Castle Biosciences (CSTL) 10-Q 3 May 23 2023 Q1 Quarterly report Financial data

Cover

Cover - shares	3 Months Ended
	Mar. 31, 2023	Apr. 24, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2023
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	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		26,691,286
Entity Central Index Key	0001447362
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q1
Amendment Flag	false

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Current Assets
Cash and cash equivalents	$ 114,821	$ 122,948
Marketable investment securities	117,234	135,677
Accounts receivable, net	27,728	23,476
Inventory	4,520	3,980
Prepaid expenses and other current assets	6,797	6,207
Total current assets	271,100	292,288
Long-term accounts receivable, net	1,218	1,087
Property and equipment, net	18,254	14,315
Operating lease assets	11,401	12,181
Goodwill and other intangible assets, net	124,126	126,348
Other assets – long-term	792	1,110
Total assets	426,891	447,329
Current Liabilities
Accounts payable	9,961	4,731
Accrued compensation	12,796	24,358
Operating lease liabilities	1,779	1,777
Other accrued and current liabilities	5,607	5,262
Total current liabilities	30,143	36,128
Noncurrent operating lease liabilities	11,103	11,533
Deferred tax liability	441	428
Other liabilities	55	90
Total liabilities	41,742	48,179
Commitments and Contingencies (Note 11)
Stockholders’ Equity
Preferred stock, $0.001 par value per share; 10,000,000 shares authorized as of March 31, 2023 and December 31, 2022; no shares issued and outstanding as of March 31, 2023 and December 31, 2022	0	0
Common stock, $0.001 par value per share; 200,000,000 shares authorized as of March 31, 2023 and December 31, 2022; 26,686,201 and 26,553,681 shares issued and outstanding as of March 31, 2023 and December 31, 2022, respectively	27	27
Additional paid-in capital	575,367	560,409
Accumulated deficit	(190,109)	(160,905)
Accumulated other comprehensive loss	(136)	(381)
Total stockholders’ equity	385,149	399,150
Total liabilities and stockholders’ equity	$ 426,891	$ 447,329

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Mar. 31, 2023	Dec. 31, 2022
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)	26,686,201	26,553,681
Common stock, shares outstanding (in shares)	26,686,201	26,553,681

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Income Statement [Abstract]
NET REVENUES	$ 42,037	$ 26,852
OPERATING EXPENSES
Cost of sales (exclusive of amortization of acquired intangible assets)	10,182	5,944
Research and development	14,393	10,761
Selling, general and administrative	46,762	30,453
Amortization of acquired intangible assets	2,222	1,648
Change in fair value of contingent consideration	0	2,562
Total operating expenses, net	73,559	51,368
Operating loss	(31,522)	(24,516)
Interest income	2,336	30
Interest expense	(4)	(3)
Loss before income taxes	(29,190)	(24,489)
Income tax expense	14	134
Net loss	$ (29,204)	$ (24,623)
Basic (in dollars per share)	$ (1.10)	$ (0.97)
Diluted (in dollars per share)	$ (1.10)	$ (0.97)
Weighted-average shares outstanding, basic (in shares)	26,607	25,424
Weighted-average shares outstanding, diluted (in shares)	26,607	25,424

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Statement of Comprehensive Income [Abstract]
Net loss	$ (29,204)	$ (24,623)
Other comprehensive income:
Net unrealized gain on marketable investment securities	245	0
Comprehensive loss	$ (28,959)	$ (24,623)

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) $ in Thousands	Total	Preferred Stock	Common Stock	Additional Paid-in Capital	Accumulated Deficit	Accumulated Other Comprehensive Loss
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 unrealized gain on marketable investment securities	0
Net 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, 2022		0	26,553,681
Beginning balance at Dec. 31, 2022	399,150	$ 0	$ 27	560,409	(160,905)	(381)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation expense	$ 13,525			13,525
Exercise of common stock options (in shares)	30,595		30,495
Exercise of common stock options	$ 95			95
Issuance of common stock from vested restricted stock units and payment of employees' taxes (in shares)			24,835
Issuance of common stock from vested restricted stock units and payment of employees’ taxes	(314)			(314)
Issuance of common stock under the employee stock purchase plan (in shares)			77,190
Issuance of common stock under the employee stock purchase plan	1,652			1,652
Net unrealized gain on marketable investment securities	245					245
Net loss	(29,204)				(29,204)
Ending balance (in shares) at Mar. 31, 2023		0	26,686,201
Ending balance at Mar. 31, 2023	$ 385,149	$ 0	$ 27	$ 575,367	$ (190,109)	$ (136)

CONDENSED CONSOLIDATED STATEM_4

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
OPERATING ACTIVITIES
Net loss	$ (29,204)	$ (24,623)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	2,892	2,151
Stock-based compensation expense	13,525	8,419
Change in fair value of contingent consideration	0	2,562
Deferred income taxes	13	123
Accretion of discounts on marketable investment securities	(1,229)	0
Other	211	12
Change in operating assets and liabilities:
Accounts receivable	(4,383)	(2,725)
Prepaid expenses and other current assets	(654)	(357)
Inventory	(540)	(329)
Operating lease assets	331	222
Other assets	319	42
Accounts payable	3,896	187
Operating lease liabilities	(68)	(226)
Accrued compensation	(11,562)	(6,917)
Other accrued and current liabilities	1,014	29
Net cash used in operating activities	(25,439)	(21,430)
INVESTING ACTIVITIES
Purchases of property and equipment	(3,338)	(402)
Proceeds from sale of property and equipment	5	0
Purchases of marketable investment securities	(30,083)	0
Proceeds from maturities of marketable investment securities	50,000	0
Net cash provided by (used in) investing activities	16,584	(402)
FINANCING ACTIVITIES
Proceeds from exercise of common stock options	95	399
Payment of employees’ taxes on vested restricted stock units	(314)	(56)
Proceeds from contributions to the employee stock purchase plan	982	897
Repayment of principal portion of finance lease liabilities	(35)	(24)
Net cash provided by financing activities	728	1,216
NET CHANGE IN CASH AND CASH EQUIVALENTS	(8,127)	(20,616)
Beginning of period	122,948	329,633
End of period	114,821	309,017
DISCLOSURE OF NON-CASH INVESTING AND FINANCING ACTIVITIES:
Accrued purchases of property and equipment	2,730	32
Deferred acquisition costs	0	1,026
Property and equipment acquired with tenant improvement allowance	$ 89	$ 0

Organization and Description of

Organization and Description of Business	3 Months Ended
	Mar. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Description of Business	Organization and Description of Business Castle 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 clinicians 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 and Pittsburgh, Pennsylvania. We have a history of recurring net losses and negative cash flows and as of March 31, 2023, we had an accumulated deficit of $190.1 million. We believe our cash and cash equivalents of $114.8 million, marketable investment securities of $117.2 million as of March 31, 2023 and revenue from our test reports will be sufficient to meet our anticipated cash requirements through at least the 12-month period following the date that these unaudited condensed consolidated financial statements were issued.

