Axogen, Inc. (AXGN) Q3 2026 Earnings Call Transcript

Joining me on today's call is Michael Dale, Axiogen's President and Chief Executive Officer, and Lindsey Hartley, Chief Financial Officer. Michael will discuss third-quarter 2026 financial results and corporate highlights. Lindsey will then provide details on financial performance and overall outlook for the year. This will be followed by a question-and-answer session. Today's call and presentation is being broadcast live via webcast, which is available on the Investor Section of Axiogen's website. Following the end of the live call, a replay will be available on the Investors section of the company's website at www.axogeninc.com. Before we begin, I would like to remind you that during this conference call, management will be making forward-looking statements. Forward-looking statements include statements regarding financial guidance and outlook, clinical development and regulatory efforts, Commercial growth initiatives, reimbursement and market access efforts, training and education initiatives, research and development activities, and overall business strategy and performance, including anticipated benefits and integration activities related to the bio-circuit acquisition. These far-looking statements are subject to risks and uncertainties that could cause actual results to differ materially, including without limitation the risks and uncertainties reflected in the company's filings with the Securities and Exchange Commission, Including the most recent annual report on Form 10-K, subsequent quarterly reports on Form 10-Q, and other filings made with the Securities and Exchange Commission. Forward-looking statements speak only as of the date they are made, and the company undertakes no obligation to update any forward-looking statements, except as required by law. In addition, for reconciliation of non-GAAP measures, please refer to today's press release, presentation with highlights from today's call, and the corporate presentation on the Investor section of the company's website. Now I'll turn the call over to Michael. Michael, please go ahead.

