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Intangible Assets | 12 Months Ended
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Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract] |
Goodwill and Intangible Assets | GOODWILL AND INTANGIBLE ASSETS Acquisitions There were no material acquisitions in 2022 and 2021. In February 2020, the Company acquired Orpheus Medical Ltd. and its wholly owned subsidiaries (“Orpheus Medical”) to deepen and expand the Company’s integrated informatics platform. Orpheus Medical provides hospitals with information technology connectivity, as well as expertise in processing and archiving surgical videos. Goodwill The following table summarizes the changes in the carrying amount of goodwill (in millions):
|  | Amount
Balance as of December 31, 2020 |  | $ | 336.7 |
Acquisition activity |  | 8.0 |
Translation and other |  | (1.1) |
Balance as of December 31, 2021 |  | 343.6 |
Acquisition activity |  | 6.5 |
Translation and other |  | (1.6) |
Balance as of December 31, 2022 |  | $ | 348.5 |
The Company completed its annual goodwill impairment test and determined that no impairment existed. As of December 31, 2022, there has been no impairment of goodwill. Intangible Assets The following table summarizes the components of gross intangible asset, accumulated amortization, and net intangible asset balances as of December 31, 2022, and 2021 (in millions):
|  | December 31, 2022 |  | December 31, 2021
|  | Gross Carrying Amount |  | Accumulated Amortization |  | Net Carrying Amount |  | Gross Carrying Amount |  | Accumulated Amortization |  | Net Carrying Amount
Patents and developed technology |  | $ | 199.1 |  |  | $ | (167.4) |  |  | $ | 31.7 |  |  | $ | 219.3 |  |  | $ | (173.2) |  |  | $ | 46.1 |
Distribution rights and others |  | 11.0 |  |  | (7.4) |  |  | 3.6 |  |  | 26.3 |  |  | (19.4) |  |  | 6.9 |
Customer relationships |  | 32.6 |  |  | (18.1) |  |  | 14.5 |  |  | 31.8 |  |  | (14.3) |  |  | 17.5 |
Total intangible assets |  | $ | 242.7 |  |  | $ | (192.9) |  |  | $ | 49.8 |  |  | $ | 277.4 |  |  | $ | (206.9) |  |  | $ | 70.5 |
Amortization expense related to intangible assets was $27.8 million, $27.4 million, and $49.8 million for the years ended December 31, 2022, 2021, and 2020, respectively. The estimated future amortization expense related to intangible assets as of December 31, 2022, is as follows (in millions):
Fiscal Year | Amount
2023 | $ | 19.2 |
2024 | 15.0 |
2025 | 10.3 |
2026 | 3.4 |
2027 | 1.0 |
2028 and thereafter | 0.9 |
Total | $ | 49.8 |
The preceding expected amortization expense is an estimate. Actual amounts of amortization expense may differ from estimated amounts due to additional intangible asset acquisitions, measurement period adjustments to intangible assets, changes in foreign currency exchange rates, impairment of intangible assets, accelerated amortization of intangible assets, and other events.

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- Definition The entire disclosure for goodwill and intangible assets. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 350 -URI https://asc.fasb.org/topic&trid=2144416 + Details
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