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Balance Sheet Components - Other Accrued Liabilities (Details) - USD ($)
$ in Thousands
Sep. 30, 2023
Dec. 31, 2022
Sep. 30, 2022
Dec. 31, 2021
Balance Sheet Components        
Reserves for refunds to insurance carriers $ 16,209 $ 18,948 $ 17,938 $ 17,210
Accrued charges for third-party testing 10,960 17,036    
Testing and laboratory materials from suppliers 19,902 13,281    
Marketing and corporate affairs 8,752 8,943    
Legal, audit and consulting fees 35,822 36,710    
Accrued shipping charges 1,203 485    
Sales and income tax payable 5,715 4,319    
Accrued third-party service fees 6,865 6,631    
Clinical trials and studies 11,056 23,301    
Operating lease liabilities, current portion 11,038 7,639    
Property and equipment purchases 1,617 1,821    
Other accrued interest 2,695 1,078    
Other accrued expenses 1,906 4,022    
Total other accrued liabilities $ 133,740 $ 144,214