0001564590-21-014182 | 10-K | XBRL Viewer

Print Document View Excel Document

Document and Entity Information - USD ($)	12 Months Ended
Document and Entity Information - USD ($)	Dec. 31, 2020	Feb. 28, 2021	Jun. 30, 2020
Cover [Abstract]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2020
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	FY
Entity Registrant Name	PROGENITY, INC.
Entity Central Index Key	0001580063
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Current Fiscal Year End Date	--12-31
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	true
Entity Ex Transition Period	false
Entity Shell Company	false
Entity Public Float			$ 95,918,409
Entity Common Stock, Shares Outstanding		60,251,833
Entity File Number	001-39334
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	27-3950390
Entity Address, Address Line One	4330 La Jolla Village Drive
Entity Address, Address Line Two	Suite 200
Entity Address, City or Town	San Diego
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	92122
City Area Code	855
Local Phone Number	293-2639
Document Annual Report	true
Document Transition Report	false
Title of 12(b) Security	Common Stock, par value $0.001 per share
Trading Symbol	PROG
Security Exchange Name	NASDAQ
Documents Incorporated by Reference	None.

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Current assets:
Cash and cash equivalents	$ 92,076	$ 33,042
Accounts receivable, net	12,682	22,189
Inventory	12,219	10,937
Income tax receivable		634
Prepaid expenses and other current assets	9,361	7,846
Total current assets	126,338	74,648
Property and equipment, net	17,842	15,891
Other assets	198	198
Goodwill	6,219	6,219
Other intangible assets, net	3,843	4,771
Total assets	154,440	101,727
Current liabilities:
Accounts payable	17,410	15,754
Accrued expenses and other current liabilities	54,677	83,615
Current portion of mortgages payable	271	241
Current portion of capital lease obligations	312	727
Total current liabilities	72,670	100,337
Capital lease obligations, net of current portion	46	358
Mortgages payable, net of current portion	2,795	3,081
Convertible notes, net of unamortized discount of $9,614 as of December 31, 2020	158,886
Note payable to related party, net of unamortized discount of $6,034 as of December 31, 2019		68,966
Embedded derivative liability	18,370
Other long-term liabilities	8,667	12,859
Total liabilities	261,434	185,601
Commitments and contingencies (Note 10)
Stockholders' deficit:
Common stock – $0.001 par value. 350,000,000 and 300,000,000 shares authorized as of December 31, 2020 and December 31, 2019, respectively; 59,287,331 and 8,451,415 shares issued as of December 31, 2020 and December 31, 2019, respectively; 55,772,303 and 4,976,843 shares outstanding as of December 31, 2020 and December 31, 2019, respectively	59	9
Additional paid-in capital	452,992	283,260
Accumulated deficit	(541,274)	(348,478)
Treasury stock – at cost; 3,515,028 shares of common stock as of December 31, 2020 and 3,474,572 shares of common stock as of December 31, 2019	(18,771)	(18,771)
Total stockholders' deficit	(106,994)	(83,874)
Total liabilities and stockholders' deficit	$ 154,440	101,727
Series A Preferred Stock
Stockholders' deficit:
Preferred Stock		4
Series B Preferred Stock
Stockholders' deficit:
Preferred Stock		$ 102

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Unamortized discount	$ 9,600	$ 6,034
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	350,000,000	300,000,000
Common stock, shares issued	59,287,331	8,451,415
Common stock, shares outstanding	55,772,303	4,976,843
Preferred stock, shares authorized	10,000,000	130,155,000
Treasury stock, at cost shares	3,515,028	3,474,572
Convertible Notes
Unamortized discount	$ 9,614
Series A Preferred Stock
Preferred stock, par value	$ 0.001	$ 0.001
Preferred stock, shares authorized	0	4,120,000
Preferred stock, shares issued	0	4,120,000
Preferred stock, shares outstanding	0	4,120,000
Series B Preferred Stock
Preferred stock, par value	$ 0.001	$ 0.001
Preferred stock, shares authorized	0	126,035,000
Preferred stock, shares issued	0	101,867,405
Preferred stock, shares outstanding	0	101,867,405

Consolidated Statements of Operations - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Income Statement [Abstract]
Revenues	$ 74,313	$ 143,985
Cost of sales	93,433	100,492
Gross profit (loss)	(19,120)	43,493
Operating expenses:
Research and development	47,743	63,400
Selling and marketing	52,887	58,888
General and administrative	75,438	61,324
Total operating expenses	176,068	183,612
Loss from operations	(195,188)	(140,119)
Interest expense	(9,984)	(9,199)
Interest and other income (expense), net	(24,888)	575
Loss before income taxes	(230,060)	(148,743)
Income tax benefit	(37,532)	(706)
Net loss	(192,528)	(148,037)
Dividend paid to preferred stockholders	(268)	(3,652)
Stock dividend on exchange of Series A-1 to Series B Preferred Stock		(27,637)
Stock dividend on Series B Preferred Stock		(49,501)
Net loss attributable to common stockholders	$ (192,796)	$ (228,827)
Net loss per share attributable to common stockholders, basic and diluted	$ (7.01)	$ (46.87)
Weighted average number of shares outstanding used in calculating net loss per share attributable to common stockholders, basic and diluted	27,512,876	4,882,662

Consolidated Statements of Stockholders' Deficit - USD ($) $ in Thousands	Total	Secondary Public Offering	IPO	Cumulative effect, period of adoption, adjustment	Common Stock	Common Stock Secondary Public Offering	Common Stock IPO	Preferred Stock Series A and A-1 Preferred Stock	Preferred Stock Series B Preferred Stock	Additional Paid-In Capital	Additional Paid-In Capital Secondary Public Offering	Additional Paid-In Capital IPO	Accumulated Deficit	Accumulated Deficit Cumulative effect, period of adoption, adjustment	Treasury Stock
Beginning Balance at Dec. 31, 2018	$ (36,968)			$ 23,666	$ 8			$ 6	$ 14	$ 124,244			$ (142,469)	$ 23,666	$ (18,771)
Beginning Balance, shares at Dec. 31, 2018					8,112,581			5,620,000	14,164,306						(3,474,572)
Issuance of common stock upon exercise of options	551				$ 1					550
Issuance of common stock upon exercise, shares					338,834
Exchange of Series A-1 Preferred Stock for Series B Preferred Stock								$ (2)	$ 36	27,603			(27,637)
Exchange of Series A-1 Preferred Stock for Series B Preferred Stock, Shares								(1,500,000)	35,664,240
Issuance of stock, net	79,039								$ 34	79,005
Issuance of stock, net, shares									34,035,354
Stock dividend on Series B Preferred Stock									$ 18	49,483			(49,501)
Stock dividend on Series B Preferred Stock, shares									18,003,505
Stock-based compensation expense	2,375									2,375
Dividends paid	(4,500)												(4,500)
Net loss	(148,037)												(148,037)
Ending Balance at Dec. 31, 2019	(83,874)				$ 9			$ 4	$ 102	283,260			(348,478)		$ (18,771)
Ending Balance, shares at Dec. 31, 2019					8,451,415			4,120,000	101,867,405						(3,474,572)
Issuance of common stock upon exercise of options	$ 626									626
Issuance of common stock upon exercise, shares	543,218				543,218
Issuance of stock, net	$ 24,005	$ 26,938	$ 88,665			$ 9	$ 7		$ 10	23,995	$ 26,929	$ 88,658
Issuance of stock, net, shares						8,792,047	6,666,667		10,478,240
Automatic conversion of preferred stock					$ 33			$ (4)	$ (112)	83
Automatic conversion of preferred stock, shares					33,443,562			(4,120,000)	(112,345,645)
Issuance of common stock upon conversion of debt	18,750				$ 1					18,749
Issuance of common stock upon conversion of debt, shares					1,250,000
Issuance of Stock Purchase Warrant										268			(268)
Issuance of common stock upon vesting of restricted stock unit awards	(244)									(244)
Issuance of common stock upon vesting of restricted stock unit awards, shares					140,422										(40,456)
Stock-based compensation expense	10,668									10,668
Net loss	(192,528)												(192,528)
Ending Balance at Dec. 31, 2020	$ (106,994)				$ 59					$ 452,992			$ (541,274)		$ (18,771)
Ending Balance, shares at Dec. 31, 2020					59,287,331										(3,515,028)

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Operating Activities:
Net loss	$ (192,528)	$ (148,037)
Adjustments to reconcile net loss to net cash used in operating activities:
Non-cash revenue reserve	33,549	39,703
Depreciation and amortization	5,059	4,679
Stock-based compensation expense	10,668	2,375
Loss on extinguishment of debt	10,952
Amortization of debt discount	3,656	1,670
Inventory write-down	143	535
Loss on disposal of property and equipment	67
Change in fair value of derivative liability	13,860
Changes in operating assets and liabilities:
Accounts receivable, net	9,508	3,429
Inventory	(1,425)	(3,857)
Income tax receivable	635	5,560
Prepaid expenses and other current assets	(2,564)	(3,867)
Other assets		(54)
Accounts payables	2,857	4,383
Accrued expenses and other liabilities	(61,424)	18,001
Other long-term liabilities	1,243	(30,644)
Net cash used in operating activities	(165,744)	(106,124)
Investing Activities:
Purchases of property and equipment	(4,944)	(3,725)
Purchases of short-term investments		(11,214)
Proceeds from sale of short-term investments		31,414
Proceeds from sale of equity method investment		50
Net cash (used in) provided by investing activities	(4,944)	16,525
Financing Activities:
Proceeds from issuance of common stock, net	116,435	551
Proceeds from issuance of Series B Preferred Stock and warrant, net of issuance cost	21,307	79,039
Proceeds from issuance of convertible notes, net	99,708
Payments for financing of insurance premiums	(6,745)
Dividends paid		(4,500)
Payments for deferred offering costs		(179)
Principal payments on mortgages payable	(256)	(228)
Principal payments on capital lease obligations	(727)	(1,047)
Net cash provided by financing activities	229,722	73,636
Net increase (decrease) in cash and cash equivalents	59,034	(15,963)
Cash and cash equivalents at beginning of period	33,042	49,005
Cash and cash equivalents at end of period	92,076	33,042
Supplemental disclosure of cash flow information:
Cash paid for interest	3,927	7,529
Cash paid for income taxes	62	6
Supplemental schedule of non-cash investing and financing activities:
Exchange of note payable for convertible notes	75,000
Conversion of convertible note	18,750
Issuance of preferred stock in settlement of interest payable	2,698
Equity financing issuance costs incurred but not paid	205	871
Debt issuance costs incurred but not paid	239
Issuance of stock options in settlement of accrued bonuses	754
Purchases of property and equipment in accounts payable	$ 1,204	337
Capital lease obligations		241
Stock dividend on exchange of Series A-1 to Series B Preferred Stock		27,637
Stock dividend on Series B Preferred Stock		$ 49,501

Organization and Description of Business

12 Months Ended

Dec. 31, 2020

Organization Consolidation And Presentation Of Financial Statements [Abstract]

Organization and Description of Business

Note 1. Organization and Description of Business

Progenity, Inc. (the “Company” or “Progenity”), a Delaware corporation, commenced operations in 2010 with its corporate office located in San Diego, California. Progenity’s primary operations include a licensed Clinical License Improvement Amendment and College of American Pathologists certified laboratory located in Michigan specializing in the molecular testing markets serving women’s health providers in the obstetric, gynecological, fertility, and maternal fetal medicine specialty areas in the United States.

The Company has expertise in the national reference laboratory, clinical genetics, laboratory molecular testing, and biotechnology markets. Distribution is managed by a dedicated women’s health physician sales force and a field operations team who support all logistical functions in receiving clinical samples to the laboratory for analysis. The Company’s core business is focused on the prenatal carrier screening and noninvasive prenatal test market, targeting preconception planning, and routine pregnancy management for genetic disease risk assessment. Through its affiliation with Mattison Pathology, LLP (“Mattison”), a Texas limited liability partnership doing business as Avero Diagnostics (“Avero”), located in Lubbock and Dallas, Texas, the Company’s operations have expanded to provide anatomic and molecular pathology testing products in the United States.

On June 10, 2020, the Company amended its certificate of incorporation to reflect a one-for-6.178 reverse stock split of the Company’s common stock. The par value and the number of authorized shares of common stock were not adjusted as a result of the reverse stock split. All issued and outstanding shares of common stock and related per share amounts contained in the accompanying consolidated financial statements have been adjusted to reflect this reverse stock split for all periods presented. The reverse stock split resulted in an adjustment to the respective Series A and B preferred stock conversion prices to reflect a proportional decrease in the number of shares of common stock to be issued upon conversion.

On June 23, 2020, the Company completed the initial public offering of its common stock (the “IPO”). In the IPO, the Company issued and sold 6,666,667 shares of its common stock, at a price to the public of $15.00 per share. The Company received approximately $88.7 million in net proceeds, after deducting underwriting discounts and commissions and other offering expenses payable by the Company. In connection with the IPO, on June 23, 2020, all outstanding Series A and B preferred stock and the outstanding convertible promissory note converted into shares of common stock and the outstanding warrant to purchase shares of convertible preferred stock became exercisable for shares of common stock.

In December 2020, the Company issued and sold 8,792,047 shares of its common stock in an underwritten public offering, at a price of $3.27 per share. The Company received approximately $26.9 million in net proceeds, after deducting underwriting discounts and commissions and other offering expenses payable by the Company. Concurrently with this underwritten public offering, the Company completed a private offering of $168.5 million principal amount of its 7.25% Convertible Senior Notes due 2025 (the “Convertible Notes”) pursuant to Rule 144A under the Securities Act. Included in the principal amount was $78.5 million of Convertible Notes issued to Athyrium Capital Management, L.P. (“Athyrium”), which were exchanged for discharge of amounts and any obligations outstanding under the Company’s existing credit and security agreement with a fund managed by Athyrium (see Note 8).

Liquidity

As of December 31, 2020, the Company had cash and cash equivalents of $92.1 million and an accumulated deficit of $541.3 million. For the year ended December 31, 2020, the Company reported a net loss of $192.5 million and cash used in operating activities of $165.7 million. The Company’s primary sources of capital have historically been the sale of common stock, private placements of preferred stock and incurrence of debt. As of December 31, 2020, the Company had $168.5 million of convertible notes outstanding (see Note 7), and mortgages outstanding of $3.1 million (see Note 9). Management does not believe that the current available cash and cash equivalents will be sufficient to fund the Company’s planned expenditures and meet its obligations for at least 12 months following the financial statement issuance date without raising additional funding. As a result, there is substantial doubt about the Company’s ability to continue as a going concern for 12 months following the issuance date of the consolidated financial statements for the year ended December 31, 2020. The Company’s ability to continue as a going concern is dependent upon its ability to raise additional funding. Management believes that the Company’s liquidity position provides sufficient runway to achieve critical research and development pipeline milestones and show continued progress in the molecular testing activities into mid-2021. Management intends to raise additional capital through equity offerings and/or debt financings, or from other potential sources of liquidity, which may include new collaborations, licensing or other commercial agreements for one or more of the Company’s research programs or patent portfolios. Adequate funding, if needed, may not be available to the Company on acceptable terms, or at all. The Company’s ability to raise additional funds may be adversely impacted by potential worsening global economic conditions and the recent disruptions to, and volatility in, the credit and financial markets in the United States and worldwide resulting from the ongoing COVID-19 pandemic. If the Company is unable to raise capital when needed or on attractive terms, it would be forced to delay, reduce, or eliminate its research and development programs or other operations. If any of these events occur, the Company’s ability to achieve its operational goals would be adversely affected.

Uncertainties Related to the COVID-19 Pandemic

The ongoing COVID‑19 pandemic has negatively impacted the global economy, disrupted global supply chains and created significant volatility and disruption of financial markets. The Company has been materially and negatively affected by the COVID-19 pandemic; however, the extent of the impact of the COVID-19 pandemic on the Company’s operational and financial performance, including its ability to execute its business strategies and initiatives in the expected time frame, will depend on future developments, including the duration and spread of the pandemic and related restrictions on travel and transports, all of which are uncertain and cannot be predicted. The Company could be further negatively affected by the widespread outbreak of an illness or any other communicable disease, or any other public health crisis that results in economic and trade disruptions, including the disruption of global supply chains. An extended period of global supply chain and economic disruption could materially affect the Company’s business, results of operations, access to sources of liquidity and financial condition.

The estimates used for, but not limited to, determining the amount to be collected for accounts receivable, fair value of long-lived assets, and fair value of goodwill could be impacted by the pandemic. While the full impact of COVID-19 is unknown at this time, the Company has made appropriate estimates based on the facts and circumstances available as of the reporting date. These estimates may change as new events occur and additional information is obtained.

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2020

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

Note 2. Summary of Significant Accounting Guidance

Basis of Presentation

The Company’s financial statements have been prepared in conformity with accounting principles generally accepted in the United States of America (“GAAP”) and include the accounts of Progenity, Inc., its wholly owned subsidiaries, and an affiliated professional partnership with Avero with respect to which the Company currently has a specific management arrangement. The Company has determined that Avero is a variable interest entity and that the Company is the primary beneficiary resulting in the consolidation of Avero as required by the accounting guidance for consolidation. All significant intercompany balances and transactions have been eliminated in consolidation (see Note 3).

Use of Estimates

The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities as of the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Significant items subject to such estimates include the estimate of variable consideration in connection with the recognition of revenue, the valuation of Series B preferred stock, the valuation of stock options, the valuation of goodwill and intangible assets, the valuation of derivative liability associated with the convertible notes, accrual for reimbursement claims and settlements, assessing future tax exposure and the realization of deferred tax assets, the useful lives and the recoverability of property and equipment. The Company bases these estimates on historical and anticipated results, trends, and various other assumptions that the Company believes are reasonable under the circumstances, including assumptions as to future events. These estimates form the basis for making judgments about the carrying values of assets and liabilities and recorded revenues and expenses that are not readily apparent from other sources. Actual results could differ from those estimates and assumptions.

Operating Segments

Operating segments are identified as components of an enterprise about which separate discrete financial information is available for evaluation by the chief operating decision maker or decision-making group in making decisions on how to allocate resources and assess performance. The Company views its operations and manages its business as one operating segment. All revenues are attributable to U.S.-based operations and all assets are held in the United States.

Revenue Recognition

Revenue is recognized in accordance with the Financial Accounting Standards Board (“FASB”) Accounting Standards Codification (“ASC”) Topic 606, Revenue from Contracts with Customers (“ASC 606”). In accordance with ASC 606, the Company follows a five-step process to recognize revenues: 1) identify the contract with the customer, 2) identify the performance obligations, 3) determine the transaction price, 4) allocate the transaction price to the performance obligations and 5) recognize revenues when the performance obligations are satisfied.

Revenue is primarily derived from providing molecular testing products, which are reimbursed through arrangements with third-party payors, laboratory distribution partners, and amounts from individual patients. Third-party payors include commercial payors, such as health insurance companies, health maintenance organizations and government health benefit programs, such as Medicare and Medicaid. The Company’s contracts generally contain a single performance obligation, which is the delivery of the test results, and the Company satisfies its performance obligation at a point in time upon the delivery of the results, which then triggers the billing for the product. The amount of revenue recognized reflects the amount of consideration the Company expects to be entitled to (the “transaction price”) and considers the effects of variable consideration. Revenue is recognized when control of the promised product is transferred to customers, in an amount that reflects the consideration the Company expects to be entitled to in exchange for those products.

The Company applies the following practical expedients and exemptions:

•

Incremental costs incurred to obtain a contract are expensed as incurred because the related amortization period would have been one year or less. The costs are included in selling and marketing expenses.

•

No adjustments to amounts of promised consideration are made for the effects of a significant financing component because the Company expects, at contract inception, that the period between the transfer of a promised good or service and customer payment for that good or service will be one year or less.

Payor Concentration

The Company relies upon reimbursements from third-party government payors and private-payor insurance companies to collect accounts receivable. The Company’s significant third-party payors and their related accounts receivable balances and revenues as a percentage of total accounts receivable balances and revenues are as follows:

	Percentage of Accounts Receivable
	December 31, 2020			December 31, 2019
Blue Shield of Texas		17.8	%	*
Aetna		4.0	%		6.0	%
Cigna		2.6	%	*
United Healthcare		6.6	%		31.5	%
Government Health Benefits Programs		26.2	%		16.7	%
Anthem		3.5	%	*
____________
* Less than 1%.

	Percentage of Revenue
	Year Ended December 31,
	2020			2019
Blue Shield of Texas		35.6	%		21.3	%
Aetna		11.0	%		9.2	%
Cigna		7.6	%		4.5	%
United Healthcare		6.7	%		30.8	%
Government Health Benefits Programs		3.7	%	*
Anthem(1)		(6.7	)%		6.1	%
____________
(1) The negative amounts presented in the percentage of revenues include accruals for reimbursement claims and settlements included in the estimates of variable consideration recorded during the year ended December 31, 2020. Revenue recognized consider the effects of variable consideration, and include adjustments for estimates of disallowed cases, discounts, and refunds. The variable consideration includes reductions in revenues for the accrual for reimbursement claims and settlements, as described in Notes 4 and 10.
* Less than 1%.

Accounts Receivable

Accounts receivable is recorded at the transaction price and considers the effects of variable consideration. The total consideration the Company expects to collect is an estimate and may be fixed or variable. Variable consideration includes reimbursement from third-party payors, laboratory distribution partners, and amounts from individual patients, and is adjusted for disallowed cases, discounts, and refunds using the expected value approach. The Company monitors these estimates at each reporting period based on actual cash collections in order to assess whether a revision to the estimate is required.

Cost of Sales

The components of the Company’s cost of sales are materials and service costs, personnel costs, including stock-based compensation expense, equipment, and infrastructure expenses associated with processing blood and other samples, quality control analyses, shipping charges to transport samples and specimens from ordering physicians, clinics or individuals, third-party laboratory testing products, and allocated overhead including rent, information technology costs, equipment depreciation, and utilities. Costs associated with performing tests are recorded when the test is processed regardless of whether and when revenues are recognized with respect to such test.

Cash and Cash Equivalents including Concentration of Credit Risk

The Company considers all highly liquid investment instruments purchased with an initial maturity of three months or less to be cash equivalents. The Company limits its exposure to credit loss by placing its cash and cash equivalents in financial institutions with high credit ratings. The Company’s cash and cash equivalents may consist of deposits held with banks, money market funds, or other highly liquid investments that may at times exceed federally insured limits. Cash equivalents are financial instruments that potentially subject the Company to concentrations of risk, to the extent of amounts recorded in the balance sheets. The Company performs evaluations of its cash equivalents and the relative credit standing of these financial institutions and limits the amount of credit exposure with any one institution. Management believes that the Company is not exposed to significant credit risk due to the financial position of the depository institutions in which those deposits are held.

Investments

All investments have been classified as “available-for-sale” and are carried at fair value as determined based upon quoted market prices or pricing models for similar securities at period end. Investments with contractual maturities less than 12 months at the balance sheet date are considered short-term investments. Those investments with contractual maturities 12 months or greater at the balance sheet date are considered long-term investments. A decline in the fair value of any security below cost that is deemed other than temporary results in a charge to earnings and the corresponding establishment of a new cost basis for the security. Dividend and interest income are recognized when earned. Realized gains and losses are included in earnings and are derived using the specific identification method for determining the cost of the securities sold.

