Valuing Diagnostic Imaging Centers in 2025: A Comprehensive Guide for Radiologists, Investors, and M&A Professionals

Will Hamilton
Jul 30
8 min read

The diagnostic imaging center industry is a critical component of the healthcare sector, providing essential services for the detection, diagnosis, and monitoring of various medical conditions. These facilities utilize advanced imaging technologies such as X-rays, Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasound, and Positron Emission Tomography (PET) to produce detailed images of the body’s internal structures. M&A activity in this sector has remained steady as health systems continue to consolidate local healthcare providers and private equity -backed platforms pursue geographic expansion.

Whether you're preparing to sell a diagnostic imaging center or portfolio of centers, evaluating a partnership opportunity, or seeking to benchmark financial performance, this article explores the key valuation methodologies, drivers, and risk factors that determine the value of a diagnostic imaging business.

I. Industry Context: Why Diagnostic Imaging is in Demand

The diagnostic imaging industry has seen significant growth over the past several decades due to increasing demand for early and accurate diagnosis, driven by the rising prevalence of chronic diseases, aging populations, and advancements in imaging technology. Diagnostic imaging centers operate in diverse settings, including standalone facilities, hospital outpatient departments, and mobile units, catering to a wide range of patients and healthcare providers. The industry is also influenced by regulatory standards, reimbursement policies, and the need for skilled radiologists and technicians to ensure high-quality patient care.

Despite its growth, the diagnostic imaging center industry faces challenges such as high operational costs, regulatory compliance, and competition from hospitals and other healthcare providers. The adoption of value-based care models and the shift towards outpatient services have created opportunities for imaging centers to enhance efficiency and patient satisfaction.

Additionally, the integration of artificial intelligence (AI) and machine learning into imaging processes is revolutionizing the industry by improving diagnostic accuracy, reducing turnaround times, and optimizing workflow. As healthcare systems worldwide continue to prioritize preventive care and personalized medicine, diagnostic imaging centers are poised to play an increasingly vital role in modern healthcare delivery. The industry’s future will likely be shaped by technological innovation, strategic partnerships, and a focus on cost-effective, patient-centered solutions.

Key Growth Drivers

Key growth drivers for the industry include the following:

Technological Advancements: Continuous innovation in imaging technologies, such as AI integration, 3D/4D imaging, and advanced modalities like PET-MRI and spectral CT, enhances diagnostic accuracy and efficiency, driving market growth.
Rising Prevalence of Chronic Diseases: The increasing incidence of chronic conditions like cancer, cardiovascular diseases, and neurological disorders necessitates advanced diagnostic imaging for early detection and treatment planning.
Aging Population: The growing elderly population is more susceptible to age-related diseases, increasing the demand for diagnostic imaging procedures.
Increasing Demand for Minimally Invasive Procedures: Diagnostic imaging plays a crucial role in guiding minimally invasive surgeries and interventions, which are preferred due to shorter recovery times and reduced risks.
Expansion of Healthcare Infrastructure: Emerging markets are investing in healthcare infrastructure, including diagnostic imaging facilities, to improve access to advanced medical services.

Reimbursement Outlook

In 2025, Medicare reimbursement for imaging services is undergoing several changes, including a reduction in the conversion factor, updates to telehealth policies, and expanded coverage for certain screening services. These changes will impact how healthcare providers are paid for imaging procedures and may require adjustments to billing and operational strategies. Moving into 2026, CMS is proposing a 2.4% reimbursement increase under the OPPS for imaging services that report requisite quality metrics, along with plans to expand the list of reimbursable radiology codes, offering incremental procedural and revenue expansion opportunities. Moreover, a new policy separating high-cost radiopharmaceutical payments should further benefit centers offering advanced imaging therapies, by ensuring those costly agents are reimbursed appropriately.

