowing adjusted EBITDA guidance to $235 million-$241 million from $234 million-$242 million.
  • Positive Sentiment: The company is expanding through de novos, acquisitions, and health-system partnerships, including its ninth joint venture with Hospital for Special Surgery. Management cited a pipeline of nearly 100 health systems with potential outpatient imaging needs.
  • Positive Sentiment: Cash generation and leverage improved substantially: Q2 free cash flow was a record $23.1 million, net leverage declined to 3.6x from 5.7x a year earlier, and June debt repricing is expected to reduce annual interest expense by approximately $4 million.
  • Neutral Sentiment: Management views proposed CMS site-neutral reimbursement provisions as a potential multiyear catalyst for freestanding imaging, but emphasized that the rule remains subject to comment and finalization. The company also expects continued investment, with quarterly cash CapEx generally around $5 million-$7 million and potentially near the high end as growth opportunities develop.
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Earnings Conference Call
Lumexa Imaging Q2 2026
00:00 / 00:00

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Operator

As a reminder, today's program is being recorded. Now I'd like to introduce your host for today's program, Sue Dooley, Investor Relations. Please go ahead, ma'am.

Sue Dooley
Sue Dooley
Investor Relations Representative at Lumexa Imaging

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.

Sue Dooley
Sue Dooley
Investor Relations Representative at Lumexa Imaging

Caitlin, please go ahead.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

Thanks, Sue. Thank you all for joining us today. Q2 was a quarter of substantial progress as we continued 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 cohort, and important progress in expanding our health system partnerships.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

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 four new centers so far this year. We have opened two de novos against our ongoing goal of eight to 10 annually. We also completed two acquisitions, including our first site with the UPMC joint venture. As we have 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.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

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 tonight. 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 am proud of the progress our team is making and the energy they bring to their work at Lumexa every day.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

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 is early days for our market opportunity, and yet our value proposition resonates strongly with patients, providers, health systems, and payers. 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 help health systems solve important operational challenges and achieve their patient care and market expansion goals. Patients love the care they receive, which is reflected in our Net Promoter Scores that consistently exceed 90.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

In fact, Kaufman Hall just published an article titled "Radiology Strategy Was Never About Radiology," which states, "Imaging is not simply a department. It is 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 lines. We view imaging access as the front door to a health system's most valuable service line, and we help 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 healthcare is moving.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

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's 2027 Medicare Physician Fee Schedule proposed rule released in July.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

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 payer rates. If finalized as proposed, we believe the CMS rule would be consistent with our planning assumption for government payer rates. Medicare Advantage and fee-for-service stand 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.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

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 number one in orthopedics in the U.S. and is recognized globally for clinical excellence. Their decision to partner with Lumexa involved a rigorous evaluation of our clinical quality and operational capabilities.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

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 healthcare markets in the country, and we are excited to serve patients and referring providers in this 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.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

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 was busy with programs to drive same center growth and expand access with discipline and an emphasis on advanced modalities. Here is a little more on that. PET was a particular highlight in Q2 with 23.2% growth. We continue to advance our strategy here, adding two of our three targeted new PET machines in July.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

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 BAC 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.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

In Q2, we continued 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.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

Lumexa Connect is foundational to our strategy, and it is designed to help us move faster, onboard new partners efficiently, improve access, increase capacity, and scale efficiently as we grow. We are already seeing this strategy deliver results. We remain on track to deploy FastScan across two-thirds of our centers by year-end, helping shorten MRI scan times and expand capacity. We are 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 times.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

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. We will 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 am 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 am proud of our teams who support this important initiative, helping make Lumexa a great place for our clinical team members to call home.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

Wrapping up, I am pleased with the gains we are 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 are 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.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

Thank you, Caitlin. Thank you all for joining us. Tonight, I will 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.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

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 and, 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 payer 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.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

While routine scans impact our earnings less than advanced, we were glad to see them improve during the quarter. Advanced modality volumes, which generally reimburse three to four times 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 are 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, reflecting growth of 5%, in line with our model.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