Summary of Significant Accounti

Summary of Significant Accounting Policies	3 Months Ended
	Mar. 31, 2023
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 March 31, 2023 and the condensed consolidated statements of operations, the condensed consolidated statements of comprehensive loss, the condensed consolidated statements of stockholders’ equity and the condensed consolidated statements of cash flows for the three months ended March 31, 2023 and 2022 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 March 31, 2023 and the results of our consolidated operations and our consolidated cash flows for the three months ended March 31, 2023 and 2022. The financial data and other information disclosed in these notes related to the three months ended March 31, 2023 and 2022 are also unaudited. The results for the three months ended March 31, 2023 are not necessarily indicative of results to be expected for the year ending December 31, 2023, any other interim periods, or any future year or period. The balance sheet as of December 31, 2022 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 (the "2022 Form 10-K") for the year ended December 31, 2022 filed with the Securities and Exchange Commission (“SEC”) on February 28, 2023. 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 realizability of deferred tax assets, the useful lives and recoverability of long-lived assets, the goodwill impairment test, the valuation of acquired intangible assets and 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. 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 financial institutions in which deposits are held. 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 any 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 of available-for-sale debt securities, if any, are recorded in our unaudited condensed consolidated statements of operations. See Notes 5 and 10 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 clinician, 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 March 31, 2023 and December 31, 2022. Adjustments for implicit price concessions attributable to variable consideration, as discussed below, are incorporated into the measurement of the accounts receivable balances and are not part of the allowance for credit losses. Accrued Compensation We accrue for liabilities under discretionary employee and executive bonus plans. Our 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 March 31, 2023 and December 31, 2022, we accrued approximately $5,858,000 and $18,209,000, respectively, for liabilities associated with these bonus plans. These amounts are classified as current or noncurrent accrued liabilities in the unaudited condensed consolidated balance sheets based on the expected timing of payment. Stock-Based Compensation Stock-based compensation expense for equity instruments issued to employees is measured based on the grant-date fair value of the awards. The fair value of employee stock options and offerings under the 2019 Employee Stock Purchase Plan (the “ESPP”) are estimated on the date of grant using the Black-Scholes option-pricing valuation model. For restricted stock units (“RSUs”) and performance-based restricted stock units (“PSUs”), the fair value is equal to the closing price of our common stock on the date of grant. For awards with graded vesting and only service conditions, we recognize compensation costs on a straight-line basis over the requisite service period of the awards. For options and RSUs, the requisite service period is generally the awards’ vesting period (typically four years). PSUs vest upon the achievement of certain performance conditions and the provision of service with us through a specified period. Accruals of compensation cost for PSUs are based on the probable outcome of the performance conditions and are reassessed each reporting period. We recognize compensation cost for PSUs separately for each vesting tranche on a ratable basis over the requisite service period. The requisite service period for PSUs is based on an analysis of vesting requirements and performance conditions for the particular award. Certain employees are entitled to acceleration of vesting of a portion of their awards upon retirement, subject to age, years of service and notice requirements. In these cases, the requisite service period takes into consideration the employee’s retirement eligibility, and is reassessed at each reporting date. For the ESPP, the requisite service period is generally the period of time from the offering date to the purchase date. Forfeitures are accounted for as they occur. 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 net unrealized gain (loss) on marketable investment securities, which is our only other item of other comprehensive income (loss).

Revenue

Revenue	3 Months Ended
	Mar. 31, 2023
Revenue from Contract with Customer [Abstract]
Revenue	Revenue All of our revenues from contracts with customers are associated with the provision of diagnostic and prognostic testing services. Our revenues are primarily attributable to our DecisionDx®-Melanoma test for cutaneous melanoma. We also provide a test for patients with cutaneous squamous cell carcinoma (“SCC”), DecisionDx®-SCC, a test for use in patients with suspicious pigmented lesions, MyPath® Melanoma, a test for uveal melanoma (“UM”), DecisionDx®-UM and a test for patients diagnosed with Barrett’s esophagus (“BE”), the TissueCypher® Barrett’s Esophagus Test. 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. The payments for our services are primarily 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 Medicare 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 local coverage determination (“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 Medicare 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 estimated using 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 Medicare, 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 March 31, 2023 and 2022 were $1,336,000 of net negative revenue adjustments and $602,000 of net positive revenue adjustments, respectively, associated with changes in estimated variable consideration related to performance obligations satisfied in previous periods. 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 expenses as incurred due to the short duration of our contracts. Contract balances consisted solely of accounts receivable (both current and noncurrent) as of March 31, 2023 and December 31, 2022. Disaggregation of Revenues The table below provides the disaggregation of revenue by type (in thousands): Three Months Ended 2023 2022 Dermatologic (1) $ 35,911 $ 24,339 Non-Dermatologic (2) 6,126 2,513 Total net revenues $ 42,037 $ 26,852 (1) Consists of DecisionDx-Melanoma, DecisionDx-SCC and Diagnostic GEP offering. (2) Consists of TissueCypher, DecisionDx-UM and IDgenetix. 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 Three Months Ended Percentage of Accounts Receivable (current) as of Percentage of Accounts Receivable (noncurrent) as of 2023 2022 March 31, 2023 December 31, 2022 March 31, 2023 December 31, 2022 Medicare 49 % 53 % 23 % 28 % * * Payor A 15 % 10 % 17 % 14 % 16 % 16 % Payor B * * * * 10 % * * Less than 10% There were no other third-party payors that individually accounted for more than 10% of our total revenue or accounts receivable for the periods shown in the table above.

