CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Cash flows (used in) provided by operating activities:
Net income	$ 27,946	$ 22,121
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	24,164	26,513
(Benefit) provision for doubtful accounts	(194)	629
Share-based compensation expense	9,407	15,565
Deferred income taxes	1,253	2,067
Amortization of debt discounts and issuance costs	1,429	1,564
Gain on sale and disposal of fixed assets	(1,004)	(729)
Changes in operating assets and liabilities, net of acquisitions:
Accounts receivable, net	(5,120)	39,531
Inventories	(6,361)	(3,834)
Other current assets and other assets	(7,170)	(3,115)
Income taxes	4,753	(6,814)
Accounts payable	(4,134)	12,912
Accrued expenses and other current liabilities	(7,670)	6,914
Accrued compensation related costs	(30,902)	2,339
Other liabilities	(4,579)	8,016
Operating lease liabilities, net of amortization of right-of-use assets	(1,173)	1,559
Changes in operating assets and liabilities:	(62,356)	57,508
Net cash provided by operating activities	645	125,238
Cash flows used in investing activities:
Acquisitions, net of cash acquired	(39,253)	(16,854)
Purchase of property, plant, and equipment	(17,201)	(19,352)
Purchase of therapeutic program equipment leased to third parties under operating leases	(1,709)	(3,194)
Proceeds from sale of property, plant, and equipment	1,812	1,578
Purchase of company-owned life insurance investment	0	(250)
Net cash used in investing activities	(56,351)	(38,072)
Cash flows used in financing activities:
Borrowings under revolving credit agreement	0	79,000
Repayment of borrowings under revolving credit agreement	0	(79,000)
Payment of employee taxes on share-based compensation	(4,570)	(6,841)
Repayment of term loan	(3,788)	(3,788)
Payment on Seller Notes	(3,319)	(2,200)
Payments under vendor financing arrangements	(1,375)	(550)
Payments of financing lease obligations	(781)	(521)
Payment of debt issuance costs	0	(214)
Proceeds from the exercise of options	524	39
Net cash used in financing activities	(13,309)	(14,075)
(Decrease) increase in cash and cash equivalents	(69,015)	73,091
Cash and cash equivalents at beginning of period	144,602	74,419
Cash and cash equivalents at end of period	75,587	147,510
Non-cash financing and investing activities:
Seller Notes and other non-cash consideration related to acquisitions	12,192	29,420
Purchase of property, plant, and equipment in accounts payable at period end	4,109	4,299
Right-of-use assets obtained in exchange for finance lease obligations	$ 119	$ 1,975