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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2025
Sep. 30, 2024
CASH FLOWS FROM OPERATING ACTIVITIES    
Net income $ 7,186 $ 24,611
Adjustments to reconcile net income to net cash provided by operating activities:    
Depreciation and amortization 111,275 101,822
Noncash operating lease expense 44,605 45,516
Equity in earnings of joint ventures, net of dividends (4,590) (10,308)
Amortization of deferred financing costs and loan discount 2,242 2,336
Loss on sale and disposal of equipment 3,168 735
Loss on extinguishment of debt 0 (2,080)
Lease abandonment charges 8,330 0
Amortization of cash flow hedge 2,273 8,242
Non-cash change in fair value of interest rate swap 6,433 7,429
Stock-based compensation 46,276 21,368
Loss on impairment 0 1,200
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 (20,476) (35,369)
Other current assets 2,093 4,738
Other assets (2,764) (7,388)
Deferred taxes 2 4,834
Operating leases (48,760) (40,497)
Deferred revenue 3,934 (255)
Accounts payable, accrued expenses and other 53,429 57,426
Net cash provided by operating activities 214,656 190,494
CASH FLOWS FROM INVESTING ACTIVITIES    
Purchase of imaging facilities and other acquisitions, net of cash acquired (66,464) (37,748)
Purchase of property and equipment and other (162,221) (145,164)
Proceeds from sale of equipment 75 151
Equity contributions in existing and purchase of interest in joint ventures (4,147) (1,496)
Collection of notes receivable 2,832 0
Net cash used in investing activities (229,925) (184,257)
CASH FLOWS FROM FINANCING ACTIVITIES    
Principal payments on notes and leases payable (5,229) (4,296)
Payments on Term Loan Debt (15,504) (688,375)
Proceeds from issuance of new debt, net of issuing costs 99,001 863,815
Purchase of noncontrolling interests by third party 2,389 7,569
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 8,641
Proceeds from issuance of common stock 0 218,385
Proceeds from issuance of common stock upon exercise of options 2,258 367
Net cash provided by financing activities 79,602 400,069
EFFECT OF EXCHANGE RATE CHANGES ON CASH 363 40
NET INCREASE IN CASH AND CASH EQUIVALENTS 64,696 406,346
CASH AND CASH EQUIVALENTS, beginning of period 740,020 342,570
CASH AND CASH EQUIVALENTS, end of period 804,716 748,916
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION    
Cash paid during the period for interest 53,679 57,227
Cash paid during the period for income taxes $ 3,480 $ 2,202