Loss Per Share

Loss Per Share	3 Months Ended
	Mar. 31, 2023
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, vesting of RSUs and PSUs or purchases under the ESPP. The treasury stock method is used to calculate the potential dilutive effect of these common stock equivalents. Contingently issuable PSU awards are included in the computation of diluted loss per share when the applicable performance criteria would be met and the common shares would be issuable if the end of the reporting period were the end of the contingency period. 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 months ended March 31, 2023 and 2022 because to do so would be antidilutive or, in the case of PSUs, the applicable performance conditions have not yet been met (in thousands): Three Months Ended 2023 2022 Stock options 3,389 3,541 RSUs and PSUs 3,420 1,140 ESPP 279 91 Total 7,088 4,772 In addition, in connection with the acquisition of AltheaDx, Inc. (“AltheaDx”), we may be required to issue shares of our common stock to satisfy the contingent consideration obligations, pending the outcome of certain commercial and regulatory milestones, as required by the definitive agreement to acquire AltheaDx. For purposes of calculating diluted loss per share, no such shares were assumed to have been issued because none of the applicable conditions have been met to date. See Note 10 for additional information.

Marketable Investment Securitie

Marketable Investment Securities	3 Months Ended
	Mar. 31, 2023
Investments, Debt and Equity Securities [Abstract]
Marketable Investment Securities	Marketable Investment Securities The following tables present our available-for-sale debt securities (in thousands): March 31, 2023 Amortized Cost Unrealized Estimated Fair Value Gains Losses U.S. government securities $ 117,370 $ — $ (136) $ 117,234 Total $ 117,370 $ — $ (136) $ 117,234 December 31, 2022 Amortized Cost Unrealized Estimated Fair Value Gains Losses U.S. government securities $ 136,058 $ — $ (381) $ 135,677 Total $ 136,058 $ — $ (381) $ 135,677 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 months ended March 31, 2023 and 2022. 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 March 31, 2023, unrealized losses on our 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 months ended March 31, 2023 and 2022. The allowance for credit losses was zero as of March 31, 2023 and December 31, 2022. As of March 31, 2023, 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 unaudited condensed consolidated balance sheets. As of March 31, 2023 and December 31, 2022 the accrued interest receivable balance was immaterial. Additional information relating to the fair value of marketable investment securities can be found in Note 10.

Acquisitions

Acquisitions	3 Months Ended
	Mar. 31, 2023
Business Combination and Asset Acquisition [Abstract]
Acquisitions	Acquisitions AltheaDx, Inc. On April 26, 2022, we completed the acquisition of 100% of the equity interests in AltheaDx which offers the IDgenetix test that focuses on mental health. We acquired AltheaDx for $30.5 million in cash and $17.1 million in common stock issued, for total consideration of $47.6 million. We have concluded that the transaction represents a business combination under ASC Topic 805, Business Combinations . The financial results of AltheaDx have been included in our unaudited condensed consolidated financial statements since the date of the acquisition. For further details refer to our consolidated financial statements included in our 2022 From 10-K filed with the SEC on February 28, 2023. Unaudited Pro Forma Financial Information The following unaudited pro forma financial information for the three months ended March 31, 2022 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. 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 2022 Net revenues $ 26,999 Net loss $ (27,883)

Property and Equipment, Net

Property and Equipment, Net	3 Months Ended
	Mar. 31, 2023
Property, Plant and Equipment [Abstract]
Property and Equipment, Net	Property and Equipment, Net Property and equipment, net consisted of the following (in thousands): March 31, 2023 December 31, 2022 Lab equipment (1) $ 9,868 $ 9,721 Leasehold improvements 6,273 5,171 Computer equipment 3,565 4,336 Furniture and fixtures 1,779 1,660 Construction in progress 2,294 1,275 Total 23,779 22,163 Less accumulated depreciation (1) (5,525) (7,848) Property and equipment, net $ 18,254 $ 14,315 (1) As of March 31, 2023 and December 31, 2022 includes lab equipment under finance lease of $369 thousand and $369 thousand, respectively and accumulated depreciation of $172 thousand and $137 thousand, respectively. Depreciation expense was recorded in the unaudited condensed consolidated statements of operations as follows (in thousands): Three Months Ended 2023 2022 Cost of sales (exclusive of amortization of acquired intangible assets) $ 295 $ 169 Selling, general and administrative 296 244 Research and development 79 90 Total $ 670 $ 503

Goodwill and Other Intangible A

Goodwill and Other Intangible Assets, Net	3 Months Ended
	Mar. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Other Intangible Assets, Net	Goodwill and Other Intangible Assets, Net Goodwill The balance of our goodwill was $10.7 million as of March 31, 2023 and December 31, 2022. There were no accumulated impairments of goodwill as of March 31, 2023 or December 31, 2022. Other Intangible Assets, Net Our other intangible assets, net consist of the following (in thousands): March 31, 2023 Gross carrying value Accumulated amortization Net Weighted-Average Remaining Life (in years) Developed technology $ 125,317 $ (12,297) $ 113,020 12.8 Assembled workforce 563 (149) 414 3.8 Total other intangible assets, net $ 125,880 $ (12,446) $ 113,434 December 31, 2022 Gross carrying value Accumulated amortization Net Weighted-Average Remaining Life (in years) Developed technology $ 125,317 $ (10,102) $ 115,215 12.9 Assembled workforce 563 (122) 441 4.0 Total other intangible assets, net $ 125,880 $ (10,224) $ 115,656

Other Accrued and Current Liabi

Other Accrued and Current Liabilities	3 Months Ended
	Mar. 31, 2023
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): March 31, 2023 December 31, 2022 Clinical studies $ 3,000 $ 1,822 Accrued service fees 1,992 2,125 ESPP contributions 230 900 Other 385 415 Total $ 5,607 $ 5,262