Inventory

Inventory is stated at lower of cost (first-in, first-out method) or net realizable value. Inventory consists entirely of supplies, which are consumed when the Company is providing its test reports, and therefore the Company does not maintain any work in process or finished goods inventory. The Company reviews its inventory on a regular basis for excess and obsolete inventory based on an estimate for future consumption. Write-downs or losses of inventory are generally due to technological advances or new product introductions in the Company’s laboratory testing products. The Company believes that the estimate used in calculating the inventory provision are reasonable and properly reflect the risk of excess and obsolete inventory. If laboratory operation demand is significantly less than inventory levels, inventory write-downs may be required, which could have a material adverse effect on the Company’s consolidated financial statements. Inventory write-downs amounted to $0.1 million and $0.5 million in the years ended December 31, 2020 and 2019, respectively.

Property and Equipment, Net

Property and equipment are stated at cost. Assets acquired under capital leases are stated at the present value of future minimum lease payments. Depreciation is recognized on a straight-line basis over the estimated useful lives of the related assets as follows:

Property and Equipment	Estimated Useful Life (in years)
Computers and software		3
Laboratory equipment		5
Furniture, fixtures, and office equipment		8
Building		15

Assets acquired under capital leases and leasehold improvements are amortized on a straight-line basis over the shorter of the lease term or the useful life of the asset. Land is not depreciated.

Goodwill

Goodwill is an asset representing the future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized. Goodwill is not amortized but instead is tested annually for impairment at the reporting unit level, or more frequently when events or changes in circumstances indicate that fair value of the reporting unit has been reduced to less than its carrying value. The Company may choose to perform a qualitative assessment to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount as a basis for determining whether it is necessary to perform the two-step goodwill impairment test.

If, after assessing qualitative factors, an entity determines it is not more likely than not that the fair value of a reporting unit is less than its carrying amount, then performing the two-step impairment test is unnecessary. If deemed necessary, a two-step test is used to identify the potential impairment and to measure the amount of goodwill impairment, if any. The first step is to compare the fair value of the reporting unit with its carrying amount, including goodwill. If the fair value of the reporting unit exceeds its carrying amount, goodwill is considered not impaired; otherwise, there is an indication that goodwill may be impaired and the amount of the loss, if any, is measured by performing step two. Under step two, the impairment loss, if any, is measured by comparing the implied fair value of the reporting unit goodwill with the carrying amount of goodwill. No impairment was recorded for the years ended December 31, 2020 and 2019.

Intangible Assets

Intangible assets consist of identifiable intangible assets acquired through acquisitions. Identifiable intangible assets include payor relationships, trade names, and noncompete agreements. The Company amortizes payor relationships and trade names using the straight-line method over their useful lives. The Company amortizes noncompete covenants using the straight-line method over the terms of the related agreements. The Company reviews impairment for intangible assets with definite useful lives whenever events or changes in circumstances indicate that the carrying amount may not be recoverable. Recoverability of these assets is measured by a comparison of the carrying amounts to the undiscounted future cash flows the assets are expected to generate. If such review indicates that the carrying amount of intangible assets is not recoverable, the carrying amount of such assets is reduced to fair value. No impairment was recorded for the years ended December 31, 2020 and 2019.

The amortization periods for the acquired intangible assets are:

Intangible Assets	Estimated Useful Life (in years)
Trade names		10
Payor relationships		10
Noncompete agreements		6

Impairment of Long-Lived Assets

The Company accounts for the impairment of long-lived assets, such as property and equipment, by reviewing these assets for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. If circumstances require a long-lived asset or asset group to be tested for possible impairment, the Company first compares undiscounted future cash flows expected to be generated by that asset or asset group to its carrying value. If the carrying value of the long-lived asset or asset group is not recoverable on an undiscounted-cash-flow basis, an impairment is recognized to the extent that the carrying value exceeds its fair value. No impairment was recorded as of December 31, 2020 and 2019.

Embedded Derivative Related to Convertible Notes

During 2020, the Company issued convertible notes with an embedded derivative that is required to be bifurcated from their host contract and remeasured to fair value at each balance sheet date. Any resulting gain or loss related to the change in the fair value of the embedded derivative is recorded to other income (expense), net on the consolidated statements of operations. Changes in the Company’s assumptions, such as the Company’s stock price and volatility of common stock, could result in material changes in the valuation in future periods.

Repair and Maintenance

The Company incurs maintenance costs on its major equipment. Repair and maintenance costs are expensed as incurred.

Research and Development

Research and development expenses consist primarily of costs associated with performing research and development activities to improve the Company’s tests, to reduce costs, and to develop new products. Research and development expenses also consist of personnel expenses, including salaries, bonuses, stock-based compensation expense, and benefits, and allocated overhead costs. Research and development expenses are expensed as incurred.

Selling and Marketing

Selling and marketing expenses consist primarily of costs for communication, advertising, conferences, and other marketing events. Selling and marketing expenses also consist of personnel expenses, including salaries, bonuses, stock-based compensation expense, benefits, and allocated overhead costs. Selling and marketing expenses are expensed as incurred. Advertising expense for the years ended December 31, 2020 and 2019 amounted to $1.6 million and $2.2 million, respectively.

General and Administrative

General and administrative expenses consist primarily of personnel costs, including salaries, bonuses, stock-based compensation expense, and benefits, for the Company’s finance and accounting, legal, human resources, and other administrative teams. Additionally, these expenses include professional fees, including audit, legal, and recruiting services. General and administrative expenses are expensed in the period incurred.

Stock-Based Compensation

Stock-based compensation related to stock options, restricted stock units (“RSUs”) and the 2020 Employee Stock Purchase Plan (“ESPP”) awards granted to the Company’s employees is measured at the grant date based on the fair value of the award. The fair value is recognized as expense over the requisite service period, which is generally the vesting period of the respective awards. Compensation related to service-based awards is recognized starting on the grant date on a straight-line basis over the vesting period, which is typically four years. For the ESPP, the requisite service period is generally the period of time from the offering date to the purchase date. The Company accounts for the forfeitures in the period in which they occur. The fair value of each restricted stock unit award is estimated based on the market price of the underlying common stock on the date of the grant.

The determination of the fair value of each stock award using the option-pricing model is affected by the Company’s assumptions regarding a number of complex and subjective variables. These variables include, but are not limited to, the fair value of the common stock at the date of grant, the expected term of the awards, the expected stock price volatility over the term of the awards, risk-free interest rate, and dividend rate. The Company’s assumptions with respect to these variables are as follows:

Fair Value of Common Stock—Prior to the IPO, the Company’s common stock was not publicly traded, therefore the Company estimated the fair value of its common stock. Following the IPO, the fair value of the Company’s common stock for awards with service-based vesting is the closing selling price per share of its common stock as reported on the Nasdaq Global Market on the date of grant or other relevant determination date.

Expected Term—The expected term represents the period that the stock-based awards are expected to be outstanding. The Company determines the expected term using the simplified method. The simplified method deems the term to be the average of the time-to-vesting and the contractual life of the options. For stock options granted to non-employees, the expected term equals the remaining contractual term of the option from the vesting date. For the ESPP, the expected term is the period of time from the offering date to the purchase date.

Expected Volatility—Given the limited period of time the Company’s stock has been traded in an active market, the expected volatility is estimated by taking the average historical price volatility for industry peers, consisting of several public companies in the Company’s industry that are similar in size, stage, or financial leverage, over a period of time commensurate with to the expected term of the awards.

Risk-Free Interest Rate—The risk-free interest rate is calculated using the average of the published interest rates of U.S. Treasury zero-coupon issues with maturities that are commensurate with the expected term.

Dividend Rate—The dividend yield assumption is zero, as the Company has no plans to make dividend payments.

Net Loss Per Share

Basic and diluted net loss per share attributable to common stockholders is presented in conformity with the two-class method required for participating securities. The Company considers all series of preferred stock to be participating securities as the holders of such stock are entitled to receive non-cumulative dividends on an as-converted basis in the event that a dividend is paid on common stock. Under the two-class method, the net loss attributable to common stockholders is not allocated to the preferred stock as the holders of preferred stock do not have a contractual obligation to share in the Company’s losses. Under the two-class method, net income is attributed to common stockholders and participating securities based on their participation rights. Basic net loss per share attributable to common stockholders is computed by dividing the net loss attributable to common stockholders by the weighted average number of shares of common stock outstanding during the period. Net loss attributable to common stockholders is calculated by adjusting net loss with dividends to preferred stockholders, if any. As the Company has reported net losses for all periods presented, all potentially dilutive securities are antidilutive and, accordingly, basic net loss per share equals diluted net loss per share.

Income Taxes

The Company accounts for income taxes under the asset-and-liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax basis and operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date.

The Company recognizes the effect of income tax positions only if those positions are more likely than not of being sustained. Recognized income tax positions are measured at the largest amount that is greater than 50% likely of being realized. Changes in recognition or measurement are recognized in the period in which the change in judgment occurs. Valuation allowances are established, when necessary, to reduce deferred tax assets to the amount expected to be realized.

Comprehensive Loss

The Company did not have any other comprehensive income or loss for any of the periods presented, and therefore comprehensive loss was the same as the Company’s net loss.

Emerging Growth Company Status

The Company is an emerging growth company (“EGC”), as defined in the Jumpstart Our Business Startups Act of 2012 (the “JOBS Act”). Under the JOBS Act, emerging growth companies can delay adopting new or revised accounting standards issued subsequent to the enactment of the JOBS Act until such time as those standards apply to private companies. The Company has elected to use this extended transition period for complying with new or revised accounting standards that have different effective dates for public and private companies until the earlier of the date that it (i) is no longer an emerging growth company or (ii) affirmatively and irrevocably opts out of the extended transition period provided in the JOBS Act. As a result, these consolidated financial statements may not be comparable to companies that comply with the new or revised accounting pronouncements as of public company effective dates.

Recent Accounting Pronouncements Adopted

In May 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers (ASC 606), which supersedes the revenue recognition requirements in ASC Topic 605, Revenue Recognition (“ASC 605”), and requires entities to recognize revenue when they transfer control of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled to in exchange for those goods or services. The Company adopted ASC 606 as of January 1, 2019, using the modified retrospective transition method applied to those contracts which were not completed as of January 1, 2019. Upon adoption, the Company recognized the cumulative effect of adopting this guidance as an adjustment to its opening accumulated deficit balance. The Company recorded a one-time increase to opening accounts receivable, net, and a reduction to opening accumulated deficit of $23.7 million as of January 1, 2019. The adjustment was primarily related to the recognition of variable consideration the Company expected to receive that was previously recognized as cash was received under ASC 605.

In June 2018, the FASB issued Accounting Standards Update (“ASU”) No. 2018-07, Improvements to Nonemployee Share-Based Payment Accounting. The standard simplifies the accounting for share-based payments granted to nonemployees for goods and services and aligns most of the guidance on such payments to the nonemployees with the requirements for share-based payments granted to employees. The Company adopted the new accounting standard in fiscal year 2020 using the retrospective transition method for each period presented, which did not have a material impact on the consolidated financial statements.

In December 2019, the FASB issued ASU No. 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes which removes certain exceptions to the general principles of Topic 740, Accounting for Income Taxes (“ASC 740”) and is intended to improve consistency and simplify GAAP in several other areas of ASC 740 by clarifying and amending existing guidance. The Company early adopted ASU No. 2019-12 for the quarter ended March 31, 2020, which did not have a material impact on the consolidated financial statements.

In January 2017, the FASB issued ASU No. 2017-04, Intangibles—Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment. The new standard simplifies the measurement of goodwill by eliminating step two of the two-step impairment test. Step two measures a goodwill impairment loss by comparing the implied fair value of a reporting unit’s goodwill with the carrying amount of that goodwill. The new guidance requires an entity to compare the fair value of a reporting unit with its carrying amount and recognize an impairment charge for the amount by which the carrying amount exceeds the reporting unit’s fair value. Additionally, an entity is required to consider income tax effects from any tax-deductible goodwill on the carrying amount of the reporting unit when measuring the goodwill impairment loss, if applicable. The Company adopted the new accounting standard in fiscal year 2020, which did not have a material impact on the consolidated financial statements.

Recent Accounting Pronouncements Not Yet Adopted

In February 2016, the FASB issued ASU 2016-02, Leases (Topic 842), which supersedes FASB ASC Topic 840, Leases (Topic 840), and provides principles for the recognition, measurement, presentation and disclosure of leases for both lessees and lessors. The new standard requires lessees to apply a dual approach, classifying leases as either finance or operating leases based on the principle of whether or not the lease is effectively a financed purchase by the lessee. This classification will determine whether lease expense is recognized based on an effective interest method for finance leases or on a straight-line basis over the term of the lease for operating leases. A lessee is also required to record a right-of-use asset and a lease liability for all leases with a term of greater than 12 months regardless of classification. Leases with a term of 12 months or less will be accounted for similar to existing guidance for operating leases. In June 2020, the FASB issued ASU No. 2020-05, Revenue from Contracts with Customers (Topic 606) and Leases (Topic 842): Effective Dates for Certain Entities, which further defers the effective date for certain entities. As a result, the ASU is now effective for EGCs for fiscal years beginning after December 15, 2021, and interim periods within fiscal years beginning after December 15, 2022. If Company maintains EGC status, it will adopt the new standard in the fourth quarter of 2022 using the modified retrospective method, under which the Company will apply the new lease standard to existing and new leases as of January 1, 2022, but prior periods will not be restated and will continue to be reported under Topic 840 guidance in effect during those periods. The Company plans to elect the package of practical expedients available in the new lease standard, allowing it not to reassess: (a) whether expired or existing contracts contain leases under the new definition of a lease; (b) lease classification for expired or existing leases; and (c) whether previously capitalized initial direct costs would qualify for capitalization under the new lease standard.

The Company continues to monitor FASB activity to assess certain interpretative issues and the associated implementation of the new standard and is in the process of reviewing its lease arrangements, including property, equipment and vehicle leases. The Company is not yet able to estimate the anticipated impact to its consolidated financial statements from the implementation of the new standard as it continues to interpret the principles of the new standard.

In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments—Credit Losses, which requires the measurement of expected credit losses for financial instruments carried at amortized cost, such as accounts receivable, held at the reporting date based on historical experience, current conditions and reasonable forecasts. The main objective of this standard is to provide financial statement users with more decision-useful information about the expected credit losses on financial instruments and other commitments to extend credit held by a reporting entity at each reporting date. In November 2018, the FASB issued ASU No. 2018-19, Codification Improvements to Topic 326, Financing Instruments–Credit Losses, which included an amendment of the effective date. The standard is effective for the Company for annual reporting periods beginning after December 15, 2022. The Company does not expect the adoption of this standard to have a significant impact on its consolidated financial statements.

In August 2020, the FASB issued ASU No. 2020-06, Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging-Contracts in Entity's Own Equity (Subtopic 815-40)-Accounting for Convertible Instruments and Contracts in an Entity's Own Equity, which simplifies the accounting for convertible instruments, amends the guidance on derivative scope exceptions for contracts in an entity's own equity, and modifies the guidance on diluted earnings per share calculations as a result of these changes. The standard is effective for the Company for annual reporting periods beginning after December 15, 2023. The Company is currently evaluating the impact the adoption of this standard may have on its consolidated financial statements.

Variable Interest Entity

12 Months Ended

Dec. 31, 2020

Variable Interest Entities [Abstract]

Variable Interest Entity

Note 3. Variable Interest Entity

In June 2015, the Company entered into a series of agreements with Avero. The Company entered into a purchase agreement to acquire certain assets from Mattison used in the operations of Avero. The purchase agreement was accounted for under the acquisition method in accordance with the provisions of ASC Topic 805, Business Combinations. The Company entered into a nominee agreement which provides it with the right, but not the obligation, to purchase, or to designate a person(s) to purchase, the stock of Avero at any time for a nominal amount.

The Company also entered into a management services arrangement that authorizes the Company to perform the management services in the manner that it deems reasonably appropriate to meet the day-to-day business needs of Avero. The Company’s management services include funding ongoing operational needs, directing activities related to contract negotiation, billing, human resources, and legal and administrative matters and processes, among others. In exchange for the management services provided, the Company is entitled to receive an annual management fee equal to the amount of the net operating income of Avero. The term of the agreement with Avero is 10 years, subject to automatic renewals. The agreement can be terminated by either party with a 90-day notice before the end of the term.

Through the management services arrangement with Avero, the Company has (1) the power to direct the activities of Avero that most significantly impact its economic performance, and (2) the obligation to absorb losses of Avero or the right to receive benefits from Avero that could potentially be significant to Avero. Based on these determinations, the Company has determined that Avero is a variable interest entity and that the Company is the primary beneficiary. The Company does not own any equity interest in Avero; however, as these agreements provide the Company the controlling financial interest in Avero, the Company consolidates Avero’s balances and activities within its consolidated financial statements.

In December 2018, Avero entered into a settlement agreement with Cigna (the “Cigna settlement obligation”) whereby Avero agreed to pay an aggregate amount of $12.0 million with an upfront payment of $6.0 million and the remaining $6.0 million to be paid over 24 months, beginning in February 2019. The Company guaranteed the $12.0 million Cigna settlement obligation. The Company provided financial support to Avero in the amount of $3.0 million and $3.0 million during the years ended December 31, 2020 and 2019, respectively, related to the Cigna settlement obligation (see Note 10), which was fully settled as of December 31, 2020. The Company did not provide any additional financial support to Avero during the years ended December 31, 2020 and 2019, other than the Cigna settlement obligation and agreed upon management services.

The following table presents the assets and liabilities of Avero that are included in the Company’s consolidated balance sheets as of December 31, 2020 and 2019, in thousands. The creditors of Avero have no recourse to the general credit of the Company, with the exception of $1.7 million and $1.9 million in mortgage payable guaranteed by the Company as of December 31, 2020 and 2019, respectively (see Note 9), and $3.0 million in remaining Cigna settlement obligation guaranteed by the Company as of December 31, 2019. The assets and liabilities exclude intercompany balances that eliminate in consolidation:

	December 31, 2020		December 31, 2019
Assets of Avero that can only be used to settle obligations of Avero
Cash and cash equivalents	$	556	$	1,837
Accounts receivable, net		6,047		4,269
Inventory		3,382		2,572
Prepaid expenses and other current assets		1,254		1,181
Property and equipment, net		5,436		5,586
Other assets		30		30
Goodwill		6,219		6,219
Other intangible assets, net		3,843		4,771
Total assets of Avero that can only be used to settle obligations of Avero	$	26,767	$	26,465
Liabilities of Avero
Accounts payable	$	4,722	$	2,450
Accrued expenses and other accrued liabilities		3,472		5,630
Current portion of capital lease obligations		46		59
Current portion of mortgage payable		199		173
Capital lease obligations, net of current portion		4		50
Mortgage payable, net of current portion		1,520		1,733
Other long-term liabilities		428		467
Total liabilities of Avero	$	10,391	$	10,562

Revenues

12 Months Ended

Dec. 31, 2020

Revenue From Contract With Customer [Abstract]

Revenues

Note 4. Revenues

Revenue is derived from contracts with healthcare insurers, government payors, laboratory partners and patients in connection with sales of prenatal genetic, anatomic or molecular pathology tests. The Company enters into contracts with healthcare insurers related to tests provided to patients who have health insurance coverage. Insurance carriers are considered third-party payors on behalf of the patients, and the patients who receive genetic, anatomic or molecular pathology test products are considered the customers. Tests may be billed to insurance carriers, patients, or a combination of insurance carriers and patients. The Company also sells tests to laboratory partners, which are also considered to be customers. The Company’s test volumes began to decrease in the second half of March 2020 as a result of the COVID-19 pandemic spreading in the United States and resulting limitations and reordering of priorities across the U.S. healthcare system. The Company expects test volumes to continue to be adversely affected by COVID-19 and cannot predict when volumes will return to normal.

In accordance with ASC 606, a performance obligation represents a promise in a contract to transfer a distinct good or service to a customer and the consideration should be allocated to each distinct performance obligation and recognized as revenue when or as the performance obligation is satisfied. The Company has evaluated its contracts with healthcare insurers, government payors, laboratory partners and patients and identified a single performance obligation in those contracts, the delivery of a test result. The Company satisfies its performance obligation at a point in time upon the delivery of the test result, at which point the Company can bill for its products. The amount of revenue recognized reflects the transaction price and considers the effects of variable consideration, which is discussed below.

Once the Company satisfies its performance obligations upon delivery of a test result and bills for the product, the timing of the collection of payments may vary based on the payment practices of the third-party payor. The Company bills patients directly for co-pays and deductibles that they are responsible for and also bills patients directly in cases where the customer does not have insurance.

The Company has established an accrual for refunds of payments previously made by healthcare insurers based on historical experience and executed settlement agreements with healthcare insurers. The refunds are accounted for as reductions in revenues in the statement of operations as an element of variable consideration. For example, during the three months ended June 30, 2020, the Company accrued $10.3 million for refunds to government payors related to reimbursement for the Company’s Preparent expanded carrier screening tests during 2019 and early 2020. In the United States, the American Medical Association (“AMA”) generally assigns specific billing codes for laboratory tests under a coding system known as Current Procedure Terminology (“CPT”), which the Company and its ordering healthcare providers must use to bill and receive reimbursement for molecular tests. Effective January 1, 2019, the AMA issued a CPT code for genetic testing for severe inherited conditions that includes sequencing of at least 15 genes, which affects potential reimbursement for the Company’s Preparent expanded carrier screening tests. As part of the Company’s work to improve its compliance program, including its internal auditing and monitoring function, the Company commissioned a third-party review of its billing processes. In connection with that audit, the Company identified that it had not effectively transitioned to the implementation of the new CPT code in 2019, and as a result the Company received an overpayment of approximately $10.3 million from government payors during 2019 and early 2020. As of December 31, 2020, the Company settled all existing obligations to the relevant government programs as due and will continue to settle any future obligation as they arise.

The transaction price is an estimate and may be fixed or variable. Variable consideration includes reimbursement from healthcare insurers, government payors, and patients and is adjusted for estimates of disallowed cases, discounts, and refunds using the expected value approach. Tests billed to healthcare insurers and directly to patients can take up to nine months to collect and the Company may be paid less than the full amount billed or not paid at all. For insurance carriers and government payors, management utilizes the expected value method using a portfolio of relevant historical data for payors with similar reimbursement characteristics. The portfolio estimate is developed using historical reimbursement data from payors and patients, as well as known current reimbursement trends not reflected in the historical data. Such variable consideration is included in the transaction price only to the extent it is probable that a significant reversal in the amount of cumulative revenue recognized will not occur when the uncertainties with respect to the amount are resolved. The Company monitors these estimates at each reporting period based on actual cash collections and the status of settlement agreements with third-party payors, in order to assess whether a revision to the estimate is required. Both the initial estimate and any subsequent revision to the estimate contain uncertainty and require the use of judgment in the estimation of the transaction price and application of the constraint for variable consideration. If actual results in the future vary from the Company’s estimates, the Company will adjust these estimates, which would affect revenue and earnings in the period such variances become known. The consideration expected from laboratory partners is generally a fixed amount.

The Company periodically updates its estimate of the variable consideration recognized for previously delivered performance obligations. These updates resulted in a reduction of $26.9 million of revenue reported for year ended December 31, 2020 and a reduction of $16.0 million for the year ended December 31, 2019. These amounts included (i) adjustments for actual collections versus estimated variable consideration as of the beginning of the reporting period and (ii) cash collections and the related recognition of revenue in the current period for tests delivered in prior periods due to the release of the constraint on variable consideration, offset by (iii) reductions in revenue for the accrual for reimbursement claims and settlements described in Note 10.

