BDSX Biodesix Inc

 

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

 

FORM 10-Q

 

 

(Mark One)

☒	QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended September 30, 2024

OR

☐	TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from to

Commission File Number: 001-39659

 

 

BIODESIX, INC.

(Exact Name of Registrant as Specified in its Charter)

 

 

Delaware	20-3986492
(State or other jurisdiction of incorporation or organization)	(I.R.S. Employer Identification No.)
919 West Dillon Rd Louisville, Colorado	80027
(Address of principal executive offices)	(Zip Code)

Registrant’s telephone number, including area code: (303) 417-0500

 

 

Securities registered pursuant to Section 12(b) of the Act:

 

Title of each class		Trading Symbol(s)		Name of each exchange on which registered
Common Stock, par value $0.001 per share		BDSX		The NASDAQ Global Market

 

Indicate by check mark whether the Registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes ☒ No ☐

Indicate by check mark whether the Registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the Registrant was required to submit such files). Yes ☒ No ☐

Indicate by check mark whether the Registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act.

 

Large accelerated filer		☐		Accelerated filer		☐
Non-accelerated filer		☒		Smaller reporting company		☒
Emerging growth company		☒

 

If an emerging growth company, indicate by check mark if the Registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐

Indicate by check mark whether the Registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ☒

Indicate by check mark whether the Registrant has filed all documents and reports required to be filed by Sections 12, 13 or 15(d) of the Securities Exchange Act of 1934 subsequent to the distribution of securities under a plan confirmed by a court. Yes ☒ No ☐

As of October 25, 2024, the Registrant had 145,467,295 shares of common stock, $0.001 par value per share, outstanding.

 

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Table of Contents

 

		Page
PART I.	FINANCIAL INFORMATION	1
Item 1.	Financial Statements (Unaudited)	1
	Condensed Balance Sheets as of September 30, 2024 and December 31, 2023	1
	Condensed Statements of Operations for the Three and Nine Months Ended September 30, 2024 and 2023	2
	Condensed Statements Stockholders' Equity (Deficit) for the Three and Nine Months Ended September 30, 2024 and 2023	3
	Condensed Statements of Cash Flows for the Nine Months Ended September 30, 2024 and 2023	5
	Notes to Condensed Financial Statements	7
Item 2.	Management’s Discussion and Analysis of Financial Condition and Results of Operations	24
Item 3.	Quantitative and Qualitative Disclosures About Market Risk	36
Item 4.	Controls and Procedures	36
PART II.	OTHER INFORMATION	38
Item 1.	Legal Proceedings	38
Item 1A.	Risk Factors	38
Item 2.	Unregistered Sales of Equity Securities and Use of Proceeds	38
Item 3.	Defaults Upon Senior Securities	39
Item 4.	Mine Safety Disclosures	39
Item 5.	Other Information	39
Item 6.	Exhibits	40
	Signature	41

 

 

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SPECIAL NOTE REGARDING FORWARD-LOOKING STATEMENTS

 

This Quarterly Report on Form 10-Q contains forward-looking statements about us and our industry that involve substantial risks and uncertainties, including but not limited to those set forth under the caption “Special Note Regarding Forward-Looking Statements” and Item 1A. “Risk Factors” of Part II of this Quarterly Report on Form 10-Q and those discussed in our other filings with the Securities and Exchange Commission (SEC), including the risks described in Item 1A. “Risk Factors” of Part I of our Annual Report on Form 10-K for the year ended December 31, 2023, which was filed on March 1, 2024. All statements other than statements of historical facts contained in this Quarterly Report on Form 10-Q, including statements regarding our future financial condition, results of operations, business strategy and plans, and objectives of management for future operations, as well as statements regarding industry trends, are forward-looking statements. In some cases, you can identify forward-looking statements by terminology such as “anticipate,” “believe,” “continue,” “could,” “estimate,” “expect,” “intend,” “may,” “plan,” “potentially,” “predict,” “should,” “will” or the negative of these terms or other similar expressions.