Fair Value Measurements

Fair Value Measurements	3 Months Ended
	Mar. 31, 2023
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 we 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 liabilities that are accounted for at fair value on a recurring basis as of March 31, 2023 and December 31, 2022 (in thousands): As of March 31, 2023 Quoted Prices in Active Markets for Identical Items (Level 1) Significant Other Observable Inputs Significant Unobservable Inputs Total Assets Money market funds (1) $ 94,280 $ — $ — $ 94,280 U.S. government securities (2) $ 117,234 $ — $ — $ 117,234 Liabilities Contingent consideration (3) $ — $ — $ — $ — As of December 31, 2022 Quoted Prices in Active Markets for Identical Items (Level 1) Significant Other Observable Inputs Significant Unobservable Inputs Total Assets Money market funds (1) $ 108,673 $ — $ — $ 108,673 U.S. government securities (2) $ 135,677 $ — $ — $ 135,677 Liabilities Contingent consideration (3) $ — $ — $ — $ — (1) Classified as “Cash and cash equivalents” in the unaudited condensed consolidated balance sheets. (2) Classified as “Marketable investment securities” in the unaudited condensed consolidated balance sheets. (3) Current portion, if any, classified as “Other accrued and current liabilities” in the unaudited condensed consolidated balance sheets. Contingent Consideration In connection with our acquisition of Cernostics, Inc. (“Cernostics”) in December 2021, we recorded a liability for contingent consideration of up to $50.0 million that could have been payable based on the achievement of certain commercial milestones relating to the year ending December 31, 2022 (“Cernostics Earnout Payments”). At our sole discretion, we could have settled Cernostics Earnout Payments in cash or shares of our common stock, the aggregate of which could not have exceeded 5,034,653 shares. Any Cernostics Earnout Payments in shares of our common stock could have been based on the volume weighted-average price of our common stock for the 15 trading days ending December 30, 2022. There were no Cernostics Earnout Payments that became payable because the commercial milestones were not achieved during the earnout period and the final valuation of the contingent consideration was assessed to be zero as of December 31, 2022. In the first quarter of 2022 the fair value of the contingent consideration associated with our acquisition of Cernostics increased by $2.6 million with no similar activity in the first quarter of 2023 . In connection with our acquisition of AltheaDx, we agreed to pay contingent consideration of up to $75.0 million based on the achievement of certain commercial milestones relating to the 2022, 2023, and 2024 commercial milestones (“AltheaDx Earnout Payments”). The portion of the AltheaDx Earnout Payments associated with the commercial milestones for the year ended December 31, 2022 was not paid since the applicable commercial milestones were not met. This portion represented $35.0 million of the $75.0 million total potential payment obligation, exclusive of the catch-up payment in 2023 of $17.5 million which will become payable if all 2023 commercial milestones are fully met. Therefore, a potential payment obligation of up to $57.5 million with respect to the remaining commercial milestones for 2023 and 2024 remains as of March 31, 2023. If the settlement of the remaining portion of the AltheaDx Earnout Payments would have occurred as of March 31, 2023, no amounts would have been due based on no achievement of the commercial milestones to date. The contingent consideration was 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 valuation of the AltheaDx contingent consideration was zero as of March 31, 2023 and December 31, 2022, and no gains or losses were recorded associated with changes in fair value during the three months ended March 31, 2023.

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2023
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	3 Months Ended
	Mar. 31, 2023
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, 2023, an additional 1,327,684 shares became available under our 2019 Equity Incentive Plan (the “2019 Plan”) pursuant to an automatic annual increase. The 2019 Plan provides for automatic annual increases to the number of shares authorized for issuance, equal to 5% of our common shares outstanding as of the immediately preceding year end, through January 1, 2029. As of March 31, 2023, we have granted awards of 24,197 in excess of the number of shares authorized for issuance under the 2019 Plan. On December 22, 2022, our board of directors approved the 2022 Inducement Plan (the “Inducement Plan”). Our Inducement Plan provides for the grant of RSU awards and other stock awards made as an inducement material to the grantee’s entering into employment with us to the extent such grantee was not previously an employee of ours or is entering into employment following a bona fide period of non-employment with us. As of March 31, 2023, there have been no awards granted under the 2022 Inducement Plan. Stock Options Stock option activity under our stock plans for the three months ended March 31, 2023 is set forth below: Weighted-Average Stock Options Exercise Remaining Aggregate Balance as of December 31, 2022 3,419,840 $ 35.11 Granted 91 $ 27.21 Exercised (30,595) $ 3.10 Forfeited/Cancelled (39,167) $ 47.11 Balance as of March 31, 2023 3,350,169 $ 35.26 7.2 $ 11,371 Exercisable at March 31, 2023 2,178,539 $ 30.99 6.8 $ 11,030 Restricted Stock Units RSUs represent the right to receive shares of our common stock at a specified future date, subject to vesting. Our RSUs generally vest annually from the grant date in four equal installments subject to the holder’s continued service with us. We issue new shares to satisfy RSUs upon vesting. The following table summarizes our RSU activity for the three months ended March 31, 2023: Restricted Stock Units Outstanding Weighted-Average Grant Date Fair Value Balance as of December 31, 2022 3,477,922 $ 27.56 Granted 43,218 $ 27.02 Vested (1) (36,992) $ 40.90 Forfeited/Cancelled (114,067) $ 27.72 Balance as of March 31, 2023 3,370,081 $ 27.40 (1) The aggregate number of shares withheld upon vesting for employee tax obligations was 12,082 for the three months ended March 31, 2023. Performance-Based Restricted Stock Units PSUs represent the right to receive shares of our common stock contingent upon the achievement of certain financial performance measures. We issue new shares to satisfy PSUs upon vesting. The following table summarizes our PSU activity for the three months ended March 31, 2023: Performance-Based Restricted Stock Units Outstanding Weighted-Average Grant Date Fair Value Balance as of December 31, 2022 196,033 $ 23.23 Granted — $ — Vested — $ — Forfeited/Cancelled — $ — Balance as of March 31, 2023 196,033 $ 23.23 Retirement Policy In January 2023, our Board approved a retirement policy (the “Retirement Policy”) that provides for acceleration of a portion of unvested awards that were granted to certain eligible employees upon meeting age, years of service and notice requirements. We considered the adoption of the Retirement Policy to be a modification of existing awards under ASC Topic 718 , Compensation – Stock Compensation . The modification did not result in any incremental compensation cost. However, adoption of the policy resulted in a new estimate of the requisite service period for certain awards. In connection with the implementation of the Retirement Policy, we accelerated the recognition of compensation expense of $0.7 million during the three months ended March 31, 2023. 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 265,536 shares becoming available under the ESPP effective January 1, 2023. During the three months ended March 31, 2023, we issued 77,190 of common stock pursuant to scheduled purchases under the ESPP. As of March 31, 2023, 1,002,945 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: Three Months Ended 2023 2022 Average expected term (years) 5.8 6.1 Expected stock price volatility 68.34% - 76.01% 68.34% - 68.44% Risk-free interest rate 1.54% - 4.21% 1.63% - 1.64% Dividend yield —% —% The following table sets forth assumptions used to determine the fair value of the purchase rights issued under the ESPP: Three Months Ended 2023 2022 Average expected term (years) 1.3 1.3 Expected stock price volatility 72.80% - 82.61% 62.98% - 66.75% Risk-free interest rate 4.77% - 5.07% 0.60% - 1.30% Dividend yield —% —% We use the closing price of our common stock on the date of grant to determine the fair value of RSUs and PSUs. Stock-Based Compensation Expense Stock-based compensation expense is included in the unaudited condensed consolidated statements of operations as follows (in thousands): Three Months Ended 2023 2022 Cost of sales (exclusive of amortization of acquired intangible assets) $ 1,272 $ 853 Research and development 2,587 1,828 Selling, general and administrative 9,666 5,738 Total stock-based compensation expense $ 13,525 $ 8,419 For the three months ended March 31, 2023 and 2022, the weighted-average grant date fair value of stock options was $17.39 and $22.76 per option, respectively, and the weighted-average grant date fair value of the purchase rights granted under the ESPP was $11.00 and $19.91 per share, respectively. As of March 31, 2023, the total unrecognized stock-based compensation cost related to outstanding awards was $118,403,000, which is expected to be recognized 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.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	3 Months Ended
	Mar. 31, 2023
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 realizability of deferred tax assets, the useful lives and recoverability of long-lived assets, the goodwill impairment test, the valuation of acquired intangible assets and 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.
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 financial institutions in which deposits are held.
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 any 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 of available-for-sale debt securities, if any, are recorded in our unaudited condensed consolidated statements of operations. See Notes 5 and 10 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 March 31, 2023 and December 31, 2022. Adjustments for implicit price concessions attributable to variable consideration, as discussed below, are incorporated into the measurement of the accounts receivable balances and are not part of the allowance for credit losses.
Accrued Compensation	We accrue for liabilities under discretionary employee and executive bonus plans. Our 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 March 31, 2023 and December 31, 2022, we accrued approximately $5,858,000 and $18,209,000, respectively, for liabilities associated with these bonus plans. These amounts are classified as current or noncurrent accrued liabilities in the unaudited condensed consolidated balance sheets based on the expected timing of payment.
Stock-Based Compensation	Stock-based compensation expense for equity instruments issued to employees is measured based on the grant-date fair value of the awards. The fair value of employee stock options and offerings under the 2019 Employee Stock Purchase Plan (the “ESPP”) are estimated on the date of grant using the Black-Scholes option-pricing valuation model. For restricted stock units (“RSUs”) and performance-based restricted stock units (“PSUs”), the fair value is equal to the closing price of our common stock on the date of grant. For awards with graded vesting and only service conditions, we recognize compensation costs on a straight-line basis over the requisite service period of the awards. For options and RSUs, the requisite service period is generally the awards’ vesting period (typically four years). PSUs vest upon the achievement of certain performance conditions and the provision of service with us through a specified period. Accruals of compensation cost for PSUs are based on the probable outcome of the performance conditions and are reassessed each reporting period. We recognize compensation cost for PSUs separately for each vesting tranche on a ratable basis over the requisite service period. The requisite service period for PSUs is based on an analysis of vesting requirements and performance conditions for the particular award. Certain employees are entitled to acceleration of vesting of a portion of their awards upon retirement, subject to age, years of service and notice requirements. In these cases, the requisite service period takes into consideration the employee’s retirement eligibility, and is reassessed at each reporting date. For the ESPP, the requisite service period is generally the period of time from the offering date to the purchase date. Forfeitures are accounted for as they occur.
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 net unrealized gain (loss) on marketable investment securities, which is our only other item of other comprehensive income (loss).

