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Consolidated Statements of Operations - USD ($)
shares in Thousands, $ in Thousands
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Net revenue:      
Total net revenue $ 484,329 $ 444,448 $ 408,830
Cost of revenue 297,269 258,555 211,994
GROSS PROFIT 187,060 185,893 196,836
Operating expenses:      
General and administrative 221,347 143,794 127,993
Research and development 21,873 8,229 8,487
Sales and marketing 62,594 47,862 47,350
Total operating expenses 305,814 199,885 183,830
(LOSS) INCOME FROM OPERATIONS (118,754) (13,992) 13,006
Interest expense, net 5,082 7,019 3,713
Other expense (income), net 499 (7,906) 4,630
Gain on investment in and loan receivable from non-consolidated affiliate, net (109,260) (3,955) 0
Loss on extinguishment of debt 0 1,400 1,018
Loss on termination of cash flow hedge 0 3,506 0
(Loss) income before taxes (15,075) (14,056) 3,645
Income tax benefit (6,728) (18,228) (4,361)
NET (LOSS) INCOME $ (8,347) $ 4,172 $ 8,006
NET (LOSS) INCOME PER SHARE      
Basic (in dollars per share) $ (0.07) $ 0.04 $ 0.08
Diluted (in dollars per share) $ (0.07) $ 0.04 $ 0.08
WEIGHTED AVERAGE COMMON SHARES OUTSTANDING      
Basic (in shares) 119,962 108,579 100,470
Diluted (in shares) 119,962 111,794 103,615
Clinical Services      
Net revenue:      
Total net revenue $ 404,172 $ 382,337 $ 361,161
Pharma Services      
Net revenue:      
Total net revenue $ 80,157 $ 62,111 $ 47,669