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Goodwill Goodwill - Narrative (Details) - USD ($) $ in Thousands | 9 Months Ended |  |
--- | --- | --- | ---
Sep. 30, 2018 | Jun. 30, 2018 | Dec. 31, 2017
Goodwill [Line Items] |  |  |
Goodwill | $ 624,455 |  | $ 454,612
Goodwill acquired during period | 168,111 |  |
Total stockholders’ equity | 641,034 |  | $ 486,104
Paragon Medical Inc |  |  |
Goodwill [Line Items] |  |  |
Goodwill | 162,438 | $ 157,421 |
Bridgemedica, LLC |  |  |
Goodwill [Line Items] |  |  |
Goodwill acquired during period | 8,000 |  |
Southern California Technical Arts, Inc. |  |  |
Goodwill [Line Items] |  |  |
Goodwill acquired during period | $ 2,700 |  |

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- Definition Amount after accumulated impairment loss of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 350 -SubTopic 20 -Section 50 -Paragraph 1 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=35741047&loc=d3e13816-109267 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 350 -SubTopic 20 -Section 45 -Paragraph 1 -URI http://asc.fasb.org/extlink&oid=6388280&loc=d3e13770-109266 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 350 -SubTopic 20 -Section 45 -Paragraph 5 -URI http://asc.fasb.org/extlink&oid=77989000&loc=SL49117168-202975 + Details
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- Definition Amount of increase in asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized resulting from a business combination. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 350 -SubTopic 20 -Section 50 -Paragraph 1 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=35741047&loc=d3e13816-109267 + Details
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- Definition Amount of stockholders' equity (deficit), net of receivables from officers, directors, owners, and affiliates of the entity, attributable to both the parent and noncontrolling interests. Amount excludes temporary equity. Alternate caption for the concept is permanent equity. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 55 -Paragraph 4I -URI http://asc.fasb.org/extlink&oid=84234705&loc=SL4590271-111686 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 45 -Paragraph 16 -URI http://asc.fasb.org/extlink&oid=96868048&loc=SL4568740-111683 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 45 -Paragraph 15 -URI http://asc.fasb.org/extlink&oid=96868048&loc=SL4568447-111683 + Details
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