We have based these forward-looking statements largely on our current expectations and projections about future events and trends that we believe may affect our financial condition, results of operations, business strategy and financial needs. These forward-looking statements are subject to a number of risks, uncertainties, factors, and assumptions described under the section titled “Risk Factors” in this Report and in the section entitled “Risk Factors” and elsewhere in our Annual Report on Form 10-K for the year ended December 31, 2023, regarding, among other things:

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These risks are not exhaustive. Other sections of this Quarterly Report on Form 10-Q may include additional factors that could harm our business and financial performance. New risk factors may emerge from time to time and it is not possible for our management to predict all risk factors, nor can we assess the impact of all factors on our business or the extent to which any factor, or combination of factors, may cause actual results to differ materially from those contained in, or implied by, any forward-looking statements.

You should not rely upon forward-looking statements as predictions of future events. Although we believe that the expectations reflected in the forward-looking statements are reasonable, we cannot guarantee future results, levels of activity, performance or achievements. Except as required by law, we undertake no obligation to update publicly any forward-looking statements for any reason after the date of this Quarterly Report on Form 10-Q or to conform these statements to actual results or to changes in our expectations.

In addition, statements that “we believe” and similar statements reflect our beliefs and opinions on the relevant subject. These statements are based upon information available to us as of the date of this Quarterly Report on Form 10-Q, and while we believe such information forms a reasonable basis for such statements, such information may be limited or incomplete, and our statements should not be read to indicate that we have conducted an exhaustive inquiry into, or review of, all potentially available relevant information. These statements are inherently uncertain and investors are cautioned not to unduly rely upon these statements.

You should read this Quarterly Report on Form 10-Q and the documents that we reference and have filed as exhibits with the understanding that our actual future results, levels of activity, performance and achievements may be different from what we expect. We qualify all of our forward-looking statements by these cautionary statements.

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PART I—FINANCIAL INFORMATION

Item 1. Financial Statements (Unaudited).

BIODESIX, INC.

Condensed Balance Sheets

(in thousands, except share data)

 

		September 30, 2024				December 31, 2023
Assets
Current assets
Cash and cash equivalents		$	31,406			$	26,284
Accounts receivable, net of allowance for credit losses of $246 and $65			8,036				7,679
Other current assets			4,575				5,720
Total current assets			44,017				39,683
Non‑current assets
Property and equipment, net			28,683				27,867
Intangible assets, net			6,438				7,911
Operating lease right-of-use assets			1,918				1,745
Goodwill			15,031				15,031
Other long-term assets			6,656				6,859
Total non‑current assets			58,726				59,413
Total assets		$	102,743			$	99,096
Liabilities and Stockholders' Equity
Current liabilities
Accounts payable		$	2,537			$	2,929
Accrued liabilities			8,553				7,710
Deferred revenue			676				324
Current portion of operating lease liabilities			624				252
Current portion of contingent consideration			—				21,857
Current portion of notes payable			29				51
Other current liabilities			544				293
Total current liabilities			12,963				33,416
Non‑current liabilities
Long‑term notes payable, net of current portion			36,112				35,225
Long-term operating lease liabilities			25,191				25,163
Other long-term liabilities			620				712
Total non‑current liabilities			61,923				61,100
Total liabilities			74,886				94,516
Commitments and contingencies
Stockholders' equity
Preferred stock, $0.001 par value, 5,000,000 authorized;     0 (2024 and 2023) issued and outstanding			—				—
Common stock, $0.001 par value, 200,000,000 authorized;     145,465,941 (2024) and 96,235,883 (2023) shares issued and outstanding			145				96
Additional paid‑in capital			481,958				424,050
Accumulated deficit			(454,246	)			(419,566	)
Total stockholders' equity			27,857				4,580
Total liabilities and stockholders' equity		$	102,743			$	99,096

 

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BIODESIX, INC.

Condensed Statements of Operations

(in thousands, except per share data)

 