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-throughs of employee, IT, and site-level costs that we pay on behalf of our joint ventures. When you are modeling us, it is important to understand these two 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 two primary components we talked about last quarter, and that will continue to impact year-over-year comparisons throughout 2026. They are as follows.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

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 2025 to $12.7 million in Q2 of 2026. This reflects the one-time 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-$28 million for full year 2027. Below operating expenses, we include our equity and earnings of unconsolidated affiliates.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

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 2025, 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 2025, 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.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

Pre-tax income was $5.8 million for Q2, compared to a pre-tax loss of $2.4 million in Q2 2025. 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.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

While our reported growth absorbed incremental pubco 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 2026, compared to 22.4% in Q2 2025, 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 2026. This is $31 million higher than Q2 2025, reflective of our lower senior credit facility debt and related interest payments.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

Free cash flow, which we define as cash flows from operating activities less CapEx, was $23.1 million for Q2 2026, a record high for the company, compared to -$2.5 million in Q2 2025. 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 de-lever.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

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%-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. 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 2026 reflects a busy quarter of investment activity and is not a change in our underlying spending plan. We continue to anticipate approximately $5 million-$7 million in cash CapEx per quarter.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

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 at the start of the quarter. As of June 30, net leverage was 3.6x compared to 5.7x a year ago. Further, we are 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 are pleased with our accomplishments in Q2, including progress across key growth initiatives. With half the year complete, we are narrowing our adjusted EBITDA guidance range to $235 million-$241 million versus the previous range of $234 million-$242 million, while maintaining the midpoint at $238 million.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

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 are narrowing adjusted EBITDA guidance while our revenue guidance remains unchanged. Tonight, we are reiterating our consolidated revenue guidance of $1.045 billion-$1.097 billion, and our adjusted EPS guidance of $0.71-$0.77 per share. As we move into Q3 and continue executing on our goals, we are energized by the opportunities in front of us and the progress we have made so far this year. With that, let us turn to your questions. Operator, would you please open the call?

Operator

Certainly. Ladies and gentlemen, we ask that you please limit yourself to one question, and our first question comes from the line of Brian Tanquilut from Jefferies. Your question please.

Brett Grulkowski
Brett Grulkowski
Analyst at Jefferies

Hey, good afternoon. This is Brett Grulkowski on for Brian Tanquilut with Jefferies. Thanks for taking the questions here. 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 is any other incremental drivers to point out as we think about the sequential ramp? Thanks.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

Thanks so much, Brett. Appreciate the question. Maybe I will kick it off, and then I will turn it over to Tony to talk a little more about second half pacing. We are very excited by the progress we have been able to demonstrate this year. Advanced imaging continues to be strong. Really thrilled by our new company record of 37.4% of volumes coming from advanced imaging. As you will remember, last year, we did a record number of de novos. We opened up nine. Pacing of those were three in the first quarter, three in the second, zero in the third, and then three in the fourth. We are excited by the progress we have been able to see in the ramping of our 2024 and 2025 de novo cohorts.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

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. Tony, I will let you maybe talk a little bit more about specific pacing.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

Sure. Yes. The momentum is what we expected as the year would unfold. There is a natural seasonality to the business, and we are seeing that happen. 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 are 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 at Q3 and Q4. Actually it was 45.3% if we want to take it out to a decimal point. So we are actually a little bit ahead of that.

Brett Grulkowski
Brett Grulkowski
Analyst at Jefferies

Great. Okay. Yeah, that is helpful. For a follow-up, could you maybe provide some additional color on the recent HSS JV, maybe on how it has progressed in the early stages, and if there is any future expansion opportunity there?

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

Sure.

Brett Grulkowski
Brett Grulkowski
Analyst at Jefferies

Then maybe more broadly, what the pipeline, as a whole, for new JV opportunities looks like. Thank you.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

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 have already targeted markets in the New York metropolitan area and are actively advancing site plans. New York does have CON requirements that will require a little bit longer of an extended timeline, but excited to talk a little bit more about this as we go into 2027. Then we think about the second part of your question about hospital engagement and hospital pipeline. One of the reasons I am 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.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

Starting first, radiology demand continues to grow for all the reasons we talked about, right? Novel treatment paradigms, increased screening mandates, technological advances. There is continued unmet demand. 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. So we have got an exciting pipeline of health systems we are talking to. We look forward to giving more updates across upcoming quarters. There is a lot of growth and opportunity in this space. Thanks so much, Brett.

