Castle Biosciences (CSTL) 10-Q 2 Nov 22 2022 Q3 Quarterly report Financial data

Cover

Cover - shares	9 Months Ended
	Sep. 30, 2022	Oct. 26, 2022
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2022
Document Transition Report	false
Entity File Number	001-38984
Entity Registrant Name	CASTLE BIOSCIENCES, INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	77-0701774
Entity Address, Address Line One	505 S. Friendswood Drive
Entity Address, Address Line Two	Suite 401
Entity Address, City or Town	Friendswood
Entity Address, State or Province	TX
Entity Address, Postal Zip Code	77546
City Area Code	866
Local Phone Number	788-9007
Title of 12(b) Security	Common Stock, $0.001 par value per share
Trading Symbol	CSTL
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		26,351,576
Entity Central Index Key	0001447362
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	Q3
Amendment Flag	false

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Current Assets
Cash and cash equivalents	$ 134,180	$ 329,633
Marketable investment securities	131,802	0
Accounts receivable, net	22,835	17,282
Inventory	3,802	2,021
Prepaid expenses and other current assets	6,795	4,807
Total current assets	299,414	353,743
Long-term accounts receivable, net	1,187	1,308
Property and equipment, net	13,054	9,501
Operating lease assets	12,604	7,383
Goodwill and other intangible assets, net	130,357	88,922
Other assets – long-term	1,195	1,715
Total assets	457,811	462,572
Current Liabilities
Accounts payable	5,768	2,546
Accrued compensation	19,532	15,483
Operating lease liabilities	1,535	1,179
Other accrued and current liabilities	5,107	5,678
Total current liabilities	31,942	24,886
Noncurrent portion of contingent consideration	1,798	18,287
Noncurrent operating lease liabilities	11,900	6,900
Deferred tax liability	614	635
Other liabilities	124	124
Total liabilities	46,378	50,832
Commitments and Contingencies (Note 12)
Stockholders’ Equity
Preferred stock, $0.001 par value per share; 10,000,000 shares authorized as of September 30, 2022 and December 31, 2021; no shares issued and outstanding as of September 30, 2022 and December 31, 2021	0	0
Common stock, $0.001 par value per share; 200,000,000 shares authorized as of September 30, 2022 and December 31, 2021; 26,350,530 and 25,378,520 shares issued and outstanding as of September 30, 2022 and December 31, 2021, respectively	26	25
Additional paid-in capital	551,883	505,482
Accumulated deficit	(140,287)	(93,767)
Accumulated other comprehensive loss	(189)	0
Total stockholders’ equity	411,433	411,740
Total liabilities and stockholders’ equity	$ 457,811	$ 462,572

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Sep. 30, 2022	Dec. 31, 2021
Statement of Financial Position [Abstract]
Preferred stock, par value (in dollars per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	10,000,000	10,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	200,000,000	200,000,000
Common stock, shares issued (in shares)	26,350,530	25,378,520
Common stock, shares outstanding (in shares)	26,350,530	25,378,520

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Income Statement [Abstract]
NET REVENUES	$ 37,011	$ 23,475	$ 98,701	$ 69,046
OPERATING EXPENSES AND OTHER OPERATING INCOME
Cost of sales (exclusive of amortization of acquired intangible assets)	8,859	4,500	22,489	11,225
Research and development	10,907	7,500	33,594	20,201
Selling, general and administrative	36,626	22,595	104,577	61,578
Amortization of acquired intangible assets	2,306	694	6,051	950
Change in fair value of contingent consideration	(151)	0	(17,987)	0
Total operating expenses, net	58,547	35,289	148,724	93,954
Operating loss	(21,536)	(11,814)	(50,023)	(24,908)
Interest income	1,293	23	1,693	51
Interest expense	(6)	0	(13)	0
Loss before income taxes	(20,249)	(11,791)	(48,343)	(24,857)
Income tax (benefit) expense	0	0	(1,823)	5
Net loss	$ (20,249)	$ (11,791)	$ (46,520)	$ (24,862)
Basic (in dollars per share)	$ (0.77)	$ (0.47)	$ (1.79)	$ (0.99)
Diluted (in dollars per share)	$ (0.77)	$ (0.47)	$ (1.79)	$ (0.99)
Weighted-average shares outstanding, basic (in shares)	26,316	25,287	25,938	25,072
Weighted-average shares outstanding, diluted (in shares)	26,316	25,287	25,938	25,072

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Statement of Comprehensive Income [Abstract]
Net loss	$ (20,249)	$ (11,791)	$ (46,520)	$ (24,862)
Other comprehensive loss:
Net unrealized loss on available-for-sale securities	(189)	0	(189)	0
Comprehensive loss	$ (20,438)	$ (11,791)	$ (46,709)	$ (24,862)

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) $ in Thousands	Total	Effect of Adoption	Preferred Stock	Common Stock	Additional Paid-in Capital	Accumulated Deficit	Accumulated Deficit Effect of Adoption	Accumulated Other Comprehensive Loss
Beginning balance (in shares) at Dec. 31, 2020			0	24,812,487
Beginning balance at Dec. 31, 2020	$ 415,691	$ 21	$ 0	$ 25	$ 478,162	$ (62,496)	$ 21	$ 0
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation expense	4,913				4,913
Exercise of common stock options (in shares)				171,315
Exercise of common stock options	991				991
Issuance of common stock under the employee stock purchase plan (in shares)				70,711
Issuance of common stock under the employee stock purchase plan	1,233				1,233
Public offering of common stock, adjustment to offering costs	39				39
Net income (loss)	(4,280)					(4,280)
Ending balance (in shares) at Mar. 31, 2021			0	25,054,513
Ending balance at Mar. 31, 2021	$ 418,608		$ 0	$ 25	485,338	(66,755)		0
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accounting Standards Update [Extensible Enumeration]	Effect of Adoption
Beginning balance (in shares) at Dec. 31, 2020			0	24,812,487
Beginning balance at Dec. 31, 2020	$ 415,691	$ 21	$ 0	$ 25	478,162	(62,496)	$ 21	0
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Unrealized loss on marketable investment securities	0
Net income (loss)	(24,862)
Ending balance (in shares) at Sep. 30, 2021			0	25,286,546
Ending balance at Sep. 30, 2021	411,734		$ 0	$ 25	499,046	(87,337)		0
Beginning balance (in shares) at Mar. 31, 2021			0	25,054,513
Beginning balance at Mar. 31, 2021	418,608		$ 0	$ 25	485,338	(66,755)		0
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation expense	4,766				4,766
Exercise of common stock options (in shares)				109,540
Exercise of common stock options	1,354				1,354
Net income (loss)	(8,791)					(8,791)
Ending balance (in shares) at Jun. 30, 2021			0	25,164,053
Ending balance at Jun. 30, 2021	415,937		$ 0	$ 25	491,458	(75,546)		0
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation expense	5,210				5,210
Exercise of common stock options (in shares)				82,756
Exercise of common stock options	1,523				1,523
Issuance of common stock under the employee stock purchase plan (in shares)				39,737
Issuance of common stock under the employee stock purchase plan	855				855
Unrealized loss on marketable investment securities	0
Net income (loss)	(11,791)					(11,791)
Ending balance (in shares) at Sep. 30, 2021			0	25,286,546
Ending balance at Sep. 30, 2021	411,734		$ 0	$ 25	499,046	(87,337)		0
Beginning balance (in shares) at Dec. 31, 2021			0	25,378,520
Beginning balance at Dec. 31, 2021	411,740		$ 0	$ 25	505,482	(93,767)		0
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation expense	8,419				8,419
Exercise of common stock options (in shares)				62,102
Exercise of common stock options	399				399
Issuance of common stock from vested restricted stock units and payment of employees' taxes (in shares)				2,466
Issuance of common stock from vested restricted stock units and payment of employees’ taxes	(56)				(56)
Issuance of common stock under the employee stock purchase plan (in shares)				42,332
Issuance of common stock under the employee stock purchase plan	1,457				1,457
Net income (loss)	(24,623)					(24,623)
Ending balance (in shares) at Mar. 31, 2022			0	25,485,420
Ending balance at Mar. 31, 2022	397,336		$ 0	$ 25	515,701	(118,390)		0
Beginning balance (in shares) at Dec. 31, 2021			0	25,378,520
Beginning balance at Dec. 31, 2021	$ 411,740		$ 0	$ 25	505,482	(93,767)		0
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Exercise of common stock options (in shares)	115,829
Unrealized loss on marketable investment securities	$ (189)
Net income (loss)	(46,520)
Ending balance (in shares) at Sep. 30, 2022			0	26,350,530
Ending balance at Sep. 30, 2022	411,433		$ 0	$ 26	551,883	(140,287)		(189)
Beginning balance (in shares) at Mar. 31, 2022			0	25,485,420
Beginning balance at Mar. 31, 2022	397,336		$ 0	$ 25	515,701	(118,390)		0
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation expense	8,783				8,783
Exercise of common stock options (in shares)				36,634
Exercise of common stock options	110				110
Issuance of common stock from vested restricted stock units and payment of employees' taxes (in shares)				6,358
Issuance of common stock from vested restricted stock units and payment of employees’ taxes	(32)				(32)
Issuance of common stock in acquisition of business (in shares)				763,887
Issuance of common stock in acquisition of business	17,111			$ 1	17,110
Net income (loss)	(1,648)					(1,648)
Ending balance (in shares) at Jun. 30, 2022			0	26,292,299
Ending balance at Jun. 30, 2022	421,660		$ 0	$ 26	541,672	(120,038)		0
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation expense	9,196				9,196
Exercise of common stock options (in shares)				17,093
Exercise of common stock options	166				166
Issuance of common stock from vested restricted stock units and payment of employees' taxes (in shares)				4,818
Issuance of common stock from vested restricted stock units and payment of employees’ taxes	(46)				(46)
Issuance of common stock under the employee stock purchase plan (in shares)				36,320
Issuance of common stock under the employee stock purchase plan	895				895
Unrealized loss on marketable investment securities	(189)							(189)
Net income (loss)	(20,249)					(20,249)
Ending balance (in shares) at Sep. 30, 2022			0	26,350,530
Ending balance at Sep. 30, 2022	$ 411,433		$ 0	$ 26	$ 551,883	$ (140,287)		$ (189)

CONDENSED CONSOLIDATED STATEM_4

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
OPERATING ACTIVITIES
Net loss	$ (46,520)	$ (24,862)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	7,702	1,956
Stock-based compensation expense	26,398	14,889
Change in fair value of contingent consideration	(17,987)	0
Deferred income taxes	(1,839)	0
Accretion of discounts on marketable investment securities	(184)	0
Other	186	(99)
Change in operating assets and liabilities:
Accounts receivable	(5,678)	(6,087)
Prepaid expenses and other current assets	(1,870)	(734)
Inventory	(1,502)	(28)
Operating lease assets	694	641
Other assets	533	(193)
Accounts payable	2,155	673
Operating lease liabilities	(559)	(638)
Accrued compensation	3,669	3,012
Medicare advance payment	0	(5,351)
Other accrued liabilities	(853)	619
Net cash used in operating activities	(35,655)	(16,202)
INVESTING ACTIVITIES
Purchases of property and equipment	(3,845)	(2,590)
Asset acquisition	547
Asset acquisition		(33,184)
Acquisition of business, net of cash and cash equivalents acquired	(26,966)	0
Proceeds from sale of property and equipment	9	6
Purchases of marketable investment securities	(131,808)	0
Net cash used in investing activities	(162,063)	(35,768)
FINANCING ACTIVITIES
Payment of common stock offering costs	0	(336)
Proceeds from exercise of common stock options	675	3,868
Payment of employees’ taxes on vested restricted stock units	(134)	0
Proceeds from contributions to the employee stock purchase plan	1,812	1,763
Repayment of principal portion of finance lease liabilities	(88)	0
Net cash provided by financing activities	2,265	5,295
NET CHANGE IN CASH AND CASH EQUIVALENTS	(195,453)	(46,675)
Beginning of period	329,633	409,852
End of period	134,180	363,177
DISCLOSURE OF NON-CASH INVESTING AND FINANCING ACTIVITIES:
Accrued purchases of property and equipment	1,131	190
Common stock issued in acquisition of business	17,111	0
Contingent consideration in acquisition of business	1,528	0
Operating lease assets obtained in exchange for lease obligations	5,912	427
Property and equipment acquired with tenant improvement allowance	$ 51	$ 54

Organization and Description of

Organization and Description of Business	9 Months Ended
	Sep. 30, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Description of Business	Organization and Description of BusinessCastle Biosciences, Inc. (the ‘‘Company,’’ “we,” “us” or “our”) was incorporated in the state of Delaware on September 12, 2007. We are a commercial-stage diagnostics company focused on providing physicians and their patients with personalized, clinically actionable information to inform treatment decisions and improve health outcomes. We are based in Friendswood, Texas (a suburb of Houston, Texas) and our laboratory operations are conducted at our facilities located in Phoenix, Arizona, Pittsburgh, Pennsylvania and San Diego, California.

