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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 6 Months Ended
Jun. 30, 2022
Jun. 30, 2021
CASH FLOWS FROM OPERATING ACTIVITIES    
Net (loss) income $ 22,194 $ 21,862
Adjustments to reconcile net income to net cash provided by operating activities:    
Depreciation and amortization 55,980 46,667
Amortization of operating lease right-of-use assets 34,055 36,834
Equity in earnings of joint ventures, net of dividends (5,266) (5,406)
Amortization of deferred financing costs and loan discount 1,295 1,959
Loss (gain) on sale and disposal of equipment and other 1,209 (2,874)
Loss on extinguishment of debt 0 1,496
Amortization of cash flow hedge, net of taxes 1,847 1,845
Non-cash change in fair value of interest rate swaps (27,125) (11,280)
Stock-based compensation 15,795 17,145
Change in fair value of contingent consideration (1,287) 1,292
Changes in operating assets and liabilities, net of assets acquired and liabilities assumed in purchase transactions:    
Accounts receivable (30,566) (28,156)
Other current assets (709) 2,963
Other assets 1,282 (4,997)
Deferred taxes 4,732 5,297
Operating lease liability (32,219) (36,564)
Deferred revenue (7,565) (7,147)
Accounts payable, accrued expenses and other 32,092 17,765
Net cash provided by operating activities 65,744 58,701
CASH FLOWS FROM INVESTING ACTIVITIES    
Purchase of imaging centers and other acquisitions (26,009) (64,918)
Purchase of property and equipment (72,659) (53,799)
Proceeds from sale of equipment 4,121 500
Equity contributions in existing and purchase of interest in joint ventures (1,441) (1,441)
Net cash used in investing activities (95,988) (119,658)
CASH FLOWS FROM FINANCING ACTIVITIES    
Principal payments on notes and leases payable 0 (3,304)
Payments on term loan debt (6,625) (613,279)
Proceeds from debt refinancing, net of issuing costs 0 716,369
Proceeds from revolving credit facility 0 128,300
Payments on revolving credit facility 0 (128,300)
Proceeds from issuance of common stock upon exercise of options 0 26
Net cash (used in) provided by financing activities (6,625) 99,812
EFFECT OF EXCHANGE RATE CHANGES ON CASH 1,433 (21)
NET (DECREASE) INCREASE IN CASH AND CASH EQUIVALENTS (35,436) 38,834
CASH AND CASH EQUIVALENTS, beginning of period 134,606 102,018
CASH AND CASH EQUIVALENTS, end of period 99,170 140,852
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION    
Cash paid during the period for interest 19,687 13,774
Cash paid during the period for income taxes $ 126 $ 1,471