Thank you, Operator, and good morning, everyone. Today, I will walk you through our third quarter performance using the same lens we've used all year, which are the six priorities that comprise our strategic plan. Once I've concluded my commentary, Lindsay will review our financials in detail, after which we'll open the call for questions. Before reviewing performance against each strategic priority, I would like to make clear how delighted we are with our third quarter and year-to-date results. We are meeting or exceeding our customer creation objectives across the board and remain confident in our ability to execute our strategic plan. Starting with our first priority, which is revenue growth and financial operating leverage. Third quarter revenue was $75.8 million, up 26.2% from third quarter 2025, with growth in all of our markets. Breast grew more than 50% year-over-year, and extremities, OMF, head-to-neck combined grew 10.7%. Advance made up 64% of revenue in the quarter and year-to-date, versus about 60% for 2025. GAAP net income was $2.3 million, adjusted net income was $13.1 million, and adjusted EBITDA was $13.4 million, with adjusted EBITDA margin up 2.3 percentage points from a year ago. We ended the quarter with $350 million in cash, cash equivalents, restricted cash, and investments, including proceeds from our September equity offering. Gross margin was 74.8%, up from 72.7% in the second quarter, and down from 76.6% a year ago. Moving to our second priority, market development. Consistent with prior quarters, all three target markets contributed positively to third-quarter results. We continue to see momentum in breast as nerve reconstruction becomes a larger part of the breast reconstruction conversation. Growth is coming from expansion within existing accounts, new surgeon adoption, and new account development, supported by rising patient awareness and interest in breast resensation. Because this market remains early in its development, we see significant long-term growth potential from expanding our commercial footprint, developing new accounts, and training new surgeons. In third quarter, we held our final two surgeon training programs planned for 2026, training more than 50 plastic surgeons in the resensation technique. We also continued investing in patient awareness and completed significant market development work to prepare for Breast Cancer Awareness Month in October. We now have roughly 485 active breast accounts, up more than 95 year-over-year, and roughly 590 active surgeons, up more than 140 year-over-year. Turning to extremities in OMF and head and neck markets, growth was double-digit in the third quarter, continuing the steady progress described on prior calls, supported by account expansion and increased surge in activation, as driven by our high-potential account strategy. Extremities grew across key indications in both upper and lower extremities. In OMF, head and neck growth was driven by adoption of our algorithm in mandible reconstruction and continued momentum in oncologic procedures such as neck dissections. With regards to priority three, commercial expansion, Brest now has 31 representatives and three regional directors, 10 more representatives than at the start of the year. Extremities in OMF and Head & Neck has 132 representatives and 15 regional directors, 15 more than at the start of the year. We also have three field-based market development managers supporting OMF and Head & Neck and three clinical development managers supporting prostate. The fourth priority of our strategic plan is commercial excellence. Our primary strategy over the past several years, focusing on high-potential accounts to build enduring nerve care practices, continues to deliver results. In these accounts, our goal is to develop new surgeons and drive adoption of best practices and the full treatment algorithm, making the restoration of peripheral nerve function a standard of care across the hospital. Year-to-date, high-potential accounts generated 61% of revenue and 55% of growth. With productivity increasing 22%, productivity in non-hypertensial counts rose 25%, while productivity across all accounts increased 22%. These results point to broader adoption of nerve care as more surgeons practice across multiple sites, supported by expanded coverage. Next, I'd like to update everyone on our fifth priority, standard of care, evidence, and coverage. Today, we have two national payer updates to provide. Let's start with Elevance. In April, Elevance removed Vance from its experimental and investigational list, but included a utilization management criterion based on the nerve gap length from the recon trial. After a collaborative meeting with Elevance and a few world-leading surgeons in the second quarter, Elevance removed the gap length criteria in August. This timing beat our internal expectations. Now, Aetna. In early October, Aetna extended coverage to events for short to medium sensory nerve caps of 30 millimeters or less in the upper extremity. As we've stated before, it is common for medical policy teams to initially adopt strict utilization management criteria for a new coverage position, and we believe that is what drove Aetna's decision. Similar to how we've handled the prior L-Events situation, our health economics and reimbursement team will partner with surgeons to educate Aetna and resolve this situation collaboratively. With the updates from L-Events and Aetna, the commercial payer coverage for events is approximately 96% of covered lives in the United States. This satisfies the milestone in our strategic plan for near-universal coverage. Since the second quarter of 2025, we have added an estimated 87.6 million commercial and Medicare-Advantaged lives across Cigna, Elevance, Aetna, and the 12 Blue Cross Blue Shield Regional Plans. Beyond expanding coverage, we continue to invest in the clinical evidence needed to advance nerve repair as an expected standard of care. This quarter, we made progress across that evidence