CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
CASH FLOWS FROM OPERATING ACTIVITIES:
Net income (loss)	$ 48,454	$ (9,843)	$ 5,451
Adjustments to reconcile net income (loss) to net cash provided by operating activities:
Depreciation and amortization	84,066	94,070	92,100
Gain on sale of business		(517)
Loss on sales and/or abandonment of property and equipment	1,303	2,159	115
Write-off of certain intangible assets and other long-term assets	4,412	36,609	25,563
Acquired in-process research and development		250	525
Amortization of right-of-use operating lease assets	11,718	12,746	12,256
Fair value adjustments to contingent consideration	3,161	(7,960)	(232)
Amortization of deferred credits	(108)	(130)	(139)
Amortization of long-term debt issuance costs	604	604	721
Deferred income taxes	(4,631)	(11,295)	(12,436)
Stock-based compensation expense	16,090	14,339	9,382
Changes in operating assets and liabilities, net of acquisitions and divestitures:
Trade receivables	(8,618)	10,425	(17,900)
Other receivables	(10,418)	1,668	1,787
Inventories	(25,183)	29,429	(27,044)
Prepaid expenses and other current assets	(3,555)	(446)	(1,239)
Prepaid income taxes	125	(162)	128
Income tax refund receivables	739	(339)	(2,247)
Other assets	(1,670)	(3,511)	(5,141)
Trade payables	6,050	333	(2,295)
Accrued expenses	36,462	4,603	4,719
Income taxes payable	(119)	(86)	(351)
Long-term income taxes payable			(45)
Liabilities related to unrecognized tax benefits	314	(576)	(794)
Deferred compensation payable	1,303	1,953	3,635
Operating lease liabilities	(12,410)	(12,659)	(11,970)
Other long-term obligations	(858)	3,606	3,264
Total adjustments	98,777	175,113	72,362
Net cash provided by operating activities	147,231	165,270	77,813
Capital expenditures for:
Property and equipment	(27,939)	(45,988)	(78,173)
Intangible assets	(2,834)	(3,288)	(3,324)
Proceeds from the sale of property and equipment	1,037	42	920
Proceeds from sale of business		1,285
Cash received for settlement of note receivable	2,000	250
Issuance of note receivable	(2,254)
Cash paid in acquisitions, net of cash acquired	(7,171)	(10,953)	(53,904)
Net cash used in investing activities	(37,161)	(58,652)	(134,481)
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from issuance of common stock	21,306	6,635	6,252
Proceeds from issuance of long-term debt	98,421	68,625	246,659
Payments on long-term debt	(206,921)	(157,000)	(202,159)
Long-term debt issuance costs			(1,479)
Contingent payments related to acquisitions	(10,665)	(13,100)	(15,740)
Payment of taxes related to an exchange of common stock	(576)	(866)
Net cash provided by (used in) financing activities	(98,435)	(95,706)	33,533
Effect of exchange rates on cash	(801)	1,684	96
Net increase (decrease) in cash and cash equivalents	10,834	12,596	(23,039)
CASH AND CASH EQUIVALENTS:
Beginning of period	56,916	44,320	67,359
End of period	67,750	56,916	44,320
SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION
Interest (net of capitalized interest of $480, $813 and $1,290, respectively)	5,261	10,077	12,434
Income taxes	8,828	8,918	12,069
SUPPLEMENTAL DISCLOSURES OF NON-CASH INVESTING AND FINANCING ACTIVITIES
Property and equipment purchases in accounts payable	2,558	2,180	7,952
Current note receivable converted to equity investment		899
Proceeds from sale of business in other receivables		321
Acquisition purchases in accrued expenses and other long-term obligations		4,358	10,541
Merit common stock surrendered (3, 39 and 3 shares, respectively) in exchange for exercise of stock options	180	1,467	93
Right-of-use operating lease assets obtained in exchange for operating lease liabilities	$ 1,524	$ 10,938	$ 10,637