Private Equity and Scale Drive Imaging Center Consolidation
The ongoing wave of imaging center mergers is being driven by private equity-backed platforms and health system acquisitions seeking operational scale, according to a recent market analysis. Smaller independent operators reportedly struggle with capital investment demands, making them attractive acquisition targets for larger groups aiming to increase leverage in payer negotiations.
- From 2014 to 2023, the number of radiologists in the U.S. grew by 17.3%, but the number of affiliated imaging practices decreased by 14.7% as smaller practices were absorbed into larger groups. Practices with 100 or more radiologists saw a 348.5% increase during this period. - A key driver for consolidation is the significant negotiating leverage larger, scaled practices have with commercial payors and hospitals, which can help offset declining reimbursement rates. This trend is a response to consolidation among payors and health systems, which puts financial pressure on smaller, independent radiology groups. - Health systems are actively acquiring outpatient imaging centers to create a more affordable, non-hospital-based option for diagnostic services, aiming to recapture patient volume lost to lower-cost independent competitors. Notable examples include Intermountain Health's acquisition of Steinberg Diagnostic Medical Imaging's 12 locations and Orlando Health's purchase of Medical Center Radiology Group. - In Florida, RadNet recently expanded its footprint by acquiring 13 outpatient centers from Radiology Regional, a move specifically aimed at meeting the rising demand from the state's aging population and deploying its AI platforms to improve workflow. - Private equity firms acquired 151 radiology practices between 2013 and 2023, resulting in 12% of all U.S. radiologists working for PE-backed companies by the end of that period. In 2025 alone, there were at least a dozen private equity deals in the diagnostic imaging sector, with many being "add-on" acquisitions to existing platforms. - Independent centers face significant capital investment challenges to keep pace with technological advancements, making it difficult to compete with larger, better-capitalized entities. This, combined with rising operating costs and staffing shortages, makes them prime targets for acquisition. - Studies show a significant price difference for services based on ownership; one analysis found that negotiated professional prices for hospital-based radiology services were 43% higher than at independent centers, while private equity-backed groups charged about 16% more. - Payers are increasingly directing patients to outpatient settings to control costs, a trend that intensifies competition for imaging volume. This site-of-care shift is a major factor driving health systems to develop and acquire their own freestanding imaging strategies.
