As always, this will be a thirty-minute presentation, and we should have some time at the end for questions. So if you do have a question, you can type them into the Q&A box at the bottom of your screen. Mark, it's all yours.
Thank you. Thank you, Jim, and thanks again for inviting us to the conference. It's always a great conference every year, and we appreciate the opportunity. Good afternoon, everyone, to those of you on the East Coast and those in my home, California, population here. Appreciate you taking the time to hear about our story today. In today's presentation, I'm gonna, you know, give you an introduction to the company, talk a little bit more about the industry and the opportunity that it presents for us to continue to grow our business.
I'll do a deeper dive later on in the presentation about our business and where our revenue comes from, and, I'll end the presentation, talking a little bit about our recent financial performance and our core strategy. For those of you who are less familiar with RadNet, RadNet is the largest owner/operator of diagnostic imaging centers in the United States. These are fixed-site ambulatory outpatient centers. We have 398 locations. We were founded almost four decades ago as a one-center operation here in Los Angeles. And we operate in a highly fragmented and very large industry, which I'll talk about shortly.
We are unique to our industry in that about 37% of our centers are held within joint ventures with some of the largest hospital systems in our markets, and I'll explain why we do that, and the opportunity to grow that business going forward. We also have a number of other ancillary revenue that we've been more recently growing, particularly in the areas of digital health including artificial intelligence and radiology software. We've been a fast-growing business. We've quadrupled the size of the business over the last 15 years.
This year, meaning 2024, we're expecting to do over $1.7 billion of revenue, in and around $275 million of EBITDA, and we have 10,000 employees in the eight states in which we operate. We are geographically concentrated, and that's by design. It's intentional. We'll talk about the benefits of being geographically concentrated, but we have 394 of our 398 locations in seven markets, which is California, the Mid-Atlantic region, Maryland, Delaware, New York, New Jersey, Texas, and Arizona, and the strategy will continue to be densely clustered. It gives us significant benefits on the cost side, as well as the contracting side with the large commercial insurance companies.
We also, from an operating perspective, have an emphasis on being a multimodality player, and what that means is the vast number of our centers perform the full breadth of imaging procedures all the way from the routine imaging through the advanced studies, and I'll talk a little bit later on the next slide why that's important. We've also been an active acquirer and integrator of other businesses. It's a highly fragmented industry, and we continue to be the leading consolidator and the scale player in our industry. We also have some other unique aspects of the business, one of which is our full risk or managed care business that we call capitation. It's full value-based care, which is where healthcare where the healthcare delivery system is moving.
We have responsibility for providing imaging to almost 2 million patient lives, predominantly here on the West Coast under about 35 contracts, and this is approximately 8% of our revenue and growing. More recently, we have been a leader in our industry in the digital health aspect of radiology. We stood up, as of January first of this year, an operating segment that we call digital health, which consists both of radiology software or what we call the informatics business, as well as artificial intelligence solutions. We got into radiology software in two thousand and nine when we decided that we wanted to own our own IT backbone, and we've not only grown that within RadNet, but we have over 200 external customers.
And we will be announcing a new software or tech stack later on this year in November called Deep Health OS, which brings these IT solutions to the cloud and builds in a number of automation tools that is not only gonna make our business significantly more efficient and low cost, but also do that for our customers. And more recently, starting in 2020, we got into the AI business, and we're convinced that AI will have a transformational impact on our business and on the industry at large. And we focused on the areas of breast, prostate, and lung cancer, and are really trying to drive population health screening opportunities for our digital health platform and for our AI platform... and this has been a nice business for us.
We're expecting the digital health segment of our company to have north of $60 million of revenue this year, and we are expecting that the AI portion of the digital health platform will exceed $20 million this year. So what do we do? As I mentioned, we're a full multi-modality company. We provide the full breadth of imaging services on a one-stop-shop basis to our referring physician community. About 80% of what we do by volume is the routine imaging and the advanced imaging, which drives a significant amount of revenue, which is roughly the other 20% of our business, drives almost 60% of the revenue. There's significant benefits for being a one-stop shop.
We're able to put one prescription pad on the desks of our referring physician communities, and they know, no matter what their, the imaging needs are of their patients, they can send it to the RadNet facilities. Additionally, it makes us indispensable to the insurance companies who need and want us to be in their network because we're providing the full breadth of imaging capabilities. I'll talk a little bit about the industry. If you believe the research out there, it's believed to be over $100 billion of imaging services revenue each year in the United States, and growing in the neighborhood of 2%-3%, and it's consistently done that over the past couple of decades.