		Three Months Ended September 30,								Nine Months Ended September 30,
		2024				2023				2024				2023
Revenues		$	18,151			$	13,491			$	50,894			$	34,419
Operating expenses:
Direct costs and expenses			4,179				3,229				11,231				9,636
Research and development			2,547				1,938				7,145				8,099
Sales, marketing, general and administrative			20,016				15,496				60,232				51,136
Impairment loss on intangible assets			—				—				135				20
Total operating expenses			26,742				20,663				78,743				68,891
Loss from operations			(8,591	)			(7,172	)			(27,849	)			(34,472	)
Other (expense) income:
Interest expense			(2,041	)			(2,386	)			(6,506	)			(7,207	)
Loss on extinguishment of liabilities			—				—				(248	)			—
Change in fair value of warrant liability, net			—				(1,393	)			—				(1,332	)
Other income (expense), net			374				2				(77	)			4
Total other expense			(1,667	)			(3,777	)			(6,831	)			(8,535	)
Net loss		$	(10,258	)		$	(10,949	)		$	(34,680	)		$	(43,007	)
Net loss per share, basic and diluted		$	(0.07	)		$	(0.14	)		$	(0.28	)		$	(0.55	)
Weighted-average shares outstanding, basic and diluted			146,296				79,709				123,634				78,672

 

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BIODESIX, INC.

Condensed Statements of Stockholders' Equity (Deficit)

(in thousands)

 

		Common Stock								Additional Paid‑In				Accumulated				Total Stockholders' Equity
		Shares				Amount				Capital				Deficit				(Deficit)
Balance ‑ December 31, 2023			96,236			$	96			$	424,050			$	(419,566	)		$	4,580
Issuance of common stock, net			314				1				606				—				607
Issuance of common stock under employee stock purchase plan			216				—				282				—				282
Exercise of stock options			6				—				3				—				3
Release of restricted stock units			387				—				—				—				—
Share‑based compensation			—				—				2,640				—				2,640
Net loss			—				—				—				(13,614	)			(13,614	)
Balance ‑ March 31, 2024			97,159				97				427,581				(433,180	)			(5,502	)
Conversion of preferred stock liabilities to common stock, net			30,435				31				33,119				—				33,150
Issuance of common stock, net			17,392				17				18,181				—				18,198
Exercise of stock options			8				—				4				—				4
Release of restricted stock units			156				—				—				—				—
Share‑based compensation			—				—				1,218				—				1,218
Net loss			—				—				—				(10,808	)			(10,808	)
Balance - June 30, 2024			145,150				145				480,103				(443,988	)			36,260
Issuance of common stock, net			—				—				(15	)			—				(15	)
Issuance of common stock under employee stock purchase plan			255				—				343				—				343
Exercise of stock options			13				—				12				—				12
Release of restricted stock units			48				—				—				—				—
Share‑based compensation			—				—				1,515				—				1,515
Net loss			—				—				—				(10,258	)			(10,258	)
Balance - September 30, 2024			145,466			$	145			$	481,958			$	(454,246	)		$	27,857

 

 

 

 

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		Common Stock								Additional Paid‑In				Accumulated				Total Stockholders' (Deficit)
		Shares				Amount				Capital				Deficit				Equity
Balance ‑ December 31, 2022			77,614			$	78			$	387,948			$	(367,420	)		$	20,606
Issuance of common stock, net			—				—				(61	)			—				(61	)
Issuance of common stock under employee stock purchase plan			270				—				420				—				420
Exercise of stock options			9				—				6				—				6
Release of restricted stock units			86				—				—				—				—
Share‑based compensation			—				—				2,281				—				2,281
Net loss			—				—				—				(18,702	)			(18,702	)
Balance ‑ March 31, 2023			77,979				78				390,594				(386,122	)			4,550
Exercise of stock options			107				—				81				—				81
Release of restricted stock units			525				1				—				—				1
Issuance of warrants			—				—				674				—				674
Share‑based compensation			—				—				1,057				—				1,057
Net loss			—				—				—				(13,356	)			(13,356	)
Balance - June 30, 2023			78,611				79				392,406				(399,478	)			(6,993	)
Issuance of common stock, net			9,455				9				15,307				—				15,316
Issuance of common stock under employee stock purchase plan			167				—				223				—				223
Exercise of stock options			6				—				3				—				3
Release of restricted stock units			77				—				—				—				—
Share‑based compensation			—				—				954				—				954
Net loss			—				—				—				(10,949	)			(10,949	)
Balance - September 30, 2023			88,316			$	88			$	408,893			$	(410,427	)		$	(1,446	)

 

 

 

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BIODESIX, INC.