Brett Grulkowski
Brett Grulkowski
Analyst at Jefferies

Thanks.

Operator

Thank you. Our next question comes from the line of Andrew Cooper from Raymond James. Your question, please.

Andrew Cooper
Andrew Cooper
Analyst at Raymond James

Hey, everybody. Thanks for the questions. Maybe first, we have heard a lot from different players in the space through the quarter or through their earnings reports already. I guess, I think, Tony, you mentioned some payer mix shifts in a few markets. Could you touch on that a little bit more and anything you are seeing from a procedure mix perspective, whether it is changes in ortho related imaging versus more kind of acute oriented procedures? Just would love your observations in kind of underlying some of the volume changes.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

Sure. I will ask that Caitlin add some color after I give you a couple numbers here. We saw just a little bit of shift in payer mix. Nothing significant. It was in a couple 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. Really nothing of note or anything that would be a long-term trend. Just kind of a modest shift. You could see, we came in where we expected, so obviously wasn't significant. Caitlin can-

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

Yeah, I can maybe take the acuity piece, Andrew. 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. Continuing to drive our focus on supporting MRI and then PET. 23.2% growth as we highlighted in the script. Throughout our journey, we have been talking about the opportunity we have at Lumexa to deepen our PET profile. Thrilled that we are able to say that two of the three machines that we had talked about this year are live in South Carolina and Arizona. We continue to see advancements in the radiotracers. We reference our new estrogen positive breast imaging radiotracer FES. We continue to see strong demand for amyloid, Clarify, also working on Ga-68 and FDG.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

Continued focus on expanding PET as a strategic service line based on the strong acuity demand there.

Operator

Thank you. Our next question comes from the line of Andrew Mok from Barclays. Your question, please.

Andrew Mok
Andrew Mok
Analyst at Barclays

Hi, good afternoon. We don't have the Q yet. 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. Thanks.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

Sure. The same site volume growth? Was that the question?

Andrew Mok
Andrew Mok
Analyst at Barclays

Same-store, yeah, same-store system-wide revenue, what did that come in in the quarter? Then maybe break that down into the components of price and volume. Thanks.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

Yeah. Same site system-wide basis was 4.4% revenue and 2.2% volume, 2.2% rate.

Andrew Mok
Andrew Mok
Analyst at Barclays

Got it. That's helpful. 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 commercial mix. One, can you help us understand where that finished in the quarter? What was that down year-over-year? To the extent that you did see some pressure in some of your markets, can you just elaborate on what exactly you saw? Thanks.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

Sure. When we get the Q published, it'll show 59% consolidated commercial mix, which is the same as it was last year. There's a very slight downward tick, but nothing significant. We have heard some of the other healthcare providers, particularly the hospitals, talk about a more significant payer mix shift. We didn't really see that. 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. Like I said, really fractional because it does this kind of a rounding error on our payer mix percentages.

Operator

Thank you. Our next question comes from the line of Whit Mayo from Leerink Partners. Your question, please.

Whit Mayo
Whit Mayo
Analyst at Leerink Partners

Hey, thanks. 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
Caitlin Zulla
CEO at Lumexa Imaging

Yeah. Hey, Whit. Thank you for the question. Maybe I will start. We saw strength of advance in Q1, and we are really proud of how it ended. Our thinking was there would be very little carryover of advance 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. One of the areas that we were focused on the recovery front was mammography. 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% per day basis over Q1. The one area where we did see a little bit of opportunity and pull-through is in mammo.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

Again, we focus on advanced because they reimburse at a significant higher rate than routine, but nice to see the recovery within the mammo book.

Whit Mayo
Whit Mayo
Analyst at Leerink Partners

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

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

Yeah, thanks, Whit. When we think about data breach, we disclosed it in our Q1 to create clarity that the breach was related to a vendor and not our systems. Second, to highlight the fact we have 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. We want to continue to be transparent about the journey we are on, and make sure that we are answering any of your questions.

