NeoGenomics (NEO) 10-Q 6 Nov 23 2023 Q3 Quarterly report Financial data

Cover

Cover - shares	9 Months Ended
	Sep. 30, 2023	Nov. 02, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2023
Document Transition Report	false
Entity File Number	001-35756
Entity Registrant Name	NEOGENOMICS, INC.
Entity Incorporation, State or Country Code	NV
Entity Tax Identification Number	74-2897368
Entity Address, Address Line One	9490 NeoGenomics Way,
Entity Address, City or Town	Fort Myers,
Entity Address, State or Province	FL
Entity Address, Postal Zip Code	33912
City Area Code	(239)
Local Phone Number	768-0600
Title of 12(b) Security	Common stock ($0.001 par value)
Trading Symbol	NEO
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding (in shares)		127,465,820
Entity Central Index Key	0001077183
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q3
Amendment Flag	false

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Current assets
Cash and cash equivalents	$ 306,239	$ 263,180
Marketable securities, at fair value	96,025	174,809
Accounts receivable, net	132,640	119,711
Inventories	24,053	24,277
Prepaid assets	18,676	15,237
Other current assets	9,317	8,077
Total current assets	586,950	605,291
Property and equipment (net of accumulated depreciation of $154,840 and $131,930, respectively)	94,517	102,499
Operating lease right-of-use assets	87,131	96,109
Intangible assets, net	381,910	408,260
Goodwill	522,766	522,766
Other assets	4,967	5,109
Total non-current assets	1,091,291	1,134,743
Total assets	1,678,241	1,740,034
Current liabilities
Accounts payable	16,819	20,510
Accrued compensation	47,594	40,141
Accrued expenses and other liabilities	18,679	15,070
Current portion of equipment financing obligations	4	70
Current portion of operating lease liabilities	6,213	6,584
Contract liabilities	3,617	7,557
Total current liabilities	92,926	89,932
Long-term liabilities
Convertible senior notes, net	537,475	535,322
Operating lease liabilities	62,007	68,952
Deferred income tax liabilities, net	25,370	34,750
Other long-term liabilities	13,035	13,055
Total long-term liabilities	637,887	652,079
Total liabilities	730,813	742,011
Commitments and contingencies (Note 11)
Stockholders’ equity
Common stock, $0.001 par value, (250,000,000 shares authorized; 127,261,476 and 126,913,992 shares issued and outstanding, respectively)	127	127
Additional paid-in capital	1,181,876	1,160,882
Accumulated other comprehensive loss	(1,846)	(3,899)
Accumulated deficit	(232,729)	(159,087)
Total stockholders’ equity	947,428	998,023
Total liabilities and stockholders’ equity	$ 1,678,241	$ 1,740,034

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Property and equipment, accumulated depreciation	$ 154,840	$ 131,930
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	250,000,000	250,000,000
Common stock, shares issued (in shares)	127,261,476	126,913,992
Common stock, shares outstanding (in shares)	127,261,476	126,913,992

CONSOLIDATED STATEMENTS OF OPER

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Total net revenue	$ 151,954,000	$ 128,782,000	$ 436,091,000	$ 371,023,000
COST OF REVENUE	89,643,000	79,889,000	259,075,000	239,952,000
GROSS PROFIT	62,311,000	48,893,000	177,016,000	131,071,000
Operating expenses:
General and administrative	61,486,000	64,282,000	183,343,000	188,481,000
Research and development	5,285,000	7,312,000	20,182,000	23,651,000
Sales and marketing	17,610,000	16,809,000	52,770,000	50,179,000
Restructuring charges	2,125,000	0	9,883,000	0
Total operating expenses	86,506,000	88,403,000	266,178,000	262,311,000
LOSS FROM OPERATIONS	(24,195,000)	(39,510,000)	(89,162,000)	(131,240,000)
Interest (income) expense, net	(2,840,000)	139,000	(6,831,000)	2,366,000
Other expense (income), net	96,000	(25,000)	(520,000)	212,000
Loss before taxes	(21,451,000)	(39,624,000)	(81,811,000)	(133,818,000)
Income tax benefit	(2,935,000)	(2,772,000)	(8,169,000)	(12,255,000)
NET LOSS	$ (18,516,000)	$ (36,852,000)	$ (73,642,000)	$ (121,563,000)
NET LOSS PER SHARE
Basic (in dollars per share)	$ (0.15)	$ (0.30)	$ (0.59)	$ (0.98)
Diluted (in dollars per share)	$ (0.15)	$ (0.30)	$ (0.59)	$ (0.98)
WEIGHTED AVERAGE COMMON SHARES OUTSTANDING
Basic (in shares)	125,687	124,425	125,358	124,055
Diluted (in shares)	125,687	124,425	125,358	124,055
Clinical Services
Total net revenue	$ 127,553,000	$ 106,162,000	$ 365,578,000	$ 310,588,000
COST OF REVENUE	73,994,000	65,261,000	213,032,000	197,563,000
GROSS PROFIT	53,559,000	40,901,000	152,546,000	113,025,000
Advanced Diagnostics
Total net revenue	24,401,000	22,620,000	70,513,000	60,435,000
COST OF REVENUE	15,649,000	14,628,000	46,043,000	42,389,000
GROSS PROFIT	$ 8,752,000	$ 7,992,000	$ 24,470,000	$ 18,046,000

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Statement of Comprehensive Income [Abstract]
NET LOSS	$ (18,516)	$ (36,852)	$ (73,642)	$ (121,563)
OTHER COMPREHENSIVE INCOME (LOSS):
Net unrealized gain (loss) on marketable securities, net of tax	726	(1,048)	2,053	(4,466)
Total other comprehensive income (loss), net of tax	726	(1,048)	2,053	(4,466)
COMPREHENSIVE LOSS	$ (17,790)	$ (37,900)	$ (71,589)	$ (126,029)

CONSOLIDATED STATEMENTS OF STOC

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-In Capital	Accumulated Other Comprehensive (Loss) Income	Accumulated Deficit
Beginning balance (in shares) at Dec. 31, 2021		124,107,500
Beginning balance at Dec. 31, 2021	$ 1,108,277	$ 124	$ 1,123,628	$ (638)	$ (14,837)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock for ESPP (in shares)		47,853
Issuance of common stock for ESPP	971		971
Issuance of restricted stock, net of forfeitures (in shares)		100,253
Issuance of restricted stock, net of forfeitures	(1,049)		(1,049)
Issuance of common stock for stock options (in shares)		466,609
Issuance of common stock for stock options	6,480	$ 1	6,479
Stock-based compensation expense - ESPP	249		249
Stock-based compensation expense - options and restricted stock	11,855		11,855
Net unrealized gain (loss) on marketable securities, net of tax	(2,371)			(2,371)
Net loss	(49,408)				(49,408)
Ending balance (in shares) at Mar. 31, 2022		124,722,215
Ending balance at Mar. 31, 2022	1,075,004	$ 125	1,142,133	(3,009)	(64,245)
Beginning balance (in shares) at Dec. 31, 2021		124,107,500
Beginning balance at Dec. 31, 2021	1,108,277	$ 124	1,123,628	(638)	(14,837)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net unrealized gain (loss) on marketable securities, net of tax	(4,466)
Net loss	(121,563)
Ending balance (in shares) at Sep. 30, 2022		126,562,037
Ending balance at Sep. 30, 2022	1,012,988	$ 127	1,154,365	(5,104)	(136,400)
Beginning balance (in shares) at Mar. 31, 2022		124,722,215
Beginning balance at Mar. 31, 2022	1,075,004	$ 125	1,142,133	(3,009)	(64,245)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock for ESPP (in shares)		89,374
Issuance of common stock for ESPP	807		807
Issuance of restricted stock, net of forfeitures (in shares)		773,010
Issuance of restricted stock, net of forfeitures	(310)	$ 1	(311)
Issuance of common stock for stock options (in shares)		94,974
Issuance of common stock for stock options	743		743
Stock-based compensation expense - ESPP	293		293
Stock-based compensation expense - options and restricted stock	3,332		3,332
Net unrealized gain (loss) on marketable securities, net of tax	(1,047)			(1,047)
Net loss	(35,303)				(35,303)
Ending balance (in shares) at Jun. 30, 2022		125,679,573
Ending balance at Jun. 30, 2022	1,043,519	$ 126	1,146,997	(4,056)	(99,548)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock for ESPP (in shares)		150,585
Issuance of common stock for ESPP	1,133		1,133
Issuance of restricted stock, net of forfeitures (in shares)		493,907
Issuance of restricted stock, net of forfeitures	(5)	$ 1	(6)
Issuance of common stock for stock options (in shares)		237,972
Issuance of common stock for stock options	1,961		1,961
Stock-based compensation expense - ESPP	257		257
Stock-based compensation expense - options and restricted stock	4,023		4,023
Net unrealized gain (loss) on marketable securities, net of tax	(1,048)			(1,048)
Net loss	(36,852)				(36,852)
Ending balance (in shares) at Sep. 30, 2022		126,562,037
Ending balance at Sep. 30, 2022	$ 1,012,988	$ 127	1,154,365	(5,104)	(136,400)
Beginning balance (in shares) at Dec. 31, 2022	126,913,992	126,913,992
Beginning balance at Dec. 31, 2022	$ 998,023	$ 127	1,160,882	(3,899)	(159,087)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock for ESPP (in shares)		96,733
Issuance of common stock for ESPP	811		811
Issuance of restricted stock, net of forfeitures (in shares)		114,738
Issuance of restricted stock, net of forfeitures	(147)		(147)
Issuance of common stock for stock options (in shares)		75,028
Issuance of common stock for stock options	751		751
Stock issuance fees and expenses	(4)		(4)
Stock-based compensation expense - ESPP	275		275
Stock-based compensation expense - options and restricted stock	4,483		4,483
Net unrealized gain (loss) on marketable securities, net of tax	1,065			1,065
Net loss	(30,795)				(30,795)
Ending balance (in shares) at Mar. 31, 2023		127,200,491
Ending balance at Mar. 31, 2023	$ 974,462	$ 127	1,167,051	(2,834)	(189,882)
Beginning balance (in shares) at Dec. 31, 2022	126,913,992	126,913,992
Beginning balance at Dec. 31, 2022	$ 998,023	$ 127	1,160,882	(3,899)	(159,087)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock for stock options (in shares)	223,044
Net unrealized gain (loss) on marketable securities, net of tax	$ 2,053
Net loss	$ (73,642)
Ending balance (in shares) at Sep. 30, 2023	127,261,476	127,261,476
Ending balance at Sep. 30, 2023	$ 947,428	$ 127	1,181,876	(1,846)	(232,729)
Beginning balance (in shares) at Mar. 31, 2023		127,200,491
Beginning balance at Mar. 31, 2023	974,462	$ 127	1,167,051	(2,834)	(189,882)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock for ESPP (in shares)		78,302
Issuance of common stock for ESPP	1,029		1,029
Issuance of restricted stock, net of forfeitures (in shares)		(194,448)
Issuance of restricted stock, net of forfeitures	(1,527)		(1,527)
Issuance of common stock for stock options (in shares)		60,073
Issuance of common stock for stock options	610		610
Stock issuance fees and expenses	(18)		(18)
Stock-based compensation expense - ESPP	255		255
Stock-based compensation expense - options and restricted stock	5,450		5,450
Net unrealized gain (loss) on marketable securities, net of tax	262			262
Net loss	(24,331)				(24,331)
Ending balance (in shares) at Jun. 30, 2023		127,144,418
Ending balance at Jun. 30, 2023	956,192	$ 127	1,172,850	(2,572)	(214,213)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock for ESPP (in shares)		64,785
Issuance of common stock for ESPP	863		863
Issuance of restricted stock, net of forfeitures (in shares)		(35,670)
Issuance of restricted stock, net of forfeitures	(41)		(41)
Issuance of common stock for stock options (in shares)		87,943
Issuance of common stock for stock options	1,026		1,026
Stock issuance fees and expenses	(1)		(1)
Stock-based compensation expense - ESPP	279		279
Stock-based compensation expense - options and restricted stock	6,900		6,900
Net unrealized gain (loss) on marketable securities, net of tax	726			726
Net loss	$ (18,516)				(18,516)
Ending balance (in shares) at Sep. 30, 2023	127,261,476	127,261,476
Ending balance at Sep. 30, 2023	$ 947,428	$ 127	$ 1,181,876	$ (1,846)	$ (232,729)

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
CASH FLOWS FROM OPERATING ACTIVITIES
Net loss	$ (73,642)	$ (121,563)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation	27,872	25,894
Amortization of intangibles	26,350	25,470
Non-cash stock-based compensation	17,643	20,009
Non-cash operating lease expense	6,860	7,375
Amortization of convertible debt discount	2,015	1,989
Amortization of debt issuance costs	139	136
Loss on disposal of assets, net	334	3,066
Impairment of assets	1,703	0
Gain on sale of assets held for sale	0	(2,048)
Other adjustments	122	1,428
Changes in assets and liabilities, net
Accounts receivable, net	(12,928)	136
Inventories	(252)	(403)
Prepaid and other assets	(5,165)	(3,605)
Operating lease liabilities	(5,871)	(7,086)
Deferred income tax liabilities, net	(9,380)	(12,781)
Accrued compensation	7,453	(313)
Accounts payable and other liabilities	(2,990)	(12)
Net cash used in operating activities	(19,737)	(62,308)
CASH FLOWS FROM INVESTING ACTIVITIES
Purchases of marketable securities	(6,756)	(73,973)
Proceeds from maturities of marketable securities	87,963	89,812
Purchases of property and equipment	(21,695)	(26,357)
Proceeds from assets held for sale	0	12,098
Net cash provided by investing activities	59,512	1,580
CASH FLOWS FROM FINANCING ACTIVITIES
Repayment of equipment financing obligations	(66)	(706)
Issuance of common stock, net	3,350	10,733
Net cash provided by financing activities	3,284	10,027
Net change in cash and cash equivalents	43,059	(50,701)
Cash and cash equivalents, beginning of period	263,180	316,827
Cash and cash equivalents, end of period	306,239	266,126
Supplemental disclosure of cash flow information:
Interest paid	2,121	2,145
Income taxes paid, net	175	155
Supplemental disclosure of non-cash investing and financing information:
Purchases of property and equipment included in accounts payable	$ 636	$ 1,144

Nature of the Business

Nature of the Business	9 Months Ended
	Sep. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Nature of the Business	Nature of the BusinessNeoGenomics, Inc., a Nevada corporation (the “Parent,” “Company,” or “NeoGenomics”), and its subsidiaries, operate as a certified, high complexity clinical laboratory in accordance with the federal government’s Clinical Laboratory Improvement Act, as amended, and is dedicated to the delivery of clinical diagnostic services to pathologists, oncologists, urologists, hospitals, and other laboratories as well as providing clinical trial services to pharmaceutical firms.