Disaggregation of Revenues

The following table shows a further disaggregation of revenues by payor type (in thousands):

	Year Ended December 31,
	2020		2019
Commercial third-party payors	$	64,433	$	139,051
Government health benefit programs(1)		2,731		195
Patient/laboratory distribution partners		7,149		4,739
Total revenues	$	74,313	$	143,985
____________
(1) The revenue amounts include accruals for reimbursement claims and settlements included in the estimates of variable consideration recorded during the years ended December 31, 2020 and 2019. Revenue recognized reflect the effects of variable consideration, and include adjustments for estimates of disallowed cases, discounts, and refunds. The variable consideration includes reductions in revenues for the accrual for reimbursement claims and settlements.

- Definition

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-URI http://asc.fasb.org/topic&trid=49130388

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 10
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130551-203045

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 13
-Subparagraph (b)(2)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130556-203045

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130554-203045

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 9
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130550-203045

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (e)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130554-203045

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130554-203045

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (d)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130554-203045

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 15
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130558-203045

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130554-203045

+ Details

Balance Sheet Components

12 Months Ended

Dec. 31, 2020

Organization Consolidation And Presentation Of Financial Statements [Abstract]

Balance Sheet Components

Note 5. Balance Sheet Components

Prepaid Expenses and Other Current Assets

Prepaid expenses and other current assets consisted of the following (in thousands):

	December 31, 2020		December 31, 2019
Prepaid expenses	$	9,116	$	6,476
Other current assets		245		1,370
Total	$	9,361	$	7,846

Property and Equipment, Net

Property and equipment, net consisted of the following (in thousands):

	December 31, 2020			December 31, 2019
Computers and software	$	14,591		$	13,913
Building and leasehold improvements		9,458			9,491
Laboratory equipment		7,678			5,580
Furniture, fixtures, and office equipment		1,686			1,633
Construction in progress		2,784			1,493
Land		1,091			1,091
Total property and equipment		37,288			33,201
Less accumulated depreciation and amortization		(19,446	)		(17,310	)
Property and equipment, net	$	17,842		$	15,891

Capital leases included in property and equipment, net consisted of the following (in thousands):

	December 31, 2020			December 31, 2019
Capital leases	$	2,467		$	3,692
Less accumulated depreciation and amortization		(1,954	)		(2,239	)
Capital leases included in property and equipment, net	$	513		$	1,453

Depreciation expense was $4.1 million and $3.7 million for the years ended December 31, 2020 and 2019, respectively.

Intangible Assets, Net

Intangible assets, net consisted of the following (in thousands):

December 31, 2020	Cost		Accumulated amortization			Net
Payor relationships	$	7,230	$	(4,037	)	$	3,193
Trade names		1,410		(787	)		623
Noncompete agreements		384		(357	)		27
Intangible assets, net	$	9,024	$	(5,181	)	$	3,843

December 31, 2019	Cost		Accumulated amortization			Net
Payor relationships	$	7,230	$	(3,314	)	$	3,916
Trade names		1,410		(646	)		764
Noncompete agreements		384		(293	)		91
Intangible assets, net	$	9,024	$	(4,253	)	$	4,771

Amortization expense of intangible assets was $0.9 million for each of the years ended December 31, 2020 and 2019.

The future amortization of intangible assets at December 31, 2020 was (in thousands):

Year ending December 31,
2021	$	891
2022		864
2023		864
2024		864
2025		360
Thereafter		—
Total future minimum lease payments	$	3,843

Accrued Expenses and Other Current Liabilities

Accrued expenses and other current liabilities consisted of the following (in thousands):

	December 31, 2020		December 31, 2019
Accrual for reimbursement claims and settlements, current	$	30,487	$	60,386
Commissions and bonuses		4,619		6,357
Vacation and payroll benefits		8,896		5,506
Accrued professional services		3,385		5,322
Contract liabilities		378		—
Other		6,912		6,044
Total	$	54,677	$	83,615

Other Long-term Liabilities

Other long-term liabilities consisted of the following (in thousands):

	December 31, 2020		December 31, 2019
Accrual for reimbursement claims and settlements, net of current portion	$	7,053	$	12,205
Other		1,614		654
Total	$	8,667	$	12,859

Fair Value Measurements

12 Months Ended

Dec. 31, 2020

Fair Value Disclosures [Abstract]

Fair Value Measurements

Note 6. Fair Value Measurements

The Company's financial assets and liabilities carried at fair value are comprised of investment assets that include money market funds. Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability (an exit price) in an orderly transaction between market participants at the reporting date.

The authoritative guidance establishes a three-level valuation hierarchy that prioritizes the inputs to valuation techniques used to measure fair value based upon whether such inputs are observable or unobservable. Observable inputs reflect market data obtained from independent sources, while unobservable inputs reflect market assumptions made by the reporting entity. The three-level hierarchy for the inputs to valuation techniques is summarized as follows:

Level 1 - Quoted prices in active markets for identical assets and liabilities that the Company has the ability to access.

Level 2 - Observable market-based inputs or unobservable inputs that are corroborated by market data, such as quoted prices, interest rates, and yield curves.

Level 3 - Inputs that are unobservable data points that are not corroborated by market data.

This hierarchy requires the Company to use observable market data, when available, and to minimize the use of unobservable inputs when determining fair value. The following table presents information about the Company’s assets and liabilities that are measured at fair value on a recurring basis and indicates the fair value hierarchy of the valuation techniques utilized to determine such fair value (in thousands):

	Quoted Prices for Identical Assets (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)
December 31, 2020
Money market funds(1)	$	90,254	$	—	$	—
Embedded derivative liability		—		—		18,370

December 31, 2019
Money market funds(1)	$	24,432	$	—	$	—
____________
(1) Included in cash and cash equivalents in the accompanying consolidated balance sheets.

The Company’s policy is to recognize transfers between levels at the end of the reporting period. There were no transfers between Level 1 and Level 2 during the years ended December 31, 2020 and 2019.

The carrying value of the Company’s accounts receivable, income tax receivable, accounts payable, and accrued expenses and other current liabilities are considered to be representative of their respective fair values because of their short-term nature.

The carrying value of the Company’s mortgages payable approximates their estimated fair value because the instruments bear interest at rates and have terms that are comparable to those available to the Company for similar loan instruments at December 31, 2020 and 2019.

The carrying value of the Company’s convertible senior notes (the “Convertible Notes”) at December 31, 2020 does not approximate its fair value because the carrying value of the Convertible Notes reflects the balance of unamortized discount related to the derivative liability associated with the value of conversion feature assessed at inception. The carrying value and the fair value of the Company’s Convertible Notes, net of discount, was $158.9 million at December 31, 2020. The Company periodically assesses the fair value of the conversion feature related to the Convertible Note. The conversion feature was bifurcated and recorded as an embedded derivative liability in the consolidated balance sheet with a corresponding discount at the date of issuance that is netted against the principal amount of the Convertible Notes. The Company utilizes a Monte Carlo simulation method to determine the fair value of the conversion feature, which utilizes inputs including the common stock price, volatility of common stock, the risk-free interest rate and the probability of conversion to common shares at the conversion rate in the event of a major transaction (e.g. a change in control). Due to the use of significant unobservable inputs, the overall fair value measurement of the conversion feature is classified as Level 3. Based on unadjusted quoted prices in active market obtained from third-party pricing services, the Company determined the fair value of the Convertible Notes was $250.2 million at December 31, 2020.

The carrying value of the Company’s note payable to a related party at December 31, 2019 did not approximate its fair value because the instrument bears interest at a rate that was not comparable to those available to the Company for a similar loan instrument at December 31, 2019. The carrying value and the fair value of the Company’s term loan (the “2017 Term Loan”) was $75.0 million and $79.8 million, respectively, at December 31, 2019. The carrying value of the 2017 Term Loan is presented on the accompanying consolidated balance sheets net of discount on the note and debt issuance cost.

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

Convertible Notes

12 Months Ended

Dec. 31, 2020

Debt Disclosure [Abstract]

Convertible Notes

Note 7. Convertible Notes

In December 2020, the Company issued a total of $168.5 million principal amount of its Convertible Notes in a private offering of the convertible notes pursuant to Rule 144A under the Securities Act. The Convertible Notes were issued pursuant to, and are governed by, an indenture, dated as of December 7, 2020, by and between the Company and The Bank of New York Mellon Trust Company, N.A., as trustee (the “Indenture”). The Convertible Notes are due on December 1, 2025, unless earlier repurchased, redeemed or converted, and accrue interest at a rate per annum equal to 7.25% payable semi-annually in arrears on June 1 and December 1 of each year, with the initial payment on June 1, 2021.

The Convertible Notes are the Company’s senior, unsecured obligations and are (i) equal in right of payment with the Company’s existing and future senior, unsecured indebtedness; (ii) senior in right of payment to the Company’s existing and future indebtedness that is expressly subordinated to the Notes; (iii) effectively subordinated to the Company’s existing and future secured indebtedness, to the extent of the value of the collateral securing that indebtedness; and (iv) structurally subordinated to all existing and future indebtedness and other liabilities, including trade payables, and (to the extent the Company is not a holder thereof) preferred equity, if any, of the Company’s subsidiaries.

At any time, noteholders may convert their Convertible Notes at their option into shares of the Company’s common stock, together, if applicable, with cash in lieu of any fractional share, at the then-applicable conversion rate. The initial conversion rate is 278.0094 shares of common stock per $1,000 principal amount of Convertible Notes, which represents an initial conversion price of approximately $3.60 per share of common stock. Noteholders that convert their Convertible Notes before December 1, 2022 will, in certain circumstances, be entitled to an additional cash payment representing the present value of any remaining interest payments on the Convertible Notes through December 1, 2022. The conversion rate and conversion price are subject to customary adjustments upon the occurrence of certain dilutive events. In addition, if certain corporate events that constitute a “Make-Whole Fundamental Change” (as defined in the Indenture) occur, then the conversion rate will, in certain circumstances, be increased for a specified period of time.

The Convertible Notes are redeemable, in whole and not in part, at the Company’s option at any time on or after December 1, 2023, at a cash redemption price equal to the principal amount of the Convertible Notes to be redeemed, plus accrued and unpaid interest, if any, to, but excluding, the redemption date, but only if the last reported sale price per share of the Company’s common stock exceeds 130% of the conversion price on (i) each of at least 20 trading days, whether or not consecutive, during the 30 consecutive trading days ending on, and including, the trading day immediately before the date the Company sends the related redemption notice; and (ii) the trading day immediately before the date the Company sends such notice. In addition, calling the Convertible Notes will constitute a Make-Whole Fundamental Change, which will result in an increase to the conversion rate in certain circumstances for a specified period of time.

The Convertible Notes have customary provision relating to the occurrence of “Events of Default” (as defined in the Indenture), which include the following: (i) certain payment defaults on the Convertible Notes (which, in the case of a default in the payment of interest on the Convertible Notes, will be subject to a 30-day cure period); (ii) the Company’s failure to send certain notices under the Indenture within specified periods of time; (iii) the Company’s failure to comply with certain covenants in the Indenture relating to the Company’s ability to consolidate with or merge with or into, or sell, lease or otherwise transfer, in one transaction or a series of transactions, all or substantially all of the assets of the Company and its subsidiaries, taken as a whole, to another person; (iv) a default by the Company in its other obligations or agreements under the Indenture or the Convertible Notes if such default is not cured or waived within 60 days after notice is given in accordance with the Indenture; (v) certain defaults by the Company or any of its subsidiaries with respect to indebtedness for borrowed money of at least $7,500,000; (vi) the rendering of certain judgments against the Company or any of its subsidiaries for the payment of at least $7,500,000, where such judgments are not discharged or stayed within 60 days after the date on which the right to appeal has expired or on which all rights to appeal have been extinguished; and (vii) certain events of bankruptcy, insolvency and reorganization involving the Company or any of the Company’s significant subsidiaries. As of December 31, 2020, the Company was in compliance with all such covenants.

The Convertible Notes have a conversion option which was required to be bifurcated upon issuance and then periodically remeasured to fair value separately as an embedded derivative. The conversion option includes additional interest payments payable to the noteholders if converted prior to December 1, 2022. The conversion feature was bifurcated as recorded separately as an embedded derivative as (1) the conversion feature is not clearly and closely related to the debt instrument and is not considered to be indexed to the Company’s equity, (2) the conversion feature standing alone meets the definition of a derivative, and (3) the Convertible Notes are not remeasured at fair value each reporting period with changes in fair value recorded in the consolidated statement of operations.

The initial embedded derivative liability of $4.6 million on the issuance date was recorded as a noncurrent liability in the consolidated balance sheet and is remeasured to fair value at each balance sheet date with a resulting non-cash gain or loss related to the change in the fair value being charged to interest and other income (expense) in the accompanying consolidated statement of operations. As of December 31, 2020, the fair value of the derivative liability was $18.4 million. As a result of the derivative liability and issuance costs of $9.7 million, a corresponding debt discount was recorded on the issuance date, which was netted against the principal amount of the Convertible Notes. As of December 31, 2020, the unamortized debt discount was $9.6 million. The Company amortizes the debt discount using the effective interest method over the term of the Convertible Notes, at a resulting effective interest rate of approximately 8.7%. For the year ended December 31, 2020, the amortization of the Convertible Notes debt discount was $0.1 million, and was included in interest expense in the consolidated statements of operations.

Related Party Transactions

12 Months Ended

Dec. 31, 2020

Related Party Transactions

Note 8. Related Party Transactions

On October 27, 2017, the Company entered into a Credit and Security Agreement and a Series B Convertible Preferred Stock Purchase Agreement with a private equity firm (the “2017 Transaction”). The 2017 Transaction provided for the 2017 Term Loan, the issuance of Series B Preferred Stock (the “Series B Preferred Stock”), and the issuance of a warrant to purchase Series B Preferred Stock (the “Series B Preferred Stock Purchase Warrant”). The 2017 Term Loan accrued interest at a rate per annum equal to 9.5% and was due October 27, 2022.

The 2017 Term Loan contained customary covenants, including a requirement to maintain a minimum unrestricted cash balance at all times of at least $5.0 million and was secured by all tangible and intangible property and assets of the Company, with the exception of its intellectual property.

As of December 31, 2019, the outstanding unpaid principal under the 2017 Term Loan was $75.0 million. As of December 31, 2019, the balance of unamortized discount and issuance costs on the 2017 Term Loan was $6.0 million. During the years ended December 31, 2020 and 2019, the Company recognized interest expense on the 2017 Term Loan of $7.5 million and $8.9 million, respectively, inclusive of $2.1 million and $1.7 million of discount amortization for the years ended December 31, 2020 and 2019, respectively.

In connection with the IPO, on June 18, 2020, the Series B Preferred Stock Purchase Warrant became exercisable for 400,160 shares of common stock.

On March 31, 2020, the Company entered into the First Amendment to the Credit Agreement (the “Credit Agreement Amendment”), with the collateral agent and lender party thereto, providing for the payment of interest due and payable as of March 31, 2020 in shares of Series B Preferred Stock, and further providing for the payment of interest due and payable as of June 30, 2020 in shares of the Series B Preferred Stock in the event the IPO has not been consummated by such date. Pursuant to the Credit Agreement Amendment, the Company concurrently entered into a Series B Preferred Stock Subscription Agreement (the “Subscription Agreement”), with the lender, which provided for the issuance of 967,130 shares of Series B Preferred Stock at a subscription price of $2.25 per share, as payment for interest due and payable as of March 31, 2020 and all applicable fees as set forth in the Credit Agreement Amendment.

On May 8, 2020, the Company entered into an unsecured convertible promissory note (the “Note”) with the same private equity firm pursuant to a note purchase agreement, in an aggregate principal amount of $15.0 million, with an annual interest rate of 8.0% and a maturity date of May 8, 2022. The Note was convertible into (i) common stock upon an initial public offering at the lesser of the conversion price then in effect and a conversion price equal to 80% of the public offering price (or, if not a “qualified IPO” as defined in the Company’s certificate of incorporation, at the election of a majority of the holders), (ii) on the maturity date or at the election of a majority of the holders, Series B preferred stock at an initial conversion price of $13.90 per share subject to certain adjustments, or (iii) at the election of a majority of the holders, shares of another class of equity securities issued by the Company in a future financing at 80% of the price per share of such class of equity securities issued in such offering. Interest under the Note was not generally payable except that if the Note is not converted pursuant to its terms on or prior to the maturity date and there are not sufficient authorized and unissued shares of Series B preferred stock for issuance upon the conversion of the Note on the maturity date, then the Company is required to pay all outstanding principal and any accrued and unpaid interest under the Note in cash. If the holders of the Note have not elected to convert the Note prior to, or in connection with, any sale transaction or a liquidation, dissolution or winding up of the Company, either voluntary or involuntary, then, upon any such sale transaction or liquidation, dissolution or winding up of the Company, the Company would have been required to pay in cash the outstanding principal balance of the Note, together with accrued and unpaid interest thereon, plus a make whole premium of 50% of the aggregate principal amount (less accrued and unpaid interest). The Company evaluated the economic features embedded in the Note and identified features that were required to be bifurcated and accounted for separately as a derivative. Accordingly, a derivative liability of $3.6 million was recorded on the issuance date of the Note and $3.8 million was subsequently reclassified to equity representing the fair value of the derivative liability on the date of extinguishment. The change in the fair value of the derivative liability of $0.2 million is included in interest and other income (expense), net in the accompanying consolidated statements of operations. In June 2020, in connection with completion of the IPO, the Note was converted into 1,250,000 shares of common stock and all obligations under the Note were extinguished. Upon the conversion, the Company recorded a $3.6 million loss on extinguishment of the debt, which represented the difference between the carrying value of the Note and the derivative liability and the fair value of the shares of common stock issued to the Note holder of $3.4 million combined with amortization of the related debt discount of $0.2 million. The loss on extinguishment of debt was included in the interest and other income (expense), net in the accompanying consolidated statement of operations for the year ended December 31, 2020. The same private equity firm participated in the IPO and acquired 3,333,333 shares at a price of $15.00 per share, which was at par with the price to other investors.

In December 2020, the private equity firm discharged any and all amounts owed and any obligations outstanding under the 2017 Term Loan in exchange for $78.5 million principal amount of Convertible Notes issued by the Company’s as described in Note 7. The exchange was accounted as extinguishment of the 2017 Term Loan and resulted in $7.6 million of loss on extinguishment, which was included in the interest and other income (expense), net in the accompanying consolidated statement of operations for the year ended December 31, 2020. This private equity firm also acquired additional $25.0 million principal amount of the Company’s Convertible Notes for cash in this private offering, which resulted in $103.5 million aggregate principal amount of the Convertible Notes described in Note 7 acquired by this private equity firm. For the year ended December 31, 2020, the accrued interest expense related to the Convertible Notes held by this private equity firm was $0.5 million. Also in December 2020, the same private equity firm participated in the underwritten public offering and acquired 4,128,440 shares as a price of $3.27 per share resulting in the proceeds to the Company of $13.2 million before expenses.

Mortgages Payable

12 Months Ended

Dec. 31, 2020

Debt Disclosure [Abstract]

Mortgages Payable

Note 9. Mortgages Payable

In January 2014, the Company executed a mortgage with Comerica Bank for $1.8 million for the purpose of acquiring property located in Ann Arbor, Michigan, which is used for laboratory testing and research purposes. The mortgage matures in 2024 and requires monthly principal and interest payments at a fixed interest rate of 2.94% plus a floating rate at LIBOR. As of December 31, 2020 and December 31, 2019, the outstanding balance of this mortgage was $1.3 million and $1.4 million, respectively. The Company also has a mortgage with American Bank of Commerce (originally executed in February 2008) outstanding on Avero’s property located in Lubbock, Texas, which is used primarily for laboratory testing. The mortgage matures in 2029 and requires monthly principal and interest payments at an interest rate of 3.25%. As of December 31, 2020 and December 31, 2019, the outstanding balance of this mortgage was $1.7 million and $1.9 million, respectively.

As of December 31, 2020, the minimum principal payments under the mortgages payable were as follows (in thousands):

Year ending December 31,	Minimum Mortgages Payable Payments Obligations
2021	$	271
2022		281
2023		292
2024		1,338
2025		884
Thereafter		—
Total future minimum payments		3,066
Less current portion of mortgages payable		(271	)
Mortgages payable, net of current portion	$	2,795

Commitments and Contingencies

12 Months Ended

Dec. 31, 2020

Commitments And Contingencies Disclosure [Abstract]

Commitments and Contingencies

Note 10. Commitments and Contingencies

Operating Leases

The Company has entered into various noncancelable operating lease agreements, primarily for office space, laboratory space, and vehicles, which expire over the next two to four years. Minimum rent payments under operating leases are recognized on a straight-line basis over the term of the lease. Rent expense for operating leases was $7.6 million and $8.9 million, for the years ended December 31, 2020 and 2019, respectively.

As of December 31, 2020, net minimum payments under the non-cancelable operating leases were as follows (in thousands):

Year ending December 31,	Minimum Operating Lease Payments
2021	$	5,750
2022		3,017
2023		1,036
2024		38
2025 and thereafter		—
Total future minimum lease payments	$	9,841

Capital Leases

The Company has entered into various capital lease agreements, primarily for equipment. The outstanding leases have a weighted average imputed interest rate of 5.98% per annum. As of December 31, 2020, the future minimum payments under the capital leases were as follows (in thousands):

Year ending December 31,	Minimum Capital Lease Payments
2021	$	324
2022		47
2023 and thereafter		—
Total minimum lease payments		371
Less amounts representing interest		(13	)
Present value of minimum capital lease payments		358
Less current portion of capital lease obligations		(312	)
Capital lease obligations, net of current portion	$	46

Contingencies

The Company, in the ordinary course of its business, can be involved in lawsuits, threats of litigation, and audit and investigative demands from third parties. While management is unable to predict the exact outcome of such matters, it is management’s current belief, that any potential liabilities resulting from these contingencies, individually or in the aggregate, could have a material impact on the Company’s financial position and results of operations.

The regulations governing government reimbursement programs (e.g., Medicaid, Tricare, and Medicare) and commercial payor reimbursement programs are complex and may be subject to interpretation. As a provider of services to patients covered under government and commercial payor programs, post payment review audits, and other forms of reviews and investigations are routine. The Company believes it complies in all material respects with the statutes, regulations, and other requirements applicable to its laboratory operations.

Federal Investigations

In April 2018, the Company received a civil investigative demand from an Assistant U.S. Attorney (“AUSA”) for the Southern District of New York (“SDNY”) and a Health Insurance Portability and Accountability Act subpoena issued by an AUSA for the Southern District of California (“SDCA”). In May 2018, the Company received a subpoena from the State of New York Medicaid Fraud Control Unit.

On July 21, 2020, July 23, 2020, and October 1, 2020, the Company entered into agreements with certain governmental agencies and the 45 states participating in the settlement (“State AGs”) to resolve, with respect to such agencies and State AGs, all of such agencies’ and State AGs’ outstanding civil, and, where applicable, federal criminal investigations described above. Specifically, the Company has entered into:

•

a civil settlement agreement, effective July 23, 2020, with the DOJ through the AUSA for SDNY, and on behalf of the Office of Inspector General of the Department of Health and Human Services (the “OIG”), and with the relator named therein (the “SDNY Civil Settlement Agreement”);

•

a civil settlement agreement, effective July 23, 2020, with the DOJ through the AUSA for SDCA, and on behalf of the Defense Health Agency, the Tricare Program and the Office of Personnel Management, which administers the Federal Employees Health Benefits Program (the “SDCA Civil Settlement Agreement”);

•

a non-prosecution agreement, effective July 21, 2020, with the AUSA for SDCA (the “Non-Prosecution Agreement”) in resolution of all criminal allegations;

•

a corporate integrity agreement, effective July 21, 2020, with the OIG (the “Corporate Integrity Agreement”); and

•

civil settlement agreements, effective October 1, 2020, with the State AGs (“the State Settlement Agreements”).