strategy, including new peer-reviewed evidence in advancement of two important clinical studies. Recently, results from our MATCH study were published providing direct comparative evidence for advanced nerve graft and nerve autograft in mixed and motor nerve reconstruction. The study demonstrated that motor recovery with advanced was comparable with autograph, further strengthening the body of clinical evidence supporting advanced and mixed in motor nerve repair. Nerve Restore, which we described last quarter, builds upon this evidence through a randomized assessor-blinded comparison of advanced nerve graft and serial nerve autograph in mixed in motor nerve repair. We are pleased to report that the first patient has now been enrolled, marking an important milestone in this study. Additional site activations are planned for the fourth quarter as enrollment continues. We are also advancing EMBRACE, our prospective multi-sensor study evaluating sensory recovery following breast reconstruction with and without nipple areolar complex nerve reconstruction. The study is designed to generate comparative evidence on restoration of nipple aureolar complex sensation, including patient-reported outcomes. Study startup is underway with the first site initiation planned for the fourth quarter. And finally, our sixth priority, which is about innovation, R&D, and therapeutic reconstruction. On October 1st, we completed our acquisition of BioCircuit, adding nerve tape as the sixth product in our nerve repair algorithm. We see significant potential to scale nerve tape as a faster, easier coaptation aid. In large gap repairs, nerve tape can be used with advanced to connect the proximal and distal nerve ends. Nerve tape also expands our reach into direct repair, an underdeveloped and effectively new opportunity for oxygen that represents approximately 40% to 50% of transected nerve procedures. In these procedures, nerve tape enables surgeons to reconnect a transected native nerve more simply and effectively than with microsuturing, the predominant method used today. BioCircuit historically sold through approximately 50 independent distributed representatives and served roughly 400 counts. As of today, Axiogen's direct sales organization has assumed all sales and distribution responsibilities. We expect the transaction to contribute to revenue growth and adjusted EBITDA margin in the first year, while Axiogen remains free cash flow positive. Looking ahead, we are confident that leveraging nerve tape across Oxygen's direct commercial platform and demonstrating its ability to enable simpler, faster, and more effective repairs will accelerate the adoption of nerve repair and strengthen our overall growth strategy. Turning to prostate. As announced in this morning's earnings release, we will initiate prostate nerve reconstruction market development in 2027. Based on collaboration with global experts in urology and men's sexual health, we validated the clinical need, which is substantial, developed a scalable technique that is efficient and reproducible, and see positive clinical outcome signals from our clinical To date, over 220 patients have received prostate nerve reconstruction with the Vance across 15 clinical development sites. Of these, 117 patients have at least six months of follow-up, 86 grafted on one side unilaterally, and 31 grafted on both sides bilaterally. No graft or grafting procedure-related complications were reported. Historically, men undergoing traditional non-nerve-sparing radical prostatectomy have a high risk of severe erectile dysfunction, with unilateral non-nerve-sparing patients reporting recovery of erectile function in only 33% to 56% of men, And those undergoing bilaterally non-nerve-sparing procedures having a less than 13% chance of recovering useful erections. When repairing the nerves with advance, we see that among patients with at least six months of postoperative follow-up, surgeons report that approximately 80% have achieved better-than-expected recovery of erectile function, defined as a sexual health inventory for men, or otherwise known as SHIM, score of 15 or higher. On this validated 25-point scale, a score of 15 or higher is generally associated with erections sufficient for sexual activity. For reference, a score of 7 or lower indicates severe erectile dysfunction. These early results suggest that meaningful erectile function may return as early as six months after surgery when following postoperative penile rehabilitation protocols as prescribed with or without PDE5 inhibitors. In addition, over 95% of patients achieved pad-free urinary continence at or above expected levels. These results demonstrate an exceptional benefit-to-risk ratio and have established the foundation to initiate prostate nerve reconstruction market development in 2027. We look forward to sharing a detailed overview of the clinical outcomes and market research underlying our decision to move forward on November 9th. Dr. David Lee, Professor of Urology at the UC Irvine School of Medicine and Director of the University of California-Irvine Health Comprehensive Prostate Cancer Program, and Dr. Zayad Xun, Assistant Professor of Urologic Surgery at Cleveland Clinic, will join us to provide clinical and patient perspectives. Regarding the financials and logistics of our prostate nerve reconstruction market development plan, we will share details during our March, 2027, Investor Day. We believe nerve reconstruction in prostatectomy can become a meaningful, long-term growth driver for accident, and more importantly, a new standard of care for men facing prostate cancer. Lastly, as a reminder, prostate is not included in our current or long-range guidance. We will provide an update on guidance in the first quarter of 2027. To close, we are delighted with our overall business performance and have high confidence in our ability to continue executing our near- and longer-term plans. With that, I will now turn the call over to Lindsay to review our financials.