Operator

Thank you. Our next question comes from the line of Stephen Baxter from Wells Fargo. Your question, please.

Stephen Baxter
Stephen Baxter
Analyst at Wells Fargo

Hi, just wanted to ask a follow-up on the cadence. I get that we are 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 is primarily going to be driven by better growth or maybe improved margin profile versus what you delivered in the first half of the year? Then, I have a follow-up. Thanks.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

Sure. Yeah, a good starting point is just what tends to happen sequentially, from Q1 all the way through Q4. As we talked about in past calls, it is a sequential ramp from when the deductibles reset, as you know. From Q1 to Q2 sequentially, our adjusted EBITDA grew nearly 11%. That is an example of what tends to happen with seasonality of the business. You see some meaningful step-ups just from the pure seasonality component. We believe that undergirds everything that happens at all the sites from year to year, and that is a big part of it. In addition, you have seen, as Caitlin described, more and more of our volumes are coming from advance, and that too provides more momentum sequentially as the quarters unfold. Then, of course, the de novos. We opened a few toward the end of 2024, a lot more in 2025.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

With our typical ramp of those, they tend to get to breakeven in a year or so. The ones we opened in 2024, it is only four compared to more than double that, nine last year. Those are ramping to profitability this year, and already are earlier in our reported numbers. There are not very many of them, but those 2024 ones are right on target, and that means they are 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 will reach breakeven and where they will go from there. We did a deep dive recently on all of them and feel great about where they are headed.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

That too is meaningful in terms of sequential growth in the second half of the year compared to what we've reported in the first half.

Stephen Baxter
Stephen Baxter
Analyst at Wells Fargo

Got it. Okay. Just to come back to the policy side, obviously appreciate you touching on the proposed changes for hospital imaging 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? Thanks.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

Yeah. 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, just always 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 multi-year catalyst versus something that's going to change our results immediately. What I do think it does is it today 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. Our model allows them to expand access, retain patients within their network, participate economically, obviously without relying on that hospital outpatient reimbursement premium.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

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

Operator

Thank you. Our next question comes from the line of Pito Chickering from Deutsche Bank. Your question please.

Pito Chickering
Pito Chickering
Analyst at Deutsche Bank

Hey, good afternoon, you guys. Thanks for taking my questions. I guess, focusing on cash flow from ops this quarter, looked pretty good, but I think a lot of it came from increase of accrued expenses. Can you talk about cash flow in the second quarter, and how we should be thinking about cash flow from ops and CapEx in the back half of the year?

Tony Martin
Tony Martin
CFO at Lumexa Imaging

Sure. Yeah. We feel real good about what Q2 means for the guidance range we provided of 25%-30% conversion rate. That translates to something like $60 million-$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. 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. For Q2, that was true in our system, our day-to-day working capital, and also the timing of distribution 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.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

We don't really view the year any differently. But we definitely see the performance in Q2 as indicative of why we guided to that 25%-30% on a full year basis anyway. Your question about the CapEx, yeah. I mean, $5 million-$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. We really will continue to do that where the return is there. That may cause us to be at the high end of the range. It wouldn't surprise me if that annual number is more driven by a $7 million a quarter run rate as we get later in the year.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

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 here to grow and deploy that capital. All that said, within the bounds of the free cash flow guidance we've given, we feel very good about that for the year.

Pito Chickering
Pito Chickering
Analyst at Deutsche Bank

Okay. Then follow up. You talked about PET in your 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 let it roll in the next 12 months? Are you taking share from the hospitals? Is it mostly the JVs or fully owned facilities that you're investing in or taking share out of? Thank you.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

Yes. We are very excited by the growth of PET. We have shared that we have eight PET machines, and the goal was to get to 11 this year. We already have two 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. We do see significant growth opportunity in PET. We expect to see significant growth rates. The 23.2% that we highlighted was before the two machines opened in July. You should expect in Q3 that growth rate will continue to go higher. As we think about where are we taking share, PET 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.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

When you think about what PET does is it helps diagnose oftentimes life-threatening diseases and show whether or not treatment is stopping the progression of the disease. Waiting weeks and months is unacceptable. 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. 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

Thank you. As a reminder, if you have a question at this time, please press star one one on your telephone. Our next question comes from the line of Matthew Mardula from William Blair. Your question please.