The industry is divided almost equally between imaging that gets performed at hospitals and large health systems, versus imaging that gets performed outside of the hospitals, including, you know, the vast majority in ambulatory outpatient imaging centers like the ones that we operate. There is a concerted effort that's occurring now in the healthcare delivery system to try to drive as much of the outpatient business outside of the hospital outpatient departments into freestanding centers, where the cost of delivering this care is much lower. It's not uncommon in our markets that the hospitals charge between 200 and 500% of the cost that we charge for the same services that we provide.
The health system, the payers and the insurance companies are doing more and more these days to try to drive this business out of the hospitals into the lower-cost sites of care. The outpatient industry is very fragmented. It's believed that there are over 6,000 imaging centers in the United States. RadNet being the largest player with 400 of them illustrates how fragmented the market is. If you put the top five imaging center chains together, including ourselves, we'd have less than 15% of the entire industry. So there's a lot of consolidation left to happen, and there is a lot of growth and an opportunity in this industry. The industry grows every year. It's growing for a number of different reasons. First, the population is growing and aging.
It's been shown that Medicare lives, meaning the sixty-five and older demographic, utilizes imaging at about three times more frequently than the under-sixty-five population. As the population continues to grow, as baby boomers continue to age, it causes more diagnostic imaging or clinical indications for ordering these tests. Additionally, the industry is being driven by technology advances. Almost every year, there are advances in the equipment, in contrast materials, in radioactive pharmaceuticals, more recently in post-processing software and AI, which just drives more clinical indications for ordering these types of diagnostic tests. We're operating not only in a growing industry, but in an industry where there's a market share shift out of the hospitals in favor of outpatient imaging centers like the ones that we operate. The industry is consolidating.
Like the rest of healthcare, scale is becoming more and more important. In order to be an efficient operator and get the benefits of scale, you have to have big operations and the ability to centralize business processes on behalf of your centers and do that at scale makes it harder and harder for the smaller players to compete, and they're not able to make the types of investments in technology that drive and improve patient care, and so there will continue to be consolidation. RadNet is an active acquirer. We have gotten more and more demand from the smaller operators who wanna join our network and get the benefits of scale that we provide.
We've done about $250 million worth of acquisitions over the last four years. I'll talk a little bit more about our strategy. As you can see by this map on page eight, we are highly concentrated in the areas, in the geographies in which we operate. All, roughly 400 of our centers are held within eight states. That's by design. These are very populous states. These are states where the populations are growing, and these are states where we have very significant brands, and very significant operations.
One of the benefits of geographic concentration is that we're able to centralize the main business functions we perform on behalf of our centers, including patient scheduling, patient call centers, pre-authorization departments, insurance verification departments, marketing departments, revenue cycle, and other functions. The other thing that geographic concentration has allowed us to be successful in is in establishing fair and equitable long-term rates with the major insurance companies. We have shown ourselves to be indispensable partners to the large insurance companies in these regions. Having this scale and having this level of market share gives us a seat at the table to maintain fair and equitable rates. On page nine, you'll see where our revenue comes from.
As I mentioned earlier, about 75% of our business, on a procedure volumes basis, comes from routine imaging. But it's that other 25%, the advanced imaging, including MRI, CT, and PET CT, that drives almost 60% of our revenue. So clearly, the high-ticket items provide us, you know, with the revenue, and what's great about this is that this is where the growth in the industry is. And all the technology advances in recent years, it has been on the advanced imaging equipment, and which is driving more and more clinical indications for these types of tests.
We noted, you know, in the first half of this year, that there's been over 100 basis point shift between routine imaging and advanced imaging in our business, and this not only is driving revenue, but it's also driving margin expansion. From a payer standpoint, we have a very diversified payer mix. Commercial insurance is still our biggest book of business, which represents over 58% of our net revenue. We have strong relationships with all the major national payers and regional payers. We're partnering with them to try to get the business effectively out of the hospitals into the lower-cost sites of care. And they have rewarded us in recent years with pricing increases and trying to shift more business to us.
22% of our business is Medicare. Though we have some influence on Medicare pricing through our relationships with lobbyists and some of the larger industry organizations, essentially, these are rates that are dictated by Medicare. In the last four or five years, rates have been fairly stable. Some small price decreases over the last few years related to a budget neutrality provision in when Medicare increased several years ago a reimbursement for primary care physicians, where they're taking it out of all the other specialties. But we expect to have stable rates on the Medicare side going forward.