Summary of Significant Accounti

Summary of Significant Accounting Policies	9 Months Ended
	Sep. 30, 2023
Accounting Changes and Error Corrections [Abstract]
Summary of Significant Accounting Policies	Summary of Significant Accounting Policies Basis of Presentation The accompanying interim Consolidated Financial Statements are unaudited and have been prepared in accordance with generally accepted accounting principles in the United States (“GAAP”) for interim financial information. All intercompany transactions and balances have been eliminated in the accompanying Consolidated Financial Statements. The accounting policies of the Company are the same as those set forth in Note 2. Summary of Significant Accounting Policies, to the audited Consolidated Financial Statements contained in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022, except for Stock-based Compensation and new accounting standards discussed under Recent Accounting Pronouncements as referenced below. Unaudited Interim Financial Information Certain information and footnote disclosures normally included in the Company’s annual audited Consolidated Financial Statements and accompanying notes have been condensed or omitted in these accompanying interim Consolidated Financial Statements and footnotes. Accordingly, the accompanying interim unaudited Consolidated Financial Statements included herein should be read in conjunction with the audited Consolidated Financial Statements and accompanying notes included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022. The results of operations presented in this Quarterly Report on Form 10-Q are not necessarily indicative of the results of operations that may be expected for any future periods. In the opinion of management, these unaudited Consolidated Financial Statements include all adjustments and accruals, consisting only of normal, recurring adjustments that are necessary for a fair statement of the results of all interim periods reported herein. Use of Estimates The Company prepares its Consolidated Financial Statements in conformity with GAAP. These principles require management to make estimates, judgments and assumptions that affect the reported amounts of assets, liabilities, revenues and expenses, together with amounts disclosed in the related notes to the Consolidated Financial Statements. Actual results and outcomes may differ from management’s estimates, judgments and assumptions. Significant estimates, judgments and assumptions used in these Consolidated Financial Statements include, but are not limited, to those related to revenues, accounts receivable and related allowances, contingencies, useful lives and recovery of long-term assets and intangible assets, income taxes and valuation allowances, stock-based compensation, impairment analysis of goodwill, and restructuring reserves. These estimates, judgments, and assumptions are reviewed periodically and the effects of material revisions in estimates are reflected on the Consolidated Financial Statements prospectively from the date of the change in estimate. Segment Reporting The Company has historically reported its activities in two reportable segments; (1) the Clinical Services segment and (2) the Pharma Services segment. In the second quarter of 2023, the Pharma Services segment was rebranded as the Advanced Diagnostics segment. Functions within the Clinical Services segment include oncology diagnostics, community-based oncology and pathology sales, patient engagement, and clinical decision support. Functions within the Advanced Diagnostics segment include pharma services, informatics, R&D, minimal residual disease, liquid biopsy and therapy selection business development. For further financial information regarding reportable segments, please refer to Note 13. Segment Information. Sales and Marketing Expenses Sales and marketing expenses are primarily attributable to employee-related costs including sales management, sales representatives, sales and marketing consultants, and marketing and customer service personnel in the Clinical Services segment. Advertising costs are expensed at the time they are incurred and were immaterial for the three and nine months ended September 30, 2023 and 2022. Stock-based Compensation In the second quarter of 2023, the Company began granting performance stock units (“PSUs”) subject to a market condition to certain of its executives as part of its executive compensation program. The number of shares awarded will be subject to adjustment based on the achievement of an absolute total shareholder return (“TSR”) performance target. If the TSR performance target is achieved, the awards will vest at the end of the three-year requisite service period so long as the employee remains employed with the Company through the applicable vesting date. The Company measures compensation expense for stock-based awards to employees, non-employee contracted physicians, and directors based upon the awards’ initial grant-date fair values. Stock-based compensation expense for stock options, restricted stock awards, restricted stock units and performance awards is recorded over the requisite service period in general and administrative expenses on the Consolidated Statements of Operations. For awards with only a service condition, the Company expenses stock-based compensation using the straight-line method over the requisite service period for the entire award. For awards with a market condition, the Company expenses the grant date fair value at the target over the vesting period regardless of the value that the award recipients ultimately receive. The fair values of stock option grants are estimated as of the date of grant by applying the Black-Scholes option valuation model (“Black-Scholes”). The fair value of restricted stock with a market condition is estimated at the date of grant using the Monte Carlo simulation model (“Monte Carlo”). The Black-Scholes and Monte Carlo models incorporate assumptions as to stock price volatility, the expected life of options or restricted stock, a risk-free interest rate and dividend yield. The fair value of restricted stock without a market condition is estimated using the current market price of the Company’s common stock on the date of grant. Black-Scholes is affected by the stock price on the date of the grant as well as assumptions regarding a number of highly complex and subjective variables. These variables include the expected term of the option, expected risk-free interest rate, the expected volatility of common stock, and expected dividend yield; each of which is described below. The assumptions for expected term and expected volatility are the two assumptions that significantly affect the grant date fair value. Expected Term: The expected term of an option is determined using the simplified method under SAB 107 which represents the average between the vesting term and the contractual term. The Company utilizes the simplified method to determine the expected life of the options due to insufficient exercise activity during recent years. Risk-free Interest Rate: The risk-free interest rate used in the Black-Scholes model is based on the implied yield at the grant date of the U.S. Treasury zero-coupon issue with an equivalent term to the stock-based award being valued. Where the expected term of a stock-based award does not correspond with the term for which a zero-coupon interest rate is quoted, the Company uses the nearest interest rate from available maturities. Expected Stock Price Volatility: The Company uses its own historical weekly volatility because that is more reflective of market conditions. Dividend Yield: Because the Company has never paid a dividend and does not expect to begin doing so in the foreseeable future, the Company assumed no dividend yield in valuing the stock-based awards. The fair value of the PSUs granted during the nine months ended September 30, 2023 was estimated as of the grant date using the Monte Carlo, which requires management to make assumptions regarding risk-free interest rates and volatility of the Company’s stock price. The Monte Carlo incorporates the same assumptions as Black-Scholes as to stock price volatility, the risk-free interest rate and dividend yield. The Company utilized the expected life of the PSUs for the expected term of the award, as the vesting term and contractual term of the awards are identical. Recent Accounting Pronouncements In October 2021, the FASB issued ASU No. 2021-08, Business Combinations (Topic 805), Accounting for Contract Assets and Contract Liabilities from Contracts with Customers (“ASU 2021-08”). This update amends guidance to require that an entity (acquirer) recognize and measure contract assets and contract liabilities acquired in a business combination in accordance with Revenue from Contracts with Customers (Topic 606). At the acquisition date, an acquirer should account for the related revenue contracts in accordance with Topic 606 as if it had originated the contracts. ASU 2021-08 is effective for fiscal years beginning after December 15, 2022, including interim periods within those fiscal years. Early adoption of the amendments is permitted including adoption in an interim period. If the Company early adopts in an interim period, the Company is required to apply the amendments (1) retrospectively to all business combinations for which the acquisition date occurs on or after the beginning of the fiscal year that includes the interim period of early application and (2) prospectively to all business combinations that occur on or after the date of initial application. The amendments in ASU 2021-08 should be applied prospectively to business combinations occurring on or after the effective date of the amendments. The Company adopted this standard as of January 1, 2023 and there was no impact on its Consolidated Financial Statements.

Fair Value Measurements

Fair Value Measurements	9 Months Ended
	Sep. 30, 2023
Fair Value Disclosures [Abstract]
Fair Value Measurements	Fair Value Measurements Fair value is defined as the exchange price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. Valuation techniques used to measure fair value must maximize the use of observable inputs and minimize the use of unobservable inputs. A fair value hierarchy has been established based on three levels of inputs, of which the first two are considered observable and the last unobservable. Level 1: Quoted prices in active markets for identical assets or liabilities. These are typically obtained from real-time quotes for transactions in active exchange markets involving identical assets. Level 2: Inputs, other than quoted prices included within Level 1, which are observable for the asset or liability, either directly or indirectly. These are typically obtained from readily-available pricing sources for comparable instruments. Level 3: Unobservable inputs, where there is little or no market activity for the asset or liability. These inputs reflect the reporting entity’s own assumptions of the data that market participants would use in pricing the asset or liability, based on the best information available in the circumstances. Assets and Liabilities that are Measured at Fair Value on a Recurring Basis The Company measures certain financial assets at fair value on a recurring basis, including its marketable securities and certain cash equivalents. The Company considers all securities available-for-sale, including those with maturity dates beyond 12 months, and therefore these securities are classified within current assets on the Consolidated Balance Sheets as they are available to support current operational liquidity needs. The money market accounts are valued based on quoted market prices in active markets and are included in cash and cash equivalents on the Consolidated Balance Sheets. The marketable securities are generally valued based on other observable inputs for those securities (including market corroborated pricing or other models that utilize observable inputs such as interest rates and yield curves) based on information provided by independent third-party pricing entities, except for U.S. Treasury securities which are valued based on quoted market prices in active markets. The following tables set forth the amortized cost, gross unrealized gains, gross unrealized losses and fair values of the Company’s marketable securities accounted for as available-for-sale securities as of September 30, 2023 and December 31, 2022. September 30, 2023 (in thousands) Amortized Cost Gross Unrealized Gains Gross Unrealized Losses Fair Value Financial Assets: Short-term marketable securities: U.S. Treasury securities $ 25,850 $ — $ (175) $ 25,675 Yankee bonds 2,605 — (37) 2,568 Agency bonds 6,041 — (98) 5,943 Municipal bonds 12,731 — (828) 11,903 Commercial paper 2,973 — — 2,973 Asset-backed securities 9,235 — (90) 9,145 Corporate bonds 38,977 — (1,159) 37,818 Total $ 98,412 $ — $ (2,387) $ 96,025 December 31, 2022 (in thousands) Amortized Cost Gross Unrealized Gains Gross Unrealized Losses Fair Value Financial Assets: Short-term marketable securities: U.S. Treasury securities $ 56,426 $ — $ (651) $ 55,775 Yankee bonds 5,358 — (92) 5,266 Agency bonds 12,485 — (116) 12,369 Municipal bonds 12,841 — (1,030) 11,811 Commercial paper 2,846 8 — 2,854 Asset-backed securities 25,544 2 (427) 25,119 Corporate bonds 63,748 3 (2,136) 61,615 Total $ 179,248 $ 13 $ (4,452) $ 174,809 The Company had $1.6 million and $0.9 million of accrued interest receivable at September 30, 2023 and December 31, 2022, respectively, included in other current assets on its Consolidated Balance Sheets related to its marketable securities. There were no realized gains or losses on marketable securities for the three and nine months ended September 30, 2023. Realized gains or losses for the three and nine months ended September 30, 2022 were immaterial. The following tables set forth the fair value of available-for-sale marketable securities by contractual maturity at September 30, 2023 and December 31, 2022. September 30, 2023 (in thousands) One Year or Less Over One Year Through Five Years Over Five Years Total Financial Assets: Marketable Securities: U.S. Treasury securities $ 25,675 $ — $ — $ 25,675 Yankee bonds 2,568 — — 2,568 Agency bonds 3,572 2,371 — 5,943 Municipal bonds 2,962 8,941 — 11,903 Commercial paper 2,973 — — 2,973 Asset-backed securities 9,145 — — 9,145 Corporate bonds 25,210 12,608 — 37,818 Total $ 72,105 $ 23,920 $ — $ 96,025 December 31, 2022 (in thousands) One Year or Less Over One Year Through Five Years Over Five Years Total Financial Assets: Marketable Securities: U.S. Treasury securities $ 40,795 $ 14,980 $ — $ 55,775 Yankee bonds 2,734 2,532 — 5,266 Agency bonds 6,470 5,899 — 12,369 Municipal bonds — 11,811 — 11,811 Commercial paper 2,854 — — 2,854 Asset-backed securities 23,179 1,940 — 25,119 Corporate bonds 35,377 26,238 — 61,615 Total $ 111,409 $ 63,400 $ — $ 174,809 The following tables set forth the Company’s cash equivalents and marketable securities accounted for as available-for-sale securities that were measured at fair value on a recurring basis based on the fair value hierarchy as of September 30, 2023 and December 31, 2022. September 30, 2023 (in thousands) Level 1 Level 2 Level 3 Total Financial Assets: Cash equivalents: Money market funds $ 299,539 $ — $ — $ 299,539 Marketable securities: U.S. Treasury securities 25,675 — — 25,675 Yankee bonds 2,568 — — 2,568 Agency bonds 5,943 — — 5,943 Municipal bonds 11,903 — — 11,903 Commercial paper — 2,973 — 2,973 Asset-backed securities — 9,145 — 9,145 Corporate bonds — 37,818 — 37,818 Total $ 345,628 $ 49,936 $ — $ 395,564 December 31, 2022 (in thousands) Level 1 Level 2 Level 3 Total Financial Assets: Cash equivalents: Money market funds $ 196,749 $ — $ — $ 196,749 Commercial paper — 36,965 — 36,965 Marketable securities: U.S. Treasury securities 55,775 — — 55,775 Yankee bonds 5,266 — — 5,266 Agency bonds 12,369 — — 12,369 Municipal bonds 11,811 — — 11,811 Commercial paper — 2,854 — 2,854 Asset-backed securities — 25,119 — 25,119 Corporate bonds — 61,615 — 61,615 Total $ 281,970 $ 126,553 $ — $ 408,523 There were no transfers of financial assets or liabilities into or out of Level 1, Level 2, or Level 3 for the three and nine months ended September 30, 2023 and September 30, 2022. The carrying value of cash and cash equivalents, accounts receivable, net, accounts payable, accrued expenses and other liabilities, and other current assets and liabilities, are considered reasonable estimates of their respective fair values at September 30, 2023 and December 31, 2022 due to their short-term nature.

