Income Taxes - Effective Tax Rates (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Effective tax rates differing from U.S. federal statutory rate
U.S. Federal taxes (benefit) at statutory rate	$ (114,832)	$ (98,931)	$ (48,226)
State tax expense	(21,676)	(29,206)	(10,672)
Research and development credits	(7,024)	(9,193)	(3,964)
Stock-based compensation	3,949	(46,128)	(23,791)
Foreign tax	332	167	55
Other nondeductible items	1,964	344	792
Nondeductible officers' compensation	4,883	24,387	8,984
Acquisition costs	3,226	8,901
Change in valuation allowance	130,156	150,277	76,920
Provision for income taxes	$ 978	$ 618	$ 98
U.S. Federal taxes (benefit) at statutory rate (as a percent)	(21.00%)	(21.00%)	(21.00%)
State tax expense (as a percent)	(3.96%)	(6.20%)	(4.65%)
Research and development credits (as a percent)	(1.28%)	(1.95%)	(1.73%)
Stock-based compensation (as a percent)	0.72%	(9.80%)	(10.36%)
Foreign tax differential (as a percent)	0.06%	0.04%	0.02%
Other nondeductible items (as a percent)	0.36%	0.07%	0.35%
Nondeductible officers' compensation (as a percent)	0.89%	5.18%	3.91%
Acquisition costs (as a percent)	0.59%	2.00%
Change in valuation allowance (as a percent)	23.80%	31.90%	33.50%
Provision for income taxes (as a percent)	0.18%	0.13%	0.04%
Income tax expense	$ 978	$ 618	$ 98
State income tax expense	600	300
Clinical testing and software licensing
Effective tax rates differing from U.S. federal statutory rate
Foreign income tax expense	$ 400	$ 300