Prepared for lenders, CDCs, and federal agencies to SBA SOP 50 10 8, USDA 7 CFR Part 5001, and conventional underwriting standards. Fiduciary duty runs to the lender and the agency, never the borrower. 4,000+ engagements since 1998 covering $41.2 billion in evaluated project value. So far in 2026: 41 engagements and $1.54 billion evaluated — 17 SBA, 11 USDA.
Imaging centers are scan-volume businesses with referral physics: modality demand — MRI, CT, ultrasound, mammography — flows from the referring-physician base and population utilization rates, against hospital outpatient departments and competing freestanding centers. The study sizes scans by modality from per-capita utilization and the referral catchment, prices them at freestanding rates with the payer differential to hospital settings documented — the differential is the business model — and tests equipment economics: capital cost, service contracts, and the technology-refresh cycle against the volume each magnet or scanner must carry.
Modality-level volume modeling from utilization benchmarks and referral-base analysis, reimbursement at freestanding technical-component rates by payer, equipment cost and refresh scheduling from vendor and service-contract data, and breakeven expressed in scans per modality per day.
Every Wert-Berater financial model is fully linked with no hardcoded values, so any reviewer can stress any input. Deliverables comprise a complete narrative report and the linked Excel model, with ten-year pro forma, sensitivity analysis at ±5, 10, and 15 percent, interest-rate stress from +0.5 to +3.0 percent, and ratio analysis benchmarked against RMA and IBISWorld data.
SBA engagements are prepared to SOP 50 10 8, including its debt-service-coverage minimums of 1.15x operating and 1.00x global. USDA engagements follow RD Staff Instruction 5001 across the Business & Industry, Community Facilities, REAP, and Value-Added Producer Grant programs. Conventional engagements are built to the lender's stated coverage standard, typically 1.20x. Owner-operator centers fit SBA 504's equipment-and-building structure precisely; radiology-group expansions route conventional; the equipment-heavy collateral profile is modeled to each program's terms.
The category applies the firm's equipment-intensive underwriting discipline — the same throughput-per-machine logic used across its industrial record — to clinical capacity. Independence is non-negotiable: determinations follow the evidence and are not revised under pressure, and studies are built to pass lender, agency, and third-party review without exception items.
A feasibility study for a diagnostic imaging center is not a generic business plan. It is a modality-by-modality underwriting document built around the specific equipment the center will operate, the payer mix it will serve, and the referral geography it can realistically capture. The scope is fixed at engagement start and does not change to accommodate a preferred outcome.
Demand for imaging services does not originate with patients; it originates with referring physicians. Building a credible demand analysis therefore begins with quantifying the referral base, not with population alone.
The catchment boundary is drawn using drive-time isochrones calibrated to the modality — primary-care and specialist referral patterns for MRI and CT differ from those for mammography screening, which follows a shorter-radius community model. Within that boundary, the active referring-physician count is assembled from state medical board licensure registries, CMS physician enrollment data, and specialty-specific directories. Utilization rates by modality are drawn from Medicare claims data published by CMS and from peer-reviewed radiology utilization studies, then adjusted for the local payer mix and age-sex distribution of the catchment population.
Competitive supply is inventoried from state certificate-of-need filings where applicable, state health department equipment registries, the American College of Radiology accreditation database, and direct field verification. Hospital outpatient department capacity is treated as a separate supply category because its reimbursement structure and patient-access friction differ from freestanding alternatives. Each competing unit of supply is assigned an estimated utilization rate so that residual unmet demand — the addressable market for the proposed center — is derived from a supply-demand balance, not assumed from thin air.
Four inputs account for the majority of coverage-ratio variance in a diagnostic imaging center feasibility study. Each is stress-tested across the full sensitivity matrix so the lender can see how much cushion remains when conditions deteriorate.
Credit officers and agency reviewers approach imaging centers with a specific set of concerns that differ from those raised by retail, hospitality, or general commercial projects. Understanding those concerns shapes how the study is structured.
SBA engagements under SOP 50 10 8 require the study to demonstrate 1.15x operating debt-service coverage and 1.00x global coverage. For an owner-operator imaging center, the 504 program's structure — which separates equipment financing from real estate — maps naturally onto the asset profile, and the study models each tranche separately so the SBA reviewer can confirm coverage at both levels. The equipment collateral position is documented against vendor liquidation values, not book value.
