Property and Equipment (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	$ 709,939	$ 694,864
Accumulated depreciation	(277,001)	(262,223)
Net property and equipment	432,938	432,641	[1]
Machinery and Equipment, Gross	207,665	203,431
Furniture and Fixtures, Gross	7,410	7,409
Construction in Progress, Gross	73,182	70,864
Land, Buildings and Improvements [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	216,042	212,283
Molds [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	59,695	59,700
Computer Equipment and Software [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	81,834	80,420
Instruments Placed with Customers [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	$ 64,111	$ 60,757

[1] December 31, 2018 balances were derived from audited consolidated financial statements.