Thanks, Mike. I'm pleased to report our third quarter 2026 financial results. For the third quarter, we reported revenue of $75.8 million, reflecting growth of 26.2% year-over-year. Revenue growth continues to be driven by strong demand for advance and adoption of our product algorithm across target markets, with unit volume serving as the primary driver, then price. Our gross profit for the quarter came in at $56.7 million. This represents a gross margin of 74.8%. Gross margin decreased 180 basis points year-over-year, driven by 3% higher product cost, partially offset by 1.2% lower write-offs. We continue to expect gross margin to decline in the fourth quarter sequentially and to be slightly less than our second quarter, as a result of adjusting our production plans beginning in the third quarter to better align production with the increased demand for long-length advance, largely stemming from the growth of our breast business. Yield improvements and pricing actions are underway, but their impact on gross margin will lag as they move through cost of goods sold. We expect full year 2027 to be more in line with full year 2026 and will provide formal 2027 guidance in the first quarter. Operating expenses increased to $55.8 million in the third quarter, up from $44.1 million in the third quarter of 2025, and increased 0.1% of revenue. The increase year-over-year was driven primarily by compensation costs, stock-based compensation expense tied to certain PSU anticipated to achieve above-target on revenue growth components, and costs related to the acquisition of BioCircuit. Sequentially, as a percentage of revenue, operating expenses decreased 2.3 percentage points. Sales and marketing expenses as a percentage of total revenue decreased 2.7 percentage points to 40% in the third quarter, compared to 42.7% in the third quarter of 2025. Sequentially, as a percentage of revenue, sales and marketing expenses decreased 4.2 percentage points. Research and development expenses increased 18.3% to $9 million in the third quarter, compared to $7.6 million in the third quarter of 2025. And as a percentage of total revenue decreased to 11.8% from 12.6%. Sequentially, as a percentage of revenue, research and development expenses decreased 0.5 percentage points. General and administrative expenses increased 51.9% to $16.5 million in the third quarter, compared to $10.8 million in the third quarter of 2025. And as a percentage of total revenue increased 3.6 percentage points to 21.7% from 18.1%. Sequentially, as a percentage of revenue, general and administrative expenses increased 2.4 percentage points. During the quarter, we incurred $2 million of costs related to our acquisition of BioCircuit, contributing to the year-over-year and sequential increases. Net income for the third quarter was $2.3 million, or $0.04 per share, compared to $700,000, or $0.01 per share in the third quarter of 2025. Sequentially, net income improved $3.9 million. Adjusted net income was $13.1 million, or $0.21 per share, for the third quarter, compared to $6.1 million, or $0.12 per share, for the third quarter of 2025. Sequentially, adjusted net income improved $5.8 million. Adjusted EBITDA for the third quarter was $13.4 million, compared to an adjusted EBITDA of $9.2 million in the same period last year, and as a percentage of revenue increased, 2.3 percentage points to 17.7 percent from 15.4 percent. Sequentially, adjusted EBITDA improved $5 million. Adjusted net income and adjusted EBITDA are calculated as net income or EBITDA adjusted for stock-based compensation, the loss on the extinguishment of debt, and the transaction and integration cost incurred in connection with the acquisition of BioCircuit. The improved bottom-line performance demonstrates our continued ability to drive both top-line growth and profitability. As of September 30th, 2026, cash equivalents, restricted cash, and investments totaled $350.1 million. Through the first nine months of 2026, we generated $18.9 million of free cash flow. On October 1st, we completed the acquisition of BioCircuit and funded the purchase price of $200 million plus transaction expenses. Integration and purchase accounting activities are underway and progressing well. In connection with our purchase accounting for the transaction, we expect to adjust the value of the acquired bio-circuit inventory and recognize goodwill and intangible assets on our balance sheet. Amortization of these intangible assets over their respective lives will significantly increase our amortization expense and general and administration expenses going forward. Our preliminary purchase price allocation and required disclosures, including pro forma historical revenue and earnings related to the Biosificit acquisition, will be included in our 2026 Form 10-K. Based on our year-to-date performance, acquisition of BioCircuit, and visibility into the remainder of the year, we are revising our full-year 2026 financial guidance. We now expect full-year 2026 revenue growth of at least 29%, or revenue of at least $290 million, including at least $7 million This guidance does not assume material benefit from payer coverage decisions. Beyond what's already known, nor from our decision to begin market development activities for prostate. While not expected, our BioCircuit revenue guidance does contemplate some level of integration or disruption risk associated with the acquisition. The expected impact resulting from the overlap of BioCircuit's nerve tape with our AxaGuard connector and AXA Guard protector products is included in our organic revenue growth guidance of at least 26%. Our gross margin guidance is presented on a gap basis, but does not include the potential impact from the purchase accounting adjustment to BioCircuit's inventory value as of the acquisition date, which is currently underway. The resulting step-up in value of the acquired inventory could We will now begin the question and answer session.