USDA engagements under RD Staff Instruction 5001 arise most often when the proposed center serves a rural or underserved catchment. The Community Facilities program and the Business & Industry guarantee each carry their own coverage and feasibility documentation requirements, and the study is structured to satisfy the applicable program's checklist without requiring the lender to request supplemental materials.
Conventional lenders typically require 1.20x coverage and focus heavily on the referral-base concentration risk — specifically, whether a small number of high-volume referring physicians represent a dependency that could impair cash flow if those relationships change. The study addresses this directly by documenting referral-base breadth and testing a referring-physician attrition scenario within the sensitivity analysis.
The engagement begins with a fixed-fee quote, delivered within one business day of the initial inquiry. The fee does not change based on the finding, and no portion of it is contingent on loan approval or project outcome. That structure is not a policy preference; it is the condition that makes the study credible to a lender or agency reviewer who knows that a contingent-fee study cannot be independent.
Standard delivery is ten to fifteen business days from receipt of a complete data room. The data room for an imaging center engagement typically includes the proposed equipment list with vendor quotes, the lease or purchase agreement for the facility, the proposed staffing model, any executed or letters-of-intent referral or medical-director agreements, and the ownership entity's financial statements. Rush delivery is available and is quoted at the time of engagement.
When the study is complete, the bound narrative report and the fully linked Excel model are published to a secure client portal. The model remains live: when a lender or agency reviewer changes an input — a different loan amount, a revised equipment cost, an alternative payer-mix assumption — the pro forma, sensitivity tables, and ratio analysis recalculate immediately. This eliminates the revision cycle that typically delays credit decisions and allows the reviewing officer to conduct independent stress testing without requesting a new engagement. The conditions statement in the narrative identifies precisely what must remain true for the base-case determination to hold.
The fee is fixed and quoted within one business day of inquiry. It does not vary based on the finding, and no portion is contingent on loan approval or project outcome. Because scope varies by modality count, catchment complexity, and lending program, a specific figure is provided after a brief intake conversation rather than published as a flat rate.
Standard delivery is ten to fifteen business days from receipt of a complete data room. Rush delivery is available and is quoted at engagement start. The most common cause of delay is an incomplete data room — missing equipment quotes, unsigned medical-director arrangements, or unavailable ownership financials — so gathering those materials before engagement start compresses the timeline.
Three factors distinguish imaging centers from simpler healthcare projects: revenue is modality-specific and reimbursed at freestanding rates that differ materially from hospital outpatient rates, so the payer-mix assumption carries unusual weight; equipment capital is large, depreciates on a technology cycle rather than a straight-line schedule, and requires service contracts that are fixed obligations regardless of volume; and demand is physician-referred, meaning the referral-base concentration risk must be quantified, not assumed away.
SBA SOP 50 10 8 and USDA RD Staff Instruction 5001 both require an independent feasibility study when the lending program mandates one. Independence means the analyst's fee is not contingent on the finding and the determination is not revised at the borrower's request. A study prepared by the borrower's own consultant or a firm with a contingent-fee arrangement does not satisfy that standard and will generate an exception item in the credit file.
Owner-operator imaging centers frequently use SBA 504 because its structure separates equipment financing from real estate, matching the asset profile of a center that carries both a building and significant installed equipment. Rural projects often route through USDA Business & Industry or Community Facilities guarantees. The feasibility study is structured to satisfy the documentation requirements of whichever program the lender selects, and the coverage analysis is run to that program's stated minimums.
A complete data room typically includes the proposed equipment list with vendor quotes, the facility lease or purchase agreement, the proposed staffing model, any executed or draft referral or medical-director agreements, and the ownership entity's financial statements. The lending program, loan amount, and proposed debt structure are also needed so the coverage analysis is built to the correct standard from the first draft rather than revised after submission.
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Wert-Berater, Inc. is an independent provider of feasibility studies and other related services. The firm does not provide financing or equity investment advice, and does not arrange, broker, or place debt or equity capital of any kind.
All appraisal assignments are performed by Bruce E. Jones, MAI, ASA-GC, BCA, CMEA, a member of the Appraisal Institute since 2006, a staff member of Wert-Berater, Inc. and owner of Special Purpose Realty Valuation.