Goodwill and Intangible Assets

Goodwill and Intangible Assets	9 Months Ended
	Sep. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	Goodwill and Intangible Assets The following table summarizes the carrying amounts of goodwill by segment at September 30, 2023 and December 31, 2022 (in thousands): September 30, 2023 December 31, 2022 Clinical Services $ 458,782 $ 458,782 Advanced Diagnostics 63,984 63,984 Total $ 522,766 $ 522,766 Intangible assets consisted of the following (in thousands): September 30, 2023 Amortization Cost Accumulated Net Customer Relationships 7 - 15 $ 143,101 $ 63,062 $ 80,039 Developed Technology 10 - 15 310,226 49,108 261,118 Marketing Assets 4 549 342 207 Trademarks 15 31,473 4,797 26,676 Trade Name 2.5 2,584 2,161 423 Trademark - Indefinite lived — 13,447 — 13,447 Total $ 501,380 $ 119,470 $ 381,910 December 31, 2022 Amortization Cost Accumulated Net Customer Relationships 7 - 15 $ 143,101 $ 55,645 $ 87,456 Developed Technology 10 - 15 310,226 33,117 277,109 Marketing Assets 4 549 238 311 Trademarks 15 31,473 3,223 28,250 Trade Name 2.5 2,584 897 1,687 Trademark - Indefinite lived — 13,447 — 13,447 Total $ 501,380 $ 93,120 $ 408,260 The Company records amortization expense within cost of revenue and general and administrative expense on the Consolidated Statement of Operations. The following table summarizes the amortization expense for the three and nine months ended September 30, 2023 and 2022 (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Amortization of intangibles included in cost of revenue $ 4,853 $ 4,853 $ 14,560 $ 14,559 Amortization of intangibles included in general and administrative expenses 3,931 3,637 11,790 10,911 Total amortization of intangibles $ 8,784 $ 8,490 $ 26,350 $ 25,470 The estimated amortization expense related to amortizable intangible assets for each of the following periods as of September 30, 2023 is as follows (in thousands): Remainder of 2023 $ 8,783 2024 33,447 2025 33,343 2026 33,308 2027 32,758 Thereafter 226,824 Total $ 368,463

Debt

Debt	9 Months Ended
	Sep. 30, 2023
Debt Disclosure [Abstract]
Debt	Debt 2028 Convertible Senior Notes On January 11, 2021, the Company completed the sale of $345.0 million of Convertible Senior Notes with a stated interest rate of 0.25% and a maturity date of January 15, 2028 (the “2028 Convertible Notes”), unless earlier converted, redeemed, or repurchased. The last reported sales price of the Company’s common stock was not greater than or equal to 130.0% of the conversion price of the 2028 Convertible Notes on at least 20 of the last 30 consecutive trading days of the quarter ended June 30, 2023. Based on the terms of the 2028 Convertible Notes, the holders could not have converted all or a portion of their 2028 Convertible Notes in the third quarter of 2023. The last reported sales price of the Company’s common stock was not greater than or equal to 130.0% of the conversion price of the 2028 Convertible Notes on at least 20 of the last 30 consecutive trading days of the quarter ended September 30, 2023. Based on the terms of the 2028 Convertible Notes, the holders cannot convert all or a portion of their 2028 Convertible Notes in the fourth quarter of 2023. The value of the 2028 Convertible Notes, if-converted, does not exceed the principal amount based on a closing stock price of $12.30 on September 29, 2023. The interest expense recognized on the 2028 Convertible Notes includes $0.2 million, $0.4 million and $8,500 for the contractual coupon interest, the amortization of the debt discount and the amortization of the debt issuance costs, respectively, for the three months ended September 30, 2023. The interest expense recognized on the 2028 Convertible Notes includes $0.6 million, $1.1 million and $26,000 for the contractual coupon interest, the amortization of the debt discount and the amortization of the debt issuance costs, respectively, for the nine months ended September 30, 2023. The interest expense recognized on the 2028 Convertible Notes includes $0.2 million, $0.4 million and $8,500 for the contractual coupon interest, the amortization of the debt discount and the amortization of the debt issuance costs, respectively, for the three months ended September 30, 2022. The interest expense recognized on the 2028 Convertible Notes includes $0.7 million, $1.1 million and $25,300 for the contractual coupon interest, the amortization of the debt discount and the amortization of the debt issuance costs, respectively, for the nine months ended September 30, 2022. The effective interest rate on the 2028 Convertible Notes is 0.70%, which includes the interest on the 2028 Convertible Notes and amortization of the debt discount and debt issuance costs. The 2028 Convertible Notes bear interest at a rate of 0.25% per annum, payable semi-annually in arrears on January 15 and July 15 of each year, beginning on July 15, 2021. At September 30, 2023, the estimated fair values (Level 2) of the 0.25% Convertible Senior Notes due 2028 was $245.8 million. At December 31, 2022, the estimated fair value (Level 2) of the 0.25% Convertible Senior Notes due 2028 was $218.2 million. 2025 Convertible Senior Notes On May 4, 2020, the Company completed the sale of $201.3 million of Convertible Senior Notes with a stated interest rate of 1.25% and a maturity date of May 1, 2025 (the “2025 Convertible Notes”), unless earlier converted, redeemed, or repurchased. The last reported sales price of the Company’s common stock was not greater than or equal to 130.0% of the conversion price of the 2025 Convertible Notes on at least 20 of the last 30 consecutive trading days of the quarter ended June 30, 2023. Based on the terms of the 2025 Convertible Notes, the holders could not have converted all or a portion of their 2025 Convertible Notes in the third quarter of 2023. The last reported sales price of the Company’s common stock was not greater than or equal to 130.0% of the conversion price of the 2025 Convertible Notes on at least 20 of the last 30 consecutive trading days of the quarter ended September 30, 2023. Based on the terms of the 2025 Convertible Notes, the holders cannot convert all or a portion of their 2025 Convertible Notes in the fourth quarter of 2023. The value of the 2025 Convertible Notes, if-converted, does not exceed the principal amount based on a closing stock price of $12.30 on September 29, 2023. The interest expense recognized on the 2025 Convertible Notes includes $0.6 million, $0.3 million and $37,900 for the contractual coupon interest, the amortization of the debt discount and the amortization of the debt issuance costs, respectively, for the three months ended September 30, 2023. The interest expense recognized on the 2025 Convertible Notes includes $1.9 million, $0.9 million and $0.1 million for the contractual coupon interest, the amortization of the debt discount and the amortization of the debt issuance costs, respectively, for the nine months ended September 30, 2023. The interest expense recognized on the 2025 Convertible Notes includes $0.6 million, $0.3 million and $37,200 for the contractual coupon interest, the amortization of the debt discount and the amortization of the debt issuance costs, respectively, for the three months ended September 30, 2022. The interest expense recognized on the 2025 Convertible Notes includes $1.9 million, $0.9 million and $0.1 million for the contractual coupon interest, the amortization of the debt discount and the amortization of the debt issuance costs, respectively, for the nine months ended September 30, 2022. The effective interest rate on the 2025 Convertible Notes is 1.96%, which includes the interest on the 2025 Convertible Notes and amortization of the debt discount and debt issuance costs. The 2025 Convertible Notes bear interest at a rate of 1.25% per annum, payable semi-annually in arrears on May 1 and November 1 of each year, which began on November 1, 2020.

Stock-Based Compensation

Stock-Based Compensation	9 Months Ended
	Sep. 30, 2023
Equity [Abstract]
Stock-Based Compensation	Stock-Based Compensation Equity Incentive Plan Effective May 25, 2023, the Company adopted the NeoGenomics, Inc. 2023 Equity Incentive Plan (the “2023 Plan”) as approved by the Board of Directors on March 28, 2023 and the Company’s stockholders on May 25, 2023. The 2023 Plan replaced the NeoGenomics, Inc. Amended and Restated Equity Incentive Plan, as most recently amended and subsequently approved by the stockholders on May 25, 2017 (the “Prior Plan”). The 2023 Plan allows for the award of equity incentives including stock options, stock appreciation rights, restricted stock awards, restricted stock units, performance shares, performance units, and other stock-based awards to certain employees, directors, or officers of, or key non-employee advisers or consultants, including contracted physicians to the Company or its subsidiaries. The 2023 Plan provides that the maximum aggregate number of shares of the Company’s common stock reserved and available for issuance under the 2023 Plan is 3,975,000. Additionally, effective May 25, 2023, any remaining unissued shares from the Prior Plan are available for the grant of new awards under the 2023 Plan. The Company recorded approximately $7.2 million and $4.3 million for stock-based compensation in general and administrative expenses on the Consolidated Statements of Operations for the three months ended September 30, 2023 and 2022, respectively, and approximately $17.6 million and $20.0 million for the nine months ended September 30, 2023 and 2022, respectively. Stock Options The Company recorded approximately $3.0 million and $1.6 million for stock-based compensation related to stock options in general and administrative expenses on the Consolidated Statements of Operations for the three months ended September 30, 2023 and 2022, respectively, and approximately $7.0 million and $6.4 million for the nine months ended September 30, 2023 and 2022, respectively. A summary of the stock option activity under the Company’s plans for the nine months ended September 30, 2023 is as follows: Number of Weighted Average Exercise Price Outstanding at December 31, 2022 4,214,617 $ 16.48 Granted 1,644,070 $ 17.17 Exercised (223,044) $ 10.70 Forfeited (1,142,470) $ 21.11 Outstanding at September 30, 2023 4,493,173 $ 15.84 Exercisable at September 30, 2023 1,126,578 $ 21.05 The fair value of each stock option award granted during the nine months ended September 30, 2023 was estimated as of the grant date using a Black-Scholes model with the following assumptions: Nine Months Ended Expected term (in years) 4.0 - 6.5 Risk-free interest rate (%) 3.3% - 4.4% Expected volatility (%) 53.3% - 67.9% Dividend yield (%) — Weighted average grant date fair value per share $9.04 As of September 30, 2023, there was approximately $15.8 million of unrecognized stock-based compensation expense related to stock options that will be recognized over a weighted-average period of approximately 1.9 years. Restricted Stock The Company recorded approximately $3.4 million and $2.4 million for stock-based compensation related to restricted stock in general and administrative expenses on the Consolidated Statements of Operations for the three months ended September 30, 2023 and 2022, respectively, and approximately $8.9 million and $12.8 million for the nine months ended September 30, 2023 and 2022, respectively. A summary of the restricted stock activity under the Company’s plans for the nine months ended September 30, 2023 is as follows: Number of Restricted Weighted Average Grant Date Fair Value Nonvested at December 31, 2022 1,994,861 $ 12.71 Granted 986,142 $ 16.90 Vested (548,543) $ 14.00 Forfeited (385,489) $ 15.72 Nonvested at September 30, 2023 2,046,971 $ 13.79 As of September 30, 2023, there was approximately $18.8 million of unrecognized stock-based compensation expense related to restricted stock that will be recognized over a weighted-average period of approximately 1.9 years. Performance-Based Restricted Stock Units In the second quarter of 2023, the Company granted 305,105 PSUs subject to a market condition to certain of its executives with an aggregated grant date fair value of approximately $6.7 million. The number of shares awarded will be subject to adjustment based on the achievement of a TSR performance target. If the TSR performance target is achieved, the awards will vest at the end of the three-year requisite service period so long as the employee remains employed with the Company through the applicable vesting date. Compensation cost for the PSUs is recognized straight-line over the requisite service period, regardless of when, if ever, the market condition is satisfied. The Company recognized approximately $0.6 million and $0.9 million of stock-based compensation related to the PSUs in general and administrative expenses on the Consolidated Statements of Operations for the three and nine months ended September 30, 2023, respectively. There were no such amounts for the three and nine months ended September 30, 2022. A summary of the PSU activity under the Company’s plans for the nine months ended September 30, 2023 is as follows: Number of Stock Units Weighted Average Grant Date Fair Value Nonvested at December 31, 2022 — $ — Granted 305,105 $ 21.83 Vested — $ — Forfeited — $ — Nonvested at September 30, 2023 305,105 $ 21.83 The fair value of each PSU granted during the nine months ended September 30, 2023 was estimated as of the grant date using a Monte Carlo with the following assumptions: Nine Months Ended Expected term (in years) 3.0 Risk-free interest rate (%) 3.6% - 4.0% Expected volatility (%) 68.4% - 69.9% Dividend yield (%) — Weighted average grant date fair value per share $21.83 As of September 30, 2023, there was approximately $5.8 million of unrecognized stock-based compensation expense related to PSUs that will be recognized over a weighted-average period of approximately 2.6 years. Modification of Stock Option and Restricted Stock Awards In the second quarter of 2023, upon the departure of certain executives from the Company and in accordance with the terms of each of their respective employment agreements, 101,937 previously granted time-based vesting stock option awards and 61,746 previously granted time-based vesting restricted stock awards accelerated vesting. The Company accounted for the effects of the accelerated vesting of these stock awards as modifications, and recognized $0.9 million of incremental stock-based compensation which consisted of $0.3 million and $0.6 million for the acceleration of stock option awards and restricted stock awards, respectively, within general and administrative expenses on the Consolidated Statements of Operations for the nine months ended September 30, 2023. There were no such amounts for the three months ended September 30, 2023 and for the three and nine months ended September 30, 2022. In the second quarter of 2022, upon the prior Chief Legal Officer’s departure from the Company and in accordance with the terms of the prior Chief Legal Officer’s employment agreement, 41,487 previously granted time-based vesting stock option awards and 76,138 previously granted time-based vesting restricted stock awards accelerated vesting. The Company accounted for the effects of the accelerated vesting of these stock awards as a modification, and recognized $2.2 million of incremental stock-based compensation which consisted of $0.3 million and $1.9 million for the acceleration of stock option awards and restricted stock awards, respectively, within general and administrative expenses on the Consolidated Statements of Operations for the nine months ended September 30, 2022. There were no such amounts for the three and nine months ended September 30, 2023. In the first quarter of 2022, upon the prior Chief Executive Officer’s departure from the Company and in accordance with the terms of the prior Chief Executive Officer’s separation agreement, 237,960 previously granted time-based vesting stock option awards and 142,302 previously granted time-based vesting restricted stock awards accelerated vesting. The Company accounted for the effects of the accelerated vesting of these stock awards as a modification, and recognized $5.9 million of incremental

