Good afternoon, everybody. Thanks so much for joining us here. My name's Matt O'Brien. I'm one of the med tech analysts here at Piper. Extremely excited and lucky to have the SI-BONE management team here with us. From the company, we have Laura, who's the CEO, and then Anshul, who's the CFO. Thank you so much for making the long flight over. I think I'd prefer to be in San Francisco, personally, but again, thanks for coming. Thank you. Laura, the standout from Q3 was the new, new position ads. Yeah. That number was phenomenal. Yeah. Thank you. I know you're gonna say it's a variety of factors, but give me one or two that really drove so many new docs deciding to train with you. I have to choose only one. You have to choose one or two of your favorites, yeah. Let me just give a little bit of a recap on Q3 if I can and put that into context. Sure. So the revenue growth was 21% in total, so a really strong quarter. What we've also seen is just the profitability of the business as well. Four quarters of adjusted EBITDA profitability and a couple of quarters of net cash break even too. So really the business firing on all cylinders. But you're right, the biggest thing that's driving the growth and what really excites me is seeing 27% growth in the number of physicians that did a procedure in Q3, 2025 versus a year ago. I mean, 330 more surgeons were at over 1,500 surgeons who did at least one procedure in the quarter. And so we're getting to the point of where we really have this strong base for the business. We've built a reputation in the industry as well as this innovator. Maybe if you ask me, is there one thing that I think has really been important to the business, it has been the reputation that we've actually built with our innovative products that are addressing unmet clinical needs. We have a number of different procedure types that we're going after. I think our commercial team is, quite frankly, the best in the business. What we've been able to do is use this hybrid approach that we've taken where we have 88, we finished the quarter with 88 territory managers in place. Those are W-2 employed, senior quota-carrying sales reps. We also have over 300 third-party agents that are out there at this point that are selling our solutions too. So we have these great innovative breakthrough devices, but we also have this very significant footprint in the United States at this point between the people that we employ, as well as third-party agents. So it's worked really well. And, you know, what are we known for, in addition to innovation, the quality of our clinical data? We have over 180 peer-reviewed published papers that show the safety and efficacy of our products. And then the educational approach that we take too because we're not doing things that are me-too, right? We're developing new markets, new market spaces, and we're delivering these breakthrough devices. And so what's key is the educational side. These are things that surgeons may not have necessarily been doing previously that they're doing now. Got it. Okay. Well, I appreciate that kind of broad perspective. Something that's coming up a little bit recently is your core IP. I think you've got some key patents that are expiring, and I think you mentioned this 180 peer-reviewed, you know, publications on you guys. So. Yeah. So, with that, you know, the training required, all the other, your field service organization. Yeah. How big a deal is your patent expiration and, like, you know, competitive headwinds, pricing erosion? How do we think about that? Yeah. It is one of the things that I don't lose sleep over at all. And why is that? We have really diversified the business over the last few years, right? So we're known as the SI Joint Fusion Company, and some of the patents that you're talking about are related to our original triangular titanium implants, our iFuse, our original iFuse product. But we have diversified into pelvic fixation with a breakthrough device, our Granite product, another breakthrough device, TNT, our second breakthrough device, for pelvic ring fractures. And then we actually have a third breakthrough device that's gonna come out next year that we may wanna talk a little bit more about separately. Yeah. And so diversified the business significantly. And also, if you think about those original patents around our triangular titanium implants, it was for our original iFuse. Our iFuse 3D product has patents that go out through 2034, I believe 2034, 2035. And that's the majority of the product that's sold that is triangular. But we have quite a few different SI joint fusion solutions, some of them triangular, some of them not, and then a number of other products as well. So we do get questions regularly about patents, and we do a really good job of developing an innovative product group that is patent protected, and we keep updating those products for the next generation of products that we're developing. Got it. Okay. Well, I appreciate that feedback and feel much better about the potential impact there. So let's get back to the fundamental business. We talked about the growth in, you know, clinicians using the product. The other thing you said on the call that I thought was interesting is that 25% of your SI joint surgeons are doing more than one case right now with you. Where can that go? And can't that just be, like, with 1,500 clinicians, can't that be a massive tail end? So I think when we talked about 25%, what we meant was of those physicians that are doing SI joint fusions. Yeah. They're around 25% of them are doing additional procedure types. So for example. Right. Pelvic fixation with our Granite product. Right. I think the point that you're getting at