Capitation, which I'll talk about more in depth on the next slide, is 8% of our business, very unique aspect of our company, and then we've got some other small books of business, including workers' comp, personal injury, and the state-run Medicaid programs. I'll spend a couple of minutes on our capitation business, which I mentioned is about 8% of our business, representing about $150 million of annual revenue. Very unique to RadNet. It's a function of our scale and our geographic concentration, particularly in California, where we contract with upwards of 30 large medical groups, where we agree to provide the imaging to these populations on an exclusive basis, roughly 2 million lives, both on commercial lives, Medicaid lives, as well as the Medicare Advantage or the senior lives.
And they pay us a per-member, per-month fee for providing these this imaging to these patient populations. RadNet then manages the utilization and takes the risk on the utilization side, and it's been a very profitable book of business we've been doing for upwards of twenty years. We have extremely high renewal rate. We do cancel contracts if we believe that we're not being paid appropriately for the services that we provide, but generally speaking, it's been a very steady and growing book of business. We have nice price increases that are built into most of our contracts, and one of the things that we really love about this business is what we call pull-through revenue.
And this is other books of business that these same physicians send to us, who are obligated to send these capitation lives to us, which are all HMO lives, but they see all the other payer classes. And because we have the relationship with them on this HMO capitated business, they tend to send us the other books of business as well. As I mentioned in my opening remarks, the hospital joint venture business has been a bigger part of what we've done over the last five years. These same hospitals that continue to lose business to outpatient players are sometimes looking for a long-term viable strategy around outpatient imaging. And many of them have been approaching us to partner with us in growing an outpatient practice on their behalf.
In many cases, we allow them to buy into existing RadNet facilities in their markets, where they can buy into an existing book of business that they otherwise wouldn't see. You know, they rely on us to continue to build that practice, and share in the economics of the growth of these businesses. We've got both consolidated and unconsolidated operations. We have very, very notable partners, including MemorialCare, the RWJBarnabas Health system, University of Maryland Medical System, Dignity Health, Adventist Health, MemorialCare, and many more. There are significant benefits to us. One, by partnering with the hospital, the hospital has relationships with referring physicians out in the community that they then are instrumental in driving those referrals into now our jointly owned facilities.
It also gives us a better seat at the table with the commercial insurance companies. We have the power and the strength of the health systems behind us in order to help us establish long-term fair and equitable rates with the payers. The benefits the hospitals get, for the most part, is that they can then share in the growth of the outpatient business, and they can now benefit from this trend of the business leaving the hospitals into the freestanding centers. They now partner with someone who has a multi-decade experience and expertise in very profitably managing outpatient imaging centers, which are run at very, very high volumes and significantly lower pricing. I'll talk a little bit about our digital health platform, which we call Deep Health.
We have two businesses within Deep Health. The first is a radiology software business that historically we've branded under the name eRAD. That is the software solution that all of RadNet's 398 facilities operate on. It is a full end-to-end solution from a radiology information solution all the way to a back-end image management solution. We got into this business in 2009, intending really to only put our own imaging centers on the platform, and then over time, we had significant demand from the rest of the industry to license this platform. And today, we have over 200 customers outside of RadNet who license the RadNet platform. We are in the process of launching the successor product to eRAD, called Deep Health OS.
OS stands for Operating System, which is a new software platform that is cloud native and incorporates in it a number of AI, generative AI solutions that are focused on fully automating or more greatly automating certain business processes that we perform on behalf of our centers, including patient scheduling, patient call centers, pre-authorization departments, insurance verification, certain revenue cycle functions. We think this is gonna have a tremendous impact on the efficiency and the cost structure of our business.
We are having our commercial launch this November at the big radiology show called the RSNA the week after Thanksgiving where we'll be launching a fully commercialized product to the rest of the industry that we'll be selling and delivering within 2025 at the same time as getting the RadNet facilities on the new platform. Very excited about this, and look forward to what that could mean, not only for our own business, but in terms of the growth of our digital health business within RadNet. The other area of digital health is our AI division. We are deep into cancer screening and population health management. Our AI division has been growing very nicely.
We did about $3.5 billion of AI revenue in 2022, when we launched the Deep Health breast product called EBCD, which is a self-pay breast AI program, and we this year will do, you know, close to $25 billion of AI revenue. So we've seen extraordinary growth in AI. We're now focused on rolling out our lung product in Europe with the National Health Service with their argeted Lung Health Check program, which is a four-country rollout in the U.K. We're hoping to get FDA approval on that lung product that we call Aidence sometime in the first half of 2025.
And we also have a product for prostate screening and for prostate MRI that we're also going to be launching in the U.S. on a self-pay program, similar to what we're doing with breast sometime next year in 2025. I'll conclude the presentation just by going through some of our financials. We've been enjoying double-digit revenue growth now for several years including growing our EBITDA. North of that, we've had some nice margin expansion over the last couple years. Last quarter, we grew our EBITDA almost 20%. Our aggregate procedure volumes are growing in the high single digits, with our same center performance on the volumes growing kind of at the mid-single digits.
