Annual report pursuant to Section 13 and 15(d)

Revenue Recognition - Schedule of Disaggregation of Revenue (Details)

v3.10.0.1
Revenue Recognition - Schedule of Disaggregation of Revenue (Details) - USD ($)
$ in Thousands
3 Months Ended 12 Months Ended
Dec. 31, 2018
Sep. 30, 2018
Jun. 30, 2018
Mar. 31, 2018
Dec. 31, 2017
Sep. 30, 2017
Jun. 30, 2017
Mar. 31, 2017
Dec. 31, 2018
Dec. 31, 2017
Dec. 31, 2016
Disaggregation of Revenue [Line Items]                      
Total revenues $ 221,852 $ 249,815 $ 263,685 $ 254,914 $ 160,983 $ 246,040 $ 292,601 $ 266,382 $ 990,266 $ 966,006 $ 1,117,494
Healthcare insurers                      
Disaggregation of Revenue [Line Items]                      
Total revenues                 370,096 368,628 649,036
Government payers                      
Disaggregation of Revenue [Line Items]                      
Total revenues                 271,590 264,493 118,526
Client payers                      
Disaggregation of Revenue [Line Items]                      
Total revenues                 150,259 128,867 127,363
Patients                      
Disaggregation of Revenue [Line Items]                      
Total revenues                 21,303 20,722 33,647
Revenue from services                      
Disaggregation of Revenue [Line Items]                      
Total revenues                 $ 813,248 $ 782,710 $ 928,572