Revenue Recognition

Revenue Recognition	9 Months Ended
	Sep. 30, 2023
Revenue from Contract with Customer [Abstract]
Revenue Recognition	Revenue Recognition The Company’s two reportable segments for which it recognizes revenue are (1) Clinical Services and (2) Advanced Diagnostics. The Clinical Services segment provides various clinical-testing services related to oncology diagnostics, community-based oncology and pathology sales, patient engagement, and clinical decision support. Functions within the Advanced Diagnostics segment include pharma services, informatics, R&D, and minimal residual disease, liquid biopsy and therapy selection business development. Clinical Services Revenue The Company’s specialized diagnostic services are performed based on a written test requisition form or an electronic equivalent. The performance obligation is satisfied and revenues are recognized once the diagnostic services have been performed and the results have been delivered to the ordering physician. These diagnostic services are billed to various payers, including client direct billing, commercial insurance, Medicare and other government payers, and patients. Revenue is recorded for all payers based on the amount expected to be collected, which considers implicit price concessions. Implicit price concessions represent differences between amounts billed and the estimated consideration the Company expects to receive based on negotiated discounts, historical collection experience, and other anticipated adjustments, including anticipated payer denials. Advanced Diagnostics Revenue The Company’s Advanced Diagnostics segment generally enters into contracts with pharmaceutical and biotech customers as well as other contract research organizations (“CROs”) to provide research and clinical trial services. Such services also include validation studies and assay development. The Company records revenue on a unit-of-service basis based on the number of units completed towards the satisfaction of a performance obligation. In addition, certain contracts include upfront fees and the revenue for those contracts is recognized over time as services are performed. Additional offerings within the Advanced Diagnostics portfolio includes Informatics, which involves the licensing of de-identified data to pharmaceutical and biotech customers in the form of either retrospective records or prospective deliveries of data. Informatics revenue is recognized at a point in time upon delivery of retrospective data or over time for prospective data feeds. The Company negotiates billing schedules and payment terms on a contract-by-contract basis, and contract terms generally provide for payments based on a unit-of-service arrangement. Amounts collected in advance of services being provided are deferred as contract liabilities on the Consolidated Balance Sheets. The associated revenue is recognized and the contract liability is reduced as the contracted services are subsequently performed. Contract assets are established for revenue recognized but not yet billed. These contract assets are reduced once the customer is invoiced and a corresponding receivable is recorded. Additionally, Advanced Diagnostics incurs sales commissions in the process of obtaining contracts with customers. Sales commissions that are payable upon contract award are recognized as assets and amortized over the expected contract term. The amortization of commission expense is based on the weighted average contract duration for all commissionable awards in the respective business in which the commission expense is paid, which approximates the period over which goods and services are transferred to the customer. For offerings with primarily short-term contracts, such as Informatics, the Company applies the practical expedient which allows costs to obtain a contract to be expensed when incurred, if the amortization period of the assets that would otherwise have been recognized is one year or less. Contract assets and capitalized commissions are included in other current assets and other assets on the Consolidated Balance Sheets. Most contracts are terminable by the customers, either immediately or according to advance notice terms specified within the contracts. All contracts require payment of fees to the Company for services rendered through the date of termination and may require payment for subsequent services necessary to conclude the study or close out the contract. The following table summarizes the values of contract assets, capitalized commissions and contract liabilities (in thousands): September 30, 2023 December 31, 2022 Current contract assets (1) $ 424 $ 1,898 Long-term contract assets (2) — 31 Total assets $ 424 $ 1,929 Current capitalized commissions (1) $ 937 $ 800 Long-term capitalized commissions (2) 257 715 Total capitalized commissions $ 1,194 $ 1,515 Current contract liabilities $ 3,617 $ 7,557 Long-term contract liabilities (3) — 19 Total contract liabilities $ 3,617 $ 7,576 (1) Recorded within other current assets on the Consolidated Balance Sheets. (2) Recorded within other assets on the Consolidated Balance Sheets. (3) Recorded within other long-term liabilities on the Consolidated Balance Sheets. Revenue recognized for the three and nine months ended September 30, 2023 related to contract liability balances outstanding at the beginning of the period was $1.4 million and $4.9 million, respectively. Revenue recognized for the three and nine months ended September 30, 2022 related to contract liability balances outstanding at the beginning of the period was $0.7 million and $4.8 million, respectively. Amortization of capitalized commissions for the three and nine months ended September 30, 2023 was $0.2 million and $0.7 million, respectively. Amortization of capitalized commissions for the three and nine months ended September 30, 2022 was $0.3 million and $0.6 million, respectively. Disaggregation of Revenue The Company considered various factors for both its Clinical Services and Advanced Diagnostics segments in determining appropriate levels of homogeneous data for its disaggregation of revenue; including the nature, amount, timing, and uncertainty of revenue and cash flows. Clinical Services categories align with the types of customers due to similarities of billing method, level of reimbursement, and timing of cash receipts. Unbilled amounts are accrued and allocated to payer categories based on historical experience. In future periods actual billings by payer category may differ from accrued amounts. Advanced Diagnostics relate to contracts with large pharmaceutical and biotech customers as well as other CROs. Because the nature, timing, and uncertainty of revenue and cash flows are similar and primarily driven by individual contract terms Advanced Diagnostics revenue is not further disaggregated. The following table details the disaggregation of revenue for both the Clinical Services and Advanced Diagnostics Segments (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Clinical Services Client direct billing $ 86,160 $ 73,234 $ 246,159 $ 208,123 Commercial Insurance 21,722 17,105 64,772 53,904 Medicare and Medicaid 19,624 15,795 54,407 48,427 Self-Pay 47 28 240 134 Total Clinical Services $ 127,553 $ 106,162 $ 365,578 $ 310,588 Advanced Diagnostics 24,401 22,620 70,513 60,435 Total Revenue $ 151,954 $ 128,782 $ 436,091 $ 371,023

Restructuring

Restructuring	9 Months Ended
	Sep. 30, 2023
Restructuring and Related Activities [Abstract]
Restructuring	Restructuring In 2022, the Company embarked on a restructuring program to improve execution and drive efficiency across the organization. This program is a framework for identifying, prioritizing and executing operational improvements. Restructuring charges incurred consist of severance and other employee costs, costs for optimizing the Company’s geographic presence (“Facility Footprint Optimization”), and consulting and other costs. There were no such charges for the three and nine months ended September 30, 2022. The following table summarizes the changes in the Company’s accrued restructuring balance (in thousands): Severance and Other Employee Costs Facility Footprint Optimization Consulting and Implementation Costs Total Balance as of December 31, 2022 $ 559 $ — $ 960 $ 1,519 Restructuring charges incurred 3,105 913 106 4,124 Impairment of facility related assets — 560 — 560 Cash payments and other adjustments (1) (1,285) (564) (346) (2,195) Balance as of March 31, 2023 $ 2,379 $ 909 $ 720 $ 4,008 Restructuring charges incurred 1,893 271 581 2,745 Impairment of facility related assets — 329 — 329 Cash payments and other adjustments (1) (1,634) (306) (1,007) (2,947) Balance as of June 30, 2023 $ 2,638 $ 1,203 $ 294 $ 4,135 Restructuring charges incurred 362 641 896 1,899 Impairment of facility related assets — 226 — 226 Cash payments and other adjustments (1) (1,613) (234) (642) (2,489) Balance as of September 30, 2023 $ 1,387 $ 1,836 $ 548 $ 3,771 Current liabilities $ 3,771 Long-term liabilities — $ 3,771 (1) Other adjustments include non-cash asset charges related to Facility Footprint Optimization costs. Restructuring activities are ongoing and the Company expects to incur additional restructuring charges of approximately $5.9 million. The Company estimates these additional restructuring charges to be comprised of approximately $0.7 million in severance and other employee costs, $4.5 million of Facility Footprint Optimization costs, and $0.7 million of consulting and other costs. In the third quarter of 2023, in response to new incremental information including ongoing negotiations with counterparties, the Company revised its original restructuring plan cost and timing of approved projects. As a result, the Company anticipates incurring further restructuring charges extending into 2024. The Company expects these charges will ultimately result in enhanced operational efficiencies as it continues to optimize its geographic presence.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2023
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes At the end of each interim period, management estimates the annual effective tax rate based on forecasted pre-tax results of the Company’s global operations and applies such rate to its ordinary quarterly earnings to calculate income tax expense related to ordinary income. The tax effects of items significant, unusual and infrequent in nature are discretely calculated and recognized in the period during which they occur. These discrete items often relate to changes in tax laws, excess tax benefits/deficiencies related to share-based compensation or adjustments to previously reported tax expense/benefits. Management assesses the recoverability of its deferred tax assets as of the end of each quarter, weighing available positive and negative evidence, and is required to establish and maintain a valuation allowance for these assets if it is more likely than not that some or all of the deferred income tax assets will not be realized. The weight given to the evidence is commensurate with the extent to which the evidence can be objectively verified. If negative evidence exists, positive evidence is necessary to support a conclusion that a valuation allowance is not needed. A cumulative loss in recent years is a significant piece of negative evidence that is difficult to overcome. Cumulative loss in recent years is commonly defined as a three-year cumulative loss position. As of September 30, 2023, all of the Company’s ongoing operations were in a three-year cumulative loss position. Management determined that sufficient objectively verifiable positive evidence did not exist to overcome the negative evidence of the Company’s cumulative loss position. Accordingly, the Company’s estimated annual effective tax rate applied to the Company’s pre-tax loss for the three and nine months ended September 30, 2023, includes the unfavorable impact of a valuation allowance against the Company’s deferred income tax assets expected to be created in 2023 for additional U.S. net operating loss and tax credit carryforwards as well as Switzerland, China and Singapore deferred tax assets. The reversal of U.K. deferred tax liabilities will provide a source of realization to support a portion of the U.K. deferred tax assets, and therefore a partial valuation has been established for those deferred tax assets. Accordingly, the Company’s estimated annual effective tax rate applied to the Company’s pre-tax loss for the nine months ended September 30, 2023, includes the favorable impact of recognizing the realizable portion of the U.K. benefit . In August 2023, the Company received notification from the Internal Revenue Service that their review of the examination of the Company’s U.S federal tax return for the tax year ended December 31, 2017 was complete. There were no changes to the reported tax and the notice had no impact to the Consolidated Financial Statements.

Net Loss Per Share

Net Loss Per Share	9 Months Ended
	Sep. 30, 2023
Earnings Per Share [Abstract]
Net Loss Per Share	Net Loss Per Share The Company presents both basic earnings per share (“EPS”) and diluted EPS. Basic EPS excludes potential dilution and is computed by dividing net loss by the weighted-average number of common shares outstanding for the period. Diluted EPS reflects the potential dilution that could occur if stock options were exercised, stock awards vested and if the 2028 Convertible Notes and 2025 Convertible Notes were converted. The potential dilution from stock awards is accounted for using the treasury stock method based on the average market value of the Company’s common stock. The potential dilution from conversion of the 2028 Convertible Notes and 2025 Convertible Notes is accounted for using the if-converted method, which requires that all of the shares of the Company’s common stock issuable upon conversion of the 2028 Convertible Notes and the 2025 Convertible Notes will be included in the calculation of diluted EPS assuming conversion of the 2028 Convertible Notes and the 2025 Convertible Notes at the beginning of the reporting period (or at time of issuance, if later). The following table shows the calculations (in thousands, except net loss per share amounts): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 NET LOSS $ (18,516) $ (36,852) $ (73,642) $ (121,563) Basic weighted average shares outstanding 125,687 124,425 125,358 124,055 Diluted weighted average shares outstanding 125,687 124,425 125,358 124,055 Basic net loss per share $ (0.15) $ (0.30) $ (0.59) $ (0.98) Diluted net loss per share $ (0.15) $ (0.30) $ (0.59) $ (0.98) The following potential dilutive shares were excluded from the calculation of diluted net loss per share because their effect would be anti-dilutive (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Stock options 451 45 444 272 Restricted stock awards 769 295 877 266 2025 Convertible Notes 5,538 5,538 5,538 5,538 2028 Convertible Notes 5,215 5,215 5,215 5,215 In addition, 408,362 and 214,169 shares of PSU awards are excluded from the computation of diluted EPS for the three and nine months ended September 30, 2023, respectively, as the contingency had not been satisfied. In connection with the 2028 Convertible Notes offering, on January 11, 2021, the Company entered into separate, privately negotiated convertible note hedge transactions (collectively, the “Capped Call Transactions”) with option counterparties pursuant to capped call confirmations at a cost of approximately $29.3 million. The potential effect of the Capped Call Transactions were excluded from the calculation of diluted net loss per share in the three and nine months ended September 30, 2023 as the Company’s closing price of $12.30 on September 29, 2023 did not exceed the conversion price of $85.75 per share. The Capped Call Transactions are not reflected in diluted net loss per share as they are anti-dilutive.