The Company refers to the SDNY Civil Settlement Agreement, the SDCA Civil Settlement Agreement, the Non-Prosecution Agreement, the Corporate Integrity Agreement and the State Settlement Agreements collectively as the Agreements.

SDNY Civil Settlement Agreement

Pursuant to the SDNY Civil Settlement Agreement, the Company is required to pay a settlement amount of approximately $19.4 million, which includes approximately $9.7 million designated as restitution to the U.S. federal government. During the year ended December 31, 2020, the Company paid approximately $14.7 million. The outstanding settlement amount is payable in two installments as follows:

•

approximately $2.0 million on or before December 31, 2021; and

•

approximately $2.8 million on or before December 31, 2022.

The remaining amounts payable to the government will be subject to interest at a rate of 1.25% per annum, and any or all amounts may be paid earlier at the option of the Company.

Furthermore, the Company has agreed that, if during calendar years 2020 through 2023, and so long as amounts payable to the government remain unpaid, the Company receives any civil settlement, damages awards, or tax refunds, to the extent that the amounts exceed $5.0 million in a calendar year, it will pay 26% of the amount received in such civil settlement, damages award, or tax refunds as an accelerated payment of the scheduled amounts set forth above, up to a maximum total acceleration of $4.1 million. During the year ended December 31, 2020, the Company received a tax refund of $37.7 million related to the NOL carryback provisions available under the Coronavirus Aid, Relief and Economic Security Act (the “CARES Act”) for taxes paid by the Company in years 2013, 2014, 2015 and 2017 (the “CARES Act Tax Benefit”) and made accelerated payments of approximately $4.1 million under the SDNY Civil Settlement Agreement.

Additionally, under the SDNY Civil Settlement Agreement, the U.S. federal government and the relator agreed to dismiss all civil claims asserted by the relator under the qui tam provisions of the federal False Claims Act.

SDCA Civil Settlement Agreement

The SDCA Civil Settlement Agreement requires the Company to pay a settlement amount of approximately $16.4 million, which includes approximately $10.0 million designated as restitution to the U.S. federal government. During the year ended December 31, 2020, the Company paid approximately $12.5 million. The outstanding settlement amount is payable in two installments as follows:

•

approximately $1.7 million on or before December 31, 2021; and

•

approximately $2.2 million on or before December 31, 2022.

The remaining amounts payable to the government, will be subject to interest at a rate of 1.25% per annum, and any or all amounts may be paid earlier at the option of the Company.

On July 21, 2020, the Company issued a promissory note to the U.S. federal government for the full settlement amount in connection with the SDCA Civil Settlement Agreement (the “Promissory Note”). The Promissory Note contains customary events of default and related acceleration of payment provisions. In addition, the Promissory Note provides, among other terms, that, if during calendar years 2020 through 2023, and so long as amounts payable to the government remain unpaid, the Company receives any civil settlement, damages awards, or tax refunds, to the extent that the amounts exceed $5.0 million in a calendar year, it will pay 22% of the amount received in such civil settlement, damages award, or tax refunds as an accelerated payment of the scheduled amounts set forth above up to a maximum total acceleration of approximately $3.4 million. During the year ended December 31, 2020, the Company received a tax refund of $37.7 million and made accelerated payments of approximately $3.4 million under the SDCA Civil Settlement Agreement.

Non-Prosecution Agreement

Effective July 21, 2020, the Company entered into the Non-Prosecution Agreement, pursuant to which the Company agreed with the DOJ to (i) pay the restitution provided for under the SDCA Civil Settlement Agreement, (ii) not commit any felonies, (iii) continue to implement a compliance and ethics program designed to prevent and detect violations of applicable fraud and kickback laws throughout its operations and (iv) fulfill certain other disclosure, reporting and cooperation obligations. The DOJ agreed that it will not prosecute the Company for any conduct described in the Non-Prosecution Agreement provided that the Company performs its obligations under the Non-Prosecution Agreement during the period from July 21, 2020 through July 21, 2021. The Non-Prosecution Agreement provides that the DOJ may unilaterally, upon notice to the Company, extend the term of the agreement in 6-month increments, for a maximum total term of 24 months (that is, two 6-month extensions).

Corporate Integrity Agreement

In connection with the resolution of the investigated matters, and in exchange for the OIG’s agreement not to exercise its authority to permissively exclude the Company from participating in federal healthcare programs, effective July 21, 2020, the Company entered into a five-year Corporate Integrity Agreement with the OIG. The Corporate Integrity Agreement requires, among other matters, that the Company maintain a Compliance Officer, a Compliance Committee, board review and oversight of certain federal healthcare compliance matters, compliance programs, and disclosure programs; provide management certifications and compliance training and education; engage an independent review organization to conduct claims and arrangements reviews; and implement a risk assessment and internal review process. The Company’s failure to comply with its obligations under the Corporate Integrity Agreement could result in monetary penalties and/or the Company being excluded from participating in federal healthcare programs.

State Settlement Agreements

Effective October 1, 2020, the Company entered into agreements with the State AGs with respect to the investigated matters. The State Settlement Agreements require the Company to pay a settlement amount of approximately $13.2 million to the participating states. The State Settlement Agreements include acceleration provisions similar to the SDNY Civil Settlement Agreement and the SDCA Civil Settlement Agreements described above upon the Company’s receipt of civil settlements, damages awards, and tax refunds, with the amount to be accelerated and the timing of accelerated payment subject to such receipts. Because the Company received the June 2020 and September 2020 tax benefits totaling approximately $37.7 million, the initial payment to the participating states included added payments reflecting 17% of that amount, for a total initial payment on October 2, 2020 of approximately $8.7 million. During the year ended December 31, 2020, the Company paid approximately $9.7 million. The outstanding settlement amount is payable in three installments as follows:

•

approximately $1.4 million on or before December 31, 2021;

•

approximately $1.9 million on or before December 31, 2022; and

•

approximately $0.2 million on or before December 31, 2023.

Settlement Accruals

As of December 31, 2019, the Company had accrued an aggregate of $35.8 million associated with a potential settlement with the DOJ and the participating State AGs within accrued expenses and other current liabilities and as a reduction of revenue as reflected on the consolidated balance sheet of the Company as of December 31, 2019 and consolidated statement of operations for the year ended December 31, 2019. In addition, in the quarter ended March 31, 2020, the Company accrued an additional $13.2 million with respect to the total amount to be paid under the agreement in principle to the DOJ and the participating State AGs, and additional amounts for related costs as of and for the quarterly period ended March 31, 2020. As of December 31, 2020, the Company’s accrual consists of $5.0 million in accrued expenses and other current liabilities and $7.1 million in other long-term liabilities.

Payor Settlement Agreements

On June 21, 2018, the Company received a letter from Cigna alleging damages related to contract terms. On December 5, 2018, Cigna and the Company entered into a settlement agreement whereby Avero agreed to pay an aggregate amount of $12.0 million with an upfront payment of $6.0 million and the remaining $6.0 million to be paid over 24 months. For the year ended December 31, 2018, the Company recorded a charge of $12.0 million associated with this claim in its consolidated statements of operations as a reduction to revenue. As of December 31, 2020, the Cigna settlement obligation was fully settled.

On June 25, 2018, the Company received a letter from Aetna’s external legal counsel that included various allegations relating to the Company’s past practices. In November 2019, the Company and Aetna entered into a settlement agreement for $15.0 million, to be paid in installment payments through December 2020. During the year ended December 31, 2018, the Company recorded a charge of $15.0 million associated with this claim in its consolidated statements of operations as a reduction to revenue. As of December 31, 2020, the Company’s accrual consists of $2.5 million included in accrued expenses and other current liabilities.

On October 18, 2018, the Company received a letter from UnitedHealth Group that included various allegations relating to the Company’s past practices. On September 30, 2019, the Company entered into a settlement agreement with United HealthCare Services, Inc. and UnitedHealthcare Insurance Company (“United”) in which the Company agreed to pay an aggregate amount of $30.0 million. The settlement is to be paid with an upfront payment of $2.0 million, and the remaining balance to be paid every six months starting December 31, 2019, with the first two installment payments of $5.0 million each, and $6.0 million each thereafter. As of December 31, 2020, the remaining settlement accrual related to United of $12.0 million is included in accrued expenses and other current liabilities.

Payor Recoveries

As noted above, the regulations governing government reimbursement programs (e.g., Medicaid, Tricare, and Medicare) and commercial payor reimbursement programs are complex and may be subject to interpretation. As a provider of services to patients covered under government reimbursement and commercial payor programs, the Company is routinely subject to post-payment review audits and other forms of reviews and investigations. If a third-party payor successfully challenges that a payment to the Company for prior testing was in breach of contract or otherwise contrary to policy or law, they may recoup such payment. The Company may also decide to negotiate and settle with a third-party payor in order to resolve an allegation of overpayment. In the ordinary course of business, the Company addresses and evaluates a number of such claims from payors. In the past, the Company has negotiated and settled these types of claims with third-party payors. The Company may be required to resolve further disputes in the future. While management is unable to predict the exact outcome of any such claims, it is management’s current belief that any potential liabilities resulting from these contingencies, individually or in the aggregate, could have a material impact on the Company’s financial position and results of operations.

In connection with the third-party review of the Company’s coding and billing processes described in Note 4, which identified that the Company had not effectively transitioned to the implementation of the new CPT code for reimbursement for the Company’s Preparent expanded carrier screening tests during 2019 and early 2020, the Company reviewed its reimbursement from commercial payors for these tests over the same time period. The Company may need to engage with payors in order to determine if any amounts could be subject to recovery or recoupment, as it is customarily done with commercial payors. Any amounts subject to recovery or recoupment will depend on the interpretation of widely variable payor medical and billing policies. The Company will not know if any overpayments exist until it completes this engagement with individual commercial payors. If negotiations with payors result in claims or conclusions that overpayments have been made, this could have a material impact on the Company’s financial results and position. The Company is unable to predict the outcome of this matter and is unable to make a meaningful estimate of the amount or range of loss, if any, that could result from any unfavorable outcome related to this matter.

Payor Dispute

On November 16, 2020, the Company received a letter from Anthem, Inc., or Anthem, informing the Company that Anthem is seeking recoupment for historical payments made by Anthem in an aggregate amount of approximately $27.4 million. The historical payments for which Anthem is seeking recoupment are claimed to relate primarily to discontinued legacy billing practices for the Company’s NIPT and microdeletion tests and secondarily to the implementation of the new CPT code for reimbursement for the Company’s Preparent expanded carrier screening tests.

As noted above, the Company has historically negotiated and settled similar claims with third-party payors. Although the Company’s practice in resolving disputes with other similar large commercial payors has generally led to agreed settlement amounts substantially less than the originally claimed amount, there can be no assurance that the Company will be successful in a similar settlement amount in any ongoing or future dispute. In management’s experience with negotiations with similarly situated commercial payors, a settlement may take six to twelve months to negotiate, and the time period over which a negotiated settlement payment may be paid could extend from one to two years, or longer. Historical settlement amounts and payment time periods may not be indicative of the final settlement terms with Anthem, if any. Management intends to negotiate and/or dispute this claim of recoupment with Anthem and seek to offset any amounts owed by Anthem to the Company. Anthem has indicated a willingness to engage in contract negotiations for in-network status separately and in parallel to discussions regarding its recoupment claim. The resolution of this dispute may or may not include our moving in network with Anthem. As a potential means of making recoupment payments, if any, the Company may negotiate to apply temporarily lowered contracted rates for a specific period. Such provider-payor disputes are not uncommon and the Company expects to approach this dispute with an aim to resolve in a mutually satisfactory manner. The Company has recorded an accrual for the estimated probable loss for this matter as of December 31, 2020.

OIG Inquiry

On October 16, 2019, the Company received an inquiry from the Texas Health & Human Services Commission Office of Inspector General (the “TX OIG”) alleging that the Company did not hold the required CLIA Laboratory Certificate of Accreditation to perform, bill for, or be reimbursed by the Texas Medicaid Program for certain tests performed by us from January 1, 2015 through December 31, 2018. Although management believes that the Company holds and have held all required CLIA certificates and/or subcontract with third-party laboratories that hold and have held such certificates to perform all of the tests subject to the TX OIG inquiry, there can be no assurance that the TX OIG will agree with this position. The Company submitted a written response to the inquiry on October 23, 2019 and are awaiting a response from the TX OIG on the matter. It is not possible to predict the outcome of these matters and the timing for resolution.

Natera Lawsuit

On June 17, 2020, Natera, Inc. (“Natera”) filed suit in the Western District of Texas (W.D. Texas Civil Action No. 6:20-cv-532) asserting the Company’s infringement of six Natera patents based on a portion of the Company’s NIPT product offering. On June 19, 2020, Natera filed a substantially similar second suit in the Northern District of Texas (N.D. Texas Civil Action No. 3:20-cv-1634). On July 31, 2020, the Company filed a motion to dismiss the Western District of Texas case based improper venue. The motion is fully briefed and remains pending before the Court. The Northern District of Texas case has been stayed until a decision with respect to the motion to dismiss is made.

On July 2, 2020, the Company filed a Complaint for Declaratory Judgment of Non-Infringement against Natera in the Southern District of California (S.D. California Civil Action No. 3:20-cv-1252). This case has been stayed pending the outcome of the Company’s venue motion in the Western District of Texas. Management believes that the claims in Natera’s complaints are without merit and the Company is vigorously defending against them.

Ravgen Lawsuit

On December 22, 2020, Ravgen, Inc., or Ravgen, filed suit in the District of Delaware (D. Del. Civil Action No. 1:20-cv-1734)
asserting the Company’s infringement of two Ravgen patents. The Company has not yet responded to the complaint. Management believes the claims in Ravgen’s complaint are without merit, and the Company intends to vigorously defend against them.

IPO Litigation

On June 23, 2020, the Company closed an initial public offering of its common stock (“the IPO”). Lawsuits were filed on August 28, 2020 and September 11, 2020 against the Company, certain of its executive officers and directors, and the underwriters of the IPO. On December 3, 2020, the U.S. District Court for the Southern District of California consolidated the two actions, appointed Lin Shen, Lingjun Lin and Fusheng Lin to serve as Lead Plaintiffs, and approved Glancy Prongay & Murray LLP to be Lead Plaintiffs’ Counsel. Lead Plaintiffs filed their amended complaint on February 4, 2021. It alleges that the Company’s registration statement and related prospectus for the IPO contained false and misleading statements and omissions in violation of the Securities Act of 1933 by failing to disclose that the Company (i) had overbilled government payors by $10.3 million and thus overstated its revenues for the full fiscal year 2019 and first quarter of 2020, and (ii) was allegedly suffering from material negative trends with respect to testing volumes, average selling prices for its tests, and revenues. Lead Plaintiffs seek certification as a class, unspecified compensatory damages, interest, costs and expenses including attorneys’ fees, and unspecified extraordinary, equitable, and/or injunctive relief. The Company’s response to the amended complaint is due by April 5, 2021. The Company intends to vigorously defend against these claims. Given the uncertainty of litigation, the preliminary stages of these cases, and the legal standards that must be met for, among other things, success on the merits, the Company is unable to predict the ultimate outcome of this action, and therefore cannot estimate the reasonably possible loss or range of loss, if any, that may result from these actions. Subject to a reservation of rights, the Company is advancing expenses subject to indemnification to the underwriters of the IPO.

Stockholders' Equity

12 Months Ended

Dec. 31, 2020

Stockholders Equity Note [Abstract]

Stockholders' Equity

Note 11. Stockholders’ Equity

Common Stock

Pursuant to the Company’s eighth amended and restated certificate of incorporation, which went into effect immediately prior to the completion of the IPO, the Company is authorized to issue 350 million shares of common stock and 10 million shares of undesignated preferred stock. Each holder of common stock is entitled to one vote per share of common stock held.

On June 18, 2020, the Company completed its IPO. In the IPO, the Company issued and sold 6,666,667 shares of its common stock, at a price to the public of $15.00 per share. The Company received approximately $88.7 million in net proceeds, after deducting $7.0 million in underwriting discounts and commissions and $4.3 million in other offering expenses payable by the Company. Other offering costs consisted primarily of legal and accounting fees, which were direct and incremental fees related to the IPO. As of December 31, 2019, $1.1 million of deferred offering costs were included in prepaid expenses and other current assets in the accompanying consolidated balance sheet.

Treasury Stock

In June 2014, the Company authorized an Equity Repurchase Program for Key Employees (the “Repurchase Program”). The Repurchase Program allowed the Company to repurchase for cash a portion of the common stock equity interests of certain employees, provided that (i) no more than 25% of the equity interest of any employee was repurchased under the Repurchase Program, (ii) the purchase price paid for each share of common stock equaled the most recent appraisal valuation of the Company’s common stock, and (iii) the aggregate repurchases did not exceed the lesser of (a) equity interest representing, in the aggregate, 0.8 million shares of common stock, (b) a purchase price, in the aggregate, of more than $6.0 million, and (c) the maximum repurchases permitted under the General Corporation Law of the State of Delaware. In addition, it was the Company’s practice to require individuals exercising stock options to hold the shares received upon exercising for a reasonable period of time in order for the holder to be exposed to the economic risks and rewards of share ownership prior to participating in the Repurchase Program. A reasonable period of time was defined as a period of at least six months and that covered at least two common stock appraisal valuations. The Repurchase Program has been discontinued.

Convertible Preferred Stock

As of December 31, 2019, the Company had outstanding Series A Preferred Stock and Series B Preferred Stock.

On August 27, 2019, the Company issued 9,090,910 shares of Series B Preferred Stock at an issuance price of $2.75 per share for an aggregate consideration of $25.0 million (the “August 2019 Financing”) pursuant to a Series B Preferred Stock Purchase Agreement with a private equity firm. In addition, the Company amended the Series B Preferred Stock Purchase Warrant dated October 27, 2017 to increase the Series B Preferred Stock underlying the Series B Preferred Stock Purchase Warrant from 1,416,431 shares to 1,818,182 shares and adjust the exercise price to $2.75 per share. The $25.0 million of proceeds from the August 2019 Financing were allocated among the newly issued Series B Preferred Stock shares and additional shares of Series B Preferred Stock Purchase Warrant based on their relative fair values.

In connection with the August 2019 Financing, the Board of Directors and stockholders approved a 1.28-for-1 stock split for the Company’s Series B Preferred Stock and Series B Preferred Stock Purchase Warrant issued and outstanding prior to the August 2019 Financing, which was effected on August 27, 2019 pursuant to an amendment to the amended and restated certificate of incorporation. The conversion price of the Series B Preferred Stock and exercise price of the outstanding Series B Preferred Stock Purchase Warrant was lowered from $3.53 to $2.75 per share. As a result, the Company issued 4,017,512 additional shares of Series B Preferred Stock as a stock dividend to the preferred stockholders, which was recorded as a $13.1 million increase to accumulated deficit in the consolidated statements of stockholders’ deficit during the year ended December 31, 2019.

On August 27, 2019, the Company entered into an Exchange Agreement with holders of Series A-1 Preferred Stock (the “Exchange Agreement”) pursuant to which the outstanding 1,500,000 shares of Series A-1 Preferred Stock were exchanged for 35,664,240 shares of Series B Preferred Stock. The exchange ratio was 1.2 to 1 on as-if converted to 4,810,651 shares of common stock that the Series A-1 Preferred Stock can be converted to, based on the conversion rate of 3.2 to 1. The Company determined that such exchange constituted a modification to the Series A-1 Preferred Stock. Accordingly, the increase comparing the fair value of the Series B Preferred Stock with the fair value of the Series A-1 Preferred Stock represented a dividend to the preferred stockholders of approximately $27.6 million, which was recorded as an increase to accumulated deficit in the consolidated statements of stockholders’ deficit during the year ended December 31, 2019.

On November 12, 2019, the Company entered into a Series B Preferred Stock Purchase Agreement (the “November Series B Preferred Stock Purchase Agreement”) with a private equity firm and received $25.0 million (the “November 2019 Financing”) in exchange for the issuance of 11,111,111 shares of Series B Preferred Stock at $2.25 per share. In connection with the November 2019 Financing, the Board of Directors and stockholders approved a 1.22-for-1 stock split for the Company’s Series B Preferred Stock and Series B Preferred Stock Purchase Warrant issued and outstanding prior to the November 2019 Financing. The conversion price of the Series B Preferred Stock and exercise price of the outstanding Series B Preferred Stock Purchase Warrant was lowered from $2.75 to $2.25 per share. As a result, the Company issued 13,985,993 additional shares of Series B Preferred Stock and adjusted the Series B Preferred Stock Purchase Warrant to purchase up to 2,222,222 shares of Series B Preferred Stock. The issuance of additional shares represented a stock dividend to the preferred stockholders, which was recorded as a $36.4 million increase to accumulated deficit in the consolidated statements of stockholders’ deficit during the year ended December 31, 2019. In connection with the November 2019 Financing, the Company amended the certificate of incorporation. Following the amendment, there are no authorized or outstanding shares of Series A-1 Preferred Stock.

On November 22, 2019, the Company completed an additional equity financing pursuant to the November Series B Preferred Stock Purchase Agreement with certain existing, accredited investors for an aggregate of $6.1 million in exchange for the issuance of an aggregate of 2,722,222 shares of Series B Preferred Stock at $2.25 per share.

On December 19, 2019, the Company completed an additional equity financing pursuant to the November Series B Preferred Stock Purchase Agreement with the same private equity firm as the November 2019 Financing for $25.0 million in exchange for the issuance of 11,111,111 shares of Series B Preferred Stock at $2.25 per share.

In February 2020, the Company issued and sold an aggregate of 5,066,666 shares of Series B Preferred Stock at a purchase price of $2.25 per share to existing investors in exchange for aggregate consideration of approximately $11.4 million.

On March 31, 2020, in connection with the Credit Agreement Amendment, which provided for the payment of interest due and payable as of March 31, 2020 and June 30, 2020 (only in the event the IPO had not been consummated by such date) in shares of Series B Preferred Stock, the Company issued an aggregate of 967,130 shares of Series B Preferred Stock at a subscription price of $2.25 per share to existing investors as payment for interest due and payable as of March 31, 2020 and all applicable fees.

On April 3, 2020, the Company issued and sold an aggregate of 4,444,444 shares of its Series B Preferred Stock at a purchase price of $2.25 per share to existing investors in exchange for aggregate consideration of approximately $10.0 million in cash.

The fair value of the preferred stock was estimated using a hybrid between a probability-weighted expected return method (“PWERM”) and option pricing model (“OPM”), estimating the probability weighted value across multiple scenarios, while using an OPM to estimate the allocation of value within one or more of these scenarios. Under a PWERM, the value of the Company’s various classes of stock was estimated based upon an analysis of future values for the Company assuming various future outcomes, including two IPO scenarios and one scenario contemplating the continued operation of the Company as a privately held enterprise. Guideline public company multiples were used to value the Company under its various scenarios. Share value for each class of stock was based upon the probability-weighted present value of expected future share values, considering each of these possible future outcomes, as well as the rights of each share class.

The significant unobservable inputs into the valuation model used to estimate the fair value of the preferred stock include the timing of potential events (primarily the IPO) and their probability of occurring, the selection of guideline public company multiples, a discount for the lack of marketability of the common stock, and the discount rate used to calculate the present value of the estimated equity value allocated to each share class.