Summary of Significant Accounti

Summary of Significant Accounting Policies	9 Months Ended
	Sep. 30, 2022
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	Summary of Significant Accounting Policies Basis of Presentation Our unaudited condensed consolidated financial statements include the accounts of Castle Biosciences, Inc. and our wholly owned subsidiaries and have been prepared in conformity with accounting principles generally accepted in the United States of America (‘‘U.S. GAAP’’). All intercompany accounts and transactions have been eliminated in consolidation. Unaudited Interim Financial Information The accompanying condensed consolidated balance sheet as of September 30, 2022; the condensed consolidated statements of operations, the condensed consolidated statements of comprehensive loss, the condensed consolidated statements of stockholders’ equity for the three and nine months ended September 30, 2022 and 2021; and the condensed consolidated statements of cash flows for the nine months ended September 30, 2022 and 2021 are unaudited. The unaudited interim condensed consolidated financial statements have been prepared on the same basis as the audited annual financial statements and, in the opinion of management, reflect all adjustments, which include only normal recurring adjustments, necessary for the fair statement of our consolidated financial position as of September 30, 2022, the results of our consolidated operations for the three and nine months ended September 30, 2022 and 2021 and our consolidated cash flows for the nine months ended September 30, 2022 and 2021. The financial data and other information disclosed in these notes related to the three and nine months ended September 30, 2022 and 2021 are also unaudited. The results for the three and nine months ended September 30, 2022 are not necessarily indicative of results to be expected for the year ending December 31, 2022, any other interim periods, or any future year or period. The balance sheet as of December 31, 2021 included herein was derived from the audited financial statements as of that date. Certain disclosures have been condensed or omitted from the unaudited interim consolidated financial statements. These unaudited condensed consolidated financial statements should be read in conjunction with our audited consolidated financial statements included in our Annual Report on Form 10-K for the year ended December 31, 2021 filed with the Securities and Exchange Commission on February 28, 2022. Use of Estimates The preparation of consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities as of the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Significant items subject to such estimates include revenue recognition, the valuation of stock-based compensation, assessing future tax exposure and the realization of deferred tax assets, the useful lives and recoverability of long-lived assets, the valuation of acquired intangible assets, the valuation of contingent consideration and other contingent liabilities. We base these estimates on historical and anticipated results, trends, and various other assumptions that we believe are reasonable under the circumstances, including assumptions as to future events. These estimates form the basis for making judgments about the carrying values of assets and liabilities and recorded revenues and expenses that are not readily apparent from other sources. Actual results could differ from those estimates and assumptions. We have considered the potential impact of the COVID-19 pandemic on our estimates and assumptions. The extent to which the COVID-19 pandemic may impact our estimates in future periods is uncertain and subject to change. Cash and Cash Equivalents including Concentrations of Credit Risk Cash equivalents consist of short-term, highly liquid investments with original maturities of three months or less. Our cash equivalents consist of money market funds, which are not insured by the Federal Deposit Insurance Corporation (“FDIC”), that are primarily invested in short-term U.S. government obligations. Cash deposits at financial institutions may exceed the amount of insurance provided by the FDIC. Management believes that we are not exposed to significant credit risk on our cash deposits due to the financial position of the institutions in which deposits are held. We have not experienced any losses on our cash or cash equivalents. Marketable Investment Securities All debt securities are recognized in accordance with Financial Accounting Standards Board (‘‘FASB’’) Accounting Standards Codification (‘‘ASC’’) Topic 320, Investments-Debt Securities (‘‘ASC 320’’). Management determines the appropriate classification of securities at the time of purchase and re-evaluates such determination at each balance sheet date. All debt securities are classified as available-for-sale and are recorded at fair value in accordance with ASC 320. We recognize the unrealized gains and losses related to changes in fair value as a separate component of accumulated other comprehensive loss within total stockholders’ equity, net of related deferred income tax effects on our condensed consolidated balance sheets. Premiums or discounts from par value are amortized to interest income over the life of the underlying investment. Realized gains and losses on available-for-sale securities are calculated at the individual security level and included in interest income in the condensed consolidated statements of operations. Impairments on available-for-sale debt securities, if any, are recorded in condensed consolidated statements of operations. See Notes 5 and 11 for further details. Revenue Recognition In accordance with ASC Topic 606, Revenue from Contracts with Customers (“ASC 606”), we follow a five-step process to recognize revenues: (1) identify the contract with the customer, (2) identify the performance obligations, (3) determine the transaction price, (4) allocate the transaction price to the performance obligations and (5) recognize revenues when the performance obligations are satisfied. We have determined that we have a contract with the patient when the treating clinician orders the test. Our contracts generally contain a single performance obligation, which is the delivery of the test report, and we satisfy our performance obligation at a point in time upon the delivery of the test report to the treating physician, at which point we can bill for the report. The amount of revenue recognized reflects the amount of consideration to which we expect to be entitled, or the transaction price, and considers the effects of variable consideration. See Note 3 for further details. Accounts Receivable and Allowance for Credit Losses We classify accounts receivable balances that are expected to be paid more than one year from the consolidated balance sheet date as noncurrent assets. The estimated timing of payment utilized as a basis for classification as noncurrent is determined by analyses of historical payor-specific payment experience, adjusted for known factors that are expected to change the timing of future payments. We accrue an allowance for credit losses against our accounts receivable based on management’s current estimate of amounts that will not be collected. Management’s estimates are typically based on historical loss information adjusted for current conditions. We generally do not perform evaluations of customers’ financial condition and generally do not require collateral. Historically, our credit losses have not been significant. The allowance for credit losses was zero as of September 30, 2022 and December 31, 2021. Adjustments for implicit price concessions attributable to variable consideration, as discussed above, are incorporated into the measurement of the accounts receivable balances and are not part of the allowance for credit losses. Goodwill Goodwill represents the excess of the purchase price over the fair value of the net tangible and intangible assets acquired in a business combination. In accordance with ASC Topic 350, Intangibles—Goodwill and Other , our goodwill is not amortized but is tested for impairment on an annual basis or whenever events or changes in circumstances indicate that it may be impaired. We perform annual impairment reviews of our goodwill balance during the fourth quarter of each year. We may perform a qualitative assessment to determine if it is necessary to perform a quantitative impairment test. If we determine that a quantitative impairment test is necessary, we apply the guidance in Accounting Standards Update (“ASU”) No. 2017-04, Intangibles—Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment , by comparing the fair value of the reporting unit to its carrying value, including the goodwill. If the carrying value exceeds the fair value, we recognize an impairment loss for the amount by which the carrying value exceeds fair value, up to the total amount of goodwill allocated to the reporting unit. We did not incur any goodwill impairment losses in any of the periods presented. Acquisitions We assess acquisitions under ASC Topic 805, Business Combinations (“ASC 805”) to determine whether a transaction represents the acquisition of assets or a business combination. Under this guidance, we apply a two-step model. The first step involves a screening test where we evaluate whether substantially all of the fair value of the gross assets acquired is concentrated in a single asset or a group of similar assets. If the screening test is met, we account for the set as an asset acquisition. If the screening test is not met, we apply the second step of the model to determine if the set meets the definition of a business based on the guidance in ASC 805. If so, the transaction is treated as a business combination. Otherwise, it is treated as an asset acquisition. Asset acquisitions are accounted for by allocating the cost of the acquisition, including transaction costs, to the individual assets acquired and liabilities assumed on a relative fair value basis without recognition of goodwill. Business combinations are accounted for using the acquisition method. Under the acquisition method, goodwill is measured as a residual amount equal to the fair value of the consideration transferred less the net recognized fair value of the identifiable assets acquired and the liabilities assumed, as of the acquisition date, and transaction costs are expensed as incurred. Contingent Consideration Under the terms of business combinations or asset acquisitions, we may be required to pay additional consideration if specified future events occur or if certain conditions are met. In a business combination, in accordance with ASC 805, contingent consideration is recorded at fair value as of the acquisition date and classified as liabilities or equity based on applicable U.S. GAAP. For contingent consideration classified as liabilities, we remeasure the contingent consideration at fair value each period with changes in fair value recorded in the statements of operations each period. For contingent consideration in transactions that are not business combinations, we apply applicable U.S. GAAP. With respect to the additional consideration that may be payable in connection with the acquisitions of Cernostics, Inc. (“Cernostics”), an asset acquisition we completed on December 3, 2021, we account for the contingent consideration as a liability in accordance with ASC Topic 480, Distinguishing Liabilities from Equity (“ASC 480”), under the guidance for obligations that must or may be settled by issuance of a variable number of shares. In accordance with ASC 480, we record the contingent consideration initially and subsequently at fair value with changes in fair value recorded in the statements of operations each period. Contingent consideration is classified as current or noncurrent in our condensed consolidated balance sheets based on the contractual timing of future settlement. For additional information on contingent consideration, see Notes 6 and 11. Accrued Compensation We accrue for liabilities under discretionary employee and executive bonus plans. These estimated compensation liabilities are based on progress against corporate objectives approved by our board of directors, compensation levels of eligible individuals, and target bonus percentage levels. Our board of directors reviews and evaluates the performance against these objectives and ultimately determines the actual achievement levels attained. We also accrue for liabilities under employee sales incentive bonus plans with accruals based on performance achieved to date compared to established targets. As of September 30, 2022 and December 31, 2021, we accrued $13,667,000 and $12,071,000, respectively, for liabilities associated with these bonus plans. These amounts are classified as current or noncurrent accrued liabilities in the condensed consolidated balance sheets based on the expected timing of payment. Comprehensive Loss Comprehensive loss is defined as a change in equity during a period from transactions and other events and circumstances from non-owner sources. Comprehensive loss is made up of net loss plus other comprehensive loss, if any.

