Property and Equipment (Details) - USD ($) $ in Thousands	Sep. 30, 2019	Dec. 31, 2018
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	$ 749,118	$ 694,864
Accumulated depreciation	(305,031)	(262,223)
Net property and equipment	444,087	432,641	[1]
Machinery and Equipment, Gross	213,957	203,431
Furniture and Fixtures, Gross	7,405	7,409
Construction in Progress, Gross	85,908	70,864
Land, Buildings and Improvements [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	228,960	212,283
Molds [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	59,749	59,700
Computer Equipment and Software [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	82,993	80,420
Instruments Placed with Customers [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	$ 70,146	$ 60,757

[1] December 31, 2018 balances were derived from audited consolidated financial statements.