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Legal Proceedings On January 20, 2021, Natera, Inc. filed a patent infringement complaint against the Company’s newly-acquired subsidiary Inivata Limited and its subsidiary Inivata, Inc. in U.S. District Court for the district of Delaware, alleging Inivata’s InVisionFirst ® -Lung cancer diagnostic test of infringing two patents. Natera then filed a second patent infringement complaint on December 20, 2022 against Inivata Limited and Inivata Inc. alleging that the RaDaR ® minimal residual disease test infringes one patent. The litigation is in the discovery stage. On July 31, 2023, Natera, Inc. filed a patent infringement complaint against the Company’s subsidiary, NeoGenomics Laboratories, Inc., in the U.S. District Court for the Middle District of North Carolina, alleging that the RaDaR ® minimal residual test infringes on two patents. The complaint seeks damages and injunctive relief. The Company believes that it has good and substantial defenses to the claims alleged in these suits, but there is no guarantee that the Company will prevail. At the time of filing the outcome of these matters are not estimable or probable. On December 16, 2022, a purported shareholder class action captioned Daniel Goldenberg v. NeoGenomics, Inc., Douglas VanOort, Mark Mallon, Kathryn McKenzie, and William Bonello was filed in the United States District Court for the Southern District of New York, naming the Company and certain of the Company’s current and former officers as defendants. This lawsuit was filed by a stockholder who claims to be suing on behalf of anyone who purchased or otherwise acquired the Company’s securities between February 27, 2020 and April 26, 2022. The lawsuit alleges that material misrepresentations and/or omissions of material fact were made in the Company’s public disclosures in violation of Sections 10(b) and 20(a) of the Exchange Act and Rule 10b-5 promulgated thereunder. The alleged improper disclosures relate to statements regarding the Company’s menu of tests, business operations and compliance with health care laws and regulations. The plaintiff seeks unspecified monetary damages on behalf of the putative class and an award of costs and expenses, including attorney’s fees and expert fees. On April 27, 2023, a shareholder of the Company filed a shareholder derivative action on behalf of the Company captioned Puskarich v. VanOort, et al. in Clark County Nevada, naming certain of the Company’s current and former officers and directors as defendants. The allegations are substantially similar to the allegations asserted in the Goldenberg action. Substantially similar shareholder derivative actions were subsequently filed in Lee County, Florida and in the United States District Court for the Southern District of New York, captioned Wong v. VanOort, et al. and Mellema v. VanOort, et al., respectively. The Company believes that it has valid defenses to the claims alleged in the lawsuits, but there is no guarantee that the Company will prevail. At the time of filing the outcome of these matters are not estimable or probable. Regulatory Matter With the assistance of outside counsel, the Company voluntarily conducted an internal investigation that focused on the compliance of certain consulting and service agreements with federal healthcare laws and regulations, including those relating to fraud, waste and abuse. Based on this internal investigation, the Company voluntarily notified the Office of Inspector General of the U.S. Department of Health and Human Services (“OIG”) of the Company’s internal investigation in November 2021. The Company’s interactions with regulatory authorities and the Company’s related review of this matter are ongoing. The Company has a reserve of $11.2 million in other long-term liabilities as of September 30, 2023 and December 31, 2022 on the Consolidated Balance Sheets for potential damages and liabilities primarily associated with the federal healthcare program revenue received by the Company in connection with the agreements at issue that were identified during the course of this internal investigation. This reserve reflects management’s best estimate of the minimum probable loss associated with this matter. As a result of the internal investigation and ongoing interactions with regulatory authorities, the Company may accrue additional reserves for any related potential damages and liabilities arising out of this matter. The Company was notified on June 30, 2022 that the Department of Justice (“DOJ”) will be leading the investigation of this matter. At this time, the Company is unable to predict the duration, scope, result or related costs associated with any further investigation, including by the OIG, DOJ, or any other governmental authority, or what penalties or remedial actions they may seek. Accordingly, at this time, the Company is unable to estimate a range of possible loss in excess of the amount reserved. Any determination that the Company’s operations or activities are not in compliance with existing laws or regulations, however, could result in the imposition of civil or criminal fines, penalties, disgorgement, restitution, equitable relief, or other losses or conduct restrictions, which could be material to the Company’s financial results or business operations.

Related Party Transactions

Related Party Transactions	9 Months Ended
	Sep. 30, 2023
Related Party Transactions [Abstract]
Related Party Transactions	Related Party TransactionsThe Company has Advanced Diagnostics contracts with HOOKIPA Pharma, Inc., an entity with whom a director of the Company, Michael A. Kelly, was a director of until April 7, 2023. In connection with these contracts, the Company recognized $0.1 million and $0.3 million of revenue in the Consolidated Statements of Operations for the three and nine months ended September 30, 2023, respectively. Revenue recognized in the Consolidated Statements of Operations in connection with these contracts was $0.3 million for both the three and nine months ended September 30, 2022.

Segment Information

Segment Information	9 Months Ended
	Sep. 30, 2023
Segment Reporting [Abstract]
Segment Information	Segment Information The Company has historically reported its activities in two reportable segments; (1) the Clinical Services segment and (2) the Pharma Services segment. In the second quarter of 2023, the Pharma Services segment was rebranded as the Advanced Diagnostics segment. The financial information reviewed by the CODM includes revenues, cost of revenue, and gross profit for both reportable segments. Assets, operating expenses, loss from operations, and net loss are not presented at the segment level as that information is not used by the CODM. For further details regarding segment reporting, please refer to Note 2. Summary of Significant Accounting Policies. The following table summarizes the segment information (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Net revenues: Clinical Services $ 127,553 $ 106,162 $ 365,578 $ 310,588 Advanced Diagnostics 24,401 22,620 70,513 60,435 Total revenue 151,954 128,782 436,091 371,023 Cost of revenue: Clinical Services (1) 73,994 65,261 213,032 197,563 Advanced Diagnostics (2) 15,649 14,628 46,043 42,389 Total cost of revenue 89,643 79,889 259,075 239,952 Gross Profit: Clinical Services 53,559 40,901 152,546 113,025 Advanced Diagnostics 8,752 7,992 24,470 18,046 Total gross profit $ 62,311 $ 48,893 $ 177,016 $ 131,071 (1) Clinical Services cost of revenue for both the three months ended September 30, 2023 and September 30, 2022 includes $4.3 million of amortization of acquired Inivata developed technology intangible assets. Clinical Services cost of revenue for both the nine months ended September 30, 2023 and September 30, 2022 includes $12.8 million of amortization of acquired Inivata developed technology intangible assets.

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Sep. 30, 2023	Sep. 30, 2022
Pay vs Performance Disclosure
NET LOSS	$ (18,516)	$ (24,331)	$ (30,795)	$ (36,852)	$ (35,303)	$ (49,408)	$ (73,642)	$ (121,563)

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended	9 Months Ended
	Sep. 30, 2023 shares	Sep. 30, 2023 shares
Trading Arrangements, by Individual
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false
Christopher Smith [Member]
Trading Arrangements, by Individual
Material Terms of Trading Arrangement		On August 15, 2023, Christopher Smith, our Director and Chief Executive Officer, adopted a Rule 10b5-1 trading arrangement providing for the sale from time to time of an aggregate of up to 140,000 shares of our common stock. The trading arrangement is intended to satisfy the affirmative defense in Rule 10b5-1(c). The duration of the trading arrangement is estimated to be from November 14, 2023 until December 31, 2024, or earlier if all transactions under the trading arrangement are completed.
Name	Christopher Smith
Title	Director and Chief Executive Officer
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	August 15, 2023
Arrangement Duration	413 days
Aggregate Available	140,000	140,000
Alicia Olivo [Member]
Trading Arrangements, by Individual
Material Terms of Trading Arrangement		On August 18, 2023, Alicia Olivo, our General Counsel and Corporate Secretary, adopted a Rule 10b5-1 trading arrangement providing for the sale from time to time of an aggregate number shares of our common stock. The planned sale of aggregated shares is to be equal to 40 restricted shares plus a designated percentage of the net number of such restricted shares vesting on certain applicable dates. The trading arrangement is intended to satisfy the affirmative defense in Rule 10b5-1(c). The duration of the trading arrangement is estimated to be from November 17, 2023 until December 31, 2024, or earlier if all transactions under the trading arrangement are completed.
Name	Alicia Olivo
Title	General Counsel and Corporate Secretary
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	August 18, 2023
Arrangement Duration	410 days
Alicia Olivo Trading Arrangement, Restricted Shares [Member] | Alicia Olivo [Member]
Trading Arrangements, by Individual
Aggregate Available	40	40

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2023
Accounting Changes and Error Corrections [Abstract]
Basis of Presentation	Basis of Presentation The accompanying interim Consolidated Financial Statements are unaudited and have been prepared in accordance with generally accepted accounting principles in the United States (“GAAP”) for interim financial information. All intercompany transactions and balances have been eliminated in the accompanying Consolidated Financial Statements. The accounting policies of the Company are the same as those set forth in Note 2. Summary of Significant Accounting Policies, to the audited Consolidated Financial Statements contained in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022, except for Stock-based Compensation and new accounting standards discussed under Recent Accounting Pronouncements as referenced below.
Use of Estimates	Use of Estimates The Company prepares its Consolidated Financial Statements in conformity with GAAP. These principles require management to make estimates, judgments and assumptions that affect the reported amounts of assets, liabilities, revenues and expenses, together with amounts disclosed in the related notes to the Consolidated Financial Statements. Actual results and outcomes may differ from management’s estimates, judgments and assumptions. Significant estimates, judgments and assumptions used in these Consolidated Financial Statements include, but are not limited, to those related to revenues, accounts receivable and related allowances, contingencies, useful lives and recovery of long-term assets and intangible assets, income taxes and valuation allowances, stock-based compensation, impairment analysis of goodwill, and restructuring reserves. These estimates, judgments, and assumptions are reviewed periodically and the effects of material revisions in estimates are reflected on the Consolidated Financial Statements prospectively from the date of the change in estimate.
Segment Reporting	Segment ReportingThe Company has historically reported its activities in two reportable segments; (1) the Clinical Services segment and (2) the Pharma Services segment. In the second quarter of 2023, the Pharma Services segment was rebranded as the Advanced Diagnostics segment. Functions within the Clinical Services segment include oncology diagnostics, community-based oncology and pathology sales, patient engagement, and clinical decision support. Functions within the Advanced Diagnostics segment include pharma services, informatics, R&D, minimal residual disease, liquid biopsy and therapy selection business development.
Sales and Marketing Expenses	Sales and Marketing Expenses Sales and marketing expenses are primarily attributable to employee-related costs including sales management, sales representatives, sales and marketing consultants, and marketing and customer service personnel in the Clinical Services segment. Advertising costs are expensed at the time they are incurred and were immaterial for the three and nine months ended September 30, 2023 and 2022.
Stock-Based Compensation	Stock-based Compensation In the second quarter of 2023, the Company began granting performance stock units (“PSUs”) subject to a market condition to certain of its executives as part of its executive compensation program. The number of shares awarded will be subject to adjustment based on the achievement of an absolute total shareholder return (“TSR”) performance target. If the TSR performance target is achieved, the awards will vest at the end of the three-year requisite service period so long as the employee remains employed with the Company through the applicable vesting date. The Company measures compensation expense for stock-based awards to employees, non-employee contracted physicians, and directors based upon the awards’ initial grant-date fair values. Stock-based compensation expense for stock options, restricted stock awards, restricted stock units and performance awards is recorded over the requisite service period in general and administrative expenses on the Consolidated Statements of Operations. For awards with only a service condition, the Company expenses stock-based compensation using the straight-line method over the requisite service period for the entire award. For awards with a market condition, the Company expenses the grant date fair value at the target over the vesting period regardless of the value that the award recipients ultimately receive. The fair values of stock option grants are estimated as of the date of grant by applying the Black-Scholes option valuation model (“Black-Scholes”). The fair value of restricted stock with a market condition is estimated at the date of grant using the Monte Carlo simulation model (“Monte Carlo”). The Black-Scholes and Monte Carlo models incorporate assumptions as to stock price volatility, the expected life of options or restricted stock, a risk-free interest rate and dividend yield. The fair value of restricted stock without a market condition is estimated using the current market price of the Company’s common stock on the date of grant. Black-Scholes is affected by the stock price on the date of the grant as well as assumptions regarding a number of highly complex and subjective variables. These variables include the expected term of the option, expected risk-free interest rate, the expected volatility of common stock, and expected dividend yield; each of which is described below. The assumptions for expected term and expected volatility are the two assumptions that significantly affect the grant date fair value. Expected Term: The expected term of an option is determined using the simplified method under SAB 107 which represents the average between the vesting term and the contractual term. The Company utilizes the simplified method to determine the expected life of the options due to insufficient exercise activity during recent years. Risk-free Interest Rate: The risk-free interest rate used in the Black-Scholes model is based on the implied yield at the grant date of the U.S. Treasury zero-coupon issue with an equivalent term to the stock-based award being valued. Where the expected term of a stock-based award does not correspond with the term for which a zero-coupon interest rate is quoted, the Company uses the nearest interest rate from available maturities. Expected Stock Price Volatility: The Company uses its own historical weekly volatility because that is more reflective of market conditions. Dividend Yield: Because the Company has never paid a dividend and does not expect to begin doing so in the foreseeable future, the Company assumed no dividend yield in valuing the stock-based awards. The fair value of the PSUs granted during the nine months ended September 30, 2023 was estimated as of the grant date using the Monte Carlo, which requires management to make assumptions regarding risk-free interest rates and volatility of the Company’s stock price. The Monte Carlo incorporates the same assumptions as Black-Scholes as to stock price volatility, the risk-free interest rate and dividend yield. The Company utilized the expected life of the PSUs for the expected term of the award, as the vesting term and contractual term of the awards are identical.
Recently Accounting Pronouncements	Recent Accounting Pronouncements In October 2021, the FASB issued ASU No. 2021-08, Business Combinations (Topic 805), Accounting for Contract Assets and Contract Liabilities from Contracts with Customers (“ASU 2021-08”). This update amends guidance to require that an entity (acquirer) recognize and measure contract assets and contract liabilities acquired in a business combination in accordance with Revenue from Contracts with Customers (Topic 606). At the acquisition date, an acquirer should account for the related revenue contracts in accordance with Topic 606 as if it had originated the contracts. ASU 2021-08 is effective for fiscal years beginning after December 15, 2022, including interim periods within those fiscal years. Early adoption of the amendments is permitted including adoption in an interim period. If the Company early adopts in an interim period, the Company is required to apply the amendments (1) retrospectively to all business combinations for which the acquisition date occurs on or after the beginning of the fiscal year that includes the interim period of early application and (2) prospectively to all business combinations that occur on or after the date of initial application. The amendments in ASU 2021-08 should be applied prospectively to business combinations occurring on or after the effective date of the amendments. The Company adopted this standard as of January 1, 2023 and there was no impact on its Consolidated Financial Statements.