Revenue

Revenue	9 Months Ended
	Sep. 30, 2022
Revenue from Contract with Customer [Abstract]
Revenue	RevenueAll of our revenues from contracts with customers are associated with the provision of diagnostic and prognostic testing services. Most of our revenues are attributable to our DecisionDx®-Melanoma test for cutaneous melanoma. We also provide a test for uveal melanoma, DecisionDx®-UM, a test for patients with cutaneous squamous cell carcinoma, DecisionDx®-SCC, two tests for use in patients with suspicious pigmented lesions, MyPath® Melanoma and DiffDx®-Melanoma, and a test for patients diagnosed with Barrett’s esophagus (“BE”), the TissueCypher® Barrett’s Esophagus Assay. We also began offering a pharmacogenomics (“PGx”) testing service focused on mental health, IDgenetix®, following a business combination completed in April 2022. Information on the disaggregation of revenues is included below. Once we satisfy our performance obligations and bill for the service, the timing of the collection of payments may vary based on the payment practices of the third-party payor and the existence of contractually established reimbursement rates. Most of the payments for our services are made by third-party payors, including Medicare and commercial health insurance carriers. Certain contracts contain a contractual commitment of a reimbursement rate that differs from our list prices. However, absent a positive coverage policy, with or without a contractually committed reimbursement rate, with a commercial carrier or governmental program, our diagnostic tests may or may not be paid by these entities. In addition, patients do not enter into direct agreements with us that commit them to pay any portion of the cost of the tests in the event that their insurance provider declines to reimburse us. We may pursue, on a case-by-case basis, reimbursement from such patients in the form of co-payments and co-insurance, in accordance with the contractual obligations that we have with the insurance carrier or health plan. These situations may result in a delay in the collection of payments. The Medicare claims that are covered by policy under a Local Coverage Determination (“LCD”) or otherwise are generally paid at a rate established on Medicare’s Clinical Laboratory Fee Schedule or by the respective Medicare contractor within 30 days from receipt. Medicare claims that were either submitted to Medicare prior to the LCD or other coverage commencement date or are not covered but meet the definition of being medically reasonable and necessary pursuant to the controlling Section 1862(a)(1)(A) of the Social Security Act are generally appealed and may ultimately be paid at the first (termed ‘‘redetermination’’), second (termed ‘‘reconsideration’’) or third level of appeal (de novo hearing with an Administrative Law Judge). A successful appeal at any of these levels may result in prompt payment. In the absence of LCD coverage, contractually established reimbursements rates or other coverage, we have concluded that our contracts include variable consideration because the amounts paid by Medicare or commercial health insurance carriers may be paid at less than our standard rates or not paid at all, with such differences considered implicit price concessions. Variable consideration attributable to these price concessions is measured at the expected value using the ‘‘most likely amount’’ method under ASC 606. The amounts are determined by historical average collection rates by test type and payor category taking into consideration the range of possible outcomes, the predictive value of our past experiences, the time period of when uncertainties expect to be resolved and the amount of consideration that is susceptible to factors outside of our influence, such as the judgment and actions of third parties. Such variable consideration is included in the transaction price only to the extent it is probable that a significant reversal in the amount of cumulative revenue recognized will not occur when the uncertainties with respect to the amount are resolved. Variable consideration may be constrained and excluded from the transaction price in situations where there is no contractually agreed upon reimbursement coverage or in the absence of a predictable pattern and history of collectability with a payor. Accordingly, in such situations revenues are recognized on the basis of actual cash collections. Variable consideration for Medicare claims that are not covered by an LCD or otherwise, including those claims undergoing appeal, is deemed to be fully constrained due to factors outside our influence (e.g., judgment or actions of third parties) and the uncertainty of the amount to be received is not expected to be resolved for a long period of time. Variable consideration is evaluated each reporting period and adjustments are recorded as increases or decreases in revenues. Included in revenues for the three months ended September 30, 2022 and 2021 were $(277,000) and $(92,000), respectively, of net positive (negative) revenue adjustments associated with changes in estimated variable consideration related to performance obligations satisfied in previous periods. Such amounts of variable consideration for the nine months ended September 30, 2022 and 2021 were $(1,850,000) and $4,130,000, respectively, of net (negative) positive revenue adjustments. These amounts include (i) adjustments for actual collections versus estimated amounts and (ii) cash collections and the related recognition of revenue in current period for tests delivered in prior periods due to the release of the constraint on variable consideration. Because our contracts with customers have an expected duration of one year or less, we have elected the practical expedient in ASC 606 to not disclose information about our remaining performance obligations. Any incremental costs to obtain contracts are recorded as selling, general and administrative expense as incurred due to the short duration of our contracts. Contract balances consisted solely of accounts receivable (both current and noncurrent) as of September 30, 2022 and December 31, 2021. Disaggregation of Revenues The table below provides the disaggregation of revenue by type (in thousands): Three Months Ended Nine Months Ended 2022 2021 2022 2021 Dermatologic $ 33,924 $ 21,593 $ 90,160 $ 62,881 Other 3,087 1,882 8,541 6,165 Total net revenues $ 37,011 $ 23,475 $ 98,701 $ 69,046 Payor Concentration We rely upon reimbursements from third-party government payors (primarily Medicare) and private-payor insurance companies to collect accounts receivable related to sales of our diagnostic and prognostic tests. Our significant third-party payors and their related revenues as a percentage of total revenues and accounts receivable balances are as follows: Percentage of Revenues Nine Months Ended Percentage of Accounts Receivable (current) Percentage of Accounts Receivable (noncurrent) 2022 2021 September 30, 2022 December 31, 2021 September 30, 2022 December 31, 2021 Medicare 52 % 57 % 26 % 24 % — % — % Medicare Advantage plans 33 % 27 % 44 % 40 % — % — % BlueCross BlueShield plans 6 % 7 % 16 % 22 % 55 % 58 %

Loss Per Share

Loss Per Share	9 Months Ended
	Sep. 30, 2022
Earnings Per Share [Abstract]
Loss Per Share	Loss Per Share Basic loss per share is computed by dividing net loss for the period by the weighted-average number of common shares outstanding during the period. Diluted loss per share reflects the additional dilution from potential issuances of common stock, such as stock issuable pursuant to the exercise of stock options or purchases under the 2019 Employee Stock Purchase Plan (“ESPP”). The treasury stock method is used to calculate the potential dilutive effect of these common stock equivalents. However, potentially dilutive shares are excluded from the computation of diluted loss per share when their effect is antidilutive. Because we reported a net loss for all periods presented, all potentially dilutive securities are antidilutive and are excluded from the computation of diluted loss per share for such periods. The table below provides the weighted-average number of potential common shares associated with outstanding securities not included in our calculation of diluted loss per share for the three and nine months ended September 30, 2022 and 2021 because to do so would be antidilutive (in thousands): Three Months Ended Nine Months Ended 2022 2021 2022 2021 Stock options and restricted stock units (“RSUs”) 5,285 3,369 4,982 3,401 ESPP 168 58 124 63 Total 5,453 3,427 5,106 3,464 In addition, in connection with the acquisitions of Cernostics and AltheaDx, Inc. (“AltheaDx”), we may issue, or may be required to issue, shares of our common stock to satisfy our contingent consideration obligations, pending the outcome of certain commercial and regulatory milestones, as required by the respective definitive agreements. See Notes 6 and 11 for additional information.

Marketable Investment Securitie

Marketable Investment Securities	9 Months Ended
	Sep. 30, 2022
Investments, Debt and Equity Securities [Abstract]
Marketable Investment Securities	Marketable Investment Securities The following table presents our available-for-sale debt securities (in thousands): Amortized Cost Unrealized Estimated Fair Value Gains Losses As of September 30, 2022 U.S. Government Securities $ 131,991 $ — $ (189) $ 131,802 Total $ 131,991 $ — $ (189) $ 131,802 We had no available-for-sale debt securities as of December 31, 2021. Although available to be sold to meet operating needs or otherwise, securities are generally held through maturity. We classify all investments as current assets, as these are readily available for use in current operations. The cost of securities sold is determined based on the specific identification method for purposes of recording gains and losses. There were no realized gains or losses on sales of investments for the three and nine months ended September 30, 2022 and 2021. We evaluated our investment portfolio under the available-for-sale debt securities impairment model guidance and determined our investment portfolio is comprised of low-risk, investment grade securities. As of September 30, 2022, unrealized losses on available-for-sale investments are not attributed to credit risk. We believe that an allowance for credit losses is unnecessary because the unrealized losses on certain of our marketable investment securities are due to market factors. No credit-related or noncredit-related impairment losses were recorded for the three and nine months ended September 30, 2022 and 2021. The allowance for credit losses was zero as of September 30, 2022 and December 31, 2021. As of September 30, 2022, all of our available-for-sale debt securities had contractual maturities of one year or less. Accrued interest receivable is included in prepaid expenses and other current assets in our condensed consolidated balance sheets. As of September 30, 2022 and December 31, 2021 the accrued interest receivable balance was immaterial and zero, respectively. Additional information relating to fair value of marketable investment securities can be found in Note 11.