If you'd like to ask a question at this time, please press star 1 from your telephone keypad and a confirmation tone will indicate your lines in the question keypad. You may press star 2 if you'd like to withdraw your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. One moment, please, while we poll for questions. The first question today comes from the line of Ray Tan with Bank of America. Please proceed with your questions.

Thanks for taking our question. My first question is related to breast, which continues to be a strong driver of growth. We saw accounts increase year over year. I was just curious what share of eligible reconstructions now include resensation with Axigen's portfolio, and how much of this growth is coming from new account activation versus increased utilization within existing accounts?

Sure. With regards to penetration, it's probably around 11 percent. We don't know exactly, but it's within that range. In terms of the drivers, it's the basic mechanics of increased same-store sales, i.e., the counts are becoming more productive as they adopt resensation as a true standard of care. Most surgeons who go through the initial training and then start eventually reach a point

whereby it's considered a part

of any kind of reconstruction procedure. And as that happens, their referral networks and otherwise reflect that. The other element is adding new surgeons within an existing account. So once one surgeon begins to practice resensation as part of their repertoire, as a standard of care, invariably other surgeons within these are the drivers, they put a fine point

We probably will get more information on the November 9th call, but just on prostate, of the 110,000 robotic prostatectomies a year, how many procedures are you planning to target at launch or can be targeted at launch, and what determines which procedures can be initially targeted?

Yeah, Jens will take that question.

Yeah, so our estimated TAN procedure volume is around 110,000 procedures. So obviously, we're not going to target all centers initially. So we're developing the targeting algorithm. We'll be focusing on academic centers, high-volume centers, and centers that do a mix of both unilateral, bilateral, Thank you.

The next question is in the line of Lawrence Butelson with Wells Fargo. Please receive your questions.

Hi. Good morning, Mike and Lindsey. This is Ross Osborne on for Larry. Thanks for taking our questions. So, to start off, there's been some confusion around how much nerve tape is incremental versus cannibalistic to your business, and we heard Lindsey's comments on 26% organic growth this year. But how should we think about the $34 million in nerve tape sales Next year, how much is incremental versus cannibalistic?

Hi, Ross. This is Lindsay. We, for next year, the $34 million that I put out in the press release at closing is incremental. That is net of cannibalization. We'll provide more guidance in the first quarter on 2027.

Okay, great. And then, regarding your Aetna coverage update, what share of your Aetna insured advanced procedures falls inside the policy of shorter than 30 millimeters today? And then, are Aetna breast cases being paid under WHCRA today, or are you seeing denials?

Yes. In the number of procedures, and, you know, Mike talked about in the prepared remarks, our match publication, and we just believe the evidence body supports the coverage criteria that we see from the other payers. So, again, we're confident we can resolve this with surgeons and at this team, and, you know, it's probably in line with next year's annual update, but that work's already underway.

Great. Thank you for taking our questions. Thanks, Ross.

Our next question is from the line of Michael Sarcone with Jeffries.

Please receive your question. Good morning, and thanks for taking the questions, and congrats on a nice quarter. I guess just to start, you know, the updated guide when you exclude the biocircuit contribution, I think that implies 4Q growth of around 27% year over year, and that's about a one-point acceleration from 3Q. So, just wanted to get your take on what you're seeing so far in 4Q and your core markets and where that expected growth acceleration is coming from in 4Q.

Sure, Mike. The growth that we're seeing is really driven by the fundamentals we mentioned each quarter, which is expand the footprint. That allows you to support more surgeons, open more accounts, open more accounts, and then go deeper within those. And so those basic sales fundamentals are what applies in our opportunity. As we've long discussed, the opportunity to add value from a benefit versus risk value proposition across the spectrum of nerve dysfunction presentation is huge. And so that question is really what drives and underlies the whole opportunity. And so our job as we see it is making sure that we have people present in each of the areas where we have the ability to develop the education process to drive that process through new surgeon development, educating new under the sun, I guess is the best way to summarize it.

And to add a little color on the guide, sequentially from Q3 to Q4, we don't see a large step up, so we just went based on our normal historical seasonality and our planning and our guide.