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	9 Months Ended
	Sep. 30, 2023
Fair Value Disclosures [Abstract]
Schedule of Fair Value, Assets Measured on Recurring and Nonrecurring Basis	The following tables set forth the amortized cost, gross unrealized gains, gross unrealized losses and fair values of the Company’s marketable securities accounted for as available-for-sale securities as of September 30, 2023 and December 31, 2022. September 30, 2023 (in thousands) Amortized Cost Gross Unrealized Gains Gross Unrealized Losses Fair Value Financial Assets: Short-term marketable securities: U.S. Treasury securities $ 25,850 $ — $ (175) $ 25,675 Yankee bonds 2,605 — (37) 2,568 Agency bonds 6,041 — (98) 5,943 Municipal bonds 12,731 — (828) 11,903 Commercial paper 2,973 — — 2,973 Asset-backed securities 9,235 — (90) 9,145 Corporate bonds 38,977 — (1,159) 37,818 Total $ 98,412 $ — $ (2,387) $ 96,025 December 31, 2022 (in thousands) Amortized Cost Gross Unrealized Gains Gross Unrealized Losses Fair Value Financial Assets: Short-term marketable securities: U.S. Treasury securities $ 56,426 $ — $ (651) $ 55,775 Yankee bonds 5,358 — (92) 5,266 Agency bonds 12,485 — (116) 12,369 Municipal bonds 12,841 — (1,030) 11,811 Commercial paper 2,846 8 — 2,854 Asset-backed securities 25,544 2 (427) 25,119 Corporate bonds 63,748 3 (2,136) 61,615 Total $ 179,248 $ 13 $ (4,452) $ 174,809
Schedule of Investments Classified by Contractual Maturity Date	The following tables set forth the fair value of available-for-sale marketable securities by contractual maturity at September 30, 2023 and December 31, 2022. September 30, 2023 (in thousands) One Year or Less Over One Year Through Five Years Over Five Years Total Financial Assets: Marketable Securities: U.S. Treasury securities $ 25,675 $ — $ — $ 25,675 Yankee bonds 2,568 — — 2,568 Agency bonds 3,572 2,371 — 5,943 Municipal bonds 2,962 8,941 — 11,903 Commercial paper 2,973 — — 2,973 Asset-backed securities 9,145 — — 9,145 Corporate bonds 25,210 12,608 — 37,818 Total $ 72,105 $ 23,920 $ — $ 96,025 December 31, 2022 (in thousands) One Year or Less Over One Year Through Five Years Over Five Years Total Financial Assets: Marketable Securities: U.S. Treasury securities $ 40,795 $ 14,980 $ — $ 55,775 Yankee bonds 2,734 2,532 — 5,266 Agency bonds 6,470 5,899 — 12,369 Municipal bonds — 11,811 — 11,811 Commercial paper 2,854 — — 2,854 Asset-backed securities 23,179 1,940 — 25,119 Corporate bonds 35,377 26,238 — 61,615 Total $ 111,409 $ 63,400 $ — $ 174,809
Schedule of Fair Value, Assets Measured on Recurring Basis	The following tables set forth the Company’s cash equivalents and marketable securities accounted for as available-for-sale securities that were measured at fair value on a recurring basis based on the fair value hierarchy as of September 30, 2023 and December 31, 2022. September 30, 2023 (in thousands) Level 1 Level 2 Level 3 Total Financial Assets: Cash equivalents: Money market funds $ 299,539 $ — $ — $ 299,539 Marketable securities: U.S. Treasury securities 25,675 — — 25,675 Yankee bonds 2,568 — — 2,568 Agency bonds 5,943 — — 5,943 Municipal bonds 11,903 — — 11,903 Commercial paper — 2,973 — 2,973 Asset-backed securities — 9,145 — 9,145 Corporate bonds — 37,818 — 37,818 Total $ 345,628 $ 49,936 $ — $ 395,564 December 31, 2022 (in thousands) Level 1 Level 2 Level 3 Total Financial Assets: Cash equivalents: Money market funds $ 196,749 $ — $ — $ 196,749 Commercial paper — 36,965 — 36,965 Marketable securities: U.S. Treasury securities 55,775 — — 55,775 Yankee bonds 5,266 — — 5,266 Agency bonds 12,369 — — 12,369 Municipal bonds 11,811 — — 11,811 Commercial paper — 2,854 — 2,854 Asset-backed securities — 25,119 — 25,119 Corporate bonds — 61,615 — 61,615 Total $ 281,970 $ 126,553 $ — $ 408,523

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	9 Months Ended
	Sep. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Goodwill	The following table summarizes the carrying amounts of goodwill by segment at September 30, 2023 and December 31, 2022 (in thousands): September 30, 2023 December 31, 2022 Clinical Services $ 458,782 $ 458,782 Advanced Diagnostics 63,984 63,984 Total $ 522,766 $ 522,766
Schedule of Classes of Intangible Assets	Intangible assets consisted of the following (in thousands): September 30, 2023 Amortization Cost Accumulated Net Customer Relationships 7 - 15 $ 143,101 $ 63,062 $ 80,039 Developed Technology 10 - 15 310,226 49,108 261,118 Marketing Assets 4 549 342 207 Trademarks 15 31,473 4,797 26,676 Trade Name 2.5 2,584 2,161 423 Trademark - Indefinite lived — 13,447 — 13,447 Total $ 501,380 $ 119,470 $ 381,910 December 31, 2022 Amortization Cost Accumulated Net Customer Relationships 7 - 15 $ 143,101 $ 55,645 $ 87,456 Developed Technology 10 - 15 310,226 33,117 277,109 Marketing Assets 4 549 238 311 Trademarks 15 31,473 3,223 28,250 Trade Name 2.5 2,584 897 1,687 Trademark - Indefinite lived — 13,447 — 13,447 Total $ 501,380 $ 93,120 $ 408,260
Schedule of Intangible Asset Amortization Expense	The following table summarizes the amortization expense for the three and nine months ended September 30, 2023 and 2022 (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Amortization of intangibles included in cost of revenue $ 4,853 $ 4,853 $ 14,560 $ 14,559 Amortization of intangibles included in general and administrative expenses 3,931 3,637 11,790 10,911 Total amortization of intangibles $ 8,784 $ 8,490 $ 26,350 $ 25,470
Schedule of Estimated Amortization Expense	The estimated amortization expense related to amortizable intangible assets for each of the following periods as of September 30, 2023 is as follows (in thousands): Remainder of 2023 $ 8,783 2024 33,447 2025 33,343 2026 33,308 2027 32,758 Thereafter 226,824 Total $ 368,463

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	9 Months Ended
	Sep. 30, 2023
Equity [Abstract]
Schedule of Stock Option Activity	A summary of the stock option activity under the Company’s plans for the nine months ended September 30, 2023 is as follows: Number of Weighted Average Exercise Price Outstanding at December 31, 2022 4,214,617 $ 16.48 Granted 1,644,070 $ 17.17 Exercised (223,044) $ 10.70 Forfeited (1,142,470) $ 21.11 Outstanding at September 30, 2023 4,493,173 $ 15.84 Exercisable at September 30, 2023 1,126,578 $ 21.05
Schedule of Fair Value of Each Stock Option Award Granted	The fair value of each stock option award granted during the nine months ended September 30, 2023 was estimated as of the grant date using a Black-Scholes model with the following assumptions: Nine Months Ended Expected term (in years) 4.0 - 6.5 Risk-free interest rate (%) 3.3% - 4.4% Expected volatility (%) 53.3% - 67.9% Dividend yield (%) — Weighted average grant date fair value per share $9.04
Schedule of Restricted Stock Activity	A summary of the restricted stock activity under the Company’s plans for the nine months ended September 30, 2023 is as follows: Number of Restricted Weighted Average Grant Date Fair Value Nonvested at December 31, 2022 1,994,861 $ 12.71 Granted 986,142 $ 16.90 Vested (548,543) $ 14.00 Forfeited (385,489) $ 15.72 Nonvested at September 30, 2023 2,046,971 $ 13.79 A summary of the PSU activity under the Company’s plans for the nine months ended September 30, 2023 is as follows: Number of Stock Units Weighted Average Grant Date Fair Value Nonvested at December 31, 2022 — $ — Granted 305,105 $ 21.83 Vested — $ — Forfeited — $ — Nonvested at September 30, 2023 305,105 $ 21.83
Schedule of Fair Value of PSU Award Granted	The fair value of each PSU granted during the nine months ended September 30, 2023 was estimated as of the grant date using a Monte Carlo with the following assumptions: Nine Months Ended Expected term (in years) 3.0 Risk-free interest rate (%) 3.6% - 4.0% Expected volatility (%) 68.4% - 69.9% Dividend yield (%) — Weighted average grant date fair value per share $21.83

Revenue Recognition (Tables)

Revenue Recognition (Tables)	9 Months Ended
	Sep. 30, 2023
Revenue from Contract with Customer [Abstract]
Schedule of Contract Assets and Liabilities	The following table summarizes the values of contract assets, capitalized commissions and contract liabilities (in thousands): September 30, 2023 December 31, 2022 Current contract assets (1) $ 424 $ 1,898 Long-term contract assets (2) — 31 Total assets $ 424 $ 1,929 Current capitalized commissions (1) $ 937 $ 800 Long-term capitalized commissions (2) 257 715 Total capitalized commissions $ 1,194 $ 1,515 Current contract liabilities $ 3,617 $ 7,557 Long-term contract liabilities (3) — 19 Total contract liabilities $ 3,617 $ 7,576 (1) Recorded within other current assets on the Consolidated Balance Sheets. (2) Recorded within other assets on the Consolidated Balance Sheets. (3) Recorded within other long-term liabilities on the Consolidated Balance Sheets.
Schedule of Disaggregation of Revenue	The following table details the disaggregation of revenue for both the Clinical Services and Advanced Diagnostics Segments (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Clinical Services Client direct billing $ 86,160 $ 73,234 $ 246,159 $ 208,123 Commercial Insurance 21,722 17,105 64,772 53,904 Medicare and Medicaid 19,624 15,795 54,407 48,427 Self-Pay 47 28 240 134 Total Clinical Services $ 127,553 $ 106,162 $ 365,578 $ 310,588 Advanced Diagnostics 24,401 22,620 70,513 60,435 Total Revenue $ 151,954 $ 128,782 $ 436,091 $ 371,023

Restructuring (Tables)

Restructuring (Tables)	9 Months Ended
	Sep. 30, 2023
Restructuring and Related Activities [Abstract]
Schedule of Accrued Restructuring	The following table summarizes the changes in the Company’s accrued restructuring balance (in thousands): Severance and Other Employee Costs Facility Footprint Optimization Consulting and Implementation Costs Total Balance as of December 31, 2022 $ 559 $ — $ 960 $ 1,519 Restructuring charges incurred 3,105 913 106 4,124 Impairment of facility related assets — 560 — 560 Cash payments and other adjustments (1) (1,285) (564) (346) (2,195) Balance as of March 31, 2023 $ 2,379 $ 909 $ 720 $ 4,008 Restructuring charges incurred 1,893 271 581 2,745 Impairment of facility related assets — 329 — 329 Cash payments and other adjustments (1) (1,634) (306) (1,007) (2,947) Balance as of June 30, 2023 $ 2,638 $ 1,203 $ 294 $ 4,135 Restructuring charges incurred 362 641 896 1,899 Impairment of facility related assets — 226 — 226 Cash payments and other adjustments (1) (1,613) (234) (642) (2,489) Balance as of September 30, 2023 $ 1,387 $ 1,836 $ 548 $ 3,771 Current liabilities $ 3,771 Long-term liabilities — $ 3,771 (1) Other adjustments include non-cash asset charges related to Facility Footprint Optimization costs.

Net Loss Per Share (Tables)

Net Loss Per Share (Tables)	9 Months Ended
	Sep. 30, 2023
Earnings Per Share [Abstract]
Schedule of Earnings Per Share, Basic and Diluted	The following table shows the calculations (in thousands, except net loss per share amounts): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 NET LOSS $ (18,516) $ (36,852) $ (73,642) $ (121,563) Basic weighted average shares outstanding 125,687 124,425 125,358 124,055 Diluted weighted average shares outstanding 125,687 124,425 125,358 124,055 Basic net loss per share $ (0.15) $ (0.30) $ (0.59) $ (0.98) Diluted net loss per share $ (0.15) $ (0.30) $ (0.59) $ (0.98)
Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share	The following potential dilutive shares were excluded from the calculation of diluted net loss per share because their effect would be anti-dilutive (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Stock options 451 45 444 272 Restricted stock awards 769 295 877 266 2025 Convertible Notes 5,538 5,538 5,538 5,538 2028 Convertible Notes 5,215 5,215 5,215 5,215

Segment Information (Tables)

Segment Information (Tables)	9 Months Ended
	Sep. 30, 2023
Segment Reporting [Abstract]
Schedule of Segment Information	The following table summarizes the segment information (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Net revenues: Clinical Services $ 127,553 $ 106,162 $ 365,578 $ 310,588 Advanced Diagnostics 24,401 22,620 70,513 60,435 Total revenue 151,954 128,782 436,091 371,023 Cost of revenue: Clinical Services (1) 73,994 65,261 213,032 197,563 Advanced Diagnostics (2) 15,649 14,628 46,043 42,389 Total cost of revenue 89,643 79,889 259,075 239,952 Gross Profit: Clinical Services 53,559 40,901 152,546 113,025 Advanced Diagnostics 8,752 7,992 24,470 18,046 Total gross profit $ 62,311 $ 48,893 $ 177,016 $ 131,071 (1) Clinical Services cost of revenue for both the three months ended September 30, 2023 and September 30, 2022 includes $4.3 million of amortization of acquired Inivata developed technology intangible assets. Clinical Services cost of revenue for both the nine months ended September 30, 2023 and September 30, 2022 includes $12.8 million of amortization of acquired Inivata developed technology intangible assets.