Preferred stock outstanding as of December 31, 2019 consisted of the following (in thousands, except share and per share data):

December 31, 2019	Shares Authorized		Shares Issued and Outstanding		Per Share Price at Issuance		Aggregate Liquidation Preference
Series A		4,120,000		4,120,000	$	0.48543	$	2,000
Series B		126,035,000		101,867,405		2.25000		229,202
Total preferred stock		130,155,000		105,987,405			$	231,202

In connection with the IPO, on June 18, 2020, all outstanding Series A Preferred Stock and Series B Preferred Stock converted into 33,443,562 shares of common stock, including the issuance of 2,045,522 shares of common stock pursuant to an adjustment in the conversion rate of all of the shares of Series B Preferred Stock outstanding immediately prior to the IPO. Upon conversion of the convertible preferred stock, the Company reclassified their carrying value to common stock and additional paid-in capital.

Common Stock Reserved for Future Issuance

The Company reserved shares of common stock, on an as-if-converted basis, for future issuance as follows:

	December 31, 2020		December 31, 2019
Outstanding stock options to purchase common stock		4,268,945		2,561,866
Restricted stock units outstanding		1,468,765		322,608
Available for future issuance under equity incentive plan		2,938,616		—
Common stock warrant		400,160		—
Common stock issuable upon conversion of convertible notes		51,529,036		—
Series A Preferred Stock		—		13,213,254
Series B Preferred Stock		—		16,488,731
Series B Preferred Stock Purchase Warrant		—		359,699
Total		60,605,522		32,946,158

Stock-Based Compensation

12 Months Ended

Dec. 31, 2020

Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]

Stock-Based Compensation

Note 12. Stock-Based Compensation

In February 2018, the Company adopted the 2018 Equity Incentive Plan (the “2018 Plan”). The 2018 Plan is the successor to and continuation of the Second Amended and Restated 2012 Stock Plan (the “2012 Plan”) and the 2015 Consultant Stock Plan (the “2015 Plan”), and is administered with either stock options or restricted stock units. The Board of Directors administers the plans. Upon adoption of the 2018 Plan, no new stock options or awards are issuable under the 2012 Plan, as amended, or the 2015 Plan. The 2018 Plan also provides for other types of equity to issue awards, which at this time the Company does not plan to utilize.

The 2018 Plan was amended in March 2019 with 1.1 million shares available for future grant. In December 2019, the Company adopted the Second Amended and Restated 2018 Equity Incentive Plan, which increased the number of shares available for future grant to 2.7 million shares. On March 4, 2020, the Board of Directors adopted the Third Amended and Restated 2018 Equity Incentive Plan (the “2018 Third Amended Plan”), which increased the number of shares available for future grant to a total of 7,615,733 shares and was approved by stockholders on March 5, 2020. As of December 31, 2020, the number of shares available for grant under the 2018 Third Amended Plan was 2,938,616. The 2018 Third Amended Plan provides for automatic annual increase in the number of shares of common stock reserved for issuance, which resulted in an additional 4,537,676 shares reserved for future issuance effective January 1, 2021.

Stock Options

The following table summarizes stock option activity under the 2012 Plan, the 2015 Plan, and the 2018 Third Amended Plan during the year ended December 31, 2020 (in thousands, except share and per share data):

	Stock Options Outstanding			Weighted- Average Exercise Price		Weighted- Average Remaining Contractual Term (in years)		Aggregate Intrinsic Value
Balance at December 31, 2019		2,561,866		$	9.01
Options granted		2,652,102			8.22
Options exercised		(543,218	)		1.15
Options forfeited/cancelled		(401,805	)		11.24
Balance at December 31, 2020		4,268,945		$	8.14		7.74	$	2,527
Vested and expected to vest at December 31, 2020		4,268,945		$	8.14		7.74	$	2,527
Vested and exercisable at December 31, 2020		1,748,573		$	8.18		5.40	$	1,708

The aggregate intrinsic value in the above table is calculated as the difference between the closing price of our common stock at December 31, 2020, of $5.31 per share and the exercise price of stock options that had strike prices below the closing price. The intrinsic value of all stock options exercised during the year ended December 31, 2020 was $4.2 million.

In January 2020, the Board of Directors approved the modification of the exercise price of certain outstanding stock options under the existing incentive plans. As a result of this modification, an additional stock-based compensation expense of $0.9 million is being recognized over the remaining vesting period for the outstanding stock options.

The Company uses the Black-Scholes option pricing model to estimate the fair value of each option grant on the date of grant or any other measurement date. The following table sets forth the assumptions used to determine the fair value of stock options granted during the years ended December 31, 2020 and 2019:

	Year ended December 31,
	2020		2019
Risk-free interest rate	0.4% - 1.7%		1.4% - 2.4%
Expected volatility	57.0% - 71.0%		57.0% - 71.0%
Expected dividend yield		—		—
Expected life (years)	4.0 - 6.3 years		6.25 years

Restricted Stock Units

The following table summarizes restricted stock unit activity for the year ended December 31, 2020:

	Number of Shares			Weighted- Average Grant Date Fair Value
Balance at December 31, 2019		323,671		$	15.19
Granted		1,389,919			8.10
Vested		(140,422	)		14.93
Forfeited/cancelled		(104,403	)		12.06
Balance at December 31, 2020		1,468,765		$	8.73

2020 Employee Stock Purchase Plan

In June 2020, the Company’s board of directors adopted the ESPP. At December 31, 2020, 510,000 shares of common stock were reserved for future issuance under the ESPP. The ESPP also provides for automatic annual increases in the number of shares of common stock reserved for issuance, which resulted in an additional 557,723 shares reserved for future issuance effective January 1, 2021. The Company commenced a series of offerings under the ESPP on December 1, 2020. The initial offering began December 1, 2020, ends on November 30, 2022 (unless terminated earlier, as described below) and consists of four purchase periods. The purchase periods end on the last trading day of May and November of each year. Eligible employees who enroll in the initial offering or any subsequent offering will be able to purchase shares of the Company’s common stock at a discount through payroll deductions, subject to certain limitations. The purchase price of the shares of common stock will be the lesser of (i) 85% of the fair market value of such shares on the offering date and (ii) 85% of the fair market value of such shares on the purchase date. Following the commencement of the initial offering, a new 24-month offering with four six-month purchase periods will automatically begin approximately every six months thereafter over the term of the ESPP. Offerings will be concurrent, but in the event the fair market value of a share of common stock on the first day of any purchase period during an offering (the “New Offering”) is less than or equal to the fair market value of a share of common stock on the offering date for an ongoing offering (the “Ongoing Offering”), then the Ongoing Offering terminates immediately following the purchase of shares on the purchase date immediately preceding the New Offering and the participants in the terminated Ongoing Offering are automatically enrolled in the New Offering. Notwithstanding the above, the Company’s board of directors (or an authorized committee thereof) may modify the terms of or suspend any future offerings prior to their commencement. The Company issues new shares for purchases of stock made pursuant to the ESPP.

Stock-Based Compensation Expense

The stock-based compensation expense related to stock options, RSUs and the ESPP is included in the accompanying consolidated statements of operations as follows (in thousands):

	Year Ended December 31,
	2020		2019
Cost of sales	$	867	$	207
Research and development		2,804		851
Selling and marketing		1,633		501
General and administrative		5,364		816
Total stock-based compensation expense	$	10,668	$	2,375

The weighted-average grant date fair value of options granted during the years ended December 31, 2020 and 2019 was $5.15 per option and $7.35 per option, respectively. At December 31, 2020, there was $12.8 million and $10.5 million, of compensation cost related to unvested stock options and RSUs, respectively, expected to be recognized over a remaining weighted average vesting period of 2.93 years. The total unrecognized compensation costs will be adjusted for forfeitures in future periods as they occur. No tax benefits related to stock-based compensation were recorded in the statements of operations because during the years ended December 31, 2020 and 2019 as the Company is in a net operating loss position with a full valuation allowance on net deferred tax assets.

Income Taxes

12 Months Ended

Dec. 31, 2020

Income Tax Disclosure [Abstract]

Income Taxes

Note 13. Income Taxes

The provision for income taxes consists of the following (in thousands):

	Year Ended December 31,
	2020			2019
Current provision:
Federal	$	(37,697	)	$	(638	)
State		82			(104	)
		(37,615	)		(742	)
Deferred expense:
Federal		22			36
State		61			—
		83			36
Net income tax provision	$	(37,532	)	$	(706	)

The components of income tax expense relate to the following (in thousands):

	Year Ended December 31,
	2020			2019
Income tax benefit at U.S. federal statutory rate	$	(48,313	)	$	(31,236	)
State income tax benefit, net of federal benefit		(5,469	)		(4,538	)
NOL carryback and other true ups		(15,517	)		—
Government litigation settlements		4,611			—
Federal research and development credit		(3,573	)		(3,232	)
Convertible debt		740			—
Stock-based compensation		84			(87	)
Meals and entertainment		—			367
Change in valuation allowance		29,845			38,514
Other		60			(494	)
Total income tax expense	$	(37,532	)	$	(706	)

Deferred income taxes reflect the net tax effects of (a) temporary differences between the carrying amounts of assets and liabilities for financial reporting purposes and the amounts used for income tax purposes, and (b) operating losses and tax credit carryforwards. The tax effects of temporary differences that give rise to portions of the deferred tax assets and deferred tax liabilities as of December 31, 2020 and 2019 are presented below (in thousands):

	December 31, 2020			December 31, 2019
Deferred tax assets:
Net operating losses and carryforwards	$	87,329		$	51,768
Reserves		7,211			17,287
Intangible assets		3,878			3,982
Accrued expenses		1,816			3,025
Stock-based compensation		2,289			194
Convertible debt		3,290			—
Total deferred tax assets		105,813			76,256
Deferred tax liabilities:
Fixed assets		(1,698	)		(1,705	)
Prepaid expenses		(1,146	)		(138	)
Goodwill		(402	)		(205	)
Adoption of ASC 606		(2,824	)		(4,227	)
Total deferred tax liabilities		(6,070	)		(6,275	)
Net deferred tax assets		99,743			69,981
Less: valuation allowance		(99,862	)		(70,017	)
Net deferred tax assets (liabilities)	$	(119	)	$	(36	)

Due to the losses generated in 2020 and 2019 and projected future taxable losses, management concluded that it is not more likely than not that the Company will realize the benefits of its deferred tax assets. As such, the Company recorded a valuation allowance of $99.9 million and $70.0 million, respectively, on its net deferred tax assets as of December 31, 2020 and 2019.

At December 31, 2020, the Company had federal and state income tax net operating loss (“NOL”) carryforwards of approximately $271.1 million and $200.0 million, respectively. The U.S. federal net operating losses will be carried forward indefinitely and state net operating losses will begin to expire in various years, depending on the applicable jurisdiction. Federal net operating loss carryforwards generated post TCJA may be carried forward indefinitely, subject to the 80% taxable income limitation on the utilization of the carryforwards. In addition, the Company had federal and state research and expenditure credit carryforwards of approximately $11.6 million and $2.5 million, respectively, as of December 31, 2020. The federal research and expenditure credit will begin to expire after 2033 if unused and the state research and expenditure credit may be carried forward indefinitely.

Pursuant to Section 382 and Section 383 of the Internal Revenue Code, annual use of the Company’s net operating loss carryforwards and tax credit carryforwards may be limited as a result of cumulative changes of ownership resulting in a change of control of the Company. The Company performed a formal study and determined future utilization of tax attribute carryforwards are not limited per Section 382 of the Internal Revenue Code.

In accordance with ASC 740-10, Income Taxes—Overall, the impact of an uncertain income tax position on the income tax return must be recognized at the largest amount that is more likely than not to be sustained upon audit by the relevant taxing authority. An uncertain income tax position will not be recognized if it has less than a 50% likelihood of being sustained. The Company has no uncertain tax positions at December 31, 2020.

The Company’s policy is to recognize interest and penalties related to income tax matters in the provision for income taxes. At December 31, 2020, there were no interest and penalties related to uncertain tax positions.

The Company is subject to taxation in the United States, various US state jurisdictions and the United Kingdom. Multiple tax years remain open to examination depending on the applicable jurisdiction.

On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) was enacted. The CARES Act includes several significant provisions for corporations, including those pertaining to net operating loss carryforwards, interest deductions and payroll tax benefits. Corporate taxpayers may carryback NOLs originating during 2018 through 2020 for up to five years. During the first quarter of 2020, the Company recorded a discrete tax benefit of $37.7 million related to the NOL carryback provisions available under the CARES Act legislation corresponding to anticipated tax refunds applicable to taxable years 2013, 2014, 2015, and 2017. If any tax refund is received that is more than $5.0 million in a single year, along with other civil settlements, damages awards, and tax refunds, the Company has agreed to pay 65% of all such amounts received to accelerate payments to the government in connection with our government settlement (see Note 10). During the year ended December 31, 2020, we received a full tax refund related to the NOL carryback provisions available under the CARES Act.

On December 27, 2020, President Trump signed into law the Consolidated Appropriations Act, 2021 (“CAA 2021”), which included a number of provisions including, but not limited to the extension of numerous employment tax credits, the extension of the Section 179D deduction, enhanced business meals deductions, and the deductibility of expenses paid with Paycheck Protection Program (“PPP”) loan funds that are forgiven. Accordingly, the effects of the CAA 2021 have been incorporated into the income tax provision for the year ended December 31, 2020. These provisions did not have a material impact on the Company’s income tax provision.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References + Details

Net Loss Per Share

12 Months Ended

Dec. 31, 2020

Earnings Per Share [Abstract]

Net Loss Per Share

Note 14. Net Loss Per Share

Net loss per share is computed by dividing net loss attributable to common stockholders for the period by the weighted average number of common shares outstanding during the period. Diluted loss per share reflects the additional dilution from potential issuances of common stock, such as stock issuable pursuant to the exercise of stock options, as well as from the possible conversion of the Company’s preferred stock and exercise of the outstanding warrant. The treasury stock and if-converted methods are used to calculate the potential dilutive effect of these common stock equivalents. However, potentially dilutive shares are excluded from the computation of diluted loss per share when their effect is antidilutive. Due to the Company reporting a net loss attributable to common stockholders for all periods presented, all potentially dilutive securities were antidilutive and have been excluded from the computation of diluted loss per share.

The table below provides potentially dilutive securities in equivalent common shares not included in the Company’s calculation of diluted loss per share because to do so would be antidilutive:

	Year Ended December 31,
	2020		2019
Stock options to purchase common stock		4,268,945		2,561,866
Restricted stock units		1,468,765		322,608
Common stock warrant		400,160		—
Stock issuable upon conversion of convertible notes		51,529,036		—
Series A Preferred Stock		—		13,213,254
Series B Preferred Stock		—		16,488,731
Series B Preferred Stock Purchase Warrant		—		359,699
Total		57,666,906		32,946,158

Employee Benefit Plan

12 Months Ended

Dec. 31, 2020

Compensation And Retirement Disclosure [Abstract]

Employee Benefit Plan

Note 15. Employee Benefit Plan

The Company has a qualified 401(k) employee savings plan for the benefit of its employees (the “plan”). Substantially all employees are eligible to participate in the plan. Under the plan, employees can contribute and defer taxes on compensation contributed. The Company has the option to make discretionary profit-sharing contributions to the plan. The Company made employer contributions to the plan of $2.9 million and $2.5 million for the years ended December 31, 2020 and 2019, respectively.

Quarterly Financial Data (Unaudited)

12 Months Ended

Dec. 31, 2020

Quarterly Financial Information Disclosure [Abstract]

Quarterly Financial Data (Unaudited)

Note 16. Quarterly Financial Data (Unaudited)

The following tables present selected quarterly financial data for the years presented, in thousands, except per share data:

	Three Months Ended
2020	December 31,			September 30,			June 30,			March 31,
Revenues	$	14,276		$	25,943		$	17,266		$	16,828
Loss from operations		(51,371	)		(44,571	)		(46,720	)		(52,526	)
Net loss		(75,528	)		(47,065	)		(52,783	)		(17,152	)
Net loss attributable to common stockholders		(75,528	)		(47,065	)		(53,051	)		(17,152	)
Net loss per share, basic and diluted		(1.53	)		(1.01	)		(6.11	)		(3.43	)

2019
Revenues	$	20,476		$	18,772		$	57,230		$	47,507
Loss from operations		(48,973	)		(54,841	)		(14,298	)		(22,007	)
Net loss		(50,476	)		(57,133	)		(16,409	)		(24,019	)
Net loss attributable to common stockholders		(86,840	)		(97,907	)		(16,409	)		(27,671	)
Net loss per share, basic and diluted		(17.46	)		(19.85	)		(3.34	)		(5.88	)

Subsequent Events

12 Months Ended

Dec. 31, 2020

Subsequent Events [Abstract]

Subsequent Events

Note 17. Subsequent Events

On February 22, 2021, the Company entered into a Securities Purchase Agreement for a private placement with certain institutional and accredited investors (the “Purchasers”). Pursuant to the Securities Purchase Agreement, the Purchasers have agreed to purchase an aggregate of 4,370,629 units (the “Units”) representing (i) 4,370,629 shares of the Company’s common stock, par value $0.001 per share, and (ii) warrants to purchase up to 4,370,629 shares of common stock. The purchase price for each Unit is $5.72, for an aggregate purchase price of approximately $25.0 million. This transaction closed on February 25, 2021.

The warrants are exercisable for cash at an exercise price of $6.86 per share, subject to adjustments as provided under the terms of the warrants. The warrants are immediately exercisable for cash and expire on the fifth anniversary of the date of issuance. If exercised for cash, the warrants would result in additional gross proceeds to the Company of approximately $30.0 million.

Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2020

Accounting Policies [Abstract]

Basis of Presentation

Use of Estimates

Operating Segments

Revenue Recognition

The Company applies the following practical expedients and exemptions:

•

Payor Concentration

	Percentage of Accounts Receivable
	December 31, 2020			December 31, 2019
Blue Shield of Texas		17.8	%	*
Aetna		4.0	%		6.0	%
Cigna		2.6	%	*
United Healthcare		6.6	%		31.5	%
Government Health Benefits Programs		26.2	%		16.7	%
Anthem		3.5	%	*
____________
* Less than 1%.

	Percentage of Revenue
	Year Ended December 31,
	2020			2019
Blue Shield of Texas		35.6	%		21.3	%
Aetna		11.0	%		9.2	%
Cigna		7.6	%		4.5	%
United Healthcare		6.7	%		30.8	%
Government Health Benefits Programs		3.7	%	*
Anthem(1)		(6.7	)%		6.1	%
____________
(1) The negative amounts presented in the percentage of revenues include accruals for reimbursement claims and settlements included in the estimates of variable consideration recorded during the year ended December 31, 2020. Revenue recognized consider the effects of variable consideration, and include adjustments for estimates of disallowed cases, discounts, and refunds. The variable consideration includes reductions in revenues for the accrual for reimbursement claims and settlements, as described in Notes 4 and 10.
* Less than 1%.

Accounts Receivable

Cost of Sales

Cash and Cash Equivalents including Concentration of Credit Risk

Investments

Inventory

Property and Equipment, Net

Property and Equipment	Estimated Useful Life (in years)
Computers and software		3
Laboratory equipment		5
Furniture, fixtures, and office equipment		8
Building		15

Assets acquired under capital leases and leasehold improvements are amortized on a straight-line basis over the shorter of the lease term or the useful life of the asset. Land is not depreciated.

Goodwill

Intangible Assets

The amortization periods for the acquired intangible assets are:

Intangible Assets	Estimated Useful Life (in years)
Trade names		10
Payor relationships		10
Noncompete agreements		6

Impairment of Long-Lived Assets

Embedded Derivative Related to Convertible Notes

Repair and Maintenance

The Company incurs maintenance costs on its major equipment. Repair and maintenance costs are expensed as incurred.

Research and Development

Selling and Marketing

General and Administrative

Stock-Based Compensation

Dividend Rate—The dividend yield assumption is zero, as the Company has no plans to make dividend payments.

Net Loss Per Share

Income Taxes

Comprehensive Loss

The Company did not have any other comprehensive income or loss for any of the periods presented, and therefore comprehensive loss was the same as the Company’s net loss.

Emerging Growth Company Status

Recent Accounting Pronouncements Adopted

Recent Accounting Pronouncements Not Yet Adopted

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2020

Accounting Policies [Abstract]

Schedule of Accounts Receivable Balances and Revenues as Percentage of Total Accounts Receivable Balances and Revenues

	Percentage of Accounts Receivable
	December 31, 2020			December 31, 2019
Blue Shield of Texas		17.8	%	*
Aetna		4.0	%		6.0	%
Cigna		2.6	%	*
United Healthcare		6.6	%		31.5	%
Government Health Benefits Programs		26.2	%		16.7	%
Anthem		3.5	%	*
____________
* Less than 1%.

	Percentage of Revenue
	Year Ended December 31,
	2020			2019
Blue Shield of Texas		35.6	%		21.3	%
Aetna		11.0	%		9.2	%
Cigna		7.6	%		4.5	%
United Healthcare		6.7	%		30.8	%
Government Health Benefits Programs		3.7	%	*
Anthem(1)		(6.7	)%		6.1	%
____________
(1) The negative amounts presented in the percentage of revenues include accruals for reimbursement claims and settlements included in the estimates of variable consideration recorded during the year ended December 31, 2020. Revenue recognized consider the effects of variable consideration, and include adjustments for estimates of disallowed cases, discounts, and refunds. The variable consideration includes reductions in revenues for the accrual for reimbursement claims and settlements, as described in Notes 4 and 10.
* Less than 1%.

Summary of Estimated Useful Life of Property and Equipment

Property and Equipment	Estimated Useful Life (in years)
Computers and software		3
Laboratory equipment		5
Furniture, fixtures, and office equipment		8
Building		15

Summary of Amortization Periods for Acquired Intangible Assets

The amortization periods for the acquired intangible assets are:

Intangible Assets	Estimated Useful Life (in years)
Trade names		10
Payor relationships		10
Noncompete agreements		6

Variable Interest Entity (Tables)

12 Months Ended

Dec. 31, 2020

Variable Interest Entities [Abstract]

Schedule of Assets and Liabilities

	December 31, 2020		December 31, 2019
Assets of Avero that can only be used to settle obligations of Avero
Cash and cash equivalents	$	556	$	1,837
Accounts receivable, net		6,047		4,269
Inventory		3,382		2,572
Prepaid expenses and other current assets		1,254		1,181
Property and equipment, net		5,436		5,586
Other assets		30		30
Goodwill		6,219		6,219
Other intangible assets, net		3,843		4,771
Total assets of Avero that can only be used to settle obligations of Avero	$	26,767	$	26,465
Liabilities of Avero
Accounts payable	$	4,722	$	2,450
Accrued expenses and other accrued liabilities		3,472		5,630
Current portion of capital lease obligations		46		59
Current portion of mortgage payable		199		173
Capital lease obligations, net of current portion		4		50
Mortgage payable, net of current portion		1,520		1,733
Other long-term liabilities		428		467
Total liabilities of Avero	$	10,391	$	10,562

- Definition

Tabular disclosure of the significant judgments and assumptions made in determining whether a variable interest (as defined) held by the entity requires the variable interest entity (VIE) (as defined) to be consolidated and (or) disclose information about its involvement with the VIE, individually or in aggregate (as applicable); the nature of restrictions, if any, on the consolidated VIE's assets and on the settlement of its liabilities reported by an entity in its statement of financial position, including the carrying amounts of such assets and liabilities; the nature of, and changes in, the risks associated with involvement in the VIE; how involvement with the VIE affects the entity's financial position, financial performance, and cash flows; the lack of recourse if creditors (or beneficial interest holders) of the consolidated VIE have no recourse to the general credit of the primary beneficiary (if applicable); the terms of arrangements, giving consideration to both explicit arrangements and implicit variable interests, if any, that could require the entity to provide financial support to the VIE, including events or circumstances that could expose the entity to a loss; the methodology used by the entity for determining whether or not it is the primary beneficiary of the variable interest entity; the significant factors considered and judgments made in determining that the power to direct the activities of a VIE that most significantly impact the VIE's economic performance are shared (as defined); the carrying amounts and classification of assets and liabilities of the VIE included in the statement of financial position; the entity's maximum exposure to loss, if any, as a result of its involvement with the VIE, including how the maximum exposure is determined and significant sources of the entity's exposure to the VIE; a comparison of the carrying amounts of the assets and liabilities and the entity's maximum exposure to loss; information about any liquidity arrangements, guarantees, and (or) other commitments by third parties that may affect the fair value or risk of the entity's variable interest in the VIE; whether or not the entity has provided financial support or other support (explicitly or implicitly) to the VIE that it was not previously contractually required to provide or whether the entity intends to provide that support, including the type and amount of the support and the primary reasons for providing the support; and supplemental information the entity determines necessary to provide.