II. Top Reasons to Get a Valuation of Your Imaging Center Portfolio of Centers

The following is a list of common reasons for commissioning a valuation analysis or appraisal of a diagnostic imaging business:

1. Preparing for a Sale or Strategic Partnership

To establish a defensible asking price when marketing the business
To evaluate offers from private equity, strategic buyers, or joint venture partners
To understand how your center compares to market benchmarks

2. Internal Ownership Transition

For buy-in or buy-out of partners
To support fair and compliant equity allocation among owners
To plan for generational succession or family transfers

3. Compliance with Healthcare Regulations

To support Fair Market Value (FMV) and Commercial Reasonableness (CR) assessments required by Stark Law and Anti-Kickback Statute in deals involving ownership by other healthcare providers
To document compliance in joint ventures, especially when there is a referral relationships (hospitals, ancillary service providers, or other physicians)

4. Estate & Tax Planning

For gift or estate tax reporting to the IRS (especially for closely held businesses)
To support asset protection strategies
To plan for long-term wealth transfer or charitable contributions

5. Litigation or Dispute Resolution

For divorce proceedings involving business asset division
In shareholder or partnership disputes
For economic damages assessments in legal proceedings

6. Business Planning & Strategic Growth

To establish a valuation baseline for performance benchmarking
To support capital raise, refinancing, or line-of-credit applications
To identify value drivers and areas for operational improvement

III. Valuation Approaches for Imaging Centers

Valuation professionals typically apply three core methodologies to estimate the value of a diagnostic imaging center:

Income Approach (Discounted Cash Flow or Capitalization of Earnings)

This approach values a business based on the present value of its expected future earnings or cash flows. It’s most appropriate when a center has a stable operating history and predictable future performance.

Key assumptions include:

Normalized EBITDA or owner’s discretionary earnings
Growth rate assumptions (organic and acquisitive)
Risk-adjusted discount rate (typically 10–20% for imaging centers)
Capital expenditure needs

Pros: Based on the business’ future earning power

Cons: Sensitive to forecasting errors and discount rate subjectivity

Market Approach (Comparable Transaction Method, e.g. Market Multiples)

This method uses observed EBITDA multiples or revenue multiples from recent M&A transactions or public companies in the diagnostic imaging space. Typical multiples for single diagnostic imaging operators are within the range of 3x to 7x EBITDA, depending on a wide variety of factors.

This article includes more details and information about diagnostic imaging valuation multiples.

Pros: Easy to benchmark; useful in active M&A environments

Cons: Requires access to quality private market data and careful adjustment for center size, margin, geography, and a variety of other factors

Asset-Based Approach

Used only when the business is underperforming or being liquidated. The value is derived from the net assets (e.g., equipment, leasehold improvements) minus liabilities.

Pros: Useful in distressed scenarios

Cons: Intangible value of the center can be difficult to quantify under this method

IV. Key Value Drivers in Diagnostic Imaging Valuation

Several specific factors can materially influence an imaging center's valuation multiple:

Earnings Quality

Buyers and valuation professionals place significant emphasis on normalized EBITDA and / or cash flow. Adjustments often include:

Owner compensation (if above/below market)
Non-recurring revenue or expenses
Related-party lease arrangements
Post-transaction adjustments
Out-of-period adjustments

Growth Potential

Discount rates and valuation multiples are a function of perceived risk and growth. Key considerations within the industry related to growth include the following:

High-Value Modality Mix: A focus on advanced, high-reimbursement modalities like MRI, CT, and PET scans—especially in outpatient settings—drives profitability and future growth potential.
Growing Demand Driven by Demographics and Preventive Care: An aging population and increasing use of imaging for early diagnosis and chronic disease management support long-term volume growth.
Capacity for Increased Volume and Extended Hours: Underutilized equipment, ability to expand hours, or add additional shifts provides a clear path for organic growth without major capital investment.
Established Referral Network with Opportunity to Expand: Strong relationships with referring physicians (e.g., orthopedists, neurologists, primary care) and the potential to broaden the referral base signal sustainable and scalable patient volume.
Opportunity to Replicate or Add Locations: A standardized, tech-enabled operational model—such as centralized scheduling, PACS/RIS integration, and billing—positions the business for multi-site expansion and M&A roll-up strategies.

