CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019
CASH FLOWS FROM OPERATING ACTIVITIES:
Net income (loss)	$ (22,212)	$ 13,054
Adjustments to reconcile net income (loss) to net cash provided by operating activities:
Depreciation and amortization	47,040	45,010
Loss on sales and/or abandonment of property and equipment	370	803
Write-off of certain intangible assets and other long-term assets	7,820	594
Acquired in-process research and development		525
Amortization of right-of-use operating lease assets	6,339	5,874
Fair value adjustments to contingent consideration	5,240	3,181
Amortization of deferred credits	(69)	(70)
Amortization of long-term debt issuance costs	302	402
Stock-based compensation expense	6,205	4,289
Changes in operating assets and liabilities, net of effects from acquisitions:
Trade receivables	15,292	(21,206)
Other receivables	643	445
Inventories	2,255	(5,138)
Prepaid expenses and other current assets	(1,349)	(1,052)
Prepaid income taxes		(45)
Income tax refund receivables	(7,329)	(3,980)
Other assets	128	(2,845)
Trade payables	(3,872)	1,338
Accrued expenses	19,664	1,079
Income taxes payable	1,572	(2,059)
Deferred compensation payable	(661)	1,518
Operating lease liabilities	(6,177)	(5,882)
Other long-term obligations	2,015	(145)
Total adjustments	95,428	22,636
Net cash provided by operating activities	73,216	35,690
Capital expenditures for:
Property and equipment	(25,803)	(35,959)
Intangible assets	(1,790)	(1,607)
Proceeds from the sale of property and equipment	27	22
Cash received for settlement of current note receivable	250
Cash paid in acquisitions, net of cash acquired	(100)	(37,256)
Net cash used in investing activities	(27,416)	(74,800)
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from issuance of common stock	3,670	3,374
Proceeds from issuance of long-term debt	38,567	125,746
Payments on long-term debt	(67,692)	(120,746)
Contingent payments related to acquisitions	(12,861)	(611)
Payment of taxes related to an exchange of common stock	(866)
Net cash provided by (used in) financing activities	(39,182)	7,763
EFFECT OF EXCHANGE RATES ON CASH	(1,236)	(830)
NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS	5,382	(32,177)
CASH AND CASH EQUIVALENTS:
Beginning of period	44,320	67,359
End of period	49,702	35,182
SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION
Interest (net of capitalized interest of $551 and $540, respectively)	5,937	5,794
Income taxes	3,808	8,856
SUPPLEMENTAL DISCLOSURES OF NON-CASH INVESTING AND FINANCING ACTIVITIES
Property and equipment purchases in accounts payable	1,970	3,331
Current note receivable converted to equity investment	899
Acquisition purchases in accrued expenses and other long-term obligations		8,400
Merit common stock surrendered (39 and 0 shares, respectively) in exchange for exercise of stock options	1,467
Right-of-use operating lease assets obtained in exchange for operating lease liabilities	$ 7,029	$ 2,927