We exited the quarter with $79 million in cash and net long term debt of $280 million. We have additional debt capacity from a delayed draw term loan of $8 million as well as a $50 million revolving debt facility providing us with sufficient financial flexibility. In terms of our outlook for 2024, we expect full year revenue of $1.190 billion to $1.240 billion, center margin of $345 million to $365 million and adjusted EBITDA of $80 million to $90 million. Our annual guidance assumes year over year revenue growth driven primarily by higher visits from clinician growth, combined with a low single digit increase in the total revenue per visit. Otherwise, we’re assuming generally consistent operational performance year over year. Our guidance also contemplates a revenue split of roughly 50/50 in the first and second half of the year due to seasonality.
Regarding earnings as compared to 2023 where they were weighted to the second half, we expect this year’s earnings to be more balanced throughout the year. This is due to the timing of investments and variation in rates, which are the result of payer rate changes and other mixed components like geography and services. For the first quarter, we expect revenue of $287 million to $307 million, center margin of $81 million to $93 million, and adjusted EBITDA of $17 million to $23 million. Additionally, we expect stock based compensation of approximately $80 million to $95 million in 2024, including approximately $20 million to $25 million from new 2024 grants. Consistent with our prior messaging on pausing M&A, we are not planning to pursue any acquisitions in 2024.
I’m excited to announce that we expect to achieve a company milestone by generating positive free cash flow for full year 2024. This will be driven by improved profitability and lower capital expenditures as we continue to strategically moderate the opening of de novos centers. We expect leverage to come down significantly this year, anticipate net leverage to be below 2.5 times by the end of the year. We continue to have sufficient financial capacity to run the business and we do not intend to raise additional debt or equity in 2024. Related to strategic initiatives, in 2023, we recognized a total of approximately $5.5 million of cost for the HRIS in credentialing and onboarding platform. Of this, $3 million were recognized as G&A expenses, with the remainder in CapEx. As Ken stated for the EHR, we are focused on improving our existing platform and related processes in 2024 and therefore will not incur any costs in the current year.
In closing, we are pleased with the progress we made in 2023 and we are confident as we look ahead to 2024. Now, we’ll turn it over to Danish to share the work done in 2023 and the priority areas for 2024 that will position us to achieve our commitments.
Danish Qureshi: Thanks, Dave. We continued to line our teams around two growth priorities, net clinician ads and clinician productivity. We grew by 227 net clinician ads in the fourth quarter and 1014 for the full year, bringing our total clinicians to 6645, an increase of 18% year over year. Importantly, our growth in Q4 remains 100% organic for the third consecutive quarter. Our clinician value proposition remains strong and we are proud of our clinician recruiting and operations team’s great work in delivering clinician growth in 2023. Turning to clinician productivity, for 2023 on a visits per average clinician basis, we saw productivity increase by 2%, driven by many of the operational actions we took throughout the year.
As a reminder, productivity is a function of two components, clinician capacity or the time clinicians give us and utilization our ability to fill clinician time with patients. In 2023, we put our focus towards utilization, delivering on our core commitment to our clinicians to fill their schedules by driving operational discipline throughout the patient funnel. At the top of the funnel, we made enhancements to our primary care referral team, organic search traffic, internal clinician referrals and enterprise referral partnerships. These actions delivered improvements in attracting new patients above the growth of our clinician base demonstrated by our growing waitlist for services. I will note that our cost per new patient acquisition continued to decline year over year and we spend a de minimis amount on paid advertising as part of our top of funnel strategy.
Second, at the middle of the funnel in terms of converting patients to scheduled appointments, we continued to leverage our digital capabilities to improve patient matching via our Online Booking experience, OB which we rolled out nationwide. Additionally, we enhanced the patient experience with better online clinician profiles, reduced scheduling complexity and enhancements to our phone intake processes, which is a key area for 2024. Finally, at the bottom of the funnel in terms of scheduled appointments converting to completed visits, our cancellation and no-show rates have now stabilized in the 9% to 10% range, which is a significant improvement from the previous 15% level when we set this as the focus area for improvement. As we head into 2024, we are shifting our attention to the other side of the productivity equation, clinician capacity.
We have early initiatives in place to grow overall clinician capacity with a goal to reward and incentivize those clinicians offering full time hours. For example, we are using tiered benefits to provide incentives such as medical coverage and 401k match to full time clinicians. Additionally, our recruiting team is focused on attracting clinicians who desire full time employment, and finally, we offer equity ownership through our long term incentive program to attract and retain our highest contributing clinicians. In addition to improving clinician productivity we made notable strides in other areas during the past year. First, in terms of leadership, we reorganized and upgraded our practice operations senior leadership team. We made significant changes streamlining the number of senior leaders, promoting top performers, and bringing in new external talent with the appropriate skill set to guide an organization of LifeStance’s current and future scale.
Second, in terms of KPIs, we reoriented our operations teams around a metrics driven approach to managing the business and instituted a new reporting suite of KPIs to bring focus, prioritization and data driven decision making to the organization while continuing to emphasize the patient and clinician experience. Third, in terms of culture, we recentered the company around supporting local operations and clinician needs while emphasizing belonging and connection. For example, we prioritized increased teammate engagement via social gatherings, recognition and appreciation and participation in community volunteer events. Fourth, in terms of cost efficiency, we completed our real estate optimization project. In total, we consolidated 82 centers in 2023 with little to no disruption to our patients and clinicians.
