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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