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Acquisitions and Investments (Details) $ in Thousands, € in Millions | 3 Months Ended | 6 Months Ended | 12 Months Ended |
--- | --- | --- | --- | ---
Dec. 31, 2018 USD ($) | Sep. 30, 2018 USD ($) | Sep. 30, 2017 USD ($) | Jun. 30, 2017 USD ($) business | Mar. 31, 2017 EUR (€) | Dec. 31, 2017 USD ($) customer_list | Dec. 31, 2018 USD ($) customer_list | Dec. 31, 2017 USD ($) | Dec. 31, 2016 USD ($) | Dec. 31, 2015 USD ($)
Business Acquisition [Line Items] |  |  |  |  |  |  |  |  |  |
Investment acquired, non-controlling interest share | $ 5,000 |  |  |  |  |  |  |  |  |
Goodwill | 214,489 |  |  |  |  | $ 199,873 | $ 214,489 | $ 199,873 | $ 178,228 | $ 178,934
Acquisition of a business, net of cash acquired |  |  |  |  |  |  | 22,500 | 14,579 | 1,964 |
Business Combinations, goodwill |  |  |  |  |  |  | 20,282 | $ 13,541 | 1,720 |
Software company |  |  |  |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |  |  |  |
Purchase price of acquired assets |  | $ 25,000 |  |  |  |  |  |  |  |
Holdback payment |  | 1,000 |  |  |  |  |  |  |  |
Contingent payment |  | $ 1,500 |  |  |  |  |  |  |  |
Contingent payment period |  | 36 months |  |  |  |  |  |  |  |
Goodwill |  | $ 20,300 |  |  |  |  |  |  |  |
Net tangible liabilities |  | 300 |  |  |  |  |  |  |  |
Two software companies |  |  |  |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |  |  |  |
Purchase price of acquired assets |  |  |  | $ 15,000 |  |  |  |  |  |
Contingent payment |  |  |  | $ 3,000 |  |  |  |  |  |
Contingent payment period |  |  |  | 36 months |  |  |  |  |  |
Number of businesses acquired | business |  |  |  | 2 |  |  |  |  |  |
Acquisition of a business, net of cash acquired |  |  |  | $ 12,000 |  |  |  |  |  |
Business Combinations, goodwill |  |  | $ 13,300 |  |  |  |  |  |  |
Reference laboratory in Austria |  |  |  |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |  |  |  |
Purchase price of acquired assets | € |  |  |  |  | € 1.3 |  |  |  |  |
Reference laboratory diagnostic and consulting businesses |  |  |  |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |  |  |  |
Acquisition of a business, net of cash acquired |  |  |  |  |  |  |  |  | $ 3,500 |
Customer relationships | Software company |  |  |  |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |  |  |  |
Intangible assets |  | 2,400 |  |  |  |  |  |  |  |
Customer relationships | Two software companies |  |  |  |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |  |  |  |
Intangible assets |  |  | 1,000 |  |  |  |  |  |  |
Technology-based intangible assets | Software company |  |  |  |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |  |  |  |
Intangible assets |  | $ 2,600 |  |  |  |  |  |  |  |
Technology-based intangible assets | Two software companies |  |  |  |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |  |  |  |
Intangible assets |  |  | $ 600 |  |  |  |  |  |  |
Customer lists | Reference laboratory in United States |  |  |  |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |  |  |  |
Purchase price of acquired assets |  |  |  |  |  | $ 2,300 | 2,200 |  |  |
Contingent payment | $ 300 |  |  |  |  |  | $ 300 |  |  |
Number of businesses acquired | customer_list |  |  |  |  |  | 4 | 4 |  |  |

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