Matthew Mardula
Matthew Mardula
Analyst at William Blair

Yeah, hello, this is Matthew on for Ryan Daniels. Thank you so much for taking all the questions. 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. 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? When we are all thinking about the drivers of advanced imaging, it sounds like it is just a good mix of industry trends and company initiatives, but is it more weighted towards one?

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

Thanks, Matt. Appreciate the question. Yes, excited that we were able to have 37.4% of total volume come from advance. Notably, that is 111 basis point improvement over Q1 2025. We are not 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 advances three to four times revenue premium and then that flows through to margin. It is a significant driver of our success and growth. When you think about what is driving advance, certainly you have the secular drivers, that is, radiology, aging population, increasing chronic conditions. You have novel treatment paradigms, and so there is just an increased demand. But we are doing everything we can to make sure we are capturing our fair share and growing at a pace exceeding the industry.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

That starts with how we are positioning our sales team. We have highlighted that we have over 120 representatives in the market selling for our value proposition all day, every day. It also goes to how we are structuring our operations to continue to expand capacity. Things like FastScan that we are on track to get to two-thirds of our MRI fleet equipped with FastScan or virtual MRIs that we are continuing to roll out to help make sure that if techs happen to call out, we are 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 is met in a geography and an opportunity to serve the population that does not have ample access to advanced imaging.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

Certainly it is exciting to be in an industry that has strong tailwinds and we are doing everything we can on a sales and operations perspective to position ourselves for outsized growth.

Operator

Thank you. Our next question comes from the line of Benjamin Rossi from JPMorgan. Your question please.

Benjamin Rossi
Benjamin Rossi
Analyst at JPMorgan

Hey, good afternoon. Thanks for taking my questions. In context of the broader labor tightness for radiologists and techs, as you have been working to leverage some of those technologies you mentioned to expand capacity, are you finding this unlocked 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 on capacity trends during 2Q and how you are managing levels to meet demand.

Tony Martin
Tony Martin
CFO at Lumexa Imaging

Yeah. Something we think about all the time. I think I can go first and throw a number or two out there, and then Caitlin can expand for broader context on this. We look at our expense for this as up 5% year-over-year. Our operating expenses from 2025 to 2026. In this kind of inflationary environment that we are in generally in the economy, that feels pretty good. It has been an inflationary type of item for us. That said, there is certainly opportunities to improve that. Caitlin, I know we do a lot to retain and recruit.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

Yeah. Ben, when you are thinking about the 5%, that includes obviously pre-ramp-up costs for de novos. Comparing against our revenue, there is expansion upon it and opportunities to, as revenue continues to grow alongside the expenses, it will grow at a higher rate. 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. 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 if we are recruiting a tech or somebody is calling out to take care of their family or take PTO. On the radiologist side, this is why we love our three-prong model.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

We have Connexia, our teleradiology 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. Between all of that, we are able to come up with the right solutions to support the continued growth.

Benjamin Rossi
Benjamin Rossi
Analyst at JPMorgan

Great. I guess as a follow-up, I wanted to spend a moment there on Connexia. I guess with that broader commentary regarding industry demand and read turnaround, could you give us an update on how you are thinking about that segment? Are you finding that your partners are leaning into this segment more or if it is maybe resonating more with your prospective partners? Thanks.

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

Yes. Ben, often when we are 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. If they do, we will support what is the most right for the partnership and 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

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

Caitlin Zulla
Caitlin Zulla
CEO at Lumexa Imaging

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.

Executives
    • Sue Dooley
      Sue Dooley
      Investor Relations Representative
    • Caitlin Zulla
      Caitlin Zulla
      CEO
    • Tony Martin
      Tony Martin
      CFO
Analysts