v3.26.3
Segment Disclosures (Details)
$ in Thousands
 3 Months Ended 9 Months Ended
Sep. 30, 2026
USD ($)
Jun. 30, 2026
USD ($)
Mar. 31, 2026
USD ($)
Sep. 30, 2025
USD ($)
Jun. 30, 2025
USD ($)
Mar. 31, 2025
USD ($)
Sep. 30, 2026
USD ($)
segment
Sep. 30, 2025
USD ($)
Segment Reporting Information [Line Items]                
Total revenue $ 716,000     $ 659,903     $ 2,129,935 $ 1,821,784
Total direct costs 492,115     462,964     1,508,087 1,266,482
Selling, general and administrative 51,765     48,082     147,785 152,643
Depreciation 6,425     6,813     19,731 20,284
Amortization 155     236     465 709
Total operating expenses 550,460     518,095     1,676,068 1,440,118
Income from operations 165,540     141,808     453,867 381,666
Miscellaneous income (expense), net 17     (489)     841 (5,180)
Interest income, net 5,349     1,517     15,452 9,058
Total other income, net 5,366     1,028     16,293 3,878
Income before income taxes 170,906     142,836     470,160 385,544
Income tax provision 33,446     31,701     87,468 69,554
Net income 137,460 $ 121,362 $ 123,870 111,135 $ 90,260 $ 114,595 $ 382,692 315,990
Number of Reportable Segments | segment             1  
Metabolic                
Segment Reporting Information [Line Items]                
Total revenue 229,927     192,635     $ 640,538 551,669
Oncology                
Segment Reporting Information [Line Items]                
Total revenue 99,955     106,398     291,552 320,296
Other                
Segment Reporting Information [Line Items]                
Total revenue 209,242     199,256     665,867 495,144
Central Nervous System                
Segment Reporting Information [Line Items]                
Total revenue 61,409     59,470     177,652 176,333
Cardiology                
Segment Reporting Information [Line Items]                
Total revenue 83,649     65,627     246,714 181,657
AVAI                
Segment Reporting Information [Line Items]                
Total revenue 31,818     36,517     107,612 96,685
Direct Costs                
Segment Reporting Information [Line Items]                
Total direct costs 204,851     186,335     605,680 549,977
Reimbursable Out of Pocket Costs                
Segment Reporting Information [Line Items]                
Total direct costs 287,264     276,629     902,407 716,505
Operating Segments | Reportable Segment                
Segment Reporting Information [Line Items]                
Total revenue 716,000     659,903     2,129,935 1,821,784
Total direct costs 492,115     462,964     1,508,087 1,266,482
Selling, general and administrative 51,765     48,082     147,785 152,643
Depreciation 6,425     6,813     19,731 20,284
Amortization 155     236     465 709
Total operating expenses 550,460     518,095     1,676,068 1,440,118
Income from operations 165,540     141,808     453,867 381,666
Miscellaneous income (expense), net 17     (489)     841 (5,180)
Interest income, net 5,349     1,517     15,452 9,058
Total other income, net 5,366     1,028     16,293 3,878
Income before income taxes 170,906     142,836     470,160 385,544
Income tax provision 33,446     31,701     87,468 69,554
Net income 137,460     111,135     382,692 315,990
Operating Segments | Reportable Segment | Direct Costs                
Segment Reporting Information [Line Items]                
Labor and Related Expense 165,451     149,295     493,143 441,164
Segment Reporting, Other Segment Item, Amount 39,400     37,040     $ 112,537 108,813
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 287,264     276,629     $ 902,407 716,505
Eliminations and Reconciling Items                
Segment Reporting Information [Line Items]                
Net income $ 0     $ 0     $ 0 $ 0