v3.26.1
Segment Disclosures (Details)
$ in Thousands
 3 Months Ended 6 Months Ended
Jun. 30, 2026
USD ($)
Mar. 31, 2026
USD ($)
Jun. 30, 2025
USD ($)
Mar. 31, 2025
USD ($)
Jun. 30, 2026
USD ($)
segment
Jun. 30, 2025
USD ($)
Segment Reporting Information [Line Items]            
Total revenue $ 707,331   $ 603,311   $ 1,413,935 $ 1,161,881
Total direct costs 505,694   423,298   1,015,972 803,518
Selling, general and administrative 48,103   46,664   96,020 104,561
Depreciation 6,555   6,777   13,306 13,471
Amortization 155   237   310 473
Total operating expenses 560,507   476,976   1,125,608 922,023
Income from operations 146,824   126,335   288,327 239,858
Miscellaneous (expense) income, net (147)   (2,875)   824 (4,691)
Interest income, net 4,986   1,078   10,103 7,541
Total other income (expense), net 4,839   (1,797)   10,927 2,850
Income before income taxes 151,663   124,538   299,254 242,708
Income tax provision 30,301   34,278   54,022 37,853
Net income 121,362 $ 123,870 90,260 $ 114,595 $ 245,232 204,855
Number of Reportable Segments | segment         1  
Metabolic            
Segment Reporting Information [Line Items]            
Total revenue 209,372   188,558   $ 410,611 359,034
Oncology            
Segment Reporting Information [Line Items]            
Total revenue 98,279   118,062   191,597 213,898
Other            
Segment Reporting Information [Line Items]            
Total revenue 219,067   147,873   456,625 295,888
Central Nervous System            
Segment Reporting Information [Line Items]            
Total revenue 59,982   58,584   116,243 116,863
Cardiology            
Segment Reporting Information [Line Items]            
Total revenue 82,858   61,129   163,065 116,030
AVAI            
Segment Reporting Information [Line Items]            
Total revenue 37,773   29,105   75,794 60,168
Direct Costs            
Segment Reporting Information [Line Items]            
Total direct costs 202,555   185,826   400,829 363,642
Reimbursable Out of Pocket Costs            
Segment Reporting Information [Line Items]            
Total direct costs 303,139   237,472   615,143 439,876
Operating Segments | Reportable Segment            
Segment Reporting Information [Line Items]            
Total revenue 707,331   603,311   1,413,935 1,161,881
Total direct costs 505,694   423,298   1,015,972 803,518
Selling, general and administrative 48,103   46,664   96,020 104,561
Depreciation 6,555   6,777   13,306 13,471
Amortization 155   237   310 473
Total operating expenses 560,507   476,976   1,125,608 922,023
Income from operations 146,824   126,335   288,327 239,858
Miscellaneous (expense) income, net (147)   (2,875)   824 (4,691)
Interest income, net 4,986   1,078   10,103 7,541
Total other income (expense), net 4,839   (1,797)   10,927 2,850
Income before income taxes 151,663   124,538   299,254 242,708
Income tax provision 30,301   34,278   54,022 37,853
Net income 121,362   90,260   245,232 204,855
Operating Segments | Reportable Segment | Direct Costs            
Segment Reporting Information [Line Items]            
Labor and Related Expense 163,089   147,942   327,692 291,869
Segment Reporting, Other Segment Item, Amount 39,466   37,884   $ 73,137 71,773
Segment Reporting, Other Segment Item, Composition, Description         (a) Direct service costs, excluding depreciation and amortization - Other segment items includes costs related to inventory, leases, project subcontractors and other direct service costs.  
Operating Segments | Reportable Segment | Reimbursable Out of Pocket Costs            
Segment Reporting Information [Line Items]            
Total direct costs 303,139   237,472   $ 615,143 439,876
Eliminations and Reconciling Items            
Segment Reporting Information [Line Items]            
Net income $ 0   $ 0   $ 0 $ 0