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Taxes Effective Tax Rate Reconciliation - USD ($) $ in Thousands | 12 Months Ended
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Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018
Income Tax Disclosure [Abstract] |  |  |
Effective Tax Rate Reconciliation, Excess Tax Benefits | $ (17,261) | $ (28,279) | $ (13,836)
Effect of Biotix contingent consideration gain | 0 | 0 | (4,394)
Income Tax Expense (Benefit), at Federal Statutory Income Tax Rate | 157,236 | 143,092 | 136,890
State and Local Income Taxes | 3,320 | 499 | 2,787
Deferred Tax Benefit, net related to Swiss Tax Reform | 0 | (15,833) | 0
Provisional one-time charge on US tax reform | 0 | 0 | 3,597
Foreign Income Tax Rate Differential | 179 | 18,546 | 12,710
Other Adjustments | 2,530 | 2,260 | 1,493
Provision for taxes | $ 146,004 | $ 120,285 | $ 139,247
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate |  | 21.00% | 21.00%

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- Definition The net benefit recorded to the income statement related to the enactment of Swiss Tax Reform. The amount primarily related to deferred benefits associated with an allowed step-up of intangible assets for tax purposes. + References No definition available. + Details
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