Acquisitions

Acquisitions	9 Months Ended
	Sep. 30, 2022
Business Combination and Asset Acquisition [Abstract]
Acquisitions	Acquisitions Myriad myPath, LLC On May 28, 2021, we completed the acquisition of all of the equity of Myriad myPath, LLC, a laboratory in Salt Lake City, for a cash purchase price of $32,500,000. Based on the guidance in ASC 805, we concluded that substantially all of the fair value of the gross assets acquired was concentrated in a single identifiable asset, the developed technology, and therefore the transaction represents an asset acquisition rather than a business combination. Cernostics, Inc. On December 3, 2021, we completed the acquisition of Cernostics, which offers the TissueCypher Barrett’s Esophagus Assay for patients with BE, for total consideration of $49,019,000, consisting of cash consideration of $30,732,000 and contingent consideration with an acquisition date fair value of $18,287,000. In connection with the acquisition, we recorded a receivable as of the acquisition date for the post-closing purchase price adjustment, representing the difference between actual and estimated cash and working capital. During the nine months ended September 30, 2022, we received cash of $547,000 in settlement of this receivable. AltheaDx, Inc. On April 26, 2022, we completed the acquisition of 100% of the equity interests in AltheaDx. AltheaDx offers the IDgenetix test, a PGx test focused on mental health. We believe this acquisition enables us to expand upon our existing portfolio of testing solutions in support of our growth strategy. We have concluded that the transaction represents a business combination under ASC 805. The financial results of AltheaDx have been included in our unaudited condensed consolidated financial statements since the date of the acquisition. The amount of revenue from AltheaDx included in the unaudited consolidated statements of operations from the acquisition date was not material. The loss attributable to AltheaDx included in the unaudited consolidated statements of operations from the acquisition date was approximately $8,199,000. This amount does not reflect transaction costs from the acquisition or the effects of the valuation allowance reduction discussed in Note 14. Transaction costs associated with the acquisition were $1,711,000 for the nine months ended September 30, 2022 and were recognized as expenses in the unaudited condensed consolidated statements of operations. The preliminary acquisition-date fair value of the consideration transferred consisted of the following (in thousands, except shares): April 26, 2022 Cash $ 30,502 Common stock (763,887 shares) 17,111 Contingent consideration 1,528 Total $ 49,141 The fair value of the common stock issued was measured using the April 26, 2022 closing price of $22.40 per share, as reported by the Nasdaq Global Market. With respect to the contingent consideration, we may be required to pay up to $75.0 million in cash and common stock in connection with the achievement of certain milestones based on 2022, 2023 and 2024 performance and expanded Medicare coverage for the IDgenetix test (the “AltheaDx Earnout Payments”). Upon achievement of each relevant milestone event, each milestone will be paid 50% in cash and 50% in shares of our common stock based on a price per share equal to the volume-weighted-average price of our common stock for the 20 trading days as of the applicable milestone determination date. In accordance with the terms of the definitive agreement governing the acquisition of AltheaDx, the maximum number of shares of our common stock issuable to former AltheaDx security holders may not exceed 1,271,718 shares. Therefore, taking into consideration the number of shares already issued at closing, a maximum of 507,831 additional shares of our common stock remain issuable with respect to the AltheaDx Earnout Payments. In the event a number of shares in excess of 507,831 would otherwise be issuable in connection with the AltheaDx Earnout Payments, we will issue shares up to the maximum number permitted and pay cash for the remaining portion of the obligation. See Note 11 for additional information on the measurement of the contingent consideration. The following table summarizes the preliminary allocation of the fair values of assets acquired and liabilities assumed in the acquisition of AltheaDx at the date of acquisition (in thousands): April 26, 2022 Cash and cash equivalents $ 3,536 Accounts receivable 302 Inventory 279 Prepaid expenses and other current assets 262 Property and equipment 314 Intangible asset 37,000 Other assets – long-term 12 Accounts payable (231) Accrued compensation (380) Other accrued and current liabilities (532) Deferred tax liabilities (1,819) Other liabilities (88) Net identifiable assets acquired 38,655 Goodwill 10,486 Total consideration transferred $ 49,141 The intangible asset is comprised of developed technology with an estimated useful life of 15 years and is being amortized on a straight-line basis. The goodwill, which is not expected to be deductible for income tax purposes, was primarily attributable to potential future growth opportunities and the organized workforce. Our calculations of the consideration transferred and the purchase price allocation for the acquisition of AltheaDx are based on a preliminary valuation and are subject to revision as the valuation is finalized and additional information about the fair value of the assets and liabilities becomes available. The primary areas that are not yet finalized are income taxes, intangible assets, contingent consideration and the resulting goodwill. The final valuation of assets acquired and liabilities assumed is expected to be completed as soon as possible, but no later than one year from the acquisition date. During the three months ended September 30, 2022, the Company recognized an immaterial measurement period adjustment to cash consideration transferred with a corresponding adjustment to goodwill. Unaudited Pro Forma Financial Information The following unaudited pro forma financial information for the three and nine months ended September 30, 2022 and 2021, respectively combines our historical financial results and the results of AltheaDx, assuming that the companies were combined as of January 1, 2021, and includes adjustments for amortization expense from the acquired intangible assets and additional stock-based compensation expense. Nonrecurring pro forma adjustments consist of acquisition-related transaction costs of $1,711,000 and an income tax benefit of $1,769,000, both assumed to have been recognized during the nine months ended September 30, 2021 and therefore removed from the nine months ended September 30, 2022 . The following unaudited pro forma financial information (in thousands) is for informational purposes only and is not necessarily indicative of (i) the results of operations that would have been achieved if the acquisition had taken place as of January 1, 2021 or (ii) the results of operations that are expected in future periods: Pro Forma Data Three Months Ended Nine Months Ended 2022 2021 2022 2021 Net revenues $ 37,011 $ 23,665 $ 99,253 $ 69,341 Net loss $ (20,211) $ (14,577) $ (52,313) $ (31,664) Related Party Transaction Derek J. Maetzold, our President and Chief Executive Officer, and a member of our board of directors, and Daniel M. Bradbury, the Chairperson of our board of directors, each served on the board of directors of AltheaDx until the acquisition of AltheaDx was completed, were direct or indirect beneficial owners of AltheaDx securities and received consideration in the transaction. Further, Frank Stokes, our Chief Financial Officer; Tobin W. Juvenal, our Chief Commercial Officer; Kristen Oelschlager, our Chief Operating Officer and certain immediate family members of Mr. Maetzold and Ms. Oelschlager were direct or indirect beneficial owners of AltheaDx securities and received consideration in the transaction. These individuals may receive additional consideration in the form of AltheaDx Earnout Payments if the relevant commercial and regulatory milestone events occur. Our entry into the definitive agreement to acquire AltheaDx was approved by our board of directors based upon the unanimous recommendation of a special transaction committee comprised entirely of independent members of our board of directors without any financial interest in AltheaDx or any conflict of interest with respect to the acquisition of AltheaDx.
Acquisitions	Acquisitions Myriad myPath, LLC On May 28, 2021, we completed the acquisition of all of the equity of Myriad myPath, LLC, a laboratory in Salt Lake City, for a cash purchase price of $32,500,000. Based on the guidance in ASC 805, we concluded that substantially all of the fair value of the gross assets acquired was concentrated in a single identifiable asset, the developed technology, and therefore the transaction represents an asset acquisition rather than a business combination. Cernostics, Inc. On December 3, 2021, we completed the acquisition of Cernostics, which offers the TissueCypher Barrett’s Esophagus Assay for patients with BE, for total consideration of $49,019,000, consisting of cash consideration of $30,732,000 and contingent consideration with an acquisition date fair value of $18,287,000. In connection with the acquisition, we recorded a receivable as of the acquisition date for the post-closing purchase price adjustment, representing the difference between actual and estimated cash and working capital. During the nine months ended September 30, 2022, we received cash of $547,000 in settlement of this receivable. AltheaDx, Inc. On April 26, 2022, we completed the acquisition of 100% of the equity interests in AltheaDx. AltheaDx offers the IDgenetix test, a PGx test focused on mental health. We believe this acquisition enables us to expand upon our existing portfolio of testing solutions in support of our growth strategy. We have concluded that the transaction represents a business combination under ASC 805. The financial results of AltheaDx have been included in our unaudited condensed consolidated financial statements since the date of the acquisition. The amount of revenue from AltheaDx included in the unaudited consolidated statements of operations from the acquisition date was not material. The loss attributable to AltheaDx included in the unaudited consolidated statements of operations from the acquisition date was approximately $8,199,000. This amount does not reflect transaction costs from the acquisition or the effects of the valuation allowance reduction discussed in Note 14. Transaction costs associated with the acquisition were $1,711,000 for the nine months ended September 30, 2022 and were recognized as expenses in the unaudited condensed consolidated statements of operations. The preliminary acquisition-date fair value of the consideration transferred consisted of the following (in thousands, except shares): April 26, 2022 Cash $ 30,502 Common stock (763,887 shares) 17,111 Contingent consideration 1,528 Total $ 49,141 The fair value of the common stock issued was measured using the April 26, 2022 closing price of $22.40 per share, as reported by the Nasdaq Global Market. With respect to the contingent consideration, we may be required to pay up to $75.0 million in cash and common stock in connection with the achievement of certain milestones based on 2022, 2023 and 2024 performance and expanded Medicare coverage for the IDgenetix test (the “AltheaDx Earnout Payments”). Upon achievement of each relevant milestone event, each milestone will be paid 50% in cash and 50% in shares of our common stock based on a price per share equal to the volume-weighted-average price of our common stock for the 20 trading days as of the applicable milestone determination date. In accordance with the terms of the definitive agreement governing the acquisition of AltheaDx, the maximum number of shares of our common stock issuable to former AltheaDx security holders may not exceed 1,271,718 shares. Therefore, taking into consideration the number of shares already issued at closing, a maximum of 507,831 additional shares of our common stock remain issuable with respect to the AltheaDx Earnout Payments. In the event a number of shares in excess of 507,831 would otherwise be issuable in connection with the AltheaDx Earnout Payments, we will issue shares up to the maximum number permitted and pay cash for the remaining portion of the obligation. See Note 11 for additional information on the measurement of the contingent consideration. The following table summarizes the preliminary allocation of the fair values of assets acquired and liabilities assumed in the acquisition of AltheaDx at the date of acquisition (in thousands): April 26, 2022 Cash and cash equivalents $ 3,536 Accounts receivable 302 Inventory 279 Prepaid expenses and other current assets 262 Property and equipment 314 Intangible asset 37,000 Other assets – long-term 12 Accounts payable (231) Accrued compensation (380) Other accrued and current liabilities (532) Deferred tax liabilities (1,819) Other liabilities (88) Net identifiable assets acquired 38,655 Goodwill 10,486 Total consideration transferred $ 49,141 The intangible asset is comprised of developed technology with an estimated useful life of 15 years and is being amortized on a straight-line basis. The goodwill, which is not expected to be deductible for income tax purposes, was primarily attributable to potential future growth opportunities and the organized workforce. Our calculations of the consideration transferred and the purchase price allocation for the acquisition of AltheaDx are based on a preliminary valuation and are subject to revision as the valuation is finalized and additional information about the fair value of the assets and liabilities becomes available. The primary areas that are not yet finalized are income taxes, intangible assets, contingent consideration and the resulting goodwill. The final valuation of assets acquired and liabilities assumed is expected to be completed as soon as possible, but no later than one year from the acquisition date. During the three months ended September 30, 2022, the Company recognized an immaterial measurement period adjustment to cash consideration transferred with a corresponding adjustment to goodwill. Unaudited Pro Forma Financial Information The following unaudited pro forma financial information for the three and nine months ended September 30, 2022 and 2021, respectively combines our historical financial results and the results of AltheaDx, assuming that the companies were combined as of January 1, 2021, and includes adjustments for amortization expense from the acquired intangible assets and additional stock-based compensation expense. Nonrecurring pro forma adjustments consist of acquisition-related transaction costs of $1,711,000 and an income tax benefit of $1,769,000, both assumed to have been recognized during the nine months ended September 30, 2021 and therefore removed from the nine months ended September 30, 2022 . The following unaudited pro forma financial information (in thousands) is for informational purposes only and is not necessarily indicative of (i) the results of operations that would have been achieved if the acquisition had taken place as of January 1, 2021 or (ii) the results of operations that are expected in future periods: Pro Forma Data Three Months Ended Nine Months Ended 2022 2021 2022 2021 Net revenues $ 37,011 $ 23,665 $ 99,253 $ 69,341 Net loss $ (20,211) $ (14,577) $ (52,313) $ (31,664) Related Party Transaction Derek J. Maetzold, our President and Chief Executive Officer, and a member of our board of directors, and Daniel M. Bradbury, the Chairperson of our board of directors, each served on the board of directors of AltheaDx until the acquisition of AltheaDx was completed, were direct or indirect beneficial owners of AltheaDx securities and received consideration in the transaction. Further, Frank Stokes, our Chief Financial Officer; Tobin W. Juvenal, our Chief Commercial Officer; Kristen Oelschlager, our Chief Operating Officer and certain immediate family members of Mr. Maetzold and Ms. Oelschlager were direct or indirect beneficial owners of AltheaDx securities and received consideration in the transaction. These individuals may receive additional consideration in the form of AltheaDx Earnout Payments if the relevant commercial and regulatory milestone events occur. Our entry into the definitive agreement to acquire AltheaDx was approved by our board of directors based upon the unanimous recommendation of a special transaction committee comprised entirely of independent members of our board of directors without any financial interest in AltheaDx or any conflict of interest with respect to the acquisition of AltheaDx.

Property and Equipment, Net

Property and Equipment, Net	9 Months Ended
	Sep. 30, 2022
Property, Plant and Equipment [Abstract]
Property and Equipment, Net	Property and Equipment, Net Property and equipment, net consisted of the following (in thousands): September 30, 2022 December 31, 2021 Lab equipment (1) $ 8,326 $ 3,727 Leasehold improvements 5,145 5,044 Computer equipment 4,306 2,457 Furniture and fixtures 1,654 1,288 Construction in progress 879 27 Total 20,310 12,543 Less accumulated depreciation (1) (7,256) (3,042) Property and equipment, net $ 13,054 $ 9,501 (1) Includes lab equipment under a finance lease of $369 thousand and accumulated depreciation of $101 thousand as of September 30, 2022 and $237 thousand and accumulated depreciation of $8 thousand as of December 31, 2021. Depreciation expense was recorded in the unaudited condensed consolidated statements of operations as follows (in thousands): Three Months Ended Nine Months Ended 2022 2021 2022 2021 Cost of sales (exclusive of amortization of acquired intangible assets) $ 267 $ 120 $ 621 $ 333 Research and development 85 67 255 175 Selling, general and administrative 265 208 775 498 Total $ 617 $ 395 $ 1,651 $ 1,006

Goodwill and Other Intangible A

Goodwill and Other Intangible Assets, Net	9 Months Ended
	Sep. 30, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Other Intangible Assets, Net	Goodwill and Other Intangible Assets, Net Goodwill Information on the change in carrying value of our goodwill is presented below (in thousands): Goodwill Balance, December 31, 2021 $ — Acquisition of AltheaDx 10,486 Balance, September 30, 2022 $ 10,486 There were no accumulated impairments of goodwill as of September 30, 2022 or December 31, 2021. Other Intangible Assets, Net Our other intangible assets, net consists of the following (in thousands): September 30, 2022 Gross carrying value Accumulated amortization Net Weighted-Average Remaining Life (in years) Developed technology $ 127,318 $ (7,916) $ 119,402 13.5 Assembled workforce 563 (94) 469 4.3 Total intangible assets, net $ 127,881 $ (8,010) $ 119,871 December 31, 2021 Gross carrying value Accumulated amortization Net Weighted-Average Remaining Life (in years) Developed technology $ 90,317 $ (1,949) $ 88,368 13.2 Assembled workforce 563 (9) 554 4.9 Total intangible assets, net $ 90,880 $ (1,958) $ 88,922 The estimated future aggregate amortization expense as of September 30, 2022 is as follows (in thousands): Years Ending December 31, 2022 (remainder of year) $ 2,305 2023 9,147 2024 9,172 2025 9,147 2026 9,137 Thereafter 80,963 Total $ 119,871 Amortization expense of intangible assets was $2.3 million and $6.1 million for the three and nine months ended September 30, 2022, respectively. Amortization expense of intangible assets was $0.7 million and $1.0 million for the three and nine months ended September 30, 2021.

Other Accrued and Current Liabi

Other Accrued and Current Liabilities	9 Months Ended
	Sep. 30, 2022
Payables and Accruals [Abstract]
Other Accrued and Current Liabilities	Other Accrued and Current Liabilities Other accrued and current liabilities consisted of the following (in thousands): September 30, 2022 December 31, 2021 Accrued service fees $ 2,564 $ 1,905 Clinical studies 1,725 1,655 Payroll-related liabilities 317 695 Employee stock purchase plan contributions 220 760 Other 281 663 Total $ 5,107 $ 5,678

Leases

Leases	9 Months Ended
	Sep. 30, 2022
Leases [Abstract]
Leases	Leases Adoption of ASC 842 In the fourth quarter of 2021, we adopted ASU No. 2016-02, Leases (Topic 842), and ASC Topic 842, Leases (“ASC 842”) using the modified retrospective approach with an effective date of January 1, 2021. The adoption had no effect on the condensed consolidated statements of operations for the three and nine months ended September 30, 2021. Net cash (used in) provided by operating activities, investing activities or financing activities for the nine months ended September 30, 2021 were also unchanged, but the presentation of certain prior period amounts within the operating activities section of the condensed consolidated statements of cash flows has been retrospectively adjusted to give effect to the adoption of ASC 842. The changes are set forth in the table below (in thousands): Nine Months Ended Before Adoption of ASC 842 Effect of Adoption After Adoption of ASC 842 Effect on Condensed Consolidated Statements of Cash Flows OPERATING ACTIVITIES Adjustments to reconcile net loss to net cash used in operating activities: Operating lease assets $ — $ 641 $ 641 Operating lease liabilities $ — $ (638) $ (638) Other liabilities $ 3 $ (3) $ — Additionally, the condensed consolidated statement of stockholders’ equity for the three and nine months ended September 30, 2021 has been retrospectively adjusted to reflect a credit to accumulated deficit of $21,000 in connection with the adoption of ASC 842 effective January 1, 2021. Lease Amendment On March 11, 2022, we amended an existing lease agreement to expand rentable space in Phoenix, Arizona. We evaluated the amendment under ASC 842 and determined that the modification was a new contract and an operating lease. In August 2022, we took control of the facilities and recognized $0.9 million of additional operating lease liabilities arising from obtaining operating lease assets. Payments for the amended lease will begin after the commencement date, upon the completion of certain leasehold improvements, and will continue for an initial term of 10.3 years. We intend to use the additional space for laboratory facilities. Pittsburgh Lease On April 1, 2022, we entered into a lease agreement for commercial office space in Pittsburgh, Pennsylvania, which provides for a term of 10.5 years, a five-year renewal option, an early termination clause, and a lease incentive allowance of $2.5 million to apply toward leasehold improvements. In September 2022, we took control of the facilities and recognized $5.0 million of additional operating lease liabilities arising from obtaining operating lease assets. Lease payments will commence at a future date upon the completion of leasehold improvements, at which point the facilities will be ready for intended use. We intend to use the additional space for general office and laboratory facilities.