That's helpful. Thank you both. And then second question is a two-parter. I guess first, can you talk about what you're seeing and your experience so far with your sales force selling nerve tape, particularly around how doctors may be transitioning from using connector to nerve tape? And then the second part of that is, Lindsay, I believe you mentioned the 26% growth guide for this year includes some, you know, your cannibalization estimate. I was wondering how you're thinking about that quantitatively and what's baked into the guide for the full year.

With regards to the process of our organization representing NerveTape, that's all just underway. All I can really speak to at the moment is great enthusiasm. People are very excited, and the reasons why we thought that this would be a good fit for organization, there's nothing that we've experienced thus far to suggest that that original sentiment wasn't well-placed and built on a good foundation. As for the issues or the question about cannibalization, nerve tape is far broader than just connector, and I think that's very important to emphasize and appreciate is that there's many different permutations on a technical nerve repair, Whether it be direct or otherwise. And so, while the product mix naturally in favor of nerve tape versus connector, connector will still continue to be used for specific procedures. Nerve tape will obviously be adopted more for large gaps, but then in particular, the application towards direct repair, where we can eliminate the requirement for microsuturing in a more effective way in a simpler and faster manner. And so nothing's changed in terms of the thesis here. And planning BioCircuit on a quarter-to-quarter basis will publish those results from a standpoint, but we have high confidence.

We're setting the guide for the organic growth. We, through our research, we modeled, so as we move forward with integrating BioCircuit, we'll continue to challenge those assumptions and see how close we are and adjust as needed. But they are baked in. We're not going to die to the exact amount of cannibalization that we are anticipating, but we're just going to disclose the organic growth.

Okay, great. Thank you.

Thank you. The next question comes from the line of Christopher Pasquale with Barclays. Please proceed with your question.

Hi, this is Michael on for Chris. Thank you for taking the question, and congrats on a nice quarter. I wanted to ask just one question on the nerve tape opportunity. It seems like there are several different levers you could pull on here to drive growth moving forward, and I just wanted to understand what you think is the biggest opportunity. Is it underring the direct nerve repair procedures, increasing nerve tape utilization in existing advanced cases, or even expanding the population of surgeons willing to use advanced because of the easier procedure? And how soon do you think you could get capitalized on each of those opportunities and at which pace? Thank you.

To be very honest, I know this might be a sad thing, but it's all of the above. So anytime you can make any procedure more adoptable through ease of use without sacrificing effectiveness, this basically removes burdens and barriers. So we think it will be enabling nerve repair in general over time to include people taking on, practicing certain elements of nerve repair that otherwise might not have been able to do so or wouldn't do so because of the microsuturing requirement. So that won't happen overnight, but that is part of the strategic rationale. In terms of its adoption, I think in the procedures where it's currently gotten to the start, OMF mandible procedures, and then you add into that breast, that will continue to grow for the reasons that it started, which simply makes the procedures more accessible and easier and faster. And then finally, strategically, direct repair, which is an area that we haven't really had tools that would provide a superior value proposition in terms of, again, effectiveness. And, again, as a reminder, we've been following this asset for quite a while. It's not as if we don't have familiarity with it.

The next question is from the line of Mike Pratke with Leering Partners. Let's just see what's your question. Hey, Mike.

Hi, everyone. Thanks for taking our questions, and congrats on another great quarter. Maybe to start, and I apologize if I missed that, can you help quantify what your growth looked like in breast during the third quarter after the 47% growth in the first half?

Higher.

Yeah, in the third quarter, the breast growth is over 60%.

Okay. Very helpful. Thanks. And then just in terms of a follow-up, can you help quantify To what extent you've seen incremental growth coming from your recent commercial wins, and is it fair to think that those commercial wins are having an outsized impact in extremities, in OMF, or is breast also benefiting from that equally?

It's very difficult to quantify it, Mike, and part of the reason is kind of a bias analysis in so far is you know when you have an issue because everyone brings it to your attention, but when it's no longer an issue, no one tells you, hey, it's no longer an issue. So, we don't really have the ability to quantify other than to generalize and say, clearly, our work is enabled in terms of customer creation simply because there's fewer and fewer coverage and reimbursement issues.

Understood. Thanks very much.

You're welcome. Our next question is from the line of Caitlin Roberts with Canaccord Genuity. Pleased to see you with your questions.