Risk Factors

Key considerations within the industry related to risk include the following:

Diverse Modality and Service Mix: Offering a wide range of imaging services (e.g., MRI, CT, X-ray, ultrasound) spreads revenue across multiple procedures and reduces dependence on any single modality.
In-Network Status with Major Payers: Established contracts with commercial insurers and Medicare reduce reimbursement uncertainty and ensure consistent patient access.
Stable and Diversified Referral Base: A broad network of referring providers—including orthopedists, primary care, and specialists—limits reliance on any one source and helps maintain steady patient volume.
Accreditation and Regulatory Compliance: Accreditation by ACR or similar bodies, along with adherence to HIPAA and imaging safety standards, demonstrates quality and reduces compliance and liability risk.
Well-Maintained Equipment and Efficient Operations: Up-to-date imaging technology and streamlined scheduling, billing, and workflow systems support high throughput, operational reliability, and lower maintenance or capital risk.

V. Current Market Trends in Diagnostic Imaging M&A

The number of announced diagnostic imaging M&A deals has fluctuated in recent years, without a clear defining trend. Much of the M&A activity in the segment is dominated by hospitals, physician groups, and joint venture entities - where public announcements are infrequent.

The diagnostic imaging industry in the U.S. remains fragmented with a large number of potential acquirers, including local hospitals and health systems. The number of platforms that have made more than a handful of acquisitions over the past few years is fairly small. By far the largest acquirer in terms of announced deals since 2019 is publicly-traded RadNet, with 32.

Cash Flow Multiples for Small Imaging Centers

There are a number of small, usually single modality imaging centers listed for sale currently, but it's difficult to glean much useful information from deals this small where the level of owner involvement is unclear. Our study of current and recently removed diagnostic imaging centers for sale shows a range of multiples from 3.89x cash flow to 5.17x cash flow at the 25th and 75th percentiles, with a median of 4.39x.

Impact of Size on Diagnostic Imaging EBITDA Multiples

To better illustrate the impact of size on diagnostic imaging valuations, we looked at historical comparable transaction data from the Scope Research Healthcare M&A Valuation Database and compared the size of the acquired company in terms of EBITDA to the implied multiple from the transaction.

VI. Final Thoughts: Keys to Maximizing Value

If you're an imaging center owner or executive planning to explore a sale or equity partnership, consider the following strategies to enhance your valuation:
- Optimize Modality Mix and Reimbursement Rates: Focus on high-value modalities such as MRI, CT, and PET scans, and negotiate strong in-network contracts with commercial payers to enhance revenue and margin stability.
- Maximize Throughput and Equipment Utilization: Improve scheduling efficiency, minimize equipment downtime, and expand hours of operation to increase scan volume per machine—key drivers of EBITDA growth.
- Build a Diversified Referral Base: Establish relationships with a wide range of referring providers (e.g., orthopedists, neurologists, PCPs) to reduce dependence on any single referral source and ensure consistent patient flow.
- Implement Scalable Operations and Compliance Systems: Standardize protocols, invest in modern PACS/RIS systems, and ensure compliance with HIPAA and accreditation standards (e.g., ACR) to support multi-site scalability and reduce buyer risk.
- Professionalize Financials: Buyers prefer accrual-based, GAAP-compliant statements.
About HealthFMV
HealthFMV specializes in appraising healthcare businesses and services arrangements, including diagnostic imaging centers.
- Business Valuation: We perform independent, third-party valuations of healthcare businesses to document regulatory, tax, and financial reporting compliance, resolve ownership disputes, and help ensure both parties to the transaction are comfortable with the financial terms.
- Transaction Advisory: We work with healthcare business owners, organization executives, providers, and their health lawyers to develop transaction structures and deal terms that further their business objectives while maintaining compliance with the complex healthcare regulatory environment.
- Services Arrangements: We prepare fair market value and commercial reasonableness opinions for a variety of healthcare services arrangements including management services, hospital-based specialty stipends, case rates and PC/TC splits, block leasing, and shared savings distributions, among others.
Contact Will Hamilton at whamilton@healthfmv.com with questions about our healthcare valuation services or to discuss your specific situation. Visit scoperesearch.co for more information about our healthcare M&A research services.