Fair Value Measurements

Fair Value Measurements	9 Months Ended
	Sep. 30, 2022
Fair Value Disclosures [Abstract]
Fair Value Measurements	Fair Value Measurements Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market in an orderly transaction between market participants at the measurement date. The fair value hierarchy prioritizes the inputs to valuation techniques used in measuring fair value. There are three levels to the fair value hierarchy based on the reliability of inputs, as follows: Level 1 – Observable inputs that reflect quoted prices (unadjusted) for identical assets or liabilities in active markets. Level 2 – Inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 3 – Unobservable inputs in which little or no market data exists, therefore requiring us to develop our own assumptions. Financial instruments measured at fair value are classified in their entirety based on the lowest level of input that is significant to the fair value measurement. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires management to make judgments and consider factors specific to the asset or liability. The use of different assumptions and/or estimation methodologies may have a material effect on estimated fair values. Accordingly, the fair value estimates disclosed, or amounts recorded may not be indicative of the amount that us or holders of the instruments could realize in a current market exchange. The table below provides information, by level within the fair value hierarchy, of our financial assets and financial liabilities that are accounted for at fair value on a recurring basis as of September 30, 2022 and December 31, 2021 (in thousands): As of September 30, 2022 Quoted Prices in Active Markets for Identical Items (Level 1) Significant Other Observable Inputs Significant Unobservable Inputs Total Assets Money market funds (1) $ 124,095 $ — $ — $ 124,095 U.S. Government Securities (2) $ 131,802 $ — $ — $ 131,802 Liabilities Contingent consideration (3) $ — $ — $ 1,828 $ 1,828 As of December 31, 2021 Quoted Prices in Active Markets for Identical Items (Level 1) Significant Other Observable Inputs Significant Unobservable Inputs Total Assets Money market funds (1) $ 327,721 $ — $ — $ 327,721 U.S. Government Securities (2) $ — $ — $ — $ — Liabilities Contingent consideration (3) $ — $ — $ 18,287 $ 18,287 (1) Classified as “Cash and cash equivalents” in the condensed consolidated balance sheets. (2) Classified as “Marketable investment securities” in the condensed consolidated balance sheets. (3) Current portion, if any, classified as “Other accrued and current liabilities” in the condensed consolidated balance sheets. Contingent Consideration In connection with our acquisition of Cernostics, we have recorded a contingent consideration liability for the additional consideration of up to $50.0 million that may become payable based on the achievement of certain commercial milestones relating to the year ending December 31, 2022 (“Cernostics Earnout Payments”). The Cernostics Earnout Payments may be settled in cash or shares of our common stock, at our sole discretion. The portion of any Cernostics Earnout Payments that may be settled in shares of our common stock is subject to certain limitations and the aggregate number of shares that may be issued for the Cernostics Earnout Payments may not exceed 5,034,653 shares. Any Cernostics Earnout Payments in shares of our common stock will be based on the volume weighted-average price of our common stock for the 15 trading days ending December 30, 2022. If the settlement were to occur as of September 30, 2022, we would make no Cernostics Earnout Payments based on the achievement of the performance conditions to date. In connection with our acquisition of AltheaDx, we have also recorded a contingent consideration liability for the additional consideration of up to $75.0 million that may become payable based on the achievement of certain commercial milestones relating to the years ending December 31, 2022, 2023, and 2024, as discussed further in Note 6. If the settlement were to occur as of September 30, 2022, we would make no AltheaDx Earnout Payments based on the achievement of the performance conditions to date. The contingent consideration is classified as a Level 3 fair value measurement due to the use of significant unobservable inputs and a Monte Carlo simulation to determine its fair value. The Monte Carlo simulation uses projections of the commercial milestones for the applicable period as well as the corresponding targets and approximate timing of payment based on the terms of the arrangement. The analysis for the Cernostics Earnout Payments uses assumptions for expected volatility of the financial metrics and a risk-adjusted discount rate, which were 40.0% and 20.0%, respectively, as of September 30, 2022, and 20.0% and 16.1%, respectively, as of December 31, 2021. The assumptions for expected volatility of the financial metrics used in the analysis for the AltheaDx Earnout Payments was 36.0% as of September 30, 2022. The risk-adjusted discount rate for years 2022, 2023, and 2024 were 7.7%, 8.8% and 8.9%, respectively. The contingent consideration liability is remeasured at fair value at each reporting period taking into account any updated assumptions or changes in circumstances. Any changes in the fair value are recorded as gains or losses in our condensed consolidated statement of operations. The following table discloses the summary of changes in the contingent consideration liability measured at fair value using Level 3 inputs for the nine months ended September 30, 2022 (in thousands): Cernostics AltheaDx Total Balance, December 31, 2021 $ 18,287 $ — $ 18,287 Acquisition of AltheaDx — 1,528 1,528 Change in fair value (18,257) 270 (17,987) Balance, September 30, 2022 $ 30 $ 1,798 $ 1,828

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2022
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies From time to time, we may be involved in legal proceedings arising in the ordinary course of business. We believe there is no threatened litigation or litigation pending that could have, individually or in the aggregate, a material adverse effect on our financial position, results of operations or cash flows.

Stock Incentive Plans and Stock

Stock Incentive Plans and Stock-Based Compensation	9 Months Ended
	Sep. 30, 2022
Share-Based Payment Arrangement [Abstract]
Stock Incentive Plans and Stock-Based Compensation	Stock Incentive Plans and Stock-Based Compensation Stock Incentive Plans Effective January 1, 2022, an additional 1,268,926 shares became available under our 2019 Equity Incentive Plan (the “2019 Plan”) pursuant to an automatic annual increase. As of September 30, 2022, 583,279 shares remained available for grant under the 2019 Plan. Stock Options Stock option activity under our stock plans for the nine months ended September 30, 2022 is set forth below: Weighted-Average Stock Options Exercise Remaining Aggregate Balance as of December 31, 2021 3,586,688 $ 34.75 Granted 263,486 $ 22.35 Exercised (115,829) $ 5.83 Forfeited/Cancelled (238,450) $ 31.87 Balance as of September 30, 2022 3,495,895 $ 34.96 7.7 $ 15,481 Exercisable at September 30, 2022 1,764,834 $ 28.26 7.0 $ 13,411 Restricted Stock Units The following table summarizes our RSU activity for the nine months ended September 30, 2022: Restricted Stock Units Outstanding Weighted-Average Grant Date Fair Value Balance as of December 31, 2021 1,050,174 $ 44.31 Granted 937,435 $ 24.81 Vested (18,015) $ 68.20 Forfeited/Cancelled (225,710) $ 26.35 Balance as of September 30, 2022 1,743,884 $ 35.90 Employee Stock Purchase Plan The ESPP provides for certain automatic increases in the number of shares of common stock reserved for issuance, which resulted in an additional 253,785 shares becoming available under the ESPP effective January 1, 2022. During the nine months ended September 30, 2022, we issued 78,652 of common stock pursuant to scheduled purchases under the ESPP. As of September 30, 2022, 814,599 shares remained available for issuance under the ESPP. Determining Fair Value - Summary of Assumptions We use the Black-Scholes option pricing model to estimate the fair value of each option grant on the date of grant or any other measurement date. The following table sets forth the assumptions used to determine the fair value of stock options: Nine Months Ended 2022 2021 Average expected term (years) 5.9 6.0 Expected stock price volatility 68.34% - 73.33% 66.50% - 68.83% Risk-free interest rate 1.54% - 3.03% 0.51% - 1.09% Dividend yield —% —% The following table sets forth assumptions used to determine the fair value of the purchase rights issued under the ESPP: Nine Months Ended 2022 2021 Average expected term (years) 1.2 1.2 Expected stock price volatility 62.98% - 91.78% 62.17% - 86.50% Risk-free interest rate 0.60% - 3.45% 0.06% - 0.20% Dividend yield —% —% The fair value of our common stock is also an assumption used to determine the fair value of stock options and purchase rights under the ESPP. The fair value of our common stock is the closing price per share, as reported by the Nasdaq Global Market, on the date of grant or other relevant determination date. Previously, because of the limited period of time our stock had been traded in an active market, we calculated expected volatility by using the historical stock prices of a group of similar companies looking back over the estimated life of the option or the ESPP purchase right and averaging the volatilities of these companies. In the third quarter of 2021, we adjusted this calculation to include our own stock price on a relative basis to the peer group in the calculation of expected volatility, as our common stock has now been traded in an active market for more than two years. We use the closing price of our common stock on the date of grant to determine the fair value of RSUs. Stock-Based Compensation Expense Stock-based compensation expense related to stock options, RSUs and the ESPP is included in the statements of operations as follows (in thousands): Three Months Ended Nine Months Ended 2022 2021 2022 2021 Cost of sales (exclusive of amortization of acquired intangible assets) $ 975 $ 555 $ 2,725 $ 1,480 Research and development 1,948 1,135 5,607 3,266 Selling, general and administrative 6,273 3,520 18,066 10,143 Total stock-based compensation expense $ 9,196 $ 5,210 $ 26,398 $ 14,889 For the nine months ended September 30, 2022 and 2021, the weighted-average grant date fair value of options granted was $14.34 and $40.76 per option, respectively, and the weighted-average grant date fair value of the purchase rights granted under the ESPP was $16.79 and $28.23 per share, respectively. As of September 30, 2022, the total unrecognized compensation cost related to outstanding awards was $94,365,000, which is expected to be recognized on a straight-line basis over a weighted-average period of 2.8 years. The total unrecognized compensation cost will be adjusted for forfeitures in future periods as they occur.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2022
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes In connection with our acquisition of AltheaDx, we recorded $1,819,000 in deferred tax liabilities based on our preliminary allocation of the fair values of assets acquired and liabilities assumed. As a result of these additional deferred tax liabilities , we determined that $1,769,000 of our existing valuation allowance on deferred tax assets should be reduced, which was reflected in our income tax benefit on the condensed consolidated statements of operations for the nine months ended September 30, 2022 as a discrete item.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2022
Accounting Policies [Abstract]
Basis of Presentation	Our unaudited condensed consolidated financial statements include the accounts of Castle Biosciences, Inc. and our wholly owned subsidiaries and have been prepared in conformity with accounting principles generally accepted in the United States of America (‘‘U.S. GAAP’’).
Consolidation	All intercompany accounts and transactions have been eliminated in consolidation.
Use of Estimates	The preparation of consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities as of the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Significant items subject to such estimates include revenue recognition, the valuation of stock-based compensation, assessing future tax exposure and the realization of deferred tax assets, the useful lives and recoverability of long-lived assets, the valuation of acquired intangible assets, the valuation of contingent consideration and other contingent liabilities. We base these estimates on historical and anticipated results, trends, and various other assumptions that we believe are reasonable under the circumstances, including assumptions as to future events. These estimates form the basis for making judgments about the carrying values of assets and liabilities and recorded revenues and expenses that are not readily apparent from other sources. Actual results could differ from those estimates and assumptions. We have considered the potential impact of the COVID-19 pandemic on our estimates and assumptions. The extent to which the COVID-19 pandemic may impact our estimates in future periods is uncertain and subject to change.
Cash and Cash Equivalents	Cash equivalents consist of short-term, highly liquid investments with original maturities of three months or less. Our cash equivalents consist of money market funds, which are not insured by the Federal Deposit Insurance Corporation (“FDIC”), that are primarily invested in short-term U.S. government obligations.
Concentration of Credit Risk	Cash deposits at financial institutions may exceed the amount of insurance provided by the FDIC. Management believes that we are not exposed to significant credit risk on our cash deposits due to the financial position of the institutions in which deposits are held. We have not experienced any losses on our cash or cash equivalents.
Marketable Investment Securities	All debt securities are recognized in accordance with Financial Accounting Standards Board (‘‘FASB’’) Accounting Standards Codification (‘‘ASC’’) Topic 320, Investments-Debt Securities (‘‘ASC 320’’). Management determines the appropriate classification of securities at the time of purchase and re-evaluates such determination at each balance sheet date. All debt securities are classified as available-for-sale and are recorded at fair value in accordance with ASC 320. We recognize the unrealized gains and losses related to changes in fair value as a separate component of accumulated other comprehensive loss within total stockholders’ equity, net of related deferred income tax effects on our condensed consolidated balance sheets. Premiums or discounts from par value are amortized to interest income over the life of the underlying investment. Realized gains and losses on available-for-sale securities are calculated at the individual security level and included in interest income in the condensed consolidated statements of operations. Impairments on available-for-sale debt securities, if any, are recorded in condensed consolidated statements of operations. See Notes 5 and 11 for further details.
Revenue Recognition	In accordance with ASC Topic 606, Revenue from Contracts with Customers (“ASC 606”),
Accounts Receivable	We classify accounts receivable balances that are expected to be paid more than one year from the consolidated balance sheet date as noncurrent assets. The estimated timing of payment utilized as a basis for classification as noncurrent is determined by analyses of historical payor-specific payment experience, adjusted for known factors that are expected to change the timing of future payments.
Allowance for Credit Losses	We accrue an allowance for credit losses against our accounts receivable based on management’s current estimate of amounts that will not be collected. Management’s estimates are typically based on historical loss information adjusted for current conditions. We generally do not perform evaluations of customers’ financial condition and generally do not require collateral. Historically, our credit losses have not been significant. The allowance for credit losses was zero as of September 30, 2022 and December 31, 2021. Adjustments for implicit price concessions attributable to variable consideration, as discussed above, are incorporated into the measurement of the accounts receivable balances and are not part of the allowance for credit losses.
Goodwill	Goodwill represents the excess of the purchase price over the fair value of the net tangible and intangible assets acquired in a business combination. In accordance with ASC Topic 350, Intangibles—Goodwill and Other , our goodwill is not amortized but is tested for impairment on an annual basis or whenever events or changes in circumstances indicate that it may be impaired. We perform annual impairment reviews of our goodwill balance during the fourth quarter of each year. We may perform a qualitative assessment to determine if it is necessary to perform a quantitative impairment test. If we determine that a quantitative impairment test is necessary, we apply the guidance in Accounting Standards Update (“ASU”) No. 2017-04, Intangibles—Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment , by comparing the fair value of the reporting unit to its carrying value, including the goodwill. If the carrying value exceeds the fair value, we recognize an impairment loss for the amount by which the carrying value exceeds fair value, up to the total amount of goodwill allocated to the reporting unit. We did not incur any goodwill impairment losses in any of the periods presented.
Acquisitions, Contingent Consideration	We assess acquisitions under ASC Topic 805, Business Combinations (“ASC 805”) to determine whether a transaction represents the acquisition of assets or a business combination. Under this guidance, we apply a two-step model. The first step involves a screening test where we evaluate whether substantially all of the fair value of the gross assets acquired is concentrated in a single asset or a group of similar assets. If the screening test is met, we account for the set as an asset acquisition. If the screening test is not met, we apply the second step of the model to determine if the set meets the definition of a business based on the guidance in ASC 805. If so, the transaction is treated as a business combination. Otherwise, it is treated as an asset acquisition. Asset acquisitions are accounted for by allocating the cost of the acquisition, including transaction costs, to the individual assets acquired and liabilities assumed on a relative fair value basis without recognition of goodwill. Business combinations are accounted for using the acquisition method. Under the acquisition method, goodwill is measured as a residual amount equal to the fair value of the consideration transferred less the net recognized fair value of the identifiable assets acquired and the liabilities assumed, as of the acquisition date, and transaction costs are expensed as incurred. Contingent Consideration Under the terms of business combinations or asset acquisitions, we may be required to pay additional consideration if specified future events occur or if certain conditions are met. In a business combination, in accordance with ASC 805, contingent consideration is recorded at fair value as of the acquisition date and classified as liabilities or equity based on applicable U.S. GAAP. For contingent consideration classified as liabilities, we remeasure the contingent consideration at fair value each period with changes in fair value recorded in the statements of operations each period. For contingent consideration in transactions that are not business combinations, we apply applicable U.S. GAAP. With respect to the additional consideration that may be payable in connection with the acquisitions of Cernostics, Inc. (“Cernostics”), an asset acquisition we completed on December 3, 2021, we account for the contingent consideration as a liability in accordance with ASC Topic 480, Distinguishing Liabilities from Equity (“ASC 480”), under the guidance for obligations that must or may be settled by issuance of a variable number of shares. In accordance with ASC 480, we record the contingent consideration initially and subsequently at fair value with changes in fair value recorded in the statements of operations each period. Contingent consideration is classified as current or noncurrent in our condensed consolidated balance sheets based on the contractual timing of future settlement. For additional information on contingent consideration, see Notes 6 and 11.
Accrued Compensation	We accrue for liabilities under discretionary employee and executive bonus plans. These estimated compensation liabilities are based on progress against corporate objectives approved by our board of directors, compensation levels of eligible individuals, and target bonus percentage levels. Our board of directors reviews and evaluates the performance against these objectives and ultimately determines the actual achievement levels attained. We also accrue for liabilities under employee sales incentive bonus plans with accruals based on performance achieved to date compared to established targets. As of September 30, 2022 and December 31, 2021, we accrued $13,667,000 and $12,071,000, respectively, for liabilities associated with these bonus plans. These amounts are classified as current or noncurrent accrued liabilities in the condensed consolidated balance sheets based on the expected timing of payment.
Comprehensive Loss	Comprehensive loss is defined as a change in equity during a period from transactions and other events and circumstances from non-owner sources. Comprehensive loss is made up of net loss plus other comprehensive loss, if any.

