Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2025	Dec. 31, 2024	Dec. 31, 2023
Cash flows from operating activities:
Net Income (Loss)	$ 165,388	$ (99,069)	$ (60,408)
Adjustments to reconcile net (loss) income to net cash provided from operating activities:
Depreciation and amortization	21,827	32,226	36,171
Amortization of premiums, discounts and issuance costs	935	954	1,239
Impairment losses	0	178,435	168,312
Loss on disposal of businesses	0	9,699	0
Net gain on investments in divested businesses	(20,906)	0	0
Stock-based compensation expense	18,045	11,868	12,323
Deferred income taxes	52,186	(2,130)	3,239
Other	(4,562)	(2,972)	(3,167)
Changes in assets and liabilities:
Accounts receivable	30,558	10,292	26,276
Prepaid expenses and other current assets	(2,920)	3,497	514
Other long-term assets	21,798	33,728	22,851
Accounts payable and accrued expenses	28,332	51,140	(11,921)
Income taxes (payable) receivable	(1,214)	(5,037)	(21,677)
Long-term professional liabilities	(8,658)	17,303	837
Other liabilities	(26,070)	(22,684)	(28,508)
Net cash provided by operating activities - continuing operations	274,739	217,250	146,081
Net cash used in operating activities - discontinued operations	(3,648)	(10,677)	(8,756)
Net cash provided by operating activities	271,091	206,573	137,325
Cash flows from investing activities:
Acquisition payments, net of cash acquired	(23,196)	(8,167)	(6,667)
Purchases of investments	(29,851)	(64,546)	(31,893)
Proceeds from maturities or sales of investments	26,674	52,494	22,905
Proceeds from investment in divested business	30,000	0	0
Purchases of property and equipment	(18,458)	(22,022)	(33,328)
Other	(3,465)	6,835	807
Net cash used in investing activities	(18,296)	(35,406)	(48,176)
Cash flows from financing activities:
Borrowings on credit agreement	0	235,500	470,000
Payments on credit agreement	0	(235,500)	(474,000)
Payments on term loan	(18,750)	(12,500)	(12,500)
Payments of contingent consideration liabilities	(3,182)	(1,167)	(1,817)
Payments on finance lease obligations	(2,000)	(2,888)	(2,618)
Proceeds from issuance of common stock	3,184	3,638	4,912
Repurchases of common stock	(86,683)	(1,703)	(919)
Other	(63)	135	(8,773)
Net cash used in financing activities	(107,494)	(14,485)	(25,715)
Net increase in cash and cash equivalents	145,301	156,682	63,434
Cash, cash equivalents at beginning of year	229,940	73,258	9,824
Cash and cash equivalents at end of year	375,241	229,940	73,258
Supplemental disclosure of cash flow information:
Cash paid for interest	34,382	40,003	42,278
Non-cash investing and financing activities:
Equipment financed through finance leases	0	0	132
Property and equipment included in accounts payable	$ 1,471	$ 1,400	$ 2,874