CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Cash flows from operating activities:
Net income (loss)	$ (328,405)	$ (30,143)	$ 30,586
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Depreciation and amortization	108,655	78,716	85,362
Non-cash interest	2,750	9,389	9,994
Amortization of deferred financing costs	1,161	785	847
Losses from investments in investees	383	629	480
Equity-based compensation – employees and non-employees	18,509	13,632	8,947
Non-cash revenue from the transfer of intellectual property	0	(3,801)	0
Realized loss (gain) on disposal of fixed assets and sales of equity securities	(455)	(33,922)	(10,681)
Loss on conversion of the 2025 Notes	0	11,111	0
Change in fair value of equity securities and derivative instruments	153,835	3,967	(101)
Change in fair value of contingent consideration	(1,312)	(1,703)	(3,989)
Gain on sale of GeneDx	(18,559)	0	0
Deferred income tax provision	(74,405)	10,159	15,640
Changes in assets and liabilities, net of the effects of acquisitions:
Accounts receivable, net	128,602	5,232	(150,437)
Inventory, net	13,662	30,684	(77,642)
Other current assets and prepaid expenses	(3,416)	1,478	20,504
Other assets	1,935	260	(447)
Accounts payable	(9,388)	(10,847)	37,159
Foreign currency measurement	2,369	2,345	(3,185)
Contract liabilities	(329)	(15,911)	(5,389)
Accrued expenses and other liabilities	(90,781)	(33,723)	81,828
Net cash used in operating activities	(95,189)	38,337	39,476
Cash flows from investing activities:
Investments in investees	0	(2,000)	0
Proceeds from sale of investments	115,423	8,079	15,110
Acquisition of businesses, net of cash acquired	(1,758)	(4,000)	0
Proceeds from the sale of property, plant and equipment	1,951	66,026	245
Capital expenditures	(24,578)	(32,156)	(33,682)
Net cash (used in) provided by investing activities	91,038	35,949	(18,327)
Cash flows from financing activities:
Debt issuance costs	0	(188)	0
Net activity from the exercise of common stock options and warrants	(774)	1,081	756
Borrowings on lines of credit	1,059,519	1,684,713	1,107,866
Repayments of lines of credit	(1,035,774)	(1,695,956)	(1,143,698)
Net cash (used in) provided by financing activities	22,971	(10,350)	(35,076)
Effect of exchange rate changes on cash and cash equivalents	(339)	(1,437)	686
Net increase (decrease) in cash and cash equivalents	18,481	62,499	(13,241)
Cash and cash equivalents at beginning of period	134,710	72,211	85,452
Cash and cash equivalents at end of period	153,191	134,710	72,211
SUPPLEMENTAL INFORMATION:
Interest paid	7,420	8,515	10,908
Income taxes paid, net of refunds	8,037	5,969	(903)
Operating lease right-of-use assets obtained in exchange for lease obligations	0	6,493	0
Assets acquired by finance leases	4,717	0	0
Non-cash financing:
Shares issued upon the conversion of: 2025 Convertible Notes	0	68,775	0
Common Stock options and warrants, surrendered in net exercise	1,268	0	0
Issuance of common stock for acquisition of ModeX	221,662	0	0
Fair value of shares included in consideration from GeneDx Holdings	$ 172,000	$ 0	$ 0