Revenue (Tables)

Revenue (Tables)	9 Months Ended
	Sep. 30, 2022
Revenue from Contract with Customer [Abstract]
Schedules of Disaggregation of Revenue	The table below provides the disaggregation of revenue by type (in thousands): Three Months Ended Nine Months Ended 2022 2021 2022 2021 Dermatologic $ 33,924 $ 21,593 $ 90,160 $ 62,881 Other 3,087 1,882 8,541 6,165 Total net revenues $ 37,011 $ 23,475 $ 98,701 $ 69,046
Schedules of Concentration of Risk, by Risk Factor	Our significant third-party payors and their related revenues as a percentage of total revenues and accounts receivable balances are as follows: Percentage of Revenues Nine Months Ended Percentage of Accounts Receivable (current) Percentage of Accounts Receivable (noncurrent) 2022 2021 September 30, 2022 December 31, 2021 September 30, 2022 December 31, 2021 Medicare 52 % 57 % 26 % 24 % — % — % Medicare Advantage plans 33 % 27 % 44 % 40 % — % — % BlueCross BlueShield plans 6 % 7 % 16 % 22 % 55 % 58 %

Loss Per Share (Tables)

Loss Per Share (Tables)	9 Months Ended
	Sep. 30, 2022
Earnings Per Share [Abstract]
Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share	The table below provides the weighted-average number of potential common shares associated with outstanding securities not included in our calculation of diluted loss per share for the three and nine months ended September 30, 2022 and 2021 because to do so would be antidilutive (in thousands): Three Months Ended Nine Months Ended 2022 2021 2022 2021 Stock options and restricted stock units (“RSUs”) 5,285 3,369 4,982 3,401 ESPP 168 58 124 63 Total 5,453 3,427 5,106 3,464

Marketable Investment Securit_2

Marketable Investment Securities (Tables)	9 Months Ended
	Sep. 30, 2022
Investments, Debt and Equity Securities [Abstract]
Debt Securities, Available-for-Sale	The following table presents our available-for-sale debt securities (in thousands): Amortized Cost Unrealized Estimated Fair Value Gains Losses As of September 30, 2022 U.S. Government Securities $ 131,991 $ — $ (189) $ 131,802 Total $ 131,991 $ — $ (189) $ 131,802

Acquisitions (Tables)

Acquisitions (Tables)	9 Months Ended
	Sep. 30, 2022
Business Combination and Asset Acquisition [Abstract]
Schedule of Business Acquisitions, by Acquisition	The preliminary acquisition-date fair value of the consideration transferred consisted of the following (in thousands, except shares): April 26, 2022 Cash $ 30,502 Common stock (763,887 shares) 17,111 Contingent consideration 1,528 Total $ 49,141
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed	The following table summarizes the preliminary allocation of the fair values of assets acquired and liabilities assumed in the acquisition of AltheaDx at the date of acquisition (in thousands): April 26, 2022 Cash and cash equivalents $ 3,536 Accounts receivable 302 Inventory 279 Prepaid expenses and other current assets 262 Property and equipment 314 Intangible asset 37,000 Other assets – long-term 12 Accounts payable (231) Accrued compensation (380) Other accrued and current liabilities (532) Deferred tax liabilities (1,819) Other liabilities (88) Net identifiable assets acquired 38,655 Goodwill 10,486 Total consideration transferred $ 49,141
Schedule of Unaudited Pro forma Financial Information and Net Income	The following unaudited pro forma financial information (in thousands) is for informational purposes only and is not necessarily indicative of (i) the results of operations that would have been achieved if the acquisition had taken place as of January 1, 2021 or (ii) the results of operations that are expected in future periods: Pro Forma Data Three Months Ended Nine Months Ended 2022 2021 2022 2021 Net revenues $ 37,011 $ 23,665 $ 99,253 $ 69,341 Net loss $ (20,211) $ (14,577) $ (52,313) $ (31,664)

Property and Equipment, Net (Ta

Property and Equipment, Net (Tables)	9 Months Ended
	Sep. 30, 2022
Property, Plant and Equipment [Abstract]
Schedule of Property, Plant and Equipment, Net	Property and equipment, net consisted of the following (in thousands): September 30, 2022 December 31, 2021 Lab equipment (1) $ 8,326 $ 3,727 Leasehold improvements 5,145 5,044 Computer equipment 4,306 2,457 Furniture and fixtures 1,654 1,288 Construction in progress 879 27 Total 20,310 12,543 Less accumulated depreciation (1) (7,256) (3,042) Property and equipment, net $ 13,054 $ 9,501 (1) Includes lab equipment under a finance lease of $369 thousand and accumulated depreciation of $101 thousand as of September 30, 2022 and $237 thousand and accumulated depreciation of $8 thousand as of December 31, 2021. Depreciation expense was recorded in the unaudited condensed consolidated statements of operations as follows (in thousands): Three Months Ended Nine Months Ended 2022 2021 2022 2021 Cost of sales (exclusive of amortization of acquired intangible assets) $ 267 $ 120 $ 621 $ 333 Research and development 85 67 255 175 Selling, general and administrative 265 208 775 498 Total $ 617 $ 395 $ 1,651 $ 1,006

Goodwill and Other Intangible_2

Goodwill and Other Intangible Assets, Net (Tables)	9 Months Ended
	Sep. 30, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Change in Carrying Value of Our Goodwill	Information on the change in carrying value of our goodwill is presented below (in thousands): Goodwill Balance, December 31, 2021 $ — Acquisition of AltheaDx 10,486 Balance, September 30, 2022 $ 10,486
Schedule of Finite-Lived Intangible Assets	Our other intangible assets, net consists of the following (in thousands): September 30, 2022 Gross carrying value Accumulated amortization Net Weighted-Average Remaining Life (in years) Developed technology $ 127,318 $ (7,916) $ 119,402 13.5 Assembled workforce 563 (94) 469 4.3 Total intangible assets, net $ 127,881 $ (8,010) $ 119,871 December 31, 2021 Gross carrying value Accumulated amortization Net Weighted-Average Remaining Life (in years) Developed technology $ 90,317 $ (1,949) $ 88,368 13.2 Assembled workforce 563 (9) 554 4.9 Total intangible assets, net $ 90,880 $ (1,958) $ 88,922
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense	The estimated future aggregate amortization expense as of September 30, 2022 is as follows (in thousands): Years Ending December 31, 2022 (remainder of year) $ 2,305 2023 9,147 2024 9,172 2025 9,147 2026 9,137 Thereafter 80,963 Total $ 119,871

