Accrued Expenses (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Payables and Accruals [Abstract]
Legal costs	$ 10,056	$ 3,760
Settlement costs	8,673	0
Pricing adjustment settlement with Veterans Affairs	6,894	5,600
Estimated returns	2,325	3,255
Accrued clinical trials	962	617
External commissions	1,233	1,397
Other	1,699	1,139
Total	$ 31,842	$ 15,768	$ 19,207

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Accrued Settlement Costs, Current

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Carrying value as of the balance sheet date of obligations incurred and payable, pertaining to costs that are statutory in nature, are incurred on contractual obligations, or accumulate over time and for which invoices have not yet been received or will not be rendered. Examples include taxes, interest, rent and utilities. Used to reflect the current portion of the liabilities (due within one year or within the normal operating cycle if longer).

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Carrying value as of the balance sheet date of obligations incurred through that date and payable for professional fees, such as for legal and accounting services received.

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Carrying value as of the balance sheet date of obligations incurred through that date and payable for sales commissions. Used to reflect the current portion of the liabilities (due within one year or within the normal operating cycle if longer).

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Amount of liability for consideration received or receivable from customer which is not included in transaction price, when consideration is expected to be refunded to customer, classified as current.

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Amount of loss contingency liability expected to be resolved within one year or the normal operating cycle, if longer.

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Amount of expenses incurred but not yet paid classified as other, due within one year or the normal operating cycle, if longer.

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