+ References + Details

Revenues (Tables)

12 Months Ended

Dec. 31, 2020

Revenue From Contract With Customer [Abstract]

Summary of Disaggregation of Revenues by Payor

The following table shows a further disaggregation of revenues by payor type (in thousands):

	Year Ended December 31,
	2020		2019
Commercial third-party payors	$	64,433	$	139,051
Government health benefit programs(1)		2,731		195
Patient/laboratory distribution partners		7,149		4,739
Total revenues	$	74,313	$	143,985
____________
(1) The revenue amounts include accruals for reimbursement claims and settlements included in the estimates of variable consideration recorded during the years ended December 31, 2020 and 2019. Revenue recognized reflect the effects of variable consideration, and include adjustments for estimates of disallowed cases, discounts, and refunds. The variable consideration includes reductions in revenues for the accrual for reimbursement claims and settlements.

Balance Sheet Components (Tables)

12 Months Ended

Dec. 31, 2020

Organization Consolidation And Presentation Of Financial Statements [Abstract]

Summary of Prepaid Expenses and Other Current Assets

Prepaid expenses and other current assets consisted of the following (in thousands):

	December 31, 2020		December 31, 2019
Prepaid expenses	$	9,116	$	6,476
Other current assets		245		1,370
Total	$	9,361	$	7,846

Summary of Property and Equipment, Net

Property and equipment, net consisted of the following (in thousands):

	December 31, 2020			December 31, 2019
Computers and software	$	14,591		$	13,913
Building and leasehold improvements		9,458			9,491
Laboratory equipment		7,678			5,580
Furniture, fixtures, and office equipment		1,686			1,633
Construction in progress		2,784			1,493
Land		1,091			1,091
Total property and equipment		37,288			33,201
Less accumulated depreciation and amortization		(19,446	)		(17,310	)
Property and equipment, net	$	17,842		$	15,891

Summary of Capital Leases Included in Property and Equipment, Net

Capital leases included in property and equipment, net consisted of the following (in thousands):

	December 31, 2020			December 31, 2019
Capital leases	$	2,467		$	3,692
Less accumulated depreciation and amortization		(1,954	)		(2,239	)
Capital leases included in property and equipment, net	$	513		$	1,453

Summary of Intangible Assets, Net

Intangible assets, net consisted of the following (in thousands):

December 31, 2020	Cost		Accumulated amortization			Net
Payor relationships	$	7,230	$	(4,037	)	$	3,193
Trade names		1,410		(787	)		623
Noncompete agreements		384		(357	)		27
Intangible assets, net	$	9,024	$	(5,181	)	$	3,843

December 31, 2019	Cost		Accumulated amortization			Net
Payor relationships	$	7,230	$	(3,314	)	$	3,916
Trade names		1,410		(646	)		764
Noncompete agreements		384		(293	)		91
Intangible assets, net	$	9,024	$	(4,253	)	$	4,771

Summary of Future Amortization of Intangible Assets

The future amortization of intangible assets at December 31, 2020 was (in thousands):

Year ending December 31,
2021	$	891
2022		864
2023		864
2024		864
2025		360
Thereafter		—
Total future minimum lease payments	$	3,843

Summary of Accrued Expenses and Other Current Liabilities

Accrued expenses and other current liabilities consisted of the following (in thousands):

	December 31, 2020		December 31, 2019
Accrual for reimbursement claims and settlements, current	$	30,487	$	60,386
Commissions and bonuses		4,619		6,357
Vacation and payroll benefits		8,896		5,506
Accrued professional services		3,385		5,322
Contract liabilities		378		—
Other		6,912		6,044
Total	$	54,677	$	83,615

Summary of Other Long-term Liabilities

Other long-term liabilities consisted of the following (in thousands):

	December 31, 2020		December 31, 2019
Accrual for reimbursement claims and settlements, net of current portion	$	7,053	$	12,205
Other		1,614		654
Total	$	8,667	$	12,859

Fair Value Measurements (Tables)

12 Months Ended

Dec. 31, 2020

Fair Value Disclosures [Abstract]

Summary of Financial Assets and Liabilities Measured at Fair Value on Recurring Basis

The following table presents information about the Company’s assets and liabilities that are measured at fair value on a recurring basis and indicates the fair value hierarchy of the valuation techniques utilized to determine such fair value (in thousands):

	Quoted Prices for Identical Assets (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)
December 31, 2020
Money market funds(1)	$	90,254	$	—	$	—
Embedded derivative liability		—		—		18,370

December 31, 2019
Money market funds(1)	$	24,432	$	—	$	—
____________
(1) Included in cash and cash equivalents in the accompanying consolidated balance sheets.

Mortgages Payable (Tables)

12 Months Ended

Dec. 31, 2020

Debt Disclosure [Abstract]

Schedule of Minimum Principal Payments

As of December 31, 2020, the minimum principal payments under the mortgages payable were as follows (in thousands):

Year ending December 31,	Minimum Mortgages Payable Payments Obligations
2021	$	271
2022		281
2023		292
2024		1,338
2025		884
Thereafter		—
Total future minimum payments		3,066
Less current portion of mortgages payable		(271	)
Mortgages payable, net of current portion	$	2,795

Commitments and Contingencies (Tables)

12 Months Ended

Dec. 31, 2020

Commitments And Contingencies Disclosure [Abstract]

Schedule of Net Minimum Payments Under Non-Cancelable Operating Leases

As of December 31, 2020, net minimum payments under the non-cancelable operating leases were as follows (in thousands):

Year ending December 31,	Minimum Operating Lease Payments
2021	$	5,750
2022		3,017
2023		1,036
2024		38
2025 and thereafter		—
Total future minimum lease payments	$	9,841

Schedule of Future Minimum Payments Under Capital Leases

As of December 31, 2020, the future minimum payments under the capital leases were as follows (in thousands):

Year ending December 31,	Minimum Capital Lease Payments
2021	$	324
2022		47
2023 and thereafter		—
Total minimum lease payments		371
Less amounts representing interest		(13	)
Present value of minimum capital lease payments		358
Less current portion of capital lease obligations		(312	)
Capital lease obligations, net of current portion	$	46

Stockholders' Equity (Tables)

12 Months Ended

Dec. 31, 2020

Stockholders Equity Note [Abstract]

Schedule of Preferred Stock Shares Authorized, Shares Issued and Outstanding, Per Share Price and Liquidation Preference

Preferred stock outstanding as of December 31, 2019 consisted of the following (in thousands, except share and per share data):

December 31, 2019	Shares Authorized		Shares Issued and Outstanding		Per Share Price at Issuance		Aggregate Liquidation Preference
Series A		4,120,000		4,120,000	$	0.48543	$	2,000
Series B		126,035,000		101,867,405		2.25000		229,202
Total preferred stock		130,155,000		105,987,405			$	231,202

Schedule of Reserved Shares of Common Stock, On An As-if-converted Basis, for Future Issuance

Common Stock Reserved for Future Issuance

The Company reserved shares of common stock, on an as-if-converted basis, for future issuance as follows:

	December 31, 2020		December 31, 2019
Outstanding stock options to purchase common stock		4,268,945		2,561,866
Restricted stock units outstanding		1,468,765		322,608
Available for future issuance under equity incentive plan		2,938,616		—
Common stock warrant		400,160		—
Common stock issuable upon conversion of convertible notes		51,529,036		—
Series A Preferred Stock		—		13,213,254
Series B Preferred Stock		—		16,488,731
Series B Preferred Stock Purchase Warrant		—		359,699
Total		60,605,522		32,946,158

Stock-Based Compensation (Tables)

12 Months Ended

Dec. 31, 2020

Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]

Summary of Stock Options Activity under Plans

	Stock Options Outstanding			Weighted- Average Exercise Price		Weighted- Average Remaining Contractual Term (in years)		Aggregate Intrinsic Value
Balance at December 31, 2019		2,561,866		$	9.01
Options granted		2,652,102			8.22
Options exercised		(543,218	)		1.15
Options forfeited/cancelled		(401,805	)		11.24
Balance at December 31, 2020		4,268,945		$	8.14		7.74	$	2,527
Vested and expected to vest at December 31, 2020		4,268,945		$	8.14		7.74	$	2,527
Vested and exercisable at December 31, 2020		1,748,573		$	8.18		5.40	$	1,708

Summary of Assumptions used to Determine Fair Value of Stock Options Granted

The following table sets forth the assumptions used to determine the fair value of stock options granted during the years ended December 31, 2020 and 2019:

	Year ended December 31,
	2020		2019
Risk-free interest rate	0.4% - 1.7%		1.4% - 2.4%
Expected volatility	57.0% - 71.0%		57.0% - 71.0%
Expected dividend yield		—		—
Expected life (years)	4.0 - 6.3 years		6.25 years

Summary of Restricted Stock Units Activity

The following table summarizes restricted stock unit activity for the year ended December 31, 2020:

	Number of Shares			Weighted- Average Grant Date Fair Value
Balance at December 31, 2019		323,671		$	15.19
Granted		1,389,919			8.10
Vested		(140,422	)		14.93
Forfeited/cancelled		(104,403	)		12.06
Balance at December 31, 2020		1,468,765		$	8.73

Schedule of Stock-based Compensation Expense

The stock-based compensation expense related to stock options, RSUs and the ESPP is included in the accompanying consolidated statements of operations as follows (in thousands):

	Year Ended December 31,
	2020		2019
Cost of sales	$	867	$	207
Research and development		2,804		851
Selling and marketing		1,633		501
General and administrative		5,364		816
Total stock-based compensation expense	$	10,668	$	2,375

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2020

Income Tax Disclosure [Abstract]

Summary of Provision for Income Taxes

The provision for income taxes consists of the following (in thousands):

	Year Ended December 31,
	2020			2019
Current provision:
Federal	$	(37,697	)	$	(638	)
State		82			(104	)
		(37,615	)		(742	)
Deferred expense:
Federal		22			36
State		61			—
		83			36
Net income tax provision	$	(37,532	)	$	(706	)

Summary of Components of Income Tax Expense

The components of income tax expense relate to the following (in thousands):

	Year Ended December 31,
	2020			2019
Income tax benefit at U.S. federal statutory rate	$	(48,313	)	$	(31,236	)
State income tax benefit, net of federal benefit		(5,469	)		(4,538	)
NOL carryback and other true ups		(15,517	)		—
Government litigation settlements		4,611			—
Federal research and development credit		(3,573	)		(3,232	)
Convertible debt		740			—
Stock-based compensation		84			(87	)
Meals and entertainment		—			367
Change in valuation allowance		29,845			38,514
Other		60			(494	)
Total income tax expense	$	(37,532	)	$	(706	)

Summary of Deferred Tax Assets and Deferred Tax Liabilities

The tax effects of temporary differences that give rise to portions of the deferred tax assets and deferred tax liabilities as of December 31, 2020 and 2019 are presented below (in thousands):

	December 31, 2020			December 31, 2019
Deferred tax assets:
Net operating losses and carryforwards	$	87,329		$	51,768
Reserves		7,211			17,287
Intangible assets		3,878			3,982
Accrued expenses		1,816			3,025
Stock-based compensation		2,289			194
Convertible debt		3,290			—
Total deferred tax assets		105,813			76,256
Deferred tax liabilities:
Fixed assets		(1,698	)		(1,705	)
Prepaid expenses		(1,146	)		(138	)
Goodwill		(402	)		(205	)
Adoption of ASC 606		(2,824	)		(4,227	)
Total deferred tax liabilities		(6,070	)		(6,275	)
Net deferred tax assets		99,743			69,981
Less: valuation allowance		(99,862	)		(70,017	)
Net deferred tax assets (liabilities)	$	(119	)	$	(36	)

Net Loss Per Share (Tables)

12 Months Ended

Dec. 31, 2020

Earnings Per Share [Abstract]

Summary of Potentially Dilutive Securities Not Included in Calculation of Diluted Loss Per Share

The table below provides potentially dilutive securities in equivalent common shares not included in the Company’s calculation of diluted loss per share because to do so would be antidilutive:

	Year Ended December 31,
	2020		2019
Stock options to purchase common stock		4,268,945		2,561,866
Restricted stock units		1,468,765		322,608
Common stock warrant		400,160		—
Stock issuable upon conversion of convertible notes		51,529,036		—
Series A Preferred Stock		—		13,213,254
Series B Preferred Stock		—		16,488,731
Series B Preferred Stock Purchase Warrant		—		359,699
Total		57,666,906		32,946,158

Quarterly Financial Data (Unaudited) (Tables)

12 Months Ended

Dec. 31, 2020

Quarterly Financial Information Disclosure [Abstract]

Summary of Quarterly Financial Data

The following tables present selected quarterly financial data for the years presented, in thousands, except per share data:

	Three Months Ended
2020	December 31,			September 30,			June 30,			March 31,
Revenues	$	14,276		$	25,943		$	17,266		$	16,828
Loss from operations		(51,371	)		(44,571	)		(46,720	)		(52,526	)
Net loss		(75,528	)		(47,065	)		(52,783	)		(17,152	)
Net loss attributable to common stockholders		(75,528	)		(47,065	)		(53,051	)		(17,152	)
Net loss per share, basic and diluted		(1.53	)		(1.01	)		(6.11	)		(3.43	)

2019
Revenues	$	20,476		$	18,772		$	57,230		$	47,507
Loss from operations		(48,973	)		(54,841	)		(14,298	)		(22,007	)
Net loss		(50,476	)		(57,133	)		(16,409	)		(24,019	)
Net loss attributable to common stockholders		(86,840	)		(97,907	)		(16,409	)		(27,671	)
Net loss per share, basic and diluted		(17.46	)		(19.85	)		(3.34	)		(5.88	)

Organization and Description of Business - Additional Information (Details) $ / shares in Units, $ in Thousands				1 Months Ended	3 Months Ended								12 Months Ended
	Jun. 23, 2020 USD ($) $ / shares shares	Jun. 18, 2020 USD ($) $ / shares shares	Jun. 10, 2020	Dec. 31, 2020 USD ($) $ / shares shares	Dec. 31, 2020 USD ($) $ / shares	Sep. 30, 2020 USD ($)	Jun. 30, 2020 USD ($)	Mar. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)	Sep. 30, 2019 USD ($)	Jun. 30, 2019 USD ($)	Mar. 31, 2019 USD ($)	Dec. 31, 2020 USD ($) $ / shares	Dec. 31, 2019 USD ($)	May 08, 2020 $ / shares
Organization Consolidation And Presentation Of Financial Statements Disclosure [Line Items]
Description of stock split													On June 10, 2020, the Company amended its certificate of incorporation to reflect a one-for-6.178 reverse stock split of the Company’s common stock.
Stock split conversion ratio			0.162
Proceeds from issuance of common stock, net													$ 116,435	$ 551
Cash and cash equivalents				$ 92,076	$ 92,076				$ 33,042				92,076	33,042
Accumulated deficit				(541,274)	(541,274)				(348,478)				(541,274)	(348,478)
Net loss					(75,528)	$ (47,065)	$ (52,783)	$ (17,152)	$ (50,476)	$ (57,133)	$ (16,409)	$ (24,019)	(192,528)	(148,037)
Cash used in operating activities													(165,744)	$ (106,124)
Mortgages
Organization Consolidation And Presentation Of Financial Statements Disclosure [Line Items]
Outstanding balance				$ 3,100	3,100								$ 3,100
7.25% Convertible Senior Notes due 2025
Organization Consolidation And Presentation Of Financial Statements Disclosure [Line Items]
Debt instrument, issuance date				Dec. 07, 2020									Dec. 31, 2020
Principal amount				$ 168,500	$ 168,500								$ 168,500
Debt instrument, annual interest rate				7.25%	7.25%								7.25%
Outstanding balance				$ 78,500	$ 78,500								$ 78,500
IPO
Organization Consolidation And Presentation Of Financial Statements Disclosure [Line Items]
Share issued price per share \| $ / shares															$ 15.00
IPO \| Common Stock
Organization Consolidation And Presentation Of Financial Statements Disclosure [Line Items]
Common stock issued and sold \| shares	6,666,667	6,666,667
Share issued price per share \| $ / shares	$ 15.00	$ 15.00
Proceeds from issuance of common stock, net	$ 88,700	$ 88,700
Underwritten Public Offering \| Common Stock
Organization Consolidation And Presentation Of Financial Statements Disclosure [Line Items]
Common stock issued and sold \| shares				8,792,047
Share issued price per share \| $ / shares				$ 3.27	$ 3.27								$ 3.27
Proceeds from issuance of common stock, net				$ 26,900									$ 26,900

Summary of Significant Accounting Policies - Additional Information (Details)	12 Months Ended
	Dec. 31, 2020 USD ($) Segment	Dec. 31, 2019 USD ($)	Mar. 31, 2020	Jan. 01, 2019 USD ($)
Summary Of Significant Accounting Policies [Line Items]
Number of operating segment \| Segment	1
Minimum Contractual maturities period of investment	12 months
Inventory write-downs	$ 143,000	$ 535,000
Impairment of goodwill	0	0
Impairment of intangible assets	0	0
Impairment of long-lived assets	0	0
Advertising expense	$ 1,600,000	2,200,000
Vesting period of stock options	4 years
Expected dividend yield	0.00%
Minimum percentage of Recognized income tax positions	50.00%
Other comprehensive income or loss	$ 0
Accumulated deficit	$ (541,274,000)	$ (348,478,000)
Adoption of ASC 606
Summary Of Significant Accounting Policies [Line Items]
Change in accounting principle, accounting standards update, adopted [true false]	true
Change in accounting principle, accounting standards update, adoption date	Jan. 01, 2019
Accumulated deficit				$ 23,700,000
Accounting Standards Update 2018-07
Summary Of Significant Accounting Policies [Line Items]
Change in accounting principle, accounting standards update, adopted [true false]	true
Change in accounting principle, accounting standards update, immaterial effect [true false]	true
Accounting Standards Update 2019-12
Summary Of Significant Accounting Policies [Line Items]
Change in accounting principle, accounting standards update, adopted [true false]			true
Change in accounting principle, accounting standards update, adoption date			Mar. 31, 2020
Change in accounting principle, accounting standards update, immaterial effect [true false]			true
Change in accounting principle, accounting standards update, early adoption [true false]			true
Accounting Standards Update 2017-04
Summary Of Significant Accounting Policies [Line Items]
Change in accounting principle, accounting standards update, adopted [true false]	true
Change in accounting principle, accounting standards update, immaterial effect [true false]	true
Accounting Standards Update 2016-02
Summary Of Significant Accounting Policies [Line Items]
Change in accounting principle, accounting standards update, adopted [true false]	false
Accounting Standards Update 2016-13
Summary Of Significant Accounting Policies [Line Items]
Change in accounting principle, accounting standards update, adopted [true false]	false
Accounting Standards Update 2020-06
Summary Of Significant Accounting Policies [Line Items]
Change in accounting principle, accounting standards update, adopted [true false]	false
Maximum
Summary Of Significant Accounting Policies [Line Items]
Amortization period	1 year

Summary of Significant Accounting Policies - Schedule of Accounts Receivable Balances and Revenues as Percentage of Total Accounts Receivable Balances and Revenues (Details) - Customer Concentration Risk	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Blue Shield of Texas \| Accounts Receivable
Concentration Risk [Line Items]
Percentage of accounts receivable	17.80%
Blue Shield of Texas \| Revenue
Concentration Risk [Line Items]
Percentage of revenues	35.60%	21.30%
Government Health Benefits Programs \| Accounts Receivable
Concentration Risk [Line Items]
Percentage of accounts receivable	26.20%	16.70%
Government Health Benefits Programs \| Revenue
Concentration Risk [Line Items]
Percentage of revenues	3.70%
Aetna \| Accounts Receivable
Concentration Risk [Line Items]
Percentage of accounts receivable	4.00%	6.00%
Aetna \| Revenue
Concentration Risk [Line Items]
Percentage of revenues	11.00%	9.20%
Cigna \| Accounts Receivable
Concentration Risk [Line Items]
Percentage of accounts receivable	2.60%
Cigna \| Revenue
Concentration Risk [Line Items]
Percentage of revenues	7.60%	4.50%
United Healthcare \| Accounts Receivable
Concentration Risk [Line Items]
Percentage of accounts receivable	6.60%	31.50%
United Healthcare \| Revenue
Concentration Risk [Line Items]
Percentage of revenues	6.70%	30.80%
Anthem \| Accounts Receivable
Concentration Risk [Line Items]
Percentage of accounts receivable	3.50%
Anthem \| Revenue
Concentration Risk [Line Items]
Percentage of revenues	(6.70%)	6.10%

Summary of Significant Accounting Policies - Summary of Estimated Useful Life of Property and Equipment (Details)	12 Months Ended
	Dec. 31, 2020
Computer and Software
Concentration Risk [Line Items]
Estimated useful life of property and equipment	3 years
Laboratory Equipment
Concentration Risk [Line Items]
Estimated useful life of property and equipment	5 years
Furniture, Fixtures, and Office Equipment
Concentration Risk [Line Items]
Estimated useful life of property and equipment	8 years
Building
Concentration Risk [Line Items]
Estimated useful life of property and equipment	15 years

Summary of Significant Accounting Policies - Summary of Amortization Periods for Acquired Intangible Assets (Details)	12 Months Ended
	Dec. 31, 2020
Trade Names
Concentration Risk [Line Items]
Useful life of intangible assets	10 years
Payor Relationships
Concentration Risk [Line Items]
Useful life of intangible assets	10 years
Noncompete Agreements
Concentration Risk [Line Items]
Useful life of intangible assets	6 years

Variable Interest Entity - Additional Information (Details) - USD ($)	1 Months Ended	12 Months Ended
	Jun. 30, 2015	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Dec. 05, 2018
Variable Interest Entity [Line Items]
Liabilities		$ 261,434,000	$ 185,601,000
Remaining settlement obligation of mortgage loan			3,000,000
Cigna Settlement Obligation
Variable Interest Entity [Line Items]
Settlement of obligations guaranteed				$ 12,000,000
Avero
Variable Interest Entity [Line Items]
Term of agreement	10 years
Liabilities		10,391,000	10,562,000
Mortgage payable		1,700,000	1,900,000
Avero \| Recourse
Variable Interest Entity [Line Items]
Liabilities		0	0
Avero \| Cigna Settlement Obligation
Variable Interest Entity [Line Items]
Litigation settlement amount agreed to pay to other party					$ 12,000,000
Litigation settlement upfront payment					6,000,000
Remaining settlement amount					$ 6,000,000
Financial support for obligation settlement		$ 3,000,000	$ 3,000,000