Revenue (Tables)

Revenue (Tables)	3 Months Ended
	Mar. 31, 2023
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 2023 2022 Dermatologic (1) $ 35,911 $ 24,339 Non-Dermatologic (2) 6,126 2,513 Total net revenues $ 42,037 $ 26,852 (1) Consists of DecisionDx-Melanoma, DecisionDx-SCC and Diagnostic GEP offering.
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 Three Months Ended Percentage of Accounts Receivable (current) as of Percentage of Accounts Receivable (noncurrent) as of 2023 2022 March 31, 2023 December 31, 2022 March 31, 2023 December 31, 2022 Medicare 49 % 53 % 23 % 28 % * * Payor A 15 % 10 % 17 % 14 % 16 % 16 % Payor B * * * * 10 % * * Less than 10%

Loss Per Share (Tables)

Loss Per Share (Tables)	3 Months Ended
	Mar. 31, 2023
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 months ended March 31, 2023 and 2022 because to do so would be antidilutive or, in the case of PSUs, the applicable performance conditions have not yet been met (in thousands): Three Months Ended 2023 2022 Stock options 3,389 3,541 RSUs and PSUs 3,420 1,140 ESPP 279 91 Total 7,088 4,772

Marketable Investment Securit_2

Marketable Investment Securities (Tables)	3 Months Ended
	Mar. 31, 2023
Investments, Debt and Equity Securities [Abstract]
Debt Securities, Available-for-Sale	The following tables present our available-for-sale debt securities (in thousands): March 31, 2023 Amortized Cost Unrealized Estimated Fair Value Gains Losses U.S. government securities $ 117,370 $ — $ (136) $ 117,234 Total $ 117,370 $ — $ (136) $ 117,234 December 31, 2022 Amortized Cost Unrealized Estimated Fair Value Gains Losses U.S. government securities $ 136,058 $ — $ (381) $ 135,677 Total $ 136,058 $ — $ (381) $ 135,677

Acquisitions (Tables)

Acquisitions (Tables)	3 Months Ended
	Mar. 31, 2023
Business Combination and Asset Acquisition [Abstract]
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 2022 Net revenues $ 26,999 Net loss $ (27,883)

