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Basis of Presentation - Disaggregation of Revenue by Each Payor Type (Details) - USD ($) | 3 Months Ended | 9 Months Ended
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Sep. 30, 2019 | Sep. 30, 2018 | Sep. 30, 2019 | Sep. 30, 2018
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | $ 156,060,224 | $ 166,729,281 | $ 381,866,961 | $ 413,319,058
Commercial |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 25,429,304 | 28,463,636 | 75,883,004 | 83,830,517
Medicare |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 60,737,135 | 79,117,660 | 155,729,758 | 186,449,517
Medicaid |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 61,189,161 | 47,318,190 | 122,836,562 | 109,870,854
Other third parties |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | $ 8,704,624 | $ 11,829,795 | $ 27,417,637 | $ 33,168,170

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- Definition Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 4 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=109196051&loc=SL49130543-203045 Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 1 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=109196051&loc=SL49130539-203045 Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 606 -SubTopic 10 -Section 50 -Paragraph 5 -URI http://asc.fasb.org/extlink&oid=109196051&loc=SL49130545-203045 + Details
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