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Consolidated Statements of Cash Flows - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2018
Operating Activities      
Net income $ 56,630 $ 62,906 $ 73,486
Adjustments to reconcile net income to cash provided by     operating activities:      
Provision for doubtful accounts 860 575 71
Depreciation - PP&E 19,264 14,934 12,884
Depreciation - Rental 9,830 9,373 6,725
Amortization of intangibles 14,746 5,658 3,505
Amortization of debt issuance 634 295 221
Stock-based compensation expense 4,119 3,269 2,450
Provision for deferred income tax (benefit) expense (1,301) 3,316 2,052
Gain on sale of property, plant and equipment (1,094) (912) (361)
Changes in operating assets and liabilities, net of acquisitions:      
       Accounts receivable 28,064 11,447 (27,029)
Inventories 39,895 657 (25,991)
Rental equipment 4,542 (20,729) (22,424)
Prepaid expenses and other 6,373 (4,633) (583)
Trade accounts payable and accrued liabilities (3,783) 6,397 4,130
Income taxes payable 6,601 (4,861) (10,332)
Long term tax payable (3,478) (1,082) (6,196)
Other assets and liabilities, net 2,431 2,203 302
Net cash provided by operating activities 184,333 88,813 12,910
Investing Activities      
Acquisitions, net of cash acquired 0 (400,784) 0
Purchase of property, plant and equipment (17,874) (31,337) (26,587)
Proceeds from sale of property, plant and equipment 3,703 2,277 1,341
Purchase of patents 0 (96) (112)
Net cash used in investing activities (14,171) (429,940) (25,358)
Financing Activities      
Borrowings on bank revolving credit facility 115,000 217,000 159,000
Repayment on bank revolving credit facility (255,000) (157,000) (134,000)
Principal payments on long-term debt and capital leases (18,867) (122) 216
Proceeds from issuance of long-term debt 0 300,002 0
Debt issuance cost 0 (2,875) 0
Dividends paid (6,124) (5,626) (5,124)
Proceeds from exercise of stock options 1,459 2,573 2,552
Treasury stock repurchased 0 (4,140) 0
Common stock repurchased (710) (589) (436)
Net cash (used in) provided by financing activities (164,242) 349,223 22,208
Effect of exchange rate changes on cash 1,964 172 (1,090)
Net change in cash and cash equivalents 7,884 8,268 8,670
Cash and cash equivalents at beginning of the year 42,311 34,043 25,373
Cash and cash equivalents at end of the year 50,195 42,311 34,043
Cash paid during the year for:      
Interest 17,049 9,455 5,199
Income taxes $ 17,140 $ 23,099 $ 30,295