Property and Equipment, Net (Ta

Property and Equipment, Net (Tables)	3 Months Ended
	Mar. 31, 2023
Property, Plant and Equipment [Abstract]
Schedule of Property, Plant and Equipment, Net	Property and equipment, net consisted of the following (in thousands): March 31, 2023 December 31, 2022 Lab equipment (1) $ 9,868 $ 9,721 Leasehold improvements 6,273 5,171 Computer equipment 3,565 4,336 Furniture and fixtures 1,779 1,660 Construction in progress 2,294 1,275 Total 23,779 22,163 Less accumulated depreciation (1) (5,525) (7,848) Property and equipment, net $ 18,254 $ 14,315 (1) As of March 31, 2023 and December 31, 2022 includes lab equipment under finance lease of $369 thousand and $369 thousand, respectively and accumulated depreciation of $172 thousand and $137 thousand, respectively. Depreciation expense was recorded in the unaudited condensed consolidated statements of operations as follows (in thousands): Three Months Ended 2023 2022 Cost of sales (exclusive of amortization of acquired intangible assets) $ 295 $ 169 Selling, general and administrative 296 244 Research and development 79 90 Total $ 670 $ 503

Goodwill and Other Intangible_2

Goodwill and Other Intangible Assets, Net (Tables)	3 Months Ended
	Mar. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Finite-Lived Intangible Assets	Our other intangible assets, net consist of the following (in thousands): March 31, 2023 Gross carrying value Accumulated amortization Net Weighted-Average Remaining Life (in years) Developed technology $ 125,317 $ (12,297) $ 113,020 12.8 Assembled workforce 563 (149) 414 3.8 Total other intangible assets, net $ 125,880 $ (12,446) $ 113,434 December 31, 2022 Gross carrying value Accumulated amortization Net Weighted-Average Remaining Life (in years) Developed technology $ 125,317 $ (10,102) $ 115,215 12.9 Assembled workforce 563 (122) 441 4.0 Total other intangible assets, net $ 125,880 $ (10,224) $ 115,656

Other Accrued and Current Lia_2

Other Accrued and Current Liabilities (Tables)	3 Months Ended
	Mar. 31, 2023
Payables and Accruals [Abstract]
Schedule of Accrued And Current Liabilities	Other accrued and current liabilities consisted of the following (in thousands): March 31, 2023 December 31, 2022 Clinical studies $ 3,000 $ 1,822 Accrued service fees 1,992 2,125 ESPP contributions 230 900 Other 385 415 Total $ 5,607 $ 5,262

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	3 Months Ended
	Mar. 31, 2023
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 liabilities that are accounted for at fair value on a recurring basis as of March 31, 2023 and December 31, 2022 (in thousands): As of March 31, 2023 Quoted Prices in Active Markets for Identical Items (Level 1) Significant Other Observable Inputs Significant Unobservable Inputs Total Assets Money market funds (1) $ 94,280 $ — $ — $ 94,280 U.S. government securities (2) $ 117,234 $ — $ — $ 117,234 Liabilities Contingent consideration (3) $ — $ — $ — $ — As of December 31, 2022 Quoted Prices in Active Markets for Identical Items (Level 1) Significant Other Observable Inputs Significant Unobservable Inputs Total Assets Money market funds (1) $ 108,673 $ — $ — $ 108,673 U.S. government securities (2) $ 135,677 $ — $ — $ 135,677 Liabilities Contingent consideration (3) $ — $ — $ — $ — (1) Classified as “Cash and cash equivalents” in the unaudited condensed consolidated balance sheets. (2) Classified as “Marketable investment securities” in the unaudited condensed consolidated balance sheets. (3) Current portion, if any, classified as “Other accrued and current liabilities” in the unaudited condensed consolidated balance sheets.

Stock Incentive Plans and Sto_2

Stock Incentive Plans and Stock-Based Compensation (Tables)	3 Months Ended
	Mar. 31, 2023
Share-Based Payment Arrangement [Abstract]
Schedule of Share-based Payment Arrangement on Stock Option Activity	Stock option activity under our stock plans for the three months ended March 31, 2023 is set forth below: Weighted-Average Stock Options Exercise Remaining Aggregate Balance as of December 31, 2022 3,419,840 $ 35.11 Granted 91 $ 27.21 Exercised (30,595) $ 3.10 Forfeited/Cancelled (39,167) $ 47.11 Balance as of March 31, 2023 3,350,169 $ 35.26 7.2 $ 11,371 Exercisable at March 31, 2023 2,178,539 $ 30.99 6.8 $ 11,030
Schedule of Share-based Payment Arrangement on Restricted Stock Units	The following table summarizes our RSU activity for the three months ended March 31, 2023: Restricted Stock Units Outstanding Weighted-Average Grant Date Fair Value Balance as of December 31, 2022 3,477,922 $ 27.56 Granted 43,218 $ 27.02 Vested (1) (36,992) $ 40.90 Forfeited/Cancelled (114,067) $ 27.72 Balance as of March 31, 2023 3,370,081 $ 27.40 (1) The aggregate number of shares withheld upon vesting for employee tax obligations was 12,082 for the three months ended March 31, 2023.
Share-Based Payment Arrangement, Performance Shares, Activity	The following table summarizes our PSU activity for the three months ended March 31, 2023: Performance-Based Restricted Stock Units Outstanding Weighted-Average Grant Date Fair Value Balance as of December 31, 2022 196,033 $ 23.23 Granted — $ — Vested — $ — Forfeited/Cancelled — $ — Balance as of March 31, 2023 196,033 $ 23.23
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: Three Months Ended 2023 2022 Average expected term (years) 5.8 6.1 Expected stock price volatility 68.34% - 76.01% 68.34% - 68.44% Risk-free interest rate 1.54% - 4.21% 1.63% - 1.64% 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: Three Months Ended 2023 2022 Average expected term (years) 1.3 1.3 Expected stock price volatility 72.80% - 82.61% 62.98% - 66.75% Risk-free interest rate 4.77% - 5.07% 0.60% - 1.30% Dividend yield —% —%
Share-based Payment Arrangement, Expensed and Capitalized, Amount	Stock-based compensation expense is included in the unaudited condensed consolidated statements of operations as follows (in thousands): Three Months Ended 2023 2022 Cost of sales (exclusive of amortization of acquired intangible assets) $ 1,272 $ 853 Research and development 2,587 1,828 Selling, general and administrative 9,666 5,738 Total stock-based compensation expense $ 13,525 $ 8,419

Organization and Description _2

Organization and Description of Business (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Accumulated deficit	$ 190,109	$ 160,905
Cash and cash equivalents	114,821	122,948
Marketable investment securities	$ 117,234	$ 135,677