is where can we go in terms of increasing the number of procedures that our physicians are doing. As I said, 1,500 physicians did procedures in the third quarter. If you looked at that for the entire year, for 2025, it'll probably be around 2,500 physicians that have done at least one procedure with an SI-BONE product. And on average, they're doing a little over one a month on average. And where can we go from there? We have an extraordinary opportunity to increase the number of procedures that surgeons are doing with us. And, you know, going from that 25% that's primarily pelvic fixation, can we get that from 25% to 50%? Can we get those physicians that are doing SI joint fusion to be doing pelvic ring fracture cases as well? They see those patients all the time. also, I'm gonna talk once again about the breakthrough device that's coming out in, the second half of 2026. That is targeted toward, what we believe is the largest unmet clinical need in spine, and that would be another very significant opportunity for us to increase the number of procedures that our surgeons actually do. So I think just if you just look at SI-BONE and this broad base of physicians that are already doing procedures with us, if we can get them to do more procedures, more procedure types as well, we have a huge opportunity to grow the business from that alone. But then in addition, the, the number of, physicians that are doing procedures, we still have a ton of opportunity to grow. There's around 12,000 spine surgeons and interventionalists that we're going after right now. 1,500 did one procedure in the quarter, 2,500 for the year. We have a huge opportunity to, to further penetrate that. And I'm not even including the general ortho trauma surgeons in those numbers right now. Okay. And so this new product that's coming out, the biggest unmet clinical need, is it, is it fair to think it's gonna be another pelvic-type product? I'm guessing you're not going up to the cervical spine. Well, here's, here's what I here's what I wanna say about how we're thinking about things. What we've done is we've built this technology platform at this point, right? It's a high-growth med device platform that we've developed here and started with SI joint fusion pelvic fixation. where we are taking the company is more broadly around applications with compromised bone. And why, why does that fit into what SI-BONE is doing? When When we started the company over 15 years ago, working with SI joint fusion, some of the poorest bone in the body is in the sacrum. So since the inception of the company, we have been developing solutions that address that particular need. And so when, especially when we developed iFuse 3D, 3D printed, fenestrated implant, you know, that provided that opportunity for bony on growth, in growth, through growth. Granite was another example of a product in pelvic fixation. A lot of the patients that are being treated are patients with poor bone quality. Our TNT product for pelvic ring fractures, another product there that virtually all of those patients are osteoporotic that have sacral insufficiency fractures. So we have built this capability with 3D printed implants, anatomy specific, but still fit into the workflow of the, the physician. We have developed this core competency in developing solutions for compromised bone. And this next product that's gonna come out at the end of 2026 is, is in that category. Got it. Okay. And Anshul, I'll get to you, I promise. is that market opportunity? Like, I have Granite's a billion-dollar market you're going after. Is that in the realm of how big this opportunity is? We haven't been talking about the TAM yet. Okay. But as you can tell, I am really excited about the size of the opportunity. And as we get closer to launch, we'll, we'll talk more about. Okay. Last question. About where that's at. Okay. The, the reason why the reason why I'm, I'm talking to this, but in a general way, is what I wanna help investors understand is the durability of the growth platform that we have. I think there have been a lot of concerns around, well, how far can we go with the business? What we have shown is we have grown over 20%, on average every single year since we were a public company. And we grew 21% in the third quarter, right? So we have a durable growth platform that we've developed, and I think it's really probably the most important thing for investors to understand. Okay. Got it. last question, I promise on this. Well, most likely. You can ask. I'll try anyway. So is this, is this an area where it's an easy add-on, drop into the bag of your existing, Salesforce? And can you get a halo effect? Like, hey, look, we do these three areas, we're adding this fourth, and everybody's gonna be, "Oh man, okay. Now we really have to pay attention to SI-BONE"? I think so. Okay. I, I think you encapsulated that perfectly. Okay. Okay. Fantastic. Can't wait to hear more about it. and then as far as reimbursement goes, can you just maybe frame up a little bit of the tail winds that you're getting on the reimbursement side as we head into 2026? There's so many. I know. There are. so let me, I'll, I'll, I'll start with, our TNT product on the trauma side. We just had a new technology add-on pla add-on payment that went into effect on October 5th of 2025, so just a couple of months ago here. And so that was $4,100 for that, an incremental payment for performing these pelvic ring fracture cases. That $4,100 is up to around a 30% higher reimbursement for those cases than is currently provided. So quite significant as a tail wind for our pelvic ring fracture business. and then, effective January 1st, 2026, there's a 17% increase in the payment for in-office