Hi, congrats on the great quarter, and thanks for taking the questions. Good morning. Maybe just some more color on the over 4,000 surgeons. I think you noted on the last call that are potentially users of nerve tape. So, you know, how many of those would be market expansionary to oxygen? And, you know, what kinds of surgeons are, you know, you adding there? And what's the, you know, the medical education strategy over the longer term for you guys there?

Sure. Well, first of all, we've only just begun, so we can't report any differences in terms of adoption yet. It's just too early. But in terms of medical education strategy, the actual technical use of the product is extremely simple. There are very, very low levels of required education. Where most of the consult of selling

and market development will take place will be in best use case scenarios in development.

So, for example, direct nerve repair. What I mentioned earlier, OMF procedures, where you have individuals who are not necessarily microsurgical trained, but have very difficult procedures where you're trying to reconnect a nerve to a nerve stump in the mandible. Those are very difficult and sometimes becomes a barrier to actually doing the nerve part of the procedure. So nerve tape enables that to making it much, much simpler by virtue of its form factor. So that's where most of the training will come back. The actual use, literally, of the tape is like in the movies that we've provided in the links. It's that simple.

I'll give you some additional color on the actual penetration. If you combine the AXA-Guard connector and NERC tape penetration of the overall procedure TAM that we see, it's around 5%. So there's a significant opportunity to grow NERC tape in procedures across all of our applications, as we see both in breath repair and in direct.

Understood. And then you also touched briefly on this on your last call relative to AXAGAR, but maybe just speak to, you know, again, the economics and the reimbursement landscape for NERV tape.

Yeah, I think we updated the corporate deck with also the CMS payments.

Thanks so much.

Next question is from the line of Ravi Mishra with True Security. Pleased to see your question.

Hi, good morning. Thanks for taking the question. So just one – my first question, just on the Salesforce kind of productivity and headcount additions, you've pretty much achieved your full-year guidance here in the third quarter, at least exiting 3Q. How should we think about the pace of rep ads for the remainder of the year? And productivity took a pretty nice step up, you know, even ahead of the nerve tape being layered into the bag. You know, do we just kind of assume similar run rate and kind of layer on NERV tape, or do you see, you know, further increases, I guess, at least in 4Q on that front?

Yeah, we're going to continue to add headcount. We'll come out in Q1 with our guidance for 2027. As we go into 2027, we will be posting for more positions and continue to hire into these roles.

Well, the constraint you mentioned before in terms of our pace of ad will be that we don't affect profitability. But that said, we see footprint expansion as to be one of the most important levers in the business.

Thanks. And then just strategically on the nerve tape integration and biocircuit integration, You know, our checks have at least suggest a pretty robust enthusiasm for this product that the company might not have been able to kind of get through hospitals on their own. How do we think about, you know, the VAC process with existing oxygen contracts or, you know, just the kind of logistics of getting this into doctors' hands now that you own it? Could you maybe provide a little bit of color how you plan on accelerating that?

That's a great question. So, FireCircuit had around 400 accounts, active accounts. We have a footprint of close to 3,000 accounts. And given our presence in these accounts and the presence of our portfolio connections within the facilities, we do believe that we'll be able to accelerate approval in the back process for NIRF tape. So, we definitely believe that we will continue to expand the presence of NerveTape throughout our accounts in the coming months, and that process has already started.

The next question is from the line of Jason Bedford with Raymond James. Please receive their questions.

Hi, Jason. Good morning, Mike. Good morning, Lindsay. Hope you guys are doing well. Zach Goldon for Jason here. Sure. I'll just take a step away from nerve tape for a second here. I feel like you've got a couple of questions on that. I think, Lindsay, you made a comment that 27 margins will be similar to 26. I don't want to kind of ask for 27 guidance before you're ready. Maybe can you walk us through some of the puts and takes? What helps? What hurts 27 margins? Does this include any impact from selling prostates? Or how did you get to 27 similar to 26 margins?