Summary of Significant Accoun_3

Summary of Significant Accounting Policies - Narrative (Details) - USD ($)	3 Months Ended
	Mar. 31, 2023	Dec. 31, 2022
Accounting Policies [Abstract]
Allowance for credit losses	$ 0	$ 0
Accrued bonuses	$ 5,858,000	$ 18,209,000
Vesting period	4 years

Revenue - Narrative (Details)

Revenue - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Revenue from Contract with Customer [Abstract]
Number of days contract with customer is generally paid	30 days
Variable consideration adjustments included in revenue	$ (1,336)	$ 602

Revenue - Disaggregation of Rev

Revenue - Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Disaggregation of Revenue [Line Items]
Total net revenues	$ 42,037	$ 26,852
Dermatologic
Disaggregation of Revenue [Line Items]
Total net revenues	35,911	24,339
Non-Dermatologic
Disaggregation of Revenue [Line Items]
Total net revenues	$ 6,126	$ 2,513

Revenue - Concentration of Risk

Revenue - Concentration of Risk, by Risk Factor (Details) - Third-Party Payor Concentration Risk	3 Months Ended		12 Months Ended
	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022
Medicare | Percentage of Revenues
Concentration Risk [Line Items]
Concentration risk percentage	49%	53%
Medicare | Percentage of Accounts Receivable (current)
Concentration Risk [Line Items]
Concentration risk percentage	23%		28%
Payor A | Percentage of Revenues
Concentration Risk [Line Items]
Concentration risk percentage	15%	10%
Payor A | Percentage of Accounts Receivable (current)
Concentration Risk [Line Items]
Concentration risk percentage	17%		14%
Payor A | Percentage of Accounts Receivable (noncurrent)
Concentration Risk [Line Items]
Concentration risk percentage	16%		16%
Payor B | Percentage of Accounts Receivable (noncurrent)
Concentration Risk [Line Items]
Concentration risk percentage	10%

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
	Mar. 31, 2023	Mar. 31, 2022
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share, amount (in shares)	7,088	4,772
Stock options
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share, amount (in shares)	3,389	3,541
RSUs and PSUs
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share, amount (in shares)	3,420	1,140
ESPP
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share, amount (in shares)	279	91

Marketable Investment Securit_3

Marketable Investment Securities - Schedule of Available-for-Sale Debt Securities (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Debt Securities, Available-for-Sale [Line Items]
Amortized Cost	$ 117,370	$ 136,058
Unrealized gains	0	0
Unrealized losses	(136)	(381)
Estimated Fair Value	117,234	135,677
U.S. government securities
Debt Securities, Available-for-Sale [Line Items]
Amortized Cost	117,370	136,058
Unrealized gains	0	0
Unrealized losses	(136)	(381)
Estimated Fair Value	$ 117,234	$ 135,677

Marketable Investment Securit_4

Marketable Investment Securities - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022
Investments, Debt and Equity Securities [Abstract]
Realized gain (loss) on sale of investment	$ 0	$ 0
Impairment loss	0	$ 0
Allowance for credit loss	$ 0		$ 0

Acquisitions - Narrative (Detai

Acquisitions - Narrative (Details) - AltheaDx, Inc $ in Millions	Apr. 26, 2022 USD ($)
Business Acquisition [Line Items]
Percentage of voting interest acquired	100%
Payments to acquire business	$ 30.5
Common stock	17.1
Total consideration	$ 47.6

Acquisitions - Schedule of Unau

Acquisitions - Schedule of Unaudited Pro forma Financial Information and Net Income (Details) - AltheaDx, Inc $ in Thousands	3 Months Ended
	Mar. 31, 2022 USD ($)
Business Acquisition [Line Items]
Net revenues	$ 26,999
Net loss	$ (27,883)

Property and Equipment, Net - P

Property and Equipment, Net - Property and Equipment (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Property, Plant and Equipment [Line Items]
Total	$ 23,779	$ 22,163
Less accumulated depreciation	(5,525)	(7,848)
Property and equipment, net	18,254	14,315
Lab equipment
Property, Plant and Equipment [Line Items]
Total	9,868	9,721
Finance lease, right-of-use asset, before accumulated amortization	369	369
Finance lease, right-of-use asset, accumulated amortization	172	137
Leasehold improvements
Property, Plant and Equipment [Line Items]
Total	6,273	5,171
Computer equipment
Property, Plant and Equipment [Line Items]
Total	3,565	4,336
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Total	1,779	1,660
Construction in progress
Property, Plant and Equipment [Line Items]
Total	$ 2,294	$ 1,275

Property and Equipment, Net - D

Property and Equipment, Net - Depreciation Expense (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Property, Plant and Equipment [Line Items]
Depreciation and amortization	$ 670	$ 503
Cost of sales (exclusive of amortization of acquired intangible assets)
Property, Plant and Equipment [Line Items]
Depreciation and amortization	295	169
Selling, general and administrative
Property, Plant and Equipment [Line Items]
Depreciation and amortization	296	244
Research and development
Property, Plant and Equipment [Line Items]
Depreciation and amortization	$ 79	$ 90

Goodwill and Other Intangible_3

Goodwill and Other Intangible Assets, Net - Narrative (Details) - USD ($)	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill	$ 10,700,000		$ 10,700,000
Goodwill accumulated impairment	0		$ 0
Amortization of acquired intangible assets	$ 2,222,000	$ 1,648,000

Goodwill and Other Intangible_4

Goodwill and Other Intangible Assets, Net - Finite-Lived Intangible Assets (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Gross carrying value	$ 125,880	$ 125,880
Accumulated amortization	(12,446)	(10,224)
Net	113,434	115,656
Developed technology
Finite-Lived Intangible Assets [Line Items]
Gross carrying value	125,317	125,317
Accumulated amortization	(12,297)	(10,102)
Net	$ 113,020	$ 115,215
Weighted-Average Remaining Life (in years)	12 years 9 months 18 days	12 years 10 months 24 days
Assembled workforce
Finite-Lived Intangible Assets [Line Items]
Gross carrying value	$ 563	$ 563
Accumulated amortization	(149)	(122)
Net	$ 414	$ 441
Weighted-Average Remaining Life (in years)	3 years 9 months 18 days	4 years

Other Accrued and Current Lia_3

Other Accrued and Current Liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Payables and Accruals [Abstract]
Clinical studies	$ 3,000	$ 1,822
Accrued service fees	1,992	2,125
ESPP contributions	230	900
Other	385	415
Total	$ 5,607	$ 5,262

