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Balance Sheet Components - Other Accrued Liabilities (Details) - USD ($)
$ in Thousands
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Balance Sheet Components      
Reserves for refunds to insurance carriers $ 23,245 $ 18,948 $ 17,210
Accrued charges for third-party testing 14,823 17,036  
Testing and laboratory materials from suppliers 11,229 13,281  
Marketing and corporate affairs 10,085 8,943  
Legal, audit and consulting fees 43,897 36,710  
Accrued shipping charges 3,646 485  
Sales and income tax payable 3,731 4,319  
Accrued third-party service fees 7,111 6,631  
Clinical trials and studies 12,126 23,301  
Operating lease liabilities, current portion 11,621 7,639  
Property and equipment purchases 4,316 1,821  
Other accrued interest 1,078 1,078  
Other accrued expenses 2,497 4,022  
Total other accrued liabilities $ 149,405 $ 144,214  
Operating Lease, Liability, Current, Statement of Financial Position [Extensible List] Total other accrued liabilities Total other accrued liabilities