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Details)	9 Months Ended
	Sep. 30, 2023 segment
Accounting Changes and Error Corrections [Abstract]
Number of reportable segments	2
Requisite service period (in years)	3 years

Fair Value Measurements - Sched

Fair Value Measurements - Schedule of Amortized Cost (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Amortized Cost	$ 98,412,000		$ 98,412,000		$ 179,248,000
Gross Unrealized Gains	0		0		13,000
Gross Unrealized Losses	(2,387,000)		(2,387,000)		(4,452,000)
Fair Value	96,025,000		96,025,000		174,809,000
Accrued interest receivable	1,600,000		1,600,000		900,000
Realized gains (losses) on marketable securities	0	$ 0	0	$ 0
U.S. Treasury securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Amortized Cost	25,850,000		25,850,000		56,426,000
Gross Unrealized Gains	0		0		0
Gross Unrealized Losses	(175,000)		(175,000)		(651,000)
Fair Value	25,675,000		25,675,000		55,775,000
Yankee bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Amortized Cost	2,605,000		2,605,000		5,358,000
Gross Unrealized Gains	0		0		0
Gross Unrealized Losses	(37,000)		(37,000)		(92,000)
Fair Value	2,568,000		2,568,000		5,266,000
Agency bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Amortized Cost	6,041,000		6,041,000		12,485,000
Gross Unrealized Gains	0		0		0
Gross Unrealized Losses	(98,000)		(98,000)		(116,000)
Fair Value	5,943,000		5,943,000		12,369,000
Municipal bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Amortized Cost	12,731,000		12,731,000		12,841,000
Gross Unrealized Gains	0		0		0
Gross Unrealized Losses	(828,000)		(828,000)		(1,030,000)
Fair Value	11,903,000		11,903,000		11,811,000
Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Amortized Cost	2,973,000		2,973,000		2,846,000
Gross Unrealized Gains	0		0		8,000
Gross Unrealized Losses	0		0		0
Fair Value	2,973,000		2,973,000		2,854,000
Asset-backed securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Amortized Cost	9,235,000		9,235,000		25,544,000
Gross Unrealized Gains	0		0		2,000
Gross Unrealized Losses	(90,000)		(90,000)		(427,000)
Fair Value	9,145,000		9,145,000		25,119,000
Corporate bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Amortized Cost	38,977,000		38,977,000		63,748,000
Gross Unrealized Gains	0		0		3,000
Gross Unrealized Losses	(1,159,000)		(1,159,000)		(2,136,000)
Fair Value	$ 37,818,000		$ 37,818,000		$ 61,615,000

Fair Value Measurements - Fair

Fair Value Measurements - Fair Value by Contractual Maturity (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
One Year or Less	$ 72,105	$ 111,409
Over One Year Through Five Years	23,920	63,400
Over Five Years	0	0
Total	96,025	174,809
U.S. Treasury securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
One Year or Less	25,675	40,795
Over One Year Through Five Years	0	14,980
Over Five Years	0	0
Total	25,675	55,775
Yankee bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
One Year or Less	2,568	2,734
Over One Year Through Five Years	0	2,532
Over Five Years	0	0
Total	2,568	5,266
Agency bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
One Year or Less	3,572	6,470
Over One Year Through Five Years	2,371	5,899
Over Five Years	0	0
Total	5,943	12,369
Municipal bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
One Year or Less	2,962	0
Over One Year Through Five Years	8,941	11,811
Over Five Years	0	0
Total	11,903	11,811
Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
One Year or Less	2,973	2,854
Over One Year Through Five Years	0	0
Over Five Years	0	0
Total	2,973	2,854
Asset-backed securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
One Year or Less	9,145	23,179
Over One Year Through Five Years	0	1,940
Over Five Years	0	0
Total	9,145	25,119
Corporate bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
One Year or Less	25,210	35,377
Over One Year Through Five Years	12,608	26,238
Over Five Years	0	0
Total	$ 37,818	$ 61,615

Fair Value Measurements - Asset

Fair Value Measurements - Assets Measured on Recurring Basis (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	$ 96,025	$ 174,809
U.S. Treasury securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	25,675	55,775
Yankee bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	2,568	5,266
Agency bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	5,943	12,369
Municipal bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	11,903	11,811
Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	2,973	2,854
Asset-backed securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	9,145	25,119
Corporate bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	37,818	61,615
Fair Value, Recurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total	395,564	408,523
Fair Value, Recurring | Money market funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash equivalents:	299,539	196,749
Fair Value, Recurring | Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash equivalents:		36,965
Fair Value, Recurring | U.S. Treasury securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	25,675	55,775
Fair Value, Recurring | Yankee bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	2,568	5,266
Fair Value, Recurring | Agency bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	5,943	12,369
Fair Value, Recurring | Municipal bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	11,903	11,811
Fair Value, Recurring | Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	2,973	2,854
Fair Value, Recurring | Asset-backed securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	9,145	25,119
Fair Value, Recurring | Corporate bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	37,818	61,615
Fair Value, Recurring | Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total	345,628	281,970
Fair Value, Recurring | Level 1 | Money market funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash equivalents:	299,539	196,749
Fair Value, Recurring | Level 1 | Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash equivalents:		0
Fair Value, Recurring | Level 1 | U.S. Treasury securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	25,675	55,775
Fair Value, Recurring | Level 1 | Yankee bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	2,568	5,266
Fair Value, Recurring | Level 1 | Agency bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	5,943	12,369
Fair Value, Recurring | Level 1 | Municipal bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	11,903	11,811
Fair Value, Recurring | Level 1 | Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	0	0
Fair Value, Recurring | Level 1 | Asset-backed securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	0	0
Fair Value, Recurring | Level 1 | Corporate bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	0	0
Fair Value, Recurring | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total	49,936	126,553
Fair Value, Recurring | Level 2 | Money market funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash equivalents:	0	0
Fair Value, Recurring | Level 2 | Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash equivalents:		36,965
Fair Value, Recurring | Level 2 | U.S. Treasury securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	0	0
Fair Value, Recurring | Level 2 | Yankee bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	0	0
Fair Value, Recurring | Level 2 | Agency bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	0	0
Fair Value, Recurring | Level 2 | Municipal bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	0	0
Fair Value, Recurring | Level 2 | Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	2,973	2,854
Fair Value, Recurring | Level 2 | Asset-backed securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	9,145	25,119
Fair Value, Recurring | Level 2 | Corporate bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	37,818	61,615
Fair Value, Recurring | Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total	0	0
Fair Value, Recurring | Level 3 | Money market funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash equivalents:	0	0
Fair Value, Recurring | Level 3 | Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash equivalents:		0
Fair Value, Recurring | Level 3 | U.S. Treasury securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	0	0
Fair Value, Recurring | Level 3 | Yankee bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	0	0
Fair Value, Recurring | Level 3 | Agency bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	0	0
Fair Value, Recurring | Level 3 | Municipal bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	0	0
Fair Value, Recurring | Level 3 | Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	0	0
Fair Value, Recurring | Level 3 | Asset-backed securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	0	0
Fair Value, Recurring | Level 3 | Corporate bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities, at fair value	$ 0	$ 0

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Schedule of Goodwill (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Goodwill [Line Items]
Goodwill	$ 522,766	$ 522,766
Clinical Services
Goodwill [Line Items]
Goodwill	458,782	458,782
Advanced Diagnostics
Goodwill [Line Items]
Goodwill	$ 63,984	$ 63,984

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Classes of Intangible Assets (Details) - USD ($) $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Accumulated Amortization	$ 119,470	$ 93,120
Finite-lived intangibles, net	368,463
Intangible Assets, Net (Excluding Goodwill) [Abstract]
Total cost of intangibles	501,380	501,380
Accumulated Amortization	119,470	93,120
Intangible assets, net	381,910	408,260
Customer Relationships
Finite-Lived Intangible Assets [Line Items]
Cost	143,101	143,101
Accumulated Amortization	63,062	55,645
Finite-lived intangibles, net	80,039	87,456
Intangible Assets, Net (Excluding Goodwill) [Abstract]
Accumulated Amortization	63,062	55,645
Developed Technology
Finite-Lived Intangible Assets [Line Items]
Cost	310,226	310,226
Accumulated Amortization	49,108	33,117
Finite-lived intangibles, net	261,118	277,109
Intangible Assets, Net (Excluding Goodwill) [Abstract]
Accumulated Amortization	$ 49,108	$ 33,117
Marketing Assets
Finite-Lived Intangible Assets [Line Items]
Amortization Period (years)	4 years	4 years
Cost	$ 549	$ 549
Accumulated Amortization	342	238
Finite-lived intangibles, net	207	311
Intangible Assets, Net (Excluding Goodwill) [Abstract]
Accumulated Amortization	$ 342	$ 238
Trademarks
Finite-Lived Intangible Assets [Line Items]
Amortization Period (years)	15 years	15 years
Cost	$ 31,473	$ 31,473
Accumulated Amortization	4,797	3,223
Finite-lived intangibles, net	26,676	28,250
Intangible Assets, Net (Excluding Goodwill) [Abstract]
Accumulated Amortization	$ 4,797	$ 3,223
Trade Name
Finite-Lived Intangible Assets [Line Items]
Amortization Period (years)	2 years 6 months	2 years 6 months
Cost	$ 2,584	$ 2,584
Accumulated Amortization	2,161	897
Finite-lived intangibles, net	423	1,687
Intangible Assets, Net (Excluding Goodwill) [Abstract]
Accumulated Amortization	$ 2,161	$ 897
Minimum | Customer Relationships
Finite-Lived Intangible Assets [Line Items]
Amortization Period (years)	7 years	7 years
Minimum | Developed Technology
Finite-Lived Intangible Assets [Line Items]
Amortization Period (years)	10 years	10 years
Maximum | Customer Relationships
Finite-Lived Intangible Assets [Line Items]
Amortization Period (years)	15 years	15 years
Maximum | Developed Technology
Finite-Lived Intangible Assets [Line Items]
Amortization Period (years)	15 years	15 years
Trademarks
Indefinite-Lived Intangible Assets [Line Items]
Trademark - Indefinite lived	$ 13,447	$ 13,447

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets - Schedule of Amortization Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Finite-Lived Intangible Assets [Line Items]
Total amortization of intangibles	$ 8,784	$ 8,490	$ 26,350	$ 25,470
Amortization of intangibles included in cost of revenue
Finite-Lived Intangible Assets [Line Items]
Total amortization of intangibles	4,853	4,853	14,560	14,559
Amortization of intangibles included in general and administrative expenses
Finite-Lived Intangible Assets [Line Items]
Total amortization of intangibles	$ 3,931	$ 3,637	$ 11,790	$ 10,911

Goodwill and Intangible Asset_5

Goodwill and Intangible Assets - Estimated Amortization Expense (Details) $ in Thousands	Sep. 30, 2023 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
Remainder of 2023	$ 8,783
2024	33,447
2025	33,343
2026	33,308
2027	32,758
Thereafter	226,824
Total	$ 368,463

Debt (Details)

Debt (Details) - Convertible Debt	3 Months Ended			9 Months Ended
	Sep. 30, 2023 USD ($) day $ / shares	Jun. 30, 2023 day	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($) $ / shares	Sep. 30, 2022 USD ($)	Sep. 29, 2023 $ / shares	Dec. 31, 2022 USD ($)	Jan. 11, 2021 USD ($)	May 04, 2020 USD ($)
2028 Convertible Notes
Line of Credit Facility [Line Items]
Debt instrument, face amount								$ 345,000,000
Stated interest rate (as a percent)	0.25%			0.25%			0.25%	0.25%
Convertible notes, conversion price (in dollars per share) | $ / shares	$ 12.30			$ 12.30		$ 12.30
Interest expense, contractual coupon interest	$ 200,000		$ 200,000	$ 600,000	$ 700,000
Interest expense, accretion of debt discount	400,000		400,000	1,100,000	1,100,000
Interest expense, amortization of debt issuance costs	8,500		8,500	$ 26,000	25,300
Effective interest rate on convertible notes (as a percent)				0.70%
2028 Convertible Notes | Level 2
Line of Credit Facility [Line Items]
Estimated fair value of debt	$ 245,800,000			$ 245,800,000			$ 218,200,000
2025 Convertible Notes
Line of Credit Facility [Line Items]
Debt instrument, face amount									$ 201,300,000
Stated interest rate (as a percent)	1.25%			1.25%			1.25%		1.25%
Convertible notes, conversion price (in dollars per share) | $ / shares						$ 12.30
Interest expense, contractual coupon interest	$ 600,000		600,000	$ 1,900,000	1,900,000
Interest expense, accretion of debt discount	300,000		300,000	900,000	900,000
Interest expense, amortization of debt issuance costs	37,900		$ 37,200	$ 100,000	$ 100,000
Effective interest rate on convertible notes (as a percent)				1.96%
2025 Convertible Notes | Level 2
Line of Credit Facility [Line Items]
Estimated fair value of debt	$ 187,300,000			$ 187,300,000			$ 169,600,000
2025 Convertible Notes | Debt Instrument, Redemption, Period One
Line of Credit Facility [Line Items]
Conversion price on applicable trading day (as a percent)	130%	130%
Threshold trading days (in days) | day	20	20
Consecutive trading days (in days) | day	30	30