Fair Value Measurements - Fair

Fair Value Measurements - Fair Value, Assets and Liabilities Measured on Recurring Basis (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Available-for-sale debt securities	$ 117,234	$ 135,677
U.S. government securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Available-for-sale debt securities	117,234	135,677
Fair Value, Recurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Money market funds	94,280	108,673
Contingent consideration	0	0
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	117,234	135,677
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	94,280	108,673
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	117,234	135,677
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	0	0
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)	3 Months Ended		12 Months Ended
	Mar. 31, 2023 USD ($) tradingDay shares	Mar. 31, 2022 USD ($)	Dec. 31, 2022 USD ($)	Apr. 26, 2022 USD ($)
AltheaDx, Inc
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Contingent consideration, portion not paid			$ 35,000,000
Additional consideration payable based on achievement of certain commercial milestones				$ 75,000,000
Contingent consideration, catch up payment			17,500,000
Potential payment obligation	$ 57,500,000
Earnout payment, amount due	0
Value of contingent consideration	0		0
Gains or losses associated with changes in fair value	0
Cernostics, Inc.
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Additional consideration payable based on achievement of certain commercial milestones	$ 50,000,000
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
Earnout payments			$ 0
Change in amount of contingent consideration	$ 0	$ 2,600,000

Stock Incentive Plans and Sto_3

Stock Incentive Plans and Stock-Based Compensation - Narrative (Details) $ / shares in Units, $ in Thousands		3 Months Ended
	Jan. 01, 2023 shares	Mar. 31, 2023 USD ($) vesting_period $ / shares shares	Mar. 31, 2022 $ / shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Accelerated recognition of compensation expense | $		$ 700
Unrecognized compensation costs | $		$ 118,403
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)		77,190
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) | $ / shares		$ 17.39	$ 22.76
Restricted Stock Units (RSUs)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Grant date vesting in period | vesting_period		4
2019 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Increase in number of shares authorized for issuance (in shares)	1,327,684
Percentage of common shares outstanding		5%
Number of shares issued in excess of shares authorized (in shares)		24,197
2022 Inducement Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares issued during period (in shares)		0
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) | $ / shares		$ 11	$ 19.91
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)	265,536
Number of shares available for issuance (in shares)		1,002,945

Stock Incentive Plans and Sto_4

Stock Incentive Plans and Stock-Based Compensation - Activity Under Stock Incentive Plan (Details) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2023 USD ($) $ / shares shares
Stock Options Outstanding
Beginning balance (in shares) | shares	3,419,840
Granted (in shares) | shares	91
Exercised (in shares) | shares	(30,595)
Forfeited/Cancelled (in shares) | shares	(39,167)
Ending balance (in shares) | shares	3,350,169
Options exercisable, number of options (in shares) | shares	2,178,539
Exercise Price
Beginning balance (in dollars per share) | $ / shares	$ 35.11
Granted (in dollars per share) | $ / shares	27.21
Exercised (in dollars per share) | $ / shares	3.10
Forfeited/Cancelled (in dollars per share) | $ / shares	47.11
Ending balance (in dollars per share) | $ / shares	35.26
Options exercisable, weighted average exercise price (in dollars per share) | $ / shares	$ 30.99
Stock Option Activity, Additional Disclosures
Options outstanding, weighted average remaining contractual term	7 years 2 months 12 days
Options exercisable, weighted average remaining contractual term	6 years 9 months 18 days
Options outstanding, aggregate intrinsic value | $	$ 11,371
Options exercisable, aggregate intrinsic value | $	$ 11,030

Stock Incentive Plans and Sto_5

Stock Incentive Plans and Stock Based Compensation - Restricted Stock Units and Performance Stock Units (Details)	3 Months Ended
	Mar. 31, 2023 $ / shares shares
Restricted Stock Units (RSUs)
Restricted Stock Units Outstanding
Beginning Balance (in shares)	3,477,922
Granted (in shares)	43,218
Vested (in shares)	(36,992)
Forfeited/Cancelled (in shares)	(114,067)
Ending Balance (in shares)	3,370,081
Weighted-Average Grant Date Fair Value
Weighted average grant date fair value at beginning balance (in dollars per share) | $ / shares	$ 27.56
Granted (in dollars per share) | $ / shares	27.02
Vested (in dollars per share) | $ / shares	40.90
Forfeited / Cancelled (in dollars per share) | $ / shares	27.72
Weighted average grant date fair value at ending balance (in dollars per share) | $ / shares	$ 27.40
Withheld upon vesting for employee tax obligations	12,082
Performance-Based Restricted Stock Units
Restricted Stock Units Outstanding
Beginning Balance (in shares)	196,033
Granted (in shares)	0
Vested (in shares)	0
Forfeited/Cancelled (in shares)	0
Ending Balance (in shares)	196,033
Weighted-Average Grant Date Fair Value
Weighted average grant date fair value at beginning balance (in dollars per share) | $ / shares	$ 23.23
Granted (in dollars per share) | $ / shares	0
Vested (in dollars per share) | $ / shares	0
Forfeited / Cancelled (in dollars per share) | $ / shares	0
Weighted average grant date fair value at ending balance (in dollars per share) | $ / shares	$ 23.23

Stock Incentive Plans and Sto_6

Stock Incentive Plans and Stock-Based Compensation - Assumptions Used in Fair Value of Stock Options and ESPP (Details)	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Employee stock purchase plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Average expected term (years)	1 year 3 months 18 days	1 year 3 months 18 days
Expected stock price volatility, minimum	72.80%	62.98%
Expected stock price volatility, maximum	82.61%	66.75%
Risk-free interest rate, minimum	4.77%	0.60%
Risk-free interest rate, maximum	5.07%	1.30%
Dividend yield	0%	0%
Stock options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Average expected term (years)	5 years 9 months 18 days	6 years 1 month 6 days
Expected stock price volatility, minimum	68.34%	68.34%
Expected stock price volatility, maximum	76.01%	68.44%
Risk-free interest rate, minimum	1.54%	1.63%
Risk-free interest rate, maximum	4.21%	1.64%
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
	Mar. 31, 2023	Mar. 31, 2022
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock-based compensation expense	$ 13,525	$ 8,419
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	1,272	853
Research and development
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock-based compensation expense	2,587	1,828
Selling, general and administrative
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock-based compensation expense	$ 9,666	$ 5,738