Other Accrued and Current Lia_2

Other Accrued and Current Liabilities (Tables)	9 Months Ended
	Sep. 30, 2022
Payables and Accruals [Abstract]
Schedule of Accrued And Current Liabilities	Other accrued and current liabilities consisted of the following (in thousands): September 30, 2022 December 31, 2021 Accrued service fees $ 2,564 $ 1,905 Clinical studies 1,725 1,655 Payroll-related liabilities 317 695 Employee stock purchase plan contributions 220 760 Other 281 663 Total $ 5,107 $ 5,678

Leases (Tables)

Leases (Tables)	9 Months Ended
	Sep. 30, 2022
Leases [Abstract]
Schedule of Adoption of Accounting Standards Update	The changes are set forth in the table below (in thousands): Nine Months Ended Before Adoption of ASC 842 Effect of Adoption After Adoption of ASC 842 Effect on Condensed Consolidated Statements of Cash Flows OPERATING ACTIVITIES Adjustments to reconcile net loss to net cash used in operating activities: Operating lease assets $ — $ 641 $ 641 Operating lease liabilities $ — $ (638) $ (638) Other liabilities $ 3 $ (3) $ —

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	9 Months Ended
	Sep. 30, 2022
Fair Value Disclosures [Abstract]
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis	The table below provides information, by level within the fair value hierarchy, of our financial assets and financial liabilities that are accounted for at fair value on a recurring basis as of September 30, 2022 and December 31, 2021 (in thousands): As of September 30, 2022 Quoted Prices in Active Markets for Identical Items (Level 1) Significant Other Observable Inputs Significant Unobservable Inputs Total Assets Money market funds (1) $ 124,095 $ — $ — $ 124,095 U.S. Government Securities (2) $ 131,802 $ — $ — $ 131,802 Liabilities Contingent consideration (3) $ — $ — $ 1,828 $ 1,828 As of December 31, 2021 Quoted Prices in Active Markets for Identical Items (Level 1) Significant Other Observable Inputs Significant Unobservable Inputs Total Assets Money market funds (1) $ 327,721 $ — $ — $ 327,721 U.S. Government Securities (2) $ — $ — $ — $ — Liabilities Contingent consideration (3) $ — $ — $ 18,287 $ 18,287 (1) Classified as “Cash and cash equivalents” in the condensed consolidated balance sheets. (2) Classified as “Marketable investment securities” in the condensed consolidated balance sheets. (3) Current portion, if any, classified as “Other accrued and current liabilities” in the condensed consolidated balance sheets.
Schedule of Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation	The following table discloses the summary of changes in the contingent consideration liability measured at fair value using Level 3 inputs for the nine months ended September 30, 2022 (in thousands): Cernostics AltheaDx Total Balance, December 31, 2021 $ 18,287 $ — $ 18,287 Acquisition of AltheaDx — 1,528 1,528 Change in fair value (18,257) 270 (17,987) Balance, September 30, 2022 $ 30 $ 1,798 $ 1,828

Stock Incentive Plans and Sto_2

Stock Incentive Plans and Stock-Based Compensation (Tables)	9 Months Ended
	Sep. 30, 2022
Share-Based Payment Arrangement [Abstract]
Schedule of Share-based Payment Arrangement on Stock Option Activity	Stock option activity under our stock plans for the nine months ended September 30, 2022 is set forth below: Weighted-Average Stock Options Exercise Remaining Aggregate Balance as of December 31, 2021 3,586,688 $ 34.75 Granted 263,486 $ 22.35 Exercised (115,829) $ 5.83 Forfeited/Cancelled (238,450) $ 31.87 Balance as of September 30, 2022 3,495,895 $ 34.96 7.7 $ 15,481 Exercisable at September 30, 2022 1,764,834 $ 28.26 7.0 $ 13,411
Schedule of Share-based Payment Arrangement on Restricted Stock Units	The following table summarizes our RSU activity for the nine months ended September 30, 2022: Restricted Stock Units Outstanding Weighted-Average Grant Date Fair Value Balance as of December 31, 2021 1,050,174 $ 44.31 Granted 937,435 $ 24.81 Vested (18,015) $ 68.20 Forfeited/Cancelled (225,710) $ 26.35 Balance as of September 30, 2022 1,743,884 $ 35.90
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions	The following table sets forth the assumptions used to determine the fair value of stock options: Nine Months Ended 2022 2021 Average expected term (years) 5.9 6.0 Expected stock price volatility 68.34% - 73.33% 66.50% - 68.83% Risk-free interest rate 1.54% - 3.03% 0.51% - 1.09% Dividend yield —% —%
Schedule of Share-based Payment Award, ESPP, Valuation Assumptions	The following table sets forth assumptions used to determine the fair value of the purchase rights issued under the ESPP: Nine Months Ended 2022 2021 Average expected term (years) 1.2 1.2 Expected stock price volatility 62.98% - 91.78% 62.17% - 86.50% Risk-free interest rate 0.60% - 3.45% 0.06% - 0.20% Dividend yield —% —%
Share-based Payment Arrangement, Expensed and Capitalized, Amount	Stock-based compensation expense related to stock options, RSUs and the ESPP is included in the statements of operations as follows (in thousands): Three Months Ended Nine Months Ended 2022 2021 2022 2021 Cost of sales (exclusive of amortization of acquired intangible assets) $ 975 $ 555 $ 2,725 $ 1,480 Research and development 1,948 1,135 5,607 3,266 Selling, general and administrative 6,273 3,520 18,066 10,143 Total stock-based compensation expense $ 9,196 $ 5,210 $ 26,398 $ 14,889

Summary of Significant Accoun_3

Summary of Significant Accounting Policies - Narrative (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021	Dec. 31, 2021
Accounting Policies [Abstract]
Allowance for credit losses	$ 0		$ 0		$ 0
Goodwill impairment losses	0	$ 0	0	$ 0
Accrued bonuses	$ 13,667,000		$ 13,667,000		$ 12,071,000

Revenue - Narrative (Details)

Revenue - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Revenue from Contract with Customer [Abstract]
Number of days contract with customer is generally paid			30 days
Variable consideration adjustments included in revenue	$ (277)	$ (92)	$ (1,850)	$ 4,130

Revenue - Disaggregation of Rev

Revenue - Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Disaggregation of Revenue [Line Items]
Total net revenues	$ 37,011	$ 23,475	$ 98,701	$ 69,046
Dermatologic
Disaggregation of Revenue [Line Items]
Total net revenues	33,924	21,593	90,160	62,881
Other
Disaggregation of Revenue [Line Items]
Total net revenues	$ 3,087	$ 1,882	$ 8,541	$ 6,165

Revenue - Concentration of Risk

Revenue - Concentration of Risk, by Risk Factor (Details) - Third-Party Payor Concentration Risk	9 Months Ended		12 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Dec. 31, 2021
Medicare | Percentage of Revenues
Concentration Risk [Line Items]
Concentration risk percentage	52%	57%
Medicare | Percentage of Accounts Receivable (current)
Concentration Risk [Line Items]
Concentration risk percentage	26%		24%
Medicare | Percentage of Accounts Receivable (noncurrent)
Concentration Risk [Line Items]
Concentration risk percentage	0%		0%
Medicare Advantage plans | Percentage of Revenues
Concentration Risk [Line Items]
Concentration risk percentage	33%	27%
Medicare Advantage plans | Percentage of Accounts Receivable (current)
Concentration Risk [Line Items]
Concentration risk percentage	44%		40%
Medicare Advantage plans | Percentage of Accounts Receivable (noncurrent)
Concentration Risk [Line Items]
Concentration risk percentage	0%		0%
BlueCross BlueShield plans | Percentage of Revenues
Concentration Risk [Line Items]
Concentration risk percentage	6%	7%
BlueCross BlueShield plans | Percentage of Accounts Receivable (current)
Concentration Risk [Line Items]
Concentration risk percentage	16%		22%
BlueCross BlueShield plans | Percentage of Accounts Receivable (noncurrent)
Concentration Risk [Line Items]
Concentration risk percentage	55%		58%

Loss Per Share - Antidilutive S

Loss Per Share - Antidilutive Securities Excluded from Computation of Earnings Per Share (Details) - shares shares in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share, amount (in shares)	5,453	3,427	5,106	3,464
Stock options and restricted stock units (“RSUs”)
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share, amount (in shares)	5,285	3,369	4,982	3,401
ESPP
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share, amount (in shares)	168	58	124	63

Marketable Investment Securit_3

Marketable Investment Securities - Schedule of Available-for-Sale Debt Securities (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Debt Securities, Available-for-Sale [Line Items]
Amortized Cost	$ 131,991
Unrealized gains	0
Unrealized losses	(189)
Estimated Fair Value	131,802	$ 0
U.S. Government Securities
Debt Securities, Available-for-Sale [Line Items]
Amortized Cost	131,991
Unrealized gains	0
Unrealized losses	(189)
Estimated Fair Value	$ 131,802

Marketable Investment Securit_4

Marketable Investment Securities - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021	Dec. 31, 2021
Investments, Debt and Equity Securities [Abstract]
Available-for-sale debt securities	$ 131,802		$ 131,802		$ 0
Realized gain (loss) on sale of investment	0	$ 0	0	$ 0
Impairment loss	0	$ 0	0	$ 0
Allowance for credit loss	$ 0		$ 0		$ 0

Acquisitions - Narrative (Detai

Acquisitions - Narrative (Details) $ / shares in Units, $ in Thousands				3 Months Ended		9 Months Ended
	Apr. 26, 2022 USD ($) tradingDay $ / shares shares	Dec. 03, 2021 USD ($)	May 28, 2021 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2021 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2021 USD ($)
Business Acquisition [Line Items]
Cash received from settlement of receivable						$ 547
Income tax (benefit) expense				$ 0	$ 0	1,823	$ (5)
Myriad myPath, LLC
Business Acquisition [Line Items]
Payments to acquire productive assets			$ 32,500
Cernostics, Inc.
Business Acquisition [Line Items]
Payments to acquire productive assets		$ 30,732
Total consideration transferred		49,019
Consideration transferred, contingent consideration		$ 18,287
Cash received from settlement of receivable						547
AltheaDx, Inc
Business Acquisition [Line Items]
Percentage of voting interest acquired	100%
Loss from acquisition date	$ 8,199
Transaction costs expensed						$ 1,711
Share price (in dollars per share) | $ / shares	$ 22.40
Additional consideration payable based on achievement of certain commercial milestones	$ 75,000
Contingent consideration paid in cash (as a percent)	50%
Contingent consideration paid in common stock (as a percent)	50%
Business acquisition, number of shares issued or issuable in transaction (in shares) | shares	763,887
AltheaDx, Inc | Acquisition-related Costs
Business Acquisition [Line Items]
Transaction costs expensed							1,711
AltheaDx, Inc | Income Tax Adjustment
Business Acquisition [Line Items]
Income tax (benefit) expense							$ 1,769
AltheaDx, Inc | Developed technology
Business Acquisition [Line Items]
Estimated useful life (in years)	15 years
AltheaDx, Inc | Common Stock
Business Acquisition [Line Items]
Common stock, share price, volume-weighted average price, number of trading days | tradingDay	20
Business acquisition, number of shares issued or issuable in transaction (in shares) | shares	1,271,718
Consideration transferred, number of remaining shares authorized to be issued (in shares) | shares	507,831

Acquisitions - Acquisition of c

Acquisitions - Acquisition of consideration transferred (Details) - AltheaDx, Inc $ in Thousands	Apr. 26, 2022 USD ($) shares
Business Acquisition [Line Items]
Cash	$ 30,502
Common stock	17,111
Contingent consideration	1,528
Total	$ 49,141
Business acquisition, number of shares issued or issuable in transaction (in shares) | shares	763,887

Acquisitions - Assets Acquired

Acquisitions - Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Apr. 26, 2022	Dec. 31, 2021
Business Acquisition [Line Items]
Goodwill	$ 10,486		$ 0
AltheaDx, Inc
Business Acquisition [Line Items]
Cash and cash equivalents		$ 3,536
Accounts receivable		302
Inventory		279
Prepaid expenses and other current assets		262
Property and equipment		314
Intangible asset		37,000
Other assets – long-term		12
Accounts payable		(231)
Accrued compensation		(380)
Other accrued and current liabilities		(532)
Deferred tax liabilities		(1,819)
Other liabilities		(88)
Net identifiable assets acquired		38,655
Goodwill		10,486
Total		$ 49,141

Acquisitions - Schedule of Unau

Acquisitions - Schedule of Unaudited Pro forma Financial Information and Net Income (Details) - AltheaDx, Inc - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Business Acquisition [Line Items]
Net revenues	$ 37,011	$ 23,665	$ 99,253	$ 69,341
Net loss	$ (20,211)	$ (14,577)	$ (52,313)	$ (31,664)