We've been announcing new joint ventures, like one with the Providence health system in California, recently. We're aggressively building de novo centers to take care of very heavy demand that we're experiencing in almost all our markets. We've got six de novo facilities that we expect to open by year-end this year, and we've got 15 additional de novo centers to open sometime in 2025. We've also recently made an important hire in our digital health division of Kees Wesdorp to be the president and CEO of our digital health platform. As you can see on page 18, we've grown our business very effectively over the last 15 years at an 8.8% compound annual growth rate on the top line.
EBITDA has been close to 6%, and, as you would imagine, we've had increasing procedure volumes throughout this period that have been driving that growth. From a capital structure standpoint, we've got a lot of cash on the balance sheet. We ended last quarter with $742 million of cash on the balance sheet. We're very unlevered. We've got about one times net debt to EBITDA from a leverage standpoint, so we've got a lot of capacity to continue to grow this business into the future, to continue to make acquisitions, and we've got a nice net operating loss carryforward that shields us at least for the next several years from paying any federal taxes.
And with that, we've got a couple of minutes, Jim, then I'll open up the floor to any questions.
Okay, first one: With the Deep Health OS rollout, will you have that up and running in your 400 centers before you license that to other centers?
We're gonna do that simultaneously, Jim. We're gonna start the rollout within the RadNet centers, you know, around year-end, maybe early on in 2025. But we're already taking orders based upon showing demos to, you know, potential customers. We're already taking orders for the digital health platform for the commercial rollout, which will occur concurrently, you know, within 2025. And the big launch of this product will be at the RSNA show the week after Thanksgiving in November.
With the new prostate screening product, is that coupled with MRIs or CTs, or you know, what technology will that be within? What will it cost?
Yes, it's a product that's coupled with MRI. That's how it was FDA cleared. We haven't come up with the final pricing. The pricing is going to include the pricing for the underlying MRI. Our hopes and aspirations is, if we can do this at scale, Jim, that we can keep the price around $300 for the screening test. So it's gonna be significantly more than the $40 that we're charging women now for their EBCD program, concurrent with their annual mammography screening. But it's, it's... We're hoping to make it affordable to enough folks where, you know, we see significant demand.
The hopes here, Jim, is that in the future, the payers and CMS will see the benefits of population health screening for prostate cancer, using something, so it's a tool that we believe is much more efficacious, and better for healthcare than the PSA test, which is a simple blood test that, frankly, is not very instructive. And we think that the prostate MRI test with using AI, if we can get the cost low enough, is something that the payers will ultimately reimburse for it.
Right, and then lastly, when you identify a market where you think there's demand, how do you decide whether to open up a new facility, partner with a hospital in that area for a joint venture, or just acquire something that's there?
If the opportunity is within an existing market that we have, that we're currently in, it generally depends upon geography in that market. So if there's an existing joint venture in that market, we have non-compete areas around those joint ventures, so that if we saw an opportunity to build or buy within that non-compete zone, we're gonna do that through the existing joint venture with the health system. If it's outside of one of those non-compete areas, that would be a RadNet wholly owned center, until such time or as we identify a partner in that particular area.
If the opportunity is outside of what our existing eight core markets or eight states, typically, we wouldn't go into a new market unless we went in there with significant scale, and that would be one of two opportunities. The first would be a very significant acquisition where we can get scale day one by buying enough centers, and having a platform from which we can then grow, and then the second would be if there were already a very large health system in that market who has scale there, who wants to bring us in as a partner, and can therefore provide, you know, a patient flow and help us, you know, establish you know, contracted rates with the local insurance companies.
And I assume Texas is that third category?
Texas is where we went in with two acquisitions, simultaneous acquisitions, that we are now in the process of merging those practices, which gives us 13 sites, which is a, you know, a nice beachhead from which we really think that we can grow, you know, significantly in that marketplace. So right now, we're doing it alone. We're not doing it with a health system partner. We'll see where that goes in the future, but there's a lot of opportunity in that market. It's the fourth-largest city in the United States from a population standpoint, and it's the second fastest demographic location in the United States. So there's real, you know, real good growth there for us.
Right. All right, well, there are a ton more questions, but we're out of time. So I just wanna say thank you, Mark, for doing the meetings today. Thank you for the time, taking the time to do the presentation, and we'll talk to you soon.
My pleasure, Jim. Take care.
All right. Bye-bye.