Variable Interest Entity - Schedule of Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Assets
Cash and cash equivalents	$ 92,076	$ 33,042
Accounts receivable, net	12,682	22,189
Inventory	12,219	10,937
Prepaid expenses and other current assets	9,361	7,846
Property and equipment, net	17,842	15,891
Other assets	198	198
Goodwill	6,219	6,219
Other intangible assets, net	3,843	4,771
Total assets	154,440	101,727
Liabilities of Avero
Accounts payable	17,410	15,754
Current portion of capital lease obligations	312	727
Current portion of mortgage payable	271	241
Capital lease obligations, net of current portion	46	358
Mortgage payable, net of current portion	2,795	3,081
Other long-term liabilities	8,667	12,859
Total liabilities	261,434	185,601
Avero
Assets
Cash and cash equivalents	556	1,837
Accounts receivable, net	6,047	4,269
Inventory	3,382	2,572
Prepaid expenses and other current assets	1,254	1,181
Property and equipment, net	5,436	5,586
Other assets	30	30
Goodwill	6,219	6,219
Other intangible assets, net	3,843	4,771
Total assets	26,767	26,465
Liabilities of Avero
Accounts payable	4,722	2,450
Accrued expenses and other accrued liabilities	3,472	5,630
Current portion of capital lease obligations	46	59
Current portion of mortgage payable	199	173
Capital lease obligations, net of current portion	4	50
Mortgage payable, net of current portion	1,520	1,733
Other long-term liabilities	428	467
Total liabilities	$ 10,391	$ 10,562

Revenues - Additional Information (Details) - USD ($) $ in Millions		3 Months Ended	12 Months Ended
	Dec. 03, 2020	Jun. 30, 2020	Dec. 31, 2020	Dec. 31, 2019
Revenue From Contract With Customer [Abstract]
Amount of reimbursement overpayment received from government payors	$ 10.3	$ 10.3
Accrued refunds to government payors			$ 10.3
Performance obligations resulted in increase (decrease) of revenue			$ (26.9)	$ (16.0)

Revenues - Summary of Disaggregation of Revenues by Payor (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2020	Dec. 31, 2019
Disaggregation of Revenue [Line Items]
Total revenues	$ 14,276	$ 25,943	$ 17,266	$ 16,828	$ 20,476	$ 18,772	$ 57,230	$ 47,507	$ 74,313	$ 143,985
Commercial Third-party Payors
Disaggregation of Revenue [Line Items]
Total revenues									64,433	139,051
Government Health Benefit Programs
Disaggregation of Revenue [Line Items]
Total revenues									2,731	195
Patient/Laboratory Distribution Partners
Disaggregation of Revenue [Line Items]
Total revenues									$ 7,149	$ 4,739

- Definition

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8906-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 40
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e9031-108599

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 41
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e9038-108599

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8933-108599

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8933-108599

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 4
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130543-203045

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8736-108599

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8736-108599

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 42
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e9054-108599

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 5
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130545-203045

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 924
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 11.L)
-URI http://asc.fasb.org/extlink&oid=6472922&loc=d3e499488-122856

+ Details

Balance Sheet Components - Summary of Prepaid Expenses and Other Current Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Prepaid expenses	$ 9,116	$ 6,476
Other current assets	245	1,370
Total	$ 9,361	$ 7,846

Balance Sheet Components - Summary of Property and Equipment, Net (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Total property and equipment	$ 37,288	$ 33,201
Less accumulated depreciation and amortization	(19,446)	(17,310)
Property and equipment, net	17,842	15,891
Computers and Software
Property, Plant and Equipment [Line Items]
Total property and equipment	14,591	13,913
Building and Leasehold Improvements
Property, Plant and Equipment [Line Items]
Total property and equipment	9,458	9,491
Laboratory Equipment
Property, Plant and Equipment [Line Items]
Total property and equipment	7,678	5,580
Furniture, Fixtures, and Office Equipment
Property, Plant and Equipment [Line Items]
Total property and equipment	1,686	1,633
Construction in Progress
Property, Plant and Equipment [Line Items]
Total property and equipment	2,784	1,493
Land
Property, Plant and Equipment [Line Items]
Total property and equipment	$ 1,091	$ 1,091

Balance Sheet Components - Summary of Capital Leases Included in Property and Equipment, Net (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Capital leases	$ 2,467	$ 3,692
Less accumulated depreciation and amortization	(1,954)	(2,239)
Capital leases included in property and equipment, net	$ 513	$ 1,453

Balance Sheet Components - Additional Information (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Depreciation expense	$ 4.1	$ 3.7
Amortization expense of intangible assets	$ 0.9	$ 0.9

Balance Sheet Components - Summary of Intangible Assets, Net (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Finite-Lived Intangible Assets [Line Items]
Cost	$ 9,024	$ 9,024
Accumulated amortization	(5,181)	(4,253)
Net	3,843	4,771
Payor Relationships
Finite-Lived Intangible Assets [Line Items]
Cost	7,230	7,230
Accumulated amortization	(4,037)	(3,314)
Net	3,193	3,916
Trade Names
Finite-Lived Intangible Assets [Line Items]
Cost	1,410	1,410
Accumulated amortization	(787)	(646)
Net	623	764
Noncompete Agreements
Finite-Lived Intangible Assets [Line Items]
Cost	384	384
Accumulated amortization	(357)	(293)
Net	$ 27	$ 91

Balance Sheet Components - Summary of Future Amortization of Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Organization Consolidation And Presentation Of Financial Statements [Abstract]
2021	$ 891
2022	864
2023	864
2024	864
2025	360
Net	$ 3,843	$ 4,771

Balance Sheet Components - Summary of Accrued Expenses and Other Current Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Accrual for reimbursement claims and settlements, current	$ 30,487	$ 60,386
Commissions and bonuses	4,619	6,357
Vacation and payroll benefits	8,896	5,506
Accrued professional services	3,385	5,322
Contract liabilities	378
Other	6,912	6,044
Total	$ 54,677	$ 83,615

Balance Sheet Components - Summary of Other Long-term Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Accrual for reimbursement claims and settlements, net of current portion	$ 7,053	$ 12,205
Other	1,614	654
Total	$ 8,667	$ 12,859

Fair Value Measurements - Summary of Financial Assets and Liabilities Measured at Fair Value on Recurring Basis (Details) - Fair Value on Recurring Basis - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Quoted Prices for Identical Assets (Level 1) \| Money Market Funds
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Total assets at fair value	$ 90,254	$ 24,432
Significant Unobservable Inputs (Level 3)
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Embedded derivative liability	$ 18,370

Fair Value Measurements - Additional Information (Details) - USD ($)	Dec. 31, 2020	Sep. 30, 2020	Dec. 31, 2019	Sep. 30, 2019
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Transfer of assets from level 1 to level 2		$ 0		$ 0
Transfer of assets from level 2 to level 1		$ 0		$ 0
Carrying value of convertible notes, net of discount	$ 158,886,000
Fair value of convertible notes	$ 250,200,000
2017 Term Loan
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Carrying value of term loan			$ 75,000,000
Fair value of term loan			$ 79,800,000

Convertible Notes - Additional Information (Details)	1 Months Ended	12 Months Ended
Convertible Notes - Additional Information (Details)	Dec. 31, 2020 USD ($) $ / shares	Dec. 31, 2020 USD ($) Day $ / shares	Dec. 31, 2019 USD ($)	Dec. 07, 2020 USD ($)
Debt Instrument [Line Items]
Embedded derivative liability				$ 4,600,000
Derivative liabilities fair value	$ 18,400,000	$ 18,400,000
Derivative liability related to debt discount				$ 9,700,000
Issuance costs	9,700,000	9,700,000
Unamortized discount	9,600,000	9,600,000	$ 6,034,000
Amortization of debt discount		3,656,000	$ 1,670,000
Interest Expense
Debt Instrument [Line Items]
Amortization of debt discount		100,000
7.25% Convertible Senior Notes due 2025
Debt Instrument [Line Items]
Principal amount	$ 168,500,000	$ 168,500,000
Debt instrument, annual interest rate	7.25%	7.25%
Debt instrument, issuance date	Dec. 07, 2020	Dec. 31, 2020
Debt instrument, frequency of periodic payment	semi-annually
Debt instrument due date	Dec. 01, 2025
Debt instrument, initial payment date	Jun. 01, 2021
Debt instrument, convertible, initial conversion rate per $1,000 principal amount of convertible notes		278.0094
Debt instrument convertible initial conversion price \| $ / shares	$ 3.60	$ 3.60
Debt instrument, redemption period, start date		Dec. 01, 2023
Debt instrument, convertible, threshold percentage of stock price trigger		130.00%
Debt instrument, convertible, threshold trading days \| Day		20
Debt instrument, convertible, threshold consecutive trading days \| Day		30
Events of default, description		The Convertible Notes have customary provision relating to the occurrence of “Events of Default” (as defined in the Indenture), which include the following: (i) certain payment defaults on the Convertible Notes (which, in the case of a default in the payment of interest on the Convertible Notes, will be subject to a 30-day cure period); (ii) the Company’s failure to send certain notices under the Indenture within specified periods of time; (iii) the Company’s failure to comply with certain covenants in the Indenture relating to the Company’s ability to consolidate with or merge with or into, or sell, lease or otherwise transfer, in one transaction or a series of transactions, all or substantially all of the assets of the Company and its subsidiaries, taken as a whole, to another person; (iv) a default by the Company in its other obligations or agreements under the Indenture or the Convertible Notes if such default is not cured or waived within 60 days after notice is given in accordance with the Indenture; (v) certain defaults by the Company or any of its subsidiaries with respect to indebtedness for borrowed money of at least $7,500,000; (vi) the rendering of certain judgments against the Company or any of its subsidiaries for the payment of at least $7,500,000, where such judgments are not discharged or stayed within 60 days after the date on which the right to appeal has expired or on which all rights to appeal have been extinguished; and (vii) certain events of bankruptcy, insolvency and reorganization involving the Company or any of the Company’s significant subsidiaries.
Debt instrument, effective interest rate	8.70%	8.70%
7.25% Convertible Senior Notes due 2025 \| Minimum
Debt Instrument [Line Items]
Debt instrument, debt default, amount	$ 7,500,000	$ 7,500,000

Related Party Transactions - Additional Information (Details) - USD ($)				1 Months Ended		2 Months Ended	12 Months Ended
	Dec. 07, 2020	May 08, 2020	Oct. 27, 2017	Dec. 31, 2020	Jun. 30, 2020	Jun. 30, 2020	Dec. 31, 2020	Dec. 31, 2019	Jun. 23, 2020	Jun. 18, 2020	Apr. 03, 2020	Mar. 31, 2020	Feb. 29, 2020
Related Party Transaction [Line Items]
Interest expense							$ 9,984,000	$ 9,199,000
Debt discount amortization							3,656,000	$ 1,670,000
Derivative liabilities fair value				$ 18,400,000			18,400,000
Change in fair value of derivative liability							(13,860,000)
Loss on extinguishment of debt							10,952,000
Unsecured Convertible Promissory Note
Related Party Transaction [Line Items]
Debt instrument due date		May 08, 2022
Debt discount amortization					$ 200,000
Principal amount		$ 15,000,000
Debt instrument, annual interest rate		8.00%
Conversion price percentage on IPO price		80.00%
Percentage of premium on aggregate principal amount		50.00%
Derivative liabilities fair value		$ 3,600,000		$ 3,800,000			$ 3,800,000
Fair value of common shares issued					3,400,000
Unsecured Convertible Promissory Note \| Interest and Other Income (Expense), Net
Related Party Transaction [Line Items]
Change in fair value of derivative liability						$ 200,000
Loss on extinguishment of debt					$ 3,600,000
IPO
Related Party Transaction [Line Items]
Issuance of common stock		3,333,333
Shares issued, price per share		$ 15.00
IPO \| Unsecured Convertible Promissory Note
Related Party Transaction [Line Items]
Number of shares on debt conversion					1,250,000
Series B Preferred Stock
Related Party Transaction [Line Items]
Preferred stock, shares issued				0			0	101,867,405			4,444,444		5,066,666
Shares issued, price per share													$ 2.25
Series B Preferred Stock \| Unsecured Convertible Promissory Note
Related Party Transaction [Line Items]
Debt instrument convertible initial conversion price		$ 13.90
Percentage of price per share		80.00%
Common Stock \| IPO
Related Party Transaction [Line Items]
Issuance of common stock							6,666,667
Shares issued, price per share									$ 15.00	$ 15.00
Common Stock \| Series B Preferred Stock Purchase Warrant \| IPO
Related Party Transaction [Line Items]
Warrants exercisable										400,160
2017 Term Loan
Related Party Transaction [Line Items]
Term loan								$ 75,000,000
Principal amount				$ 103,500,000			$ 103,500,000
Loss on extinguishment of debt							7,600,000
Exchanged for principal amount of convertible notes	$ 78,500,000
Acquired additional principal amount				25,000,000			25,000,000
Accrued interest expense				$ 500,000			$ 500,000
2017 Term Loan \| Common Stock \| IPO
Related Party Transaction [Line Items]
Shares issued, price per share				$ 3.27			$ 3.27
Common stock issued underwritten public offering price acquired				4,128,440
Gross proceeds from issuance of common stock underwritten public offering price				$ 13,200,000
Credit and Security Agreement and Series B Convertible Preferred Stock Purchase Agreement with Private Equity Firm \| 2017 Term Loan
Related Party Transaction [Line Items]
Debt instrument, interest rate per annum			9.50%
Debt instrument due date			Oct. 27, 2022
Debt instrument, covenant description							The 2017 Term Loan contained customary covenants, including a requirement to maintain a minimum unrestricted cash balance at all times of at least $5.0 million and was secured by all tangible and intangible property and assets of the Company, with the exception of its intellectual property.
Term loan								75,000,000
Unamortized discount and issuance costs								6,000,000
Interest expense							$ 7,500,000	8,900,000
Debt discount amortization							$ 2,100,000	$ 1,700,000
Credit and Security Agreement and Series B Convertible Preferred Stock Purchase Agreement with Private Equity Firm \| 2017 Term Loan \| Minimum
Related Party Transaction [Line Items]
Unrestricted cash			$ 5,000,000
Subscription Agreement with Lender \| Series B Preferred Stock
Related Party Transaction [Line Items]
Preferred stock, shares issued												967,130
Shares issued, price per share												$ 2.25

Mortgages Payable - Additional Information (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Jan. 31, 2014
Comerica Bank
Debt Instrument [Line Items]
Mortgages Payable			$ 1.8
Outstanding balance	$ 1.3	$ 1.4
Mortgage maturity year	2024
Comerica Bank \| London Interbank Offered Rate (LIBOR)
Debt Instrument [Line Items]
Interest rate	2.94%
American Bank of Commerce
Debt Instrument [Line Items]
Outstanding balance	$ 1.7	$ 1.9
Interest rate	3.25%
Mortgage maturity year	2029

Mortgages Payable - Schedule of Minimum Principal Payments (Details) - Mortgages $ in Thousands	Dec. 31, 2020 USD ($)
Debt Instrument [Line Items]
2021	$ 271
2022	281
2023	292
2024	1,338
2025	884
Total future minimum payments	3,066
Less current portion of mortgages payable	(271)
Mortgages payable, net of current portion	$ 2,795

Commitments and Contingencies - Additional Information (Details)									3 Months Ended			12 Months Ended
	Dec. 22, 2020 Case	Dec. 03, 2020 USD ($) Case	Nov. 16, 2020 USD ($)	Jul. 23, 2020 USD ($)	Jul. 21, 2020 USD ($) State	Dec. 05, 2018 USD ($)	Oct. 18, 2018 USD ($)	Jun. 25, 2018 USD ($)	Dec. 31, 2020 USD ($)	Jun. 30, 2020 USD ($)	Mar. 31, 2020 USD ($)	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)	Oct. 02, 2020 USD ($)	Oct. 01, 2020 USD ($)
Commitment And Contingencies [Line Items]
Rent expense for operating leases												$ 7,600,000	$ 8,900,000
Weighted average imputed interest rate									5.98%			5.98%
Number of states participating in settlement \| State					45
Contractual obligation									$ 13,200,000			$ 13,200,000		$ 8,700,000	$ 13,200,000
Contractual obligation in December 2021															1,400,000
Contractual obligation in December 2022															1,900,000
Income taxes civil settlement damages awards and tax refund amount in single year, CARES Act											$ 5,000,000
Income taxes percentage of payments related to civil settlement damages awards and tax refund, CARES Act											65.00%
Income tax discrete benefit related to net operating loss, CARES Act									37,700,000
Contractual obligation tax benefits												37,700,000
Percentage of contractual obligation initial payments														17.00%
Contractual obligation in December 2020												9,700,000
Contractual obligation in December 2023															$ 200,000
Accrual settlement amount											$ 13,200,000		$ 35,800,000
Aggregate amount of historical payments			$ 27,400,000
Number of actions pending \| Case	2	2
Amount of reimbursement overpayment received from government payors		$ 10,300,000								$ 10,300,000
Accrued Expenses And Other Current Liabilities
Commitment And Contingencies [Line Items]
Remaining accrual balance									5,000,000			5,000,000
Other Long Term Liabilities
Commitment And Contingencies [Line Items]
Remaining accrual balance									7,100,000			7,100,000
Cigna Settlement Obligation \| Avero
Commitment And Contingencies [Line Items]
Litigation settlement agreement date						December 5, 2018
Litigation settlement amount agreed to pay to other party						$ 12,000,000
Litigation settlement upfront payment						6,000,000
Remaining settlement amount						6,000,000
Litigation settlement reduction of revenue						$ 12,000,000
Aetna Settlement Agreement
Commitment And Contingencies [Line Items]
Litigation settlement agreement date								November 2019
Litigation settlement amount agreed to pay to other party								$ 15,000,000
Litigation settlement reduction of revenue								$ 15,000,000
Aetna Settlement Agreement \| Accrued Expenses And Other Current Liabilities
Commitment And Contingencies [Line Items]
Remaining accrual balance									2,500,000			2,500,000
United Health Group Settlement Agreement
Commitment And Contingencies [Line Items]
Litigation settlement agreement date							September 30, 2019
Litigation settlement amount agreed to pay to other party							$ 30,000,000
Litigation settlement upfront payment							2,000,000
Litigation settlement amount for first two installments							5,000,000
Litigation settlement amount for remaining installments							$ 6,000,000
United Health Group Settlement Agreement \| Accrued Expenses And Other Current Liabilities
Commitment And Contingencies [Line Items]
Remaining accrual balance									12,000,000			12,000,000
SDNY Civil Settlement Agreement
Commitment And Contingencies [Line Items]
Contractual obligation				$ 19,400,000
Initial payment amount									14,700,000			14,700,000
Contractual obligation in December 2021				2,000,000
Contractual obligation in December 2022				$ 2,800,000
Interest rate				1.25%
Income taxes percentage of payments related to civil settlement damages awards and tax refund, CARES Act				26.00%
Maximum acceleration amount				$ 4,100,000
Income tax discrete benefit related to net operating loss, CARES Act												37,700,000
Accelerated payments									4,100,000			4,100,000
SDNY Civil Settlement Agreement \| U.S. Federal Government
Commitment And Contingencies [Line Items]
Contractual obligation				9,700,000
SDCA Civil Settlement Agreement
Commitment And Contingencies [Line Items]
Contractual obligation					$ 16,400,000
Initial payment amount									12,500,000			12,500,000
Contractual obligation in December 2021					1,700,000
Contractual obligation in December 2022					$ 2,200,000
Interest rate					1.25%
Income taxes percentage of payments related to civil settlement damages awards and tax refund, CARES Act					22.00%
Maximum acceleration amount					$ 3,400,000
Income tax discrete benefit related to net operating loss, CARES Act												37,700,000
Accelerated payments									$ 3,400,000			$ 3,400,000
SDCA Civil Settlement Agreement \| U.S. Federal Government
Commitment And Contingencies [Line Items]
Contractual obligation					$ 10,000,000
Non-Prosecution Agreement
Commitment And Contingencies [Line Items]
Maximum extension of term of agreement					24 months
Minimum
Commitment And Contingencies [Line Items]
Noncancelable operating lease term									2 years			2 years
Negotiated settlement payment period			1 year
Minimum \| SDNY Civil Settlement Agreement
Commitment And Contingencies [Line Items]
Income taxes civil settlement damages awards and tax refund amount in single year, CARES Act				$ 5,000,000
Minimum \| SDCA Civil Settlement Agreement
Commitment And Contingencies [Line Items]
Income taxes civil settlement damages awards and tax refund amount in single year, CARES Act					$ 5,000,000
Maximum
Commitment And Contingencies [Line Items]
Noncancelable operating lease term									4 years			4 years
Negotiated settlement payment period			2 years

Commitments and Contingencies - Schedule of Net Minimum Payments Under Non-Cancelable Operating Leases (Details) $ in Thousands	Dec. 31, 2020 USD ($)
Commitments And Contingencies Disclosure [Abstract]
2021	$ 5,750
2022	3,017
2023	1,036
2024	38
Total future minimum lease payments	$ 9,841

Commitments and Contingencies - Schedule of Future Minimum Payments Under Capital Leases (Details) $ in Thousands	Dec. 31, 2020 USD ($)
Commitments And Contingencies Disclosure [Abstract]
2021	$ 324
2022	47
Total minimum lease payments	371
Less amounts representing interest	(13)
Present value of minimum capital lease payments	358
Less current portion of capital lease obligations	(312)
Capital lease obligations, net of current portion	$ 46