Property and Equipment, Net - P

Property and Equipment, Net - Property and Equipment (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Property, Plant and Equipment [Line Items]
Total	$ 20,310	$ 12,543
Less accumulated depreciation	(7,256)	(3,042)
Property and equipment, net	13,054	9,501
Lab equipment
Property, Plant and Equipment [Line Items]
Total	8,326	3,727
Finance lease, right-of-use asset, before accumulated amortization	369	237
Finance lease, right-of-use asset, accumulated amortization	101	8
Leasehold improvements
Property, Plant and Equipment [Line Items]
Total	5,145	5,044
Computer equipment
Property, Plant and Equipment [Line Items]
Total	4,306	2,457
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Total	1,654	1,288
Construction in progress
Property, Plant and Equipment [Line Items]
Total	$ 879	$ 27

Property and Equipment, Net - D

Property and Equipment, Net - Depreciation Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Property, Plant and Equipment [Line Items]
Depreciation and amortization	$ 617	$ 395	$ 1,651	$ 1,006
Cost of sales (exclusive of amortization of acquired intangible assets)
Property, Plant and Equipment [Line Items]
Depreciation and amortization	267	120	621	333
Research and development
Property, Plant and Equipment [Line Items]
Depreciation and amortization	85	67	255	175
Selling, general and administrative
Property, Plant and Equipment [Line Items]
Depreciation and amortization	$ 265	$ 208	$ 775	$ 498

Goodwill and Other Intangible_3

Goodwill and Other Intangible Assets, Net - Schedule of Change in Carrying Value of Our Goodwill (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2022 USD ($)
Goodwill [Roll Forward]
Goodwill, beginning balance	$ 0
Acquisition of AltheaDx	10,486
Goodwill, ending balance	$ 10,486

Goodwill and Other Intangible_4

Goodwill and Other Intangible Assets, Net - Narrative (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021	Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill accumulated impairment	$ 0		$ 0		$ 0
Amortization of acquired intangible assets	$ 2,306,000	$ 694,000	$ 6,051,000	$ 950,000

Goodwill and Other Intangible_5

Goodwill and Other Intangible Assets, Net - Finite-Lived Intangible Assets (Details) - USD ($) $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2022	Dec. 31, 2021
Finite-Lived Intangible Assets [Line Items]
Gross carrying value	$ 127,881	$ 90,880
Accumulated amortization	(8,010)	(1,958)
Net	119,871	88,922
Developed technology
Finite-Lived Intangible Assets [Line Items]
Gross carrying value	127,318	90,317
Accumulated amortization	(7,916)	(1,949)
Net	$ 119,402	$ 88,368
Weighted-Average Remaining Life (in years)	13 years 6 months	13 years 2 months 12 days
Assembled workforce
Finite-Lived Intangible Assets [Line Items]
Gross carrying value	$ 563	$ 563
Accumulated amortization	(94)	(9)
Net	$ 469	$ 554
Weighted-Average Remaining Life (in years)	4 years 3 months 18 days	4 years 10 months 24 days

Goodwill and Other Intangible_6

Goodwill and Other Intangible Assets, Net - Finite-Lived Intangible Assets, Future Amortization Expense (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
2022 (remainder of year)	$ 2,305
2023	9,147
2024	9,172
2025	9,147
2026	9,137
Thereafter	80,963
Net	$ 119,871	$ 88,922

Other Accrued and Current Lia_3

Other Accrued and Current Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Payables and Accruals [Abstract]
Accrued service fees	$ 2,564	$ 1,905
Clinical studies	1,725	1,655
Payroll-related liabilities	317	695
Employee stock purchase plan contributions	220	760
Other	281	663
Total	$ 5,107	$ 5,678

Leases - Assets And Liabilities

Leases - Assets And Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Aug. 31, 2022	Dec. 31, 2021	Sep. 30, 2021
Operating Leased Assets [Line Items]
Operating lease assets	$ 12,604		$ 7,383	$ 0
Operating lease liabilities		$ (900)		0
Other liabilities				3
Effect of Adoption | Effect of Adoption
Operating Leased Assets [Line Items]
Operating lease assets				641
Operating lease liabilities				(638)
Other liabilities				(3)
After Adoption of ASC 842
Operating Leased Assets [Line Items]
Operating lease assets				641
Operating lease liabilities				(638)
Other liabilities				$ 0

Leases - Narrative (Details)

Leases - Narrative (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Aug. 31, 2022	Apr. 01, 2022	Mar. 11, 2022	Dec. 31, 2021	Sep. 30, 2021	Jan. 01, 2021
Lessee, Lease, Description [Line Items]
Adjustment to accumulated deficit	$ (140,287)				$ (93,767)
Operating lease liabilities		$ 900				$ 0
Term of contract				10 years 3 months 18 days
Pittsburgh Lease
Lessee, Lease, Description [Line Items]
Operating lease liabilities	$ 5,000
Term of contract			10 years 6 months
Renewal term			5 years
Leasehold improvements to be contributed by landlord			$ 2,500
Effect of Adoption | Effect of Adoption
Lessee, Lease, Description [Line Items]
Adjustment to accumulated deficit							$ 21
Operating lease liabilities						$ 638

Fair Value Measurements - Fair

Fair Value Measurements - Fair Value, Assets and Liabilities Measured on Recurring Basis (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Available-for-sale debt securities	$ 131,802	$ 0
U.S. Government Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Available-for-sale debt securities	131,802
Fair Value, Recurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Money market funds	124,095	327,721
Contingent consideration	1,828	18,287
Fair Value, Recurring | U.S. Government Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Available-for-sale debt securities	131,802	0
Fair Value, Recurring | Quoted Prices in Active Markets for Identical Items (Level 1)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Money market funds	124,095	327,721
Contingent consideration	0	0
Fair Value, Recurring | Quoted Prices in Active Markets for Identical Items (Level 1) | U.S. Government Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Available-for-sale debt securities	131,802	0
Fair Value, Recurring | Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Money market funds	0	0
Contingent consideration	0	0
Fair Value, Recurring | Significant Other Observable Inputs (Level 2) | U.S. Government Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Available-for-sale debt securities	0	0
Fair Value, Recurring | Significant Unobservable Inputs (Level 3)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Money market funds	0	0
Contingent consideration	1,828	18,287
Fair Value, Recurring | Significant Unobservable Inputs (Level 3) | U.S. Government Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Available-for-sale debt securities	$ 0	$ 0

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) $ in Millions	9 Months Ended	12 Months Ended
	Sep. 30, 2022 USD ($) tradingDay shares	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
AltheaDx, Inc
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Contingent consideration in acquisition of business	$ 75
Expected stock price volatility | Valuation, Income Approach | AltheaDx, Inc
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Asset acquisition, contingent consideration, liability, measurement input	36%
Measurement Input, Discount Rate | Valuation, Income Approach | Forecast | AltheaDx, Inc
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Asset acquisition, contingent consideration, liability, measurement input		8.90%	8.80%	7.70%
Cernostics, Inc.
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Additional consideration payable based on achievement of certain commercial milestones	$ 50
Maximum number of shares payable in earnout payment (in shares) | shares	5,034,653
Number of trading days to determine volume weighted-average price of common stock | tradingDay	15
Cernostics, Inc. | Expected stock price volatility | Valuation, Income Approach
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Asset acquisition, contingent consideration, liability, measurement input	40%				20%
Cernostics, Inc. | Measurement Input, Discount Rate | Valuation, Income Approach
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Asset acquisition, contingent consideration, liability, measurement input	20%				16.10%

Fair Value Measurements - Fai_2

Fair Value Measurements - Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2022 USD ($)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ 18,287
Acquisition of AltheaDx	1,528
Change in fair value	(17,987)
Ending balance	1,828
AltheaDx, Inc
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	0
Acquisition of AltheaDx	1,528
Change in fair value	270
Ending balance	1,798
Cernostics, Inc.
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	18,287
Acquisition of AltheaDx	0
Change in fair value	(18,257)
Ending balance	$ 30

Stock Incentive Plans and Sto_3

Stock Incentive Plans and Stock-Based Compensation - Narrative (Details) - USD ($) $ / shares in Units, $ in Thousands		9 Months Ended
	Jan. 01, 2022	Sep. 30, 2022	Sep. 30, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation costs		$ 94,365
Unrecognized compensation expense, period for recognition		2 years 9 months 18 days
ESPP
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares issued during period (in shares)		78,652
Stock options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options granted, weighted average grant date fair value (in dollars per share)		$ 14.34	$ 40.76
2019 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Increase in number of shares authorized for issuance (in shares)	1,268,926
Number of shares available for issuance (in shares)		583,279
Employee stock purchase plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options granted, weighted average grant date fair value (in dollars per share)		$ 16.79	$ 28.23
Employee stock purchase plan | ESPP
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Increase in number of shares authorized for issuance (in shares)	253,785
Number of shares available for issuance (in shares)		814,599

Stock Incentive Plans and Sto_4

Stock Incentive Plans and Stock-Based Compensation - Activity Under Stock Incentive Plan (Details) - USD ($) $ / shares in Units, $ in Thousands	9 Months Ended
	Sep. 30, 2022
Stock Options Outstanding
Beginning balance (in shares)	3,586,688
Granted (in shares)	263,486
Exercised (in shares)	(115,829)
Forfeited/Cancelled (in shares)	(238,450)
Ending balance (in shares)	3,495,895
Options exercisable, number of options (in shares)	1,764,834
Exercise Price
Beginning balance (in dollars per share)	$ 34.75
Granted (in dollars per share)	22.35
Exercised (in dollars per share)	5.83
Forfeited/Cancelled (in dollars per share)	31.87
Ending balance (in dollars per share)	34.96
Options exercisable, weighted average exercise price (in dollars per share)	$ 28.26
Stock Option Activity, Additional Disclosures
Options outstanding, weighted average remaining contractual term	7 years 8 months 12 days
Options exercisable, weighted average remaining contractual term	7 years
Options outstanding, aggregate intrinsic value	$ 15,481
Options exercisable, aggregate intrinsic value	$ 13,411

Stock Incentive Plans and Sto_5

Stock Incentive Plans and Stock-Based Compensation - Restricted Stock Units Activity (Details) - Restricted Stock Units (RSUs)	9 Months Ended
	Sep. 30, 2022 $ / shares shares
Restricted Stock Units Outstanding
Beginning Balance (in shares) | shares	1,050,174
Granted (in shares) | shares	937,435
Vested (in shares) | shares	(18,015)
Forfeited/Cancelled (in shares) | shares	(225,710)
Ending Balance (in shares) | shares	1,743,884
Weighted-Average Grant Date Fair Value
Weighted average grant date fair value at beginning balance (in dollars per share) | $ / shares	$ 44.31
Granted (in dollars per share) | $ / shares	24.81
Vested (in dollars per share) | $ / shares	68.20
Forfeited / Cancelled (in dollars per share) | $ / shares	26.35
Weighted average grant date fair value at ending balance (in dollars per share) | $ / shares	$ 35.90

Stock Incentive Plans and Sto_6

Stock Incentive Plans and Stock-Based Compensation - Assumptions Used in Fair Value of Stock Options and ESPP (Details)	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Employee stock purchase plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Average expected term (years)	1 year 2 months 12 days	1 year 2 months 12 days
Expected stock price volatility, minimum	62.98%	62.17%
Expected stock price volatility, maximum	91.78%	86.50%
Risk-free interest rate, minimum	0.60%	0.06%
Risk-free interest rate, maximum	3.45%	0.20%
Dividend yield	0%	0%
Stock options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Average expected term (years)	5 years 10 months 24 days	6 years
Expected stock price volatility, minimum	68.34%	66.50%
Expected stock price volatility, maximum	73.33%	68.83%
Risk-free interest rate, minimum	1.54%	0.51%
Risk-free interest rate, maximum	3.03%	1.09%
Dividend yield	0%	0%

Stock Incentive Plans and Sto_7

Stock Incentive Plans and Stock-Based Compensation - Stock-based Compensation Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock-based compensation expense	$ 9,196	$ 5,210	$ 26,398	$ 14,889
Cost of sales (exclusive of amortization of acquired intangible assets)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock-based compensation expense	975	555	2,725	1,480
Research and development
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock-based compensation expense	1,948	1,135	5,607	3,266
Selling, general and administrative
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock-based compensation expense	$ 6,273	$ 3,520	$ 18,066	$ 10,143

Income Taxes (Details)

Income Taxes (Details) - AltheaDx, Inc - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Apr. 26, 2022
Business Acquisition [Line Items]
Deferred tax liabilities		$ 1,819
Reduction of existing valuation allowance on deferred tax assets	$ 1,769