Yes. So we're going through right now some pricing initiatives as well as yield initiatives. And as we put those into place, they're just going to take time to be able to go through COG. And so we don't predict right now that we'll see a big uplift in 27 from that. So that's why I've guided the way that I have informally until we get to Q1 and we have pricing big. Like, with prostate, it does help with our initiatives in production in terms of just getting more from each donor, and we do see that as being helpful, but again, we won't probably see that in 20 years.

Got it. That makes sense. And then on prostate, just to follow up there, I know breast has been a source of margin softness just given the length of the breast, and Mike, you've talked about this last quarter. With the COGS proportional, will you guys see sort of a similar margin dynamic from prostate? Is it also sort of a disproportionate COGS versus revenue dynamic?

Generally speaking, prostate should be helpful. The grafts are shorter in length, so therefore your productivity per donor is better. So the answer to the question is we don't see the same pressure. Got it. Thank you, guys. You're welcome.

The next question is from the line of Anthony Patron with Mizuho. Please receive your question.

Thanks, and congrats, Aaron, on a solid quarter. Maybe one on core extremities, and then I'll have a follow-up on prostate. On core extremities, Mike, maybe could we just kind of go back to those numbers and maybe put an estimate out there of where penetration in that core peripheral market is? And I know in the quarter just leading in, there was a little noise in some of the data that was out there. There was some tough comps, I think, in the September month. But it certainly seems like we're still relatively early in terms of penetration into core extremities. So just a revisit on those numbers would be helpful, and I'll have one on prostate.

That's correct, Anthony. So we still view that market as underpenetrated. If you make an adjustment for the case stock from third quarter prior year, growth in extremities was about 15 percent. And as we look at the business on a going-forward basis, we still believe that Xtremenes will be a business that will range from a very high single-digit to low double-digit growth quarter to quarter, year in, year out, just by virtue of the logistics of the selling process. And until we see other dynamics that would change that, that's the best way to model the business.

That's very helpful. And on prostate, you know, the initial studies here on da Vinci prostatectomy, 110,000 a year, but, you know, you have a pretty big active surveillance prostate population out there of, you know, nearly a million patients, and there's certainly intermediate risk patients out there as well. So, when you just think of prostate more broadly beyond DVP, are you going to go after active surveillance, intermediate patients, or should we be thinking about this as exclusive, you know, to DVPs, at least for the first few years? Thanks, and congratulations. Thank you, Anthony.

You know, it's first things first. I mean, the value proposition that we can speak to with high confidence is the unilateral or bilateral non-nervous spared patients. So in those situations, we unequivocally bring to bear a value without risk that there's simply no alternative or comparison to. Now, what we expect and what we've heard from market research and from surgeons is that as the potential risk of cancer intervention itself shows promise of mitigation, that they expect that more patients would be more willing to, first of all, enter into the screening process itself, which is one of the biggest issues is most men just don't even want to know the answer, much less an intervention. And so these things will take time. Awareness will have to build, but everyone believes that this will be a tide that will raise everybody's boats in terms of better cancer care and better screening.

Thank you. Our final question is from the line of Frank Tackett with Lake Street Capital. Please receive your questions.

Great. Thank you for taking the questions. Just one from me, a little bit broader question. And any guideline updates we should be looking for over the next, we'll call it 12 months or so? I know you've gotten a few this year already, but any other major ones outstanding that are in the relative near term?

Are you referring to clinical guidelines or coverage updates?

Clinical guidelines.

Okay. We don't see any changes to clinical guidelines.

Okay. Fair enough. Thanks for the questions.

Thanks, Mike. Thank you. Ladies and gentlemen, this concludes our question and answer session. I now turn the floor back to Mr. Dale for any final comments.

Thank you, Operator. On behalf of the Action Team, I want to thank everyone for their time and interest in our work to fulfill the promise and potential for all stakeholders of our business purpose, which is to restore health and improve quality of life by making restoration of peripheral nerve function an expected standard of care. We look forward to updating you on our continued progress on our earnings call next quarter. Thank you very much.

Thank you. That does conclude today's teleconference and webcast. You may disconnect your lines this time and have a wonderful day. We thank you for your participation.