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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 6 Months Ended
Jun. 30, 2025
Jun. 30, 2024
CASH FLOWS FROM OPERATING ACTIVITIES    
Net (loss) income $ (6,703) $ 12,355
Adjustments to reconcile net (loss) income to net cash provided by operating activities:    
Depreciation and amortization 71,476 66,843
Noncash operating lease expense 29,356 30,006
Equity in earnings of joint ventures, net of dividends (1,267) (6,713)
Amortization of deferred financing costs and loan discount 1,471 1,541
Loss on sale and disposal of equipment 2,126 587
Loss on extinguishment of debt 0 (2,080)
Lease abandonment charges 5,511 0
Amortization of cash flow hedge 2,712 7,256
Non-cash change in fair value of interest rate swap 4,062 674
Stock-based compensation 37,235 16,645
Change in fair value of contingent consideration 0 1,974
Changes in operating assets and liabilities, net of assets acquired and liabilities assumed in purchase transactions:    
Accounts receivable (14,159) (31,581)
Other current assets 22,381 5,242
Other assets (2,544) (5,553)
Deferred taxes (3,511) 1,791
Operating leases (34,726) (27,707)
Deferred revenue 145 (185)
Accounts payable, accrued expenses and other 48,264 57,835
Net cash provided by operating activities 161,829 133,090
CASH FLOWS FROM INVESTING ACTIVITIES    
Purchase of imaging facilities and other acquisitions, net of cash acquired (31,985) (32,771)
Purchase of property and equipment and other (101,776) (104,095)
Proceeds from sale of equipment 40 9
Equity contributions in existing and purchase of interest in joint ventures (20,480) (1,421)
Net cash used in investing activities (154,201) (138,278)
CASH FLOWS FROM FINANCING ACTIVITIES    
Principal payments on notes and leases payable (3,461) (2,624)
Payments on Term Loan Debt (10,252) (682,438)
Proceeds from issuance of new debt, net of issuing costs 99,001 863,869
Purchase of noncontrolling interests by third party 2,389 4,169
Payments on contingent consideration and holdbacks 0 (3,614)
Distributions paid to noncontrolling interests (3,313) (2,423)
Proceeds from sale of economic interests in majority owned subsidiary, net of taxes 0 8,713
Proceeds from issuance of common stock 0 218,385
Proceeds from issuance of common stock upon exercise of options 554 367
Net cash provided by financing activities 84,918 404,404
EFFECT OF EXCHANGE RATE CHANGES ON CASH 586 (107)
NET INCREASE IN CASH AND CASH EQUIVALENTS 93,132 399,109
CASH AND CASH EQUIVALENTS, beginning of period 740,020 342,570
CASH AND CASH EQUIVALENTS, end of period 833,152 741,679
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION    
Cash paid during the period for interest 35,018 34,203
Cash paid during the period for income taxes $ 2,428 705
Maximum    
Adjustments to reconcile net (loss) income to net cash provided by operating activities:    
Loss on sale and disposal of equipment   $ 587