performed procedures, SI joint fusion procedures. So our intra product specifically is positively impacted there. And intra, our intra product is, is, it's an exciting product. It's a SI joint fusion product, posterior product. It's a percutaneous procedure, so, something that's very familiar to an interventionalist that already does, these posterior, therapeutic injections for, for patients. It's, it's something along those lines for them. Easily can be done in, in an in-office, area. And then finally, there's a third opportunity here where a lot of the procedures that were inpatient only have moved to outpatient, and that has a particularly interesting it provides a particularly interesting opportunity for our pelvic, fixation Granite product, doing more shorter constructs in the outpatient setting. And our estimates right now say that around 40% of pelvic fixation cases could be performed on an outpatient basis. We also do have a, a, a transitional pass-through code that covers completely the cost of the Granite technology that will continue to be in effect next year too. So there's a lot of different tail winds, whether it's our SI joint fusion business, our pelvic fixation business, or our pelvic ring fracture business. Got it. Okay. And so as I look at your business, you have a $190 million domestic business. International's still small right now. much of that is SI dysfunction. you know, that I'm I know we don't have exact numbers, but that would get me to something around 10% penetrated of that market opportunity. For, for SI dysfunction. For SI dysfunction. Yeah. Sorry. Fusion. Yeah. Yep. so, you know, again, don't know exact numbers there. How do you get that up to 15%- 20% over time? Or can you go. Yeah. Significantly higher than that? Yeah. We, we did a survey not that long ago of, of, customers who do who actually do perform SI joint fusion procedures. And these are surgeons, and around 6% of their business was SI joint fusion. It should be more in the 15% range, right? And so I, we think there's a few things that are important to, to first of all, get full adoption of the technology, but then also to get all physicians diagnosing and treating for SI for SI joint dysfunction. And, and so, you know, how do how do we actually go about, you know, making that happen? I think one of the things that's going to be important here is, the new products that we're going to put out early next year. So we've talked a little bit about a new product that targets SI joint dysfunction. the, the product is targeted more toward the ASC environment. It is a, simpler workflow is the way that I would, would describe it. And so we think that that product is going to have applications with both surgeons who haven't adopted as well as interventionalists as well. So product is, is one of the ways that we're going to get at it, and that's, one of the things that we're doing right now. Got it. Okay. And then on Granite, the billion-dollar, sacral pelvic fixation market, I'm assuming you're probably somewhere in the mid-single-digit share range there. again, it just seems like it makes a ton of sense in these constructs. And then you're going after short constructs, and you've got good reimbursement. Can you double, triple that business over the next several years? I think we can. And, you know, when we initially launched the business, we launched for primarily adult deformity cases. So long constructs, there are around 30,000 of those cases per year in the United States. And w-what we said in the beginning is that we think we can become the standard of care in that area. And we are seeing, you know, very significant adoption, of the technology, in those cases. So, so that was the first opportunity that we really went after to penetrate. The second opportunity is with a different group. They're more of the degenerative spine cases or the shorter constructs. Yeah. And that's around 100,000 cases a year. So a significantly larger population, but it's more around, patient selection. So, you know, which patients should receive pelvic fixation that are getting a shorter construct? You know, maybe those that have compromised bone, for example, or obesity or, we call it high pelvic incidence, just the musculoskeletal structure is such where, you may have problems with fixation failure. So we developed our Granite 95 product in order to really get at those shorter construct opportunities. So I'm giving it product, once again, how do we keep further penetrating these areas? And then getting the transitional pass-through code as well. And, you know, all of those things are important, making sure that the economics line up and the right incentives are in place in order to, to really get the utilization that's there. we, we have a really significant focus there. Okay. So, Laura, you keep talking about all these different, you know, tail winds and momentum. I know. And why are you a mid-teens grower next year? Well, what we said on the third, the, the, the third quarter call is we said we feel comfortable with where consensus is, is at currently. but we also said specifically with our core product portfolio. Yeah. we have these two products, as I said, that are launching in 2026, and we do believe that that provides incremental opportunity. But we like to grow into where we're going to be. so w-we think, as I said, since we've been public, we've been growing over 20% a year. and we have all of these tail winds in the business, and we do have the opportunity to, to overachieve, but we like to be thoughtful with, with what we talk to. Got it. Talk to the street about. Yep. Makes sense. Okay. So Anshul, I know you've been waiting patiently. Appreciate that. you guys