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Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018
Cash flows from operating activities |  |  |
Net loss | $ (43,830) | $ (54,568) | $ (50,378)
Adjustments to reconcile net loss to net cash used in operating activities: |  |  |
Depreciation and amortization | 6,900 | 3,445 | 2,269
Stock-based compensation | 41,515 | 26,241 | 16,329
Amortization of debt discount and issuance costs | 0 | 37 | 210
Accretion of discounts on investments, net of premium amortization | 430 | (884) | (907)
Loss on disposal of assets | 0 | 0 | 75
Provision for bad debt and contractual allowance | 31,431 | 24,647 | 16,448
Loss on extinguishment of debt | 0 | 0 | 3,029
Repayment of interest paid in kind | 0 | 0 | (3,141)
Cost of operating lease right-of-use assets | 6,030 | 8,953 | 0
Changes in operating assets and liabilities: |  |  |
Accounts receivable | (37,957) | (28,725) | (21,747)
Inventory | (1,389) | (1,974) | (380)
Prepaid expenses and other current assets | (3,027) | (696) | (1,568)
Other assets | (6,149) | (4,732) | 269
Accounts payable | (3,881) | 5,604 | (192)
Accrued liabilities | 1,308 | 6,002 | 10,501
Deferred rent | 0 | 0 | 105
Deferred revenue | (321) | 28 | (15)
Operating lease liabilities | (4,819) | (5,241) | 0
Net cash used in operating activities | (13,759) | (21,863) | (29,093)
Cash flows from investing activities |  |  |
Purchases of property and equipment | (13,551) | (20,457) | (5,180)
Purchases of available-for-sale investments | (277,510) | (165,915) | (93,133)
Sales of available-for-sale investments | 14,525 | 1,498 | 5,962
Maturities of available-for-sale investments | 144,145 | 95,600 | 126,493
Net cash provided by (used in) investing activities | (132,391) | (89,274) | 34,142
Cash flows from financing activities |  |  |
Issuance of common stock in connection with follow-on public offering, net | 206,025 | 107,369 | 0
Proceeds from issuance of common stock in connection with employee equity incentive plans | 20,244 | 9,495 | 9,319
Tax withholding upon vesting of restricted stock awards | (10,009) | (5,288) | (3,877)
Proceeds from long-term debt, net of debt discount | 0 | 0 | 35,000
Repayments of long-term debt | (1,944) | 0 | (31,500)
Payments of issuance costs for long term debt | 0 | 0 | (121)
Premiums paid on extinguishment of debt | 0 | 0 | (2,518)
Net cash provided by financing activities | 214,316 | 111,576 | 6,303
Net increase in cash and cash equivalents | 68,166 | 439 | 11,352
Cash and cash equivalents, beginning of year | 20,462 | 20,023 | 8,671
Cash and cash equivalents, end of year | 88,628 | 20,462 | 20,023
Supplemental disclosures of cash flow information |  |  |
Interest paid | 1,502 | 1,644 | 6,065
Non-cash investing and financing activities |  |  |
Property and equipment included in accounts payable and accrued liabilities | 3 | 293 | 101
Deferred offering costs included in accounts payable and accrued liabilities | 0 | 77 | 0
Right-of-use assets obtained in exchange for new operating lease liabilities | 621 | 88,860 | 0
Capitalized stock-based compensation | $ 1,129 | $ 0 | $ 0

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