Revenue from Contracts with Customers Contract Assets and Liabilities (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Dec. 31, 2018
Revenue from Contracts with Customers [Abstract]
Accounts Receivable, Net	$ 15,867	$ 20,655
Disaggregation of Revenue [Line Items]
Contract with Customer, Asset, Net	5,360	2,595
Contract asset payments received	(26)
Contract assets recognized	2,791
Contract with Customer, Liability	5,452	8,938
Medical devices [Member]
Disaggregation of Revenue [Line Items]
Contract with Customer, Asset, Net	0	0
Contract asset payments received	0
Contract assets recognized	0
Contract with Customer, Liability	1,105
Pharmaceutical [Member]
Disaggregation of Revenue [Line Items]
Contract with Customer, Asset, Net	5,360	$ 2,595
Contract asset payments received	(26)
Contract assets recognized	2,791
Contract with Customer, Liability	$ 4,347