murdered gross margin in Q3. Sorry. Like, not very. Good luck. Not, not very professional there, but. Good luck. You guys crushed the Q3 gross margin number, you know, and that follows concerns coming out of Q2, like, "Oh, everything's gonna be weak." Why the gross margin strength? And then again, you know, got these tailwinds that we're looking at. You know, why would we, why is the street's modeling things down the next couple of years? Why would that be the case? Yeah. So on the gross margin side, we're really pleased with, the industry-leading gross margins that we have. we started the year with expectations of 77%-78% gross margin for the year. not only did we outperform that, but we actually saw an improvement year-over-year on gross margins. Now, why is that? there's three aspects to what impacts gross margin. One's ASP. That's performed better than what we expected. Part of that is procedure volume mix, where we're seeing more of the, let's say, stacked Granites, which is two implants on either side, do better than what we anticipated coming into the year. I think that's number one. Number two is, we've been really focused on supply chain efficiencies as well. So, over the last 18 months, we've really focused on, with scaling of products, how do you get the cost down? You've seen some of the benefit of that. And we wanted to see that play out in the P&L, which it's now playing out, so it's sticky. And then, the third piece is just trying to make sure we get more efficient with our trade cost and trade utilization in the field. That's starting to play out as well. That's what's allowed us to outperform on the gross margins. Now, when you think about our expectations going into next year, on the gross margin side, what we've said is, over the next two or three years, think about gross margin at that 78% level. Now, that's better than what we had, you know, even two quarters ago because of some of the stickiness in the improvement that we've seen. Majority of that impact is non-cash depreciation. A lot of that's associated with putting out surgical capacity for new products. What generally tends to happen is you'll put out a lot more surgical capacity when you start out with a new launch, and then you start focusing on productivity with that surgical capacity, bringing the cost down too. That's natural that that happens. We will we feel comfortable there. Also, as we scale, you know, what we're focused on is how do we build out these new TAMs, drive that top-line growth. Yes, it may have a little bit of an impact on gross margins, but what we see is tremendous leverage in the middle of the P&L on the OpEx side. Our focus is now starting to shift to how do we get non-GAAP and GAAP operating margins to continue to grow at a pretty healthy clip in the future. As you guys are rolling out these new products, are they gonna be dilutive to gross margin, especially the new trauma ones? they will be diluted because they're subscale. Okay. When they start out. Now, what we're not incorporating in that guidance is sort of what we did with the existing portfolio is, as you scale, you get the cost down, you get the efficiency higher. So that would be a potential area for outperformance. But we're being deliberate in not incorporating that in that 78% number. Okay. Okay. You've been at 80% in the past. Can you get back there? with some of the operational initiatives that we're focused on, getting the cost down, getting the cost of instruments down, and driving more efficiency in the field. You know, we're at 79.8%. Yeah. For this quarter. We think we have the line of sight to be able to get back to that number. Wow. Okay. Fantastic. And then, on the EBITDA side, which, again, congrats on all the improvements there, on an absolute basis, the last two years, you've improved that metric by $12 million, each of the last two years. So is that a similar kind of number we can expect for you guys going forward? Or because of these, well, the new TAM that you're going after, is that is that potentially, you know, you gotta make some investments there on sales and marketing, etc., and so you, you shouldn't expect as much? Yeah. So the way we think about our business is our expectation is revenue growth's gonna outperform OpEx growth going forward on a consistent basis. Now, it may range on a year-to-year basis. Some years, it might be 1.25's operating leverage. In certain years, it'll be 1.75. So it'll range. And the delta between that range is exactly what you said. When you're launching new products, you've got sales and marketing expenses associated with it. You're closing out your R&D expenses as well. But that's still gonna be good, healthy leverage. So if you look at a long-term average and you say it's 1.5 times operating leverage on the business, that does translate into pretty healthy adjusted EBITDA margins and eventually EBITDA margins. again, we remain focused on growth. we wanna make sure that we're at least at the levels of growth that we've demonstrated, if not higher. That's number one. Number two is we wanna make sure we're investing in R&D. this compromised bone opportunity is massive for us. So we got two products next year, but that's not the end of the pipeline. We have a pretty active pipeline over the next five years. So we wanna invest in there. But you will see leverage across R&D, even as a absolute dollar basis. You will see leverage on the sales and marketing side, but you'll see the most leverage on the G&A side. Got it. Okay. All right. Well, I think we're just about out of time, so I'll go ahead and end it there. Thank you so much. A lot of really good things going on at SI-BONE. Appreciate it. Thank you. Thanks for hosting us.