Stockholders' Equity - Additional Information (Details) $ / shares in Units, $ in Thousands									1 Months Ended			12 Months Ended
	Jun. 23, 2020 USD ($) $ / shares shares	Jun. 18, 2020 USD ($) $ / shares shares	Jun. 10, 2020	Apr. 03, 2020 USD ($) $ / shares shares	Dec. 19, 2019 USD ($) $ / shares shares	Nov. 22, 2019 USD ($) $ / shares shares	Nov. 12, 2019 USD ($) $ / shares shares	Aug. 27, 2019 USD ($) $ / shares shares	Dec. 31, 2020 USD ($) $ / shares shares	Feb. 29, 2020 USD ($) $ / shares shares	Jun. 30, 2014 USD ($) Appraisal shares	Dec. 31, 2020 USD ($) Vote $ / shares shares	Dec. 31, 2019 USD ($) shares	May 08, 2020 $ / shares	Mar. 31, 2020 $ / shares shares	Dec. 31, 2018 shares	Oct. 27, 2017 shares
Class Of Stock [Line Items]
Common stock authorized to issue									350,000,000			350,000,000	300,000,000
Preferred stock, shares authorized									10,000,000			10,000,000	130,155,000
Number of vote per share of common stock held \| Vote												1
Proceeds from issuance of common stock, net \| $												$ 116,435	$ 551
Deferred offering costs \| $													$ 1,100
Stock repurchased during period									3,515,028			3,515,028	3,474,572
Stock value repurchased during period \| $									$ 18,771			$ 18,771	$ 18,771
Stock split			0.162
Accumulated deficit \| $									$ 541,274			541,274	348,478
Amount received in exchange for issuance of shares of preferred stock \| $												$ 21,307	79,039
August 2019 Financing
Class Of Stock [Line Items]
Preferred stock dividends, shares												4,017,512
Increase in accumulated deficit \| $													13,100
Exchange Agreement
Class Of Stock [Line Items]
Exchange ratio of shares								3.20%
Accumulated deficit \| $													27,600
November Series B Preferred Stock Purchase Agreement
Class Of Stock [Line Items]
Increase in accumulated deficit \| $													$ 36,400
Series B Preferred Stock Purchase Warrant \| August 2019 Financing
Class Of Stock [Line Items]
Preferred stock, shares issued								9,090,910
Shares issued, price per share \| $ / shares								$ 2.75
Consideration paid \| $								$ 25,000
Amended underlying preferred stock purchase warrant								1,416,431									1,818,182
Series B Preferred Stock
Class Of Stock [Line Items]
Preferred stock, shares authorized									0			0	126,035,000
Preferred stock, shares issued				4,444,444					0	5,066,666		0	101,867,405
Shares issued, price per share \| $ / shares				$ 2.25
Consideration paid \| $													$ 102
Amount received in exchange for issuance of shares of preferred stock \| $				$ 10,000						$ 11,400
Shares issued, price per share \| $ / shares										$ 2.25
Preferred stock, shares outstanding									0			0	101,867,405
Series B Preferred Stock \| August 2019 Financing
Class Of Stock [Line Items]
Stock split												1.28
Stock split, description												1.28-for-1
Series B Preferred Stock \| Exchange Agreement
Class Of Stock [Line Items]
Number of shares issued on conversion/exchange								35,664,240
Series B Preferred Stock \| November Series B Preferred Stock Purchase Agreement
Class Of Stock [Line Items]
Preferred stock, shares issued							11,111,111
Amount received in exchange for issuance of shares of preferred stock \| $							$ 25,000
Shares issued, price per share \| $ / shares							$ 2.25
Additional shares of preferred stock issued							13,985,993
Series B Preferred Stock \| November Series B Preferred Stock Purchase Agreement \| Series B Preferred Stock Purchase Warrant Issued and Outstanding
Class Of Stock [Line Items]
Stock split							1.22
Stock split, description												1.22-for-1
Conversion price and exercise price of preferred stock and preferred stock purchase warrants \| $ / shares							$ 2.75
Reduction in conversion price and exercise price of preferred stock and preferred stock purchase warrants \| $ / shares							$ 2.25
Adjusted preferred stock purchase warrant to purchase shares of preferred stock							2,222,222
Series B Preferred Stock \| Additional Equity Financing
Class Of Stock [Line Items]
Preferred stock, shares issued					11,111,111	2,722,222
Amount received in exchange for issuance of shares of preferred stock \| $					$ 25,000	$ 6,100
Shares issued, price per share \| $ / shares					$ 2.25	$ 2.25
Series B Preferred Stock \| Credit Agreement Amendment
Class Of Stock [Line Items]
Preferred stock, shares issued															967,130
Shares issued, price per share \| $ / shares															$ 2.25
Series A-1 Preferred Stock
Class Of Stock [Line Items]
Preferred stock, shares authorized							0
Preferred stock, shares outstanding							0
Series A-1 Preferred Stock \| Exchange Agreement
Class Of Stock [Line Items]
Shares outstanding								1,500,000
Exchange ratio of shares								1.20%
Minimum \| August 2019 Financing
Class Of Stock [Line Items]
Convertible conversion and exercise price \| $ / shares									$ 2.75			$ 2.75
Maximum \| August 2019 Financing
Class Of Stock [Line Items]
Convertible conversion and exercise price \| $ / shares									$ 3.53			$ 3.53
Repurchase Program
Class Of Stock [Line Items]
Percentage of equity interest repurchased by certain employee											25.00%
Stock repurchased during period											800,000
Stock value repurchased during period \| $											$ 6,000
Repurchase Program \| Minimum
Class Of Stock [Line Items]
Reasonable period of time to hold the shares under the program											6 months
Number of common stock appraisal valuations covered \| Appraisal											2
Common Stock
Class Of Stock [Line Items]
Shares outstanding									59,287,331			59,287,331	8,451,415			8,112,581
Number of shares issued on conversion/exchange		33,443,562										1,250,000
Number of shares issued to an adjustment in the conversion rate		2,045,522
Common Stock \| Exchange Agreement
Class Of Stock [Line Items]
Number of shares issued on conversion/exchange								4,810,651
IPO
Class Of Stock [Line Items]
Shares issued, price per share \| $ / shares														$ 15.00
IPO \| Common Stock
Class Of Stock [Line Items]
Common stock issued and sold	6,666,667	6,666,667
Shares issued, price per share \| $ / shares	$ 15.00	$ 15.00
Proceeds from issuance of common stock, net \| $	$ 88,700	$ 88,700
Underwriting discounts and commissions \| $		7,000
Other offering expenses \| $		$ 4,300
IPO \| Common Stock \| Series B Preferred Stock Purchase Warrant
Class Of Stock [Line Items]
Adjusted preferred stock purchase warrant to purchase shares of preferred stock		400,160
Underwritten Public Offering \| Common Stock
Class Of Stock [Line Items]
Common stock issued and sold									8,792,047
Shares issued, price per share \| $ / shares									$ 3.27			$ 3.27
Proceeds from issuance of common stock, net \| $									$ 26,900			$ 26,900

Stockholders' Equity - Schedule of Preferred Stock Shares Authorized, Shares Issued and Outstanding, Per Share Price and Liquidation Preference (Details) - USD ($) $ / shares in Units, $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Class Of Stock [Line Items]
Shares Authorized	10,000,000	130,155,000
Shares Issued and Outstanding		105,987,405
Aggregate Liquidation Preference		$ 231,202
Series A
Class Of Stock [Line Items]
Shares Authorized	0	4,120,000
Shares Issued and Outstanding		4,120,000
Per Share Price at Issuance		$ 0.48543
Aggregate Liquidation Preference		$ 2,000
Series B
Class Of Stock [Line Items]
Shares Authorized	0	126,035,000
Shares Issued and Outstanding		101,867,405
Per Share Price at Issuance		$ 2.25000
Aggregate Liquidation Preference		$ 229,202

Stockholders' Equity - Schedule of Reserved Shares of Common Stock, On An As-if-converted Basis, for Future Issuance (Details) - USD ($)	Dec. 31, 2020	Dec. 31, 2019
Class Of Stock [Line Items]
Common stock shares reserved for future issuance	$ 60,605,522	$ 32,946,158
Series A Preferred Stock
Class Of Stock [Line Items]
Common stock shares reserved for future issuance		13,213,254
Series B Preferred Stock
Class Of Stock [Line Items]
Common stock shares reserved for future issuance		16,488,731
Common Stock Issuable Upon Conversion of Convertible Notes
Class Of Stock [Line Items]
Common stock shares reserved for future issuance	51,529,036
Series B Preferred Stock Purchase Warrant
Class Of Stock [Line Items]
Common stock shares reserved for future issuance		359,699
Common Stock Warrant
Class Of Stock [Line Items]
Common stock shares reserved for future issuance	400,160
Outstanding Stock Options to Purchase Common Stock
Class Of Stock [Line Items]
Common stock shares reserved for future issuance	4,268,945	2,561,866
Restricted Stock Units Outstanding
Class Of Stock [Line Items]
Common stock shares reserved for future issuance	1,468,765	$ 322,608
Available for Future Issuance under Equity Incentive Plan
Class Of Stock [Line Items]
Common stock shares reserved for future issuance	$ 2,938,616

Stock-Based Compensation - Additional Information (Details) $ / shares in Units, $ in Thousands	1 Months Ended		12 Months Ended
	Jun. 30, 2020 Period shares	Jan. 31, 2020 USD ($)	Dec. 31, 2020 USD ($) $ / shares shares	Dec. 31, 2019 USD ($) $ / shares shares	Jan. 01, 2021 shares	Mar. 04, 2020 shares	Mar. 31, 2019 shares	Feb. 28, 2018 shares
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Closing market price of common tock \| $ / shares			$ 5.31
Intrinsic value of all stock options exercised \| $			$ 4,200
Stock-based compensation expense \| $		$ 900	$ 10,668	$ 2,375
Weighted-average grant date fair value of options granted \| $ / shares			$ 5.15	$ 7.35
Unrecognized compensation cost related to unvested stock options expected to be recognized amount \| $			$ 12,800
Unrecognized compensation cost related to unvested stock options and RSUs expected to be recognized over remaining weighted average vesting period			2 years 11 months 4 days
Tax benefits related to stock-based compensation \| $			$ 0	$ 0
Restricted Stock Units (RSUs)
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Unrecognized compensation cost related to restricted stock options expected to be recognized amount \| $			$ 10,500
Second Amended and Restated 2012 Stock Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock options issuable under the plan								0
2015 Consultant Stock Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock options issuable under the plan								0
2018 Equity Incentive Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares available for future grant							1,100,000
Second Amended and Restated 2018 Equity Incentive Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares available for future grant				2,700,000
Third Amended and Restated 2018 Equity Incentive Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares available for future grant						7,615,733
2018 Third Amended Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares available for future grant			2,938,616
2018 Third Amended Plan \| Subsequent Event
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares reserved for future issuance					4,537,676
2020 Employee Stock Purchase Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares reserved for future issuance	510,000
Percentage of fair market value of shares on the offering date	85.00%
Percentage of fair market value of shares on the purchase date	85.00%
Maximum duration for purchase under employee stock purchase plan	24 months
Number of purchase periods \| Period	4
Duration of each purchase period	6 months
2020 Employee Stock Purchase Plan \| Subsequent Event
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares reserved for future issuance					557,723

Stock-Based Compensation - Summary of Stock Options Activity under Plans (Details) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2020 USD ($) $ / shares shares
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Stock Options Outstanding Balance at December 31, 2019 \| shares	2,561,866
Stock Options Outstanding Options granted \| shares	2,652,102
Stock Options Outstanding Options exercised \| shares	(543,218)
Stock Options Outstanding Options forfeited/cancelled \| shares	(401,805)
Stock Options Outstanding Balance at December 31, 2020 \| shares	4,268,945
Stock Options Outstanding Vested and expected to vest at December 31, 2020 \| shares	4,268,945
Stock Options Outstanding Vested and exercisable at December 31, 2020 \| shares	1,748,573
Weighted-Average Exercise Price Balance at December 31, 2019 \| $ / shares	$ 9.01
Weighted-Average Exercise Price Options granted \| $ / shares	8.22
Weighted-Average Exercise Price Options exercised \| $ / shares	1.15
Weighted-Average Exercise Price Options forfeited/cancelled \| $ / shares	11.24
Weighted-Average Exercise Price Balance at December 31, 2020 \| $ / shares	8.14
Weighted-Average Exercise Price Vested and expected to vest at December 30, 2020 \| $ / shares	8.14
Weighted-Average Exercise Price Vested and exercisable at December 30, 2020 \| $ / shares	$ 8.18
Weighted-Average Remaining Contractual Term (in years) Balance at December 31, 2020	7 years 8 months 26 days
Weighted-Average Remaining Contractual Term (in years) Vested and expected to vest at December 31, 2020	7 years 8 months 26 days
Weighted-Average Remaining Contractual Term (in years) Vested and exercisable at December 31, 2020	5 years 4 months 24 days
Aggregate Intrinsic Value Balance at December 31, 2020 \| $	$ 2,527
Aggregate Intrinsic Value Vested and expected to vest at December 31, 2020 \| $	2,527
Aggregate Intrinsic Value Vested and exercisable at December 31, 2020 \| $	$ 1,708

Stock-Based Compensation - Summary of Assumptions used to Determine Fair Value of Stock Options Granted (Details)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Risk-free interest rate, minimum	0.40%	1.40%
Risk-free interest rate, maximum	1.70%	2.40%
Expected volatility, minimum	57.00%	57.00%
Expected volatility, maximum	71.00%	71.00%
Expected dividend yield	0.00%
Expected life (years)		6 years 3 months
Minimum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Expected life (years)	4 years
Maximum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Expected life (years)	6 years 3 months 18 days

Stock-Based Compensation - Summary of Restricted Stock Units Activity (Details) - Restricted Stock Units (RSUs)	12 Months Ended
	Dec. 31, 2020 $ / shares shares
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Number of Shares, Beginning Balance \| shares	323,671
Number of Shares, Granted \| shares	1,389,919
Number of Shares, Vested \| shares	(140,422)
Number of Shares, Forfeited/cancelled \| shares	(104,403)
Number of Shares, Ending Balance \| shares	1,468,765
Weighted Average Grant Date Fair Value beginning of period \| $ / shares	$ 15.19
Weighted Average Grant Date Fair Value, Granted \| $ / shares	8.10
Weighted Average Grant Date Fair Value, Vested \| $ / shares	14.93
Weighted Average Grant Date Fair Value, Forfeited/cancelled \| $ / shares	12.06
Weighted Average Grant Date Fair Value end of period \| $ / shares	$ 8.73

Stock-Based Compensation - Schedule of Stock-based Compensation Expense (Details) - USD ($) $ in Thousands	1 Months Ended	12 Months Ended
	Jan. 31, 2020	Dec. 31, 2020	Dec. 31, 2019
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Stock-based compensation expense	$ 900	$ 10,668	$ 2,375
Cost of Sales
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Stock-based compensation expense		867	207
Research and Development
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Stock-based compensation expense		2,804	851
Selling and Marketing
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Stock-based compensation expense		1,633	501
General and Administrative
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Stock-based compensation expense		$ 5,364	$ 816

Income Taxes - Summary of Provision for Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Current provision:
Federal	$ (37,697)	$ (638)
State	82	(104)
Current provision	(37,615)	(742)
Deferred expense:
Federal	22	36
State	61
Deferred expense	83	36
Net income tax provision	$ (37,532)	$ (706)

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Income Taxes - Summary of Components of Income Tax Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Income Tax Expense Benefit Continuing Operations [Abstract]
Income tax benefit at U.S. federal statutory rate	$ (48,313)	$ (31,236)
State income tax benefit, net of federal benefit	(5,469)	(4,538)
NOL carryback and other true ups	(15,517)
Government litigation settlements	4,611
Federal research and development credit	(3,573)	(3,232)
Convertible debt	740
Stock-based compensation	84	(87)
Meals and entertainment		367
Change in valuation allowance	29,845	38,514
Other	60	(494)
Net income tax provision	$ (37,532)	$ (706)

Income Taxes - Summary of Deferred Tax Assets and Deferred Tax Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Deferred tax assets:
Net operating losses and carryforwards	$ 87,329	$ 51,768
Reserves	7,211	17,287
Intangible assets	3,878	3,982
Accrued expenses	1,816	3,025
Stock-based compensation	2,289	194
Convertible debt	3,290
Total deferred tax assets	105,813	76,256
Deferred tax liabilities:
Fixed assets	(1,698)	(1,705)
Prepaid expenses	(1,146)	(138)
Goodwill	(402)	(205)
Adoption of ASC 606	(2,824)	(4,227)
Total deferred tax liabilities	(6,070)	(6,275)
Net deferred tax assets	99,743	69,981
Less: valuation allowance	(99,862)	(70,017)
Net deferred tax assets (liabilities)	$ (119)	$ (36)

Income Taxes - Additional Information (Details) - USD ($)	3 Months Ended		12 Months Ended
	Dec. 31, 2020	Mar. 31, 2020	Dec. 31, 2020	Dec. 31, 2019
Income Tax [Line Items]
Deferred tax assets, valuation allowance	$ 99,862,000		$ 99,862,000	$ 70,017,000
Federal, net operating loss carryforwards	271,100,000		271,100,000
State income tax, net operating loss carryforwards	$ 200,000,000		$ 200,000,000
Federal net operating loss carryforwards, percentage of taxable income	80.00%		80.00%
Uncertain tax positions			$ 0
Uncertain income tax position, description			An uncertain income tax position will not be recognized if it has less than a 50% likelihood of being sustained.
Interest and penalties related to uncertain tax positions	$ 0		$ 0
Net operating loss carryback period in CARES Act			5 years
Income tax discrete benefit related to net operating loss, CARES Act	37,700,000
Income taxes civil settlement damages awards and tax refund amount in single year CARES Act		$ 5,000,000
Income taxes percentage of payments related to civil settlement damages awards and tax refund CARES Act		65.00%
Minimum
Income Tax [Line Items]
Percentage of shift in stock ownership to determine whether ownership change occurred			50.00%
Federal
Income Tax [Line Items]
Research and expenditure credit carryforwards	11,600,000		$ 11,600,000
Federal \| Research and Expenditure Credit Carryforwards
Income Tax [Line Items]
Net operating loss carryforwards, expiration date			Dec. 31, 2033
State and Local Jurisdiction
Income Tax [Line Items]
Research and expenditure credit carryforwards	$ 2,500,000		$ 2,500,000

Net Loss Per Share - Summary of Potentially Dilutive Securities Not Included in Calculation of Diluted Loss Per Share (Details) - shares	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive securities not included in calculation of diluted loss per share	57,666,906	32,946,158
Outstanding Stock Options to Purchase Common Stock
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive securities not included in calculation of diluted loss per share	4,268,945	2,561,866
Restricted Stock Units (RSUs)
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive securities not included in calculation of diluted loss per share	1,468,765	322,608
Common Stock Warrant
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive securities not included in calculation of diluted loss per share	400,160
Stock Issuable Upon Conversion Of Convertible Notes
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive securities not included in calculation of diluted loss per share	51,529,036
Series A Preferred Stock
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive securities not included in calculation of diluted loss per share		13,213,254
Series B Preferred Stock
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive securities not included in calculation of diluted loss per share		16,488,731
Series B Preferred Stock Purchase Warrant
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive securities not included in calculation of diluted loss per share		359,699

Employee Benefit Plan - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Employee Benefits And Share Based Compensation [Abstract]
Employee benefit plan, contributions by employer	$ 2.9	$ 2.5

- Definition

Amount of contribution received by defined benefit plan from employer which increases plan assets.

+ References + Details

Quarterly Financial Data (Unaudited) - Summary of Quarterly Financial Data (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2020	Dec. 31, 2019
Quarterly Financial Information Disclosure [Abstract]
Revenues	$ 14,276	$ 25,943	$ 17,266	$ 16,828	$ 20,476	$ 18,772	$ 57,230	$ 47,507	$ 74,313	$ 143,985
Loss from operations	(51,371)	(44,571)	(46,720)	(52,526)	(48,973)	(54,841)	(14,298)	(22,007)	(195,188)	(140,119)
Net loss	(75,528)	(47,065)	(52,783)	(17,152)	(50,476)	(57,133)	(16,409)	(24,019)	$ (192,528)	$ (148,037)
Net loss attributable to common stockholders	$ (75,528)	$ (47,065)	$ (53,051)	$ (17,152)	$ (86,840)	$ (97,907)	$ (16,409)	$ (27,671)
Net loss per share, basic and diluted	$ (1.53)	$ (1.01)	$ (6.11)	$ (3.43)	$ (17.46)	$ (19.85)	$ (3.34)	$ (5.88)	$ (7.01)	$ (46.87)

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 220
-SubTopic 10
-Section 45
-Paragraph 1A
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=121641772&loc=SL7669619-108580

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 31
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8924-108599

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 250
-SubTopic 10
-Section 50
-Paragraph 11
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=109234566&loc=d3e22694-107794

Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 220
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-04(22))
-URI http://asc.fasb.org/extlink&oid=120399700&loc=SL114874048-224260

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 250
-SubTopic 10
-Section 50
-Paragraph 11
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=109234566&loc=d3e22694-107794

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (f)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8933-108599

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 7
-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721683-107760

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 250
-SubTopic 10
-Section 50
-Paragraph 4
-URI http://asc.fasb.org/extlink&oid=109234566&loc=d3e22595-107794

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 220
-SubTopic 10
-Section 45
-Paragraph 1B
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=121641772&loc=SL7669625-108580

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8736-108599

Reference 11: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 944
-SubTopic 220
-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-04(18))
-URI http://asc.fasb.org/extlink&oid=120400993&loc=SL114874131-224263

Reference 12: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 220
-SubTopic 10
-Section S99
-Paragraph 2
-Subparagraph (SX 210.5-03(20))
-URI http://asc.fasb.org/extlink&oid=120395209&loc=SL114868664-224227

Reference 13: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 230
-SubTopic 10
-Section 45
-Paragraph 28
-URI http://asc.fasb.org/extlink&oid=121586364&loc=d3e3602-108585

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 250
-SubTopic 10
-Section 50
-Paragraph 1
-Subparagraph (b)(2)
-URI http://asc.fasb.org/extlink&oid=109234566&loc=d3e22499-107794

Reference 15: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 250
-SubTopic 10
-Section 50
-Paragraph 9
-URI http://asc.fasb.org/extlink&oid=109234566&loc=d3e22663-107794

Reference 16: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 825
-SubTopic 10
-Section 50
-Paragraph 28
-Subparagraph (f)
-URI http://asc.fasb.org/extlink&oid=75031198&loc=d3e14064-108612

Reference 17: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8906-108599

Reference 18: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 250
-SubTopic 10
-Section 50
-Paragraph 3
-URI http://asc.fasb.org/extlink&oid=109234566&loc=d3e22583-107794

Reference 19: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(g)(1)(ii))
-URI http://asc.fasb.org/extlink&oid=120395691&loc=d3e23780-122690

Reference 20: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 260
-SubTopic 10
-Section 45
-Paragraph 60B
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=121326447&loc=SL5780133-109256

Reference 21: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 323
-SubTopic 10
-Section 50
-Paragraph 3
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=114001798&loc=d3e33918-111571

Reference 22: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8933-108599

Reference 23: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 250
-SubTopic 10
-Section 50
-Paragraph 8
-URI http://asc.fasb.org/extlink&oid=109234566&loc=d3e22658-107794

+ Details

- Definition

Amount, after deduction of tax, noncontrolling interests, dividends on preferred stock and participating securities; of income (loss) available to common shareholders.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 250
-SubTopic 10
-Section 50
-Paragraph 4
-URI http://asc.fasb.org/extlink&oid=109234566&loc=d3e22595-107794

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 260
-SubTopic 10
-Section 45
-Paragraph 10
-URI http://asc.fasb.org/extlink&oid=121326447&loc=d3e1448-109256

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 250
-SubTopic 10
-Section 50
-Paragraph 11
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=109234566&loc=d3e22694-107794

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 260
-SubTopic 10
-Section 45
-Paragraph 11
-URI http://asc.fasb.org/extlink&oid=121326447&loc=d3e1377-109256

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 260
-SubTopic 10
-Section 50
-Paragraph 1
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=6371337&loc=d3e3550-109257

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8736-108599

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 250
-SubTopic 10
-Section 50
-Paragraph 11
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=109234566&loc=d3e22694-107794

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 260
-SubTopic 10
-Section 45
-Paragraph 60B
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=121326447&loc=SL5780133-109256

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (f)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8933-108599

Reference 10: http://www.xbrl.org/2003/role/exampleRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 31
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8924-108599

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8906-108599

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 250
-SubTopic 10
-Section 50
-Paragraph 3
-URI http://asc.fasb.org/extlink&oid=109234566&loc=d3e22583-107794

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8933-108599

Subsequent Events - Additional Information (Details) - USD ($) $ / shares in Units, $ in Thousands		12 Months Ended
	Feb. 22, 2021	Dec. 31, 2020	Dec. 31, 2019
Subsequent Event [Line Items]
Common stock, par value		$ 0.001	$ 0.001
Issuance of stock, net		$ 24,005	$ 79,039
Subsequent Event \| Private Placement \| Securities Purchase Agreement
Subsequent Event [Line Items]
Issuance of stock, net, shares	4,370,629
Warrants to purchase shares of common stock	4,370,629
Shares issued, price per share	$ 5.72
Issuance of stock, net	$ 25,000
Warrants exercise price per share	$ 6.86
Gross proceeds from warrants	$ 30,000
Subsequent Event \| Private Placement \| Securities Purchase Agreement \| Common Stock
Subsequent Event [Line Items]
Issuance of stock, net, shares	4,370,629
Common stock, par value	$ 0.001