Stock-Based Compensation - Narr

Stock-Based Compensation - Narrative (Details) - USD ($)	3 Months Ended					9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Sep. 30, 2023	Sep. 30, 2022	Mar. 25, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock compensation expense (gain)	$ 7,200,000		$ 4,300,000			$ 17,600,000	$ 20,000,000
Unrecognized stock-based compensation cost, option	15,800,000					$ 15,800,000
Requisite service period (in years)						3 years
Incremental stock-based compensation for accelerated vesting						$ 900,000
Chief Legal Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Incremental stock-based compensation for accelerated vesting							2,200,000
Chief Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Incremental stock-based compensation for accelerated vesting							5,900,000
Stock options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock compensation expense (gain)	3,000,000		1,600,000			$ 7,000,000	6,400,000
Unrecognized share-based compensation expense, weighted-average recognition period (in years)						1 year 10 months 24 days
Stock options | Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Repurchase program adjustment			0				0
Accelerated vesting (in shares)		101,937
Incremental stock-based compensation for accelerated vesting						$ 300,000
Stock options | Chief Legal Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Repurchase program adjustment	0
Accelerated vesting (in shares)				41,487
Incremental stock-based compensation for accelerated vesting							300,000
Stock options | Chief Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Repurchase program adjustment	0
Accelerated vesting (in shares)					237,960
Incremental stock-based compensation for accelerated vesting							2,300,000
Restricted stock awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock compensation expense (gain)	3,400,000		2,400,000			$ 8,900,000	12,800,000
Unrecognized share-based compensation expense, weighted-average recognition period (in years)						1 year 10 months 24 days
Unrecognized stock-based compensation cost, non-option	18,800,000					$ 18,800,000
Granted (in shares)						986,142
Restricted stock awards | Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Repurchase program adjustment	0
Accelerated vesting (in shares)		61,746
Incremental stock-based compensation for accelerated vesting						$ 600,000
Restricted stock awards | Chief Legal Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Repurchase program adjustment						0
Accelerated vesting (in shares)				76,138
Incremental stock-based compensation for accelerated vesting							1,900,000
Restricted stock awards | Chief Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Repurchase program adjustment						0
Accelerated vesting (in shares)					142,302
Incremental stock-based compensation for accelerated vesting							3,600,000
PSU
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock compensation expense (gain)	600,000					$ 900,000
Unrecognized share-based compensation expense, weighted-average recognition period (in years)						2 years 7 months 6 days
Unrecognized stock-based compensation cost, non-option	$ 5,800,000					$ 5,800,000
Granted (in shares)		305,105				305,105
Granted in period, fair value		$ 6,700,000
Requisite service period (in years)		3 years
Repurchase program adjustment			$ 0				$ 0
Equity Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Maximum number shares available for future issuance (in shares)								3,975,000

Stock-Based Compensation - Summ

Stock-Based Compensation - Summary of Stock Option Activity (Details) - $ / shares	9 Months Ended
	Sep. 30, 2023
Number of Shares
Beginning balance (in shares)	4,214,617
Granted (in shares)	1,644,070
Exercised (in shares)	(223,044)
Forfeited (in shares)	(1,142,470)
Ending balance (in shares)	4,493,173
Exercisable at end of period (in shares)	1,126,578
Weighted Average Exercise Price
Beginning balance (in dollars per share)	$ 16.48
Granted (in dollars per share)	17.17
Exercised (in dollars per share)	10.70
Forfeited (in dollars per share)	21.11
Ending balance (in dollars per share)	15.84
Exercisable, ending balance (in dollars per share)	$ 21.05

Stock-Based Compensation - Fair

Stock-Based Compensation - Fair Value of Each Stock Option and PSU Award Granted (Details)	9 Months Ended
	Sep. 30, 2023 $ / shares
Stock options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate (%) - (Minimum)	3.30%
Risk-free interest rate (%) - (Maximum)	4.40%
Expected volatility (%) - (Minimum)	53.30%
Expected volatility (%) - (Maximum)	67.90%
Dividend yield (%)	0%
Weighted average fair value/share at grant date (in dollars per share)	$ 9.04
PSU
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term (in years)	3 years
Risk-free interest rate (%) - (Minimum)	3.60%
Risk-free interest rate (%) - (Maximum)	4%
Expected volatility (%) - (Minimum)	68.40%
Expected volatility (%) - (Maximum)	69.90%
Dividend yield (%)	0%
Weighted average fair value/share at grant date (in dollars per share)	$ 21.83
Minimum | Stock options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term (in years)	4 years
Maximum | Stock options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term (in years)	6 years 6 months

Stock-Based Compensation - Su_2

Stock-Based Compensation - Summary of Restricted Stock Activity (Details) - $ / shares	3 Months Ended	9 Months Ended
	Jun. 30, 2023	Sep. 30, 2023
Restricted stock awards
Number of Restricted Shares
Beginning balance (in shares)		1,994,861
Granted (in shares)		986,142
Vested (in shares)		(548,543)
Forfeited (in shares)		(385,489)
Ending balance (in shares)		2,046,971
Weighted Average Grant Date Fair Value
Beginning balance (in dollars per share)		$ 12.71
Granted (in dollars per share)		16.90
Vested (in dollars per share)		14
Forfeited (in dollars per share)		15.72
Ending balance (in dollars per share)		$ 13.79
PSU
Number of Restricted Shares
Beginning balance (in shares)		0
Granted (in shares)	305,105	305,105
Vested (in shares)		0
Forfeited (in shares)		0
Ending balance (in shares)		305,105
Weighted Average Grant Date Fair Value
Beginning balance (in dollars per share)		$ 0
Granted (in dollars per share)		21.83
Vested (in dollars per share)		0
Forfeited (in dollars per share)		0
Ending balance (in dollars per share)		$ 21.83

Revenue Recognition - Narrative

Revenue Recognition - Narrative (Details) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($) segment	Sep. 30, 2022 USD ($)
Revenue from Contract with Customer [Abstract]
Number of operating segments | segment			2
Pharma contract liability, revenue recognized	$ 1.4	$ 0.7	$ 4.9	$ 4.8
Amortization of contract commissions	$ 0.2	$ 0.3	$ 0.7	$ 0.6

Revenue Recognition - Contract

Revenue Recognition - Contract Assets and Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Contract with Customer, Asset, Net [Abstract]
Current contract assets	$ 424	$ 1,898
Long-term contract assets	0	31
Total assets	424	1,929
Capitalized Contract Cost [Abstract]
Current capitalized commissions	937	800
Long-term capitalized commissions	257	715
Total capitalized commissions	1,194	1,515
Contract with Customer, Liability [Abstract]
Current contract liabilities	3,617	7,557
Long-term contract liabilities	0	19
Total contract liabilities	$ 3,617	$ 7,576

Revenue Recognition - Disaggreg

Revenue Recognition - Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Disaggregation of Revenue [Line Items]
Total Revenue	$ 151,954	$ 128,782	$ 436,091	$ 371,023
Clinical Services
Disaggregation of Revenue [Line Items]
Total Revenue	127,553	106,162	365,578	310,588
Clinical Services | Client direct billing
Disaggregation of Revenue [Line Items]
Total Revenue	86,160	73,234	246,159	208,123
Clinical Services | Commercial Insurance
Disaggregation of Revenue [Line Items]
Total Revenue	21,722	17,105	64,772	53,904
Clinical Services | Medicare and Medicaid
Disaggregation of Revenue [Line Items]
Total Revenue	19,624	15,795	54,407	48,427
Clinical Services | Self-Pay
Disaggregation of Revenue [Line Items]
Total Revenue	47	28	240	134
Advanced Diagnostics
Disaggregation of Revenue [Line Items]
Total Revenue	$ 24,401	$ 22,620	$ 70,513	$ 60,435

Restructuring - Narrative (Deta

Restructuring - Narrative (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Restructuring Cost and Reserve [Line Items]
Restructuring charges	$ 2,125,000	$ 0	$ 9,883,000	$ 0
Restructuring cost	5,900,000		5,900,000
Severance and Other Employee Costs
Restructuring Cost and Reserve [Line Items]
Restructuring cost	700,000		700,000
Facility Footprint Optimization
Restructuring Cost and Reserve [Line Items]
Restructuring cost	4,500,000		4,500,000
Consulting costs
Restructuring Cost and Reserve [Line Items]
Restructuring cost	$ 700,000		$ 700,000

Restructuring - Schedule of Res

Restructuring - Schedule of Restructuring Activities (Details) - USD ($) $ in Thousands	3 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023
Restructuring Reserve [Roll Forward]
Beginning balance	$ 4,135	$ 4,008	$ 1,519
Restructuring charges incurred	1,899	2,745	4,124
Impairment of facility related assets	226	329	560
Cash payments and other adjustments	(2,489)	(2,947)	(2,195)
Ending balance	$ 3,771	$ 4,135	$ 4,008
Restructuring incurred cost statement of income or comprehensive income extensible enumeration not disclosed flag	Restructuring charges incurred	Restructuring charges incurred	Restructuring charges incurred
Current liabilities	$ 3,771
Long-term liabilities	0
Restructuring reserve	3,771	$ 4,135	$ 4,008
Severance and Other Employee Costs
Restructuring Reserve [Roll Forward]
Beginning balance	2,638	2,379	559
Restructuring charges incurred	362	1,893	3,105
Impairment of facility related assets	0	0	0
Cash payments and other adjustments	(1,613)	(1,634)	(1,285)
Ending balance	1,387	2,638	2,379
Restructuring reserve	1,387	2,638	2,379
Facility Footprint Optimization
Restructuring Reserve [Roll Forward]
Beginning balance	1,203	909	0
Restructuring charges incurred	641	271	913
Impairment of facility related assets	226	329	560
Cash payments and other adjustments	(234)	(306)	(564)
Ending balance	1,836	1,203	909
Restructuring reserve	1,836	1,203	909
Consulting and Implementation Costs
Restructuring Reserve [Roll Forward]
Beginning balance	294	720	960
Restructuring charges incurred	896	581	106
Impairment of facility related assets	0	0	0
Cash payments and other adjustments	(642)	(1,007)	(346)
Ending balance	548	294	720
Restructuring reserve	$ 548	$ 294	$ 720

Net Loss Per Share - Schedule o

Net Loss Per Share - Schedule of Basic and Diluted Income (Loss) Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Earnings Per Share [Abstract]
NET LOSS	$ (18,516)	$ (36,852)	$ (73,642)	$ (121,563)
Basic weighted average shares outstanding (in shares)	125,687	124,425	125,358	124,055
Diluted weighted average shares outstanding (in shares)	125,687	124,425	125,358	124,055
Basic net loss per share (in dollars per share)	$ (0.15)	$ (0.30)	$ (0.59)	$ (0.98)
Diluted net loss per share (in dollars per share)	$ (0.15)	$ (0.30)	$ (0.59)	$ (0.98)

Net Loss Per Share - Schedule_2

Net Loss Per Share - Schedule of Antidilutive Shares (Details) - USD ($) $ / shares in Units, $ in Millions		3 Months Ended		9 Months Ended
	Jan. 11, 2021	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Sep. 29, 2023
Capped Call Transactions
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Proceeds from convertible debt	$ 29.3
Offering price per share (in dollars per share)		$ 85.75		$ 85.75
2025 Convertible Notes | Convertible Debt
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Convertible notes, conversion price (in dollars per share)						$ 12.30
2028 Convertible Notes | Convertible Debt
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Convertible notes, conversion price (in dollars per share)		$ 12.30		$ 12.30		$ 12.30
Stock options
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities (in shares)		451,000	45,000	444,000	272,000
Restricted stock awards
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities (in shares)		769,000	295,000	877,000	266,000
Convertible Debt Securities | 2025 Convertible Notes
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities (in shares)		5,538,000	5,538,000	5,538,000	5,538,000
Convertible Debt Securities | 2028 Convertible Notes
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities (in shares)		5,215,000	5,215,000	5,215,000	5,215,000
PSU
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities (in shares)		408,362		214,169

Commitments and Contingencies (

Commitments and Contingencies (Details) $ in Millions	Jul. 31, 2023 patent	Dec. 20, 2022 patent	Jan. 20, 2021 patent	Sep. 30, 2023 USD ($)	Dec. 31, 2022 USD ($)
Patent Infringement Complaint
Contractual Obligation [Line Items]
Number of patents allegedly infringed upon | patent	2	1	2
Federal Healthcare Program Revenue
Contractual Obligation [Line Items]
Loss contingency accrual | $				$ 11.2	$ 11.2

Related Party Transactions (Det

Related Party Transactions (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Related Party Transaction [Line Items]
Total Revenue	$ 151,954	$ 128,782	$ 436,091	$ 371,023
Related Party
Related Party Transaction [Line Items]
Total Revenue	$ 100	$ 300	$ 300	$ 300

Segment Information - Narrative

Segment Information - Narrative (Details)	9 Months Ended
	Sep. 30, 2023 segment
Segment Reporting [Abstract]
Number of reportable segments	2

Segment Information - Schedule

Segment Information - Schedule of Segment Information (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($) segment	Sep. 30, 2022 USD ($)
Segment Reporting [Abstract]
Number of operating segments | segment			2
Segment Reporting Information [Line Items]
Total Revenue	$ 151,954	$ 128,782	$ 436,091	$ 371,023
Total cost of revenue	89,643	79,889	259,075	239,952
GROSS PROFIT	62,311	48,893	177,016	131,071
Amortization of acquired intangible assets				12,800
Clinical Services
Segment Reporting Information [Line Items]
Total Revenue	127,553	106,162	365,578	310,588
Total cost of revenue	73,994	65,261	213,032	197,563
GROSS PROFIT	53,559	40,901	152,546	113,025
Amortization of acquired intangible assets	4,300	4,300	12,800
Advanced Diagnostics
Segment Reporting Information [Line Items]
Total Revenue	24,401	22,620	70,513	60,435
Total cost of revenue	15,649	14,628	46,043	42,389
GROSS PROFIT	8,752	7,992	24,470	18,046
Amortization of acquired intangible assets	$ 600	$ 600	$ 1,800	$ 1,800