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Leases - Lease Costs (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended
--- | --- | ---
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022
Leases [Abstract] |  |  |  |
Facility operating expense | $ 1,732 | $ 1,561 | $ 3,358 | $ 3,084
Facility lease expense | 50,512 | 41,538 | 96,639 | 83,102
Operating lease expense | 52,244 | 43,099 | 99,997 | 86,186
Operating lease expense adjustment | 11,557 | 8,308 | 22,362 | 16,615
Changes in operating lease assets and liabilities for lessor capital expenditure reimbursements | 0 | (3,367) | (2,244) | (4,857)
Operating net cash outflows from operating leases | 63,801 | 48,040 | 120,115 | 97,944
Depreciation and amortization | 2,515 | 7,607 | 7,743 | 15,273
Interest expense: financing lease obligations | 5,453 | 11,994 | 12,005 | 24,052
Financing lease expense | 7,968 | 19,601 | 19,748 | 39,325
Operating cash outflows from financing leases | 5,453 | 11,994 | 12,005 | 24,052
Financing cash outflows from financing leases | 2,126 | 5,610 | 7,978 | 11,100
Changes in financing lease assets and liabilities for lessor capital expenditure reimbursement | 0 | (3,770) | 0 | (6,977)
Total net cash outflows from financing leases | $ 7,579 | $ 13,834 | $ 19,983 | $ 28,175

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