Condensed Statements of Cash Flows

(in thousands)

		Nine Months Ended September 30,
		2024				2023
Cash flows from operating activities
Net loss		$	(34,680	)		$	(43,007	)
Adjustments to reconcile net loss to net cash, cash equivalents, and restricted    cash used in operating activities
Depreciation and amortization			4,324				2,351
(Accretion) amortization of lease right-of-use assets			(266	)			1,851
Loss on extinguishment of liabilities			248				—
Share‑based compensation expense			5,373				4,292
Change in fair value of warrant liability, net			—				1,332
Provision for doubtful accounts			453				467
Accrued interest, amortization of debt issuance costs and other			2,167				3,954
Inventory excess and obsolescence			20				115
Impairment loss on intangible assets			135				20
Changes in operating assets and liabilities:
Accounts receivable			(810	)			(1,178	)
Other current assets			778				1,798
Other long-term assets			49				(26	)
Accounts payable and other accrued liabilities			(57	)			(247	)
Deferred revenue			273				(395	)
Contingent consideration			(23,242	)			—
Tenant improvement allowances received			—				18,323
Current and long-term operating lease liabilities			682				(237	)
Net cash and cash equivalents and restricted cash used in operating activities			(44,553	)			(10,587	)
Cash flows from investing activities
Purchase of property and equipment			(2,391	)			(19,935	)
Patent costs and intangible asset acquisition, net			(165	)			(126	)
Net cash and cash equivalents and restricted cash used in investing activities			(2,556	)			(20,061	)
Cash flows from financing activities
Proceeds from the issuance of common stock			55,625				15,316
Proceeds from issuance of common stock under employee stock purchase plan			624				643
Proceeds from exercise of stock options			19				90
Payment of contingent consideration			—				(7,591	)
Repayment of term loan and notes payable			(38	)			(36	)
Payment of debt issuance costs			(38	)			(833	)
Equity financing costs			(3,685	)			(61	)
Other			(276	)			(127	)
Net cash and cash equivalents and restricted cash provided by financing activities			52,231				7,401
Net increase (decrease) in cash and cash equivalents and restricted cash			5,122				(23,247	)
Cash, cash equivalents, and restricted cash ‑ beginning of period			26,371				43,174
Cash, cash equivalents, and restricted cash ‑ end of period		$	31,493			$	19,927

 

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BIODESIX, INC.

Statements of Cash Flows

(in thousands)

(Continued from the previous page)

Supplemental cash flow information:

		Nine Months Ended September 30,
		2024				2023
Issuance of Perceptive Warrants		$	—			$	674
Operating lease right-of-use asset obtained in exchange for lease liabilities			281				867
Finance lease right-of-use assets obtained in exchange for lease liabilities			514				773
Cash paid for interest			4,443				3,241
Purchases of property & equipment included in accounts payable and accrued liabilities			526				824

 

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BIODESIX, INC.

Notes to Unaudited Condensed Financial Statements

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Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations.

Biodesix, Inc. is referred to throughout this Quarterly Report on Form 10-Q for the period ended September 30, 2024 (Form 10-Q) as “we”, “us”, “our” or the “Company”.

The following Management’s Discussion and Analysis of Financial Condition and Results of Operations (MD&A) should be read in conjunction with our Annual Report on Form 10-K for the year ended December 31, 2023 (Form 10-K) and the Condensed Financial Statements as of September 30, 2024 and for the three and nine months ended September 30, 2024 and 2023, included in Part I, Item 1 of this Form 10-Q, which provide additional information regarding our financial position, results of operations and cash flows. To the extent that the following MD&A contains statements which are not of a historical nature, such statements are forward-looking statements, which involve risks and uncertainties, including but not limited to those set forth under the caption “Special Note Regarding Forward-Looking Statements” and Item 1A. “Risk Factors” of Part II in this Quarterly Report on Form 10-Q and those discussed in our other filings with the Securities and Exchange Commission (SEC), including the risks described in Item 1A. “Risk Factors” of Part I of our Annual Report on Form 10-K for the year ended December 31, 2023, which was filed on March 1, 2024.

The following MD&A discussion is provided to supplement the Condensed Financial Statements as of September 30, 2024 and 2023 and for the three and nine months then ended included in Part I, Item 1 of this Quarterly Report on Form 10-Q. We intend for this discussion to provide you with information that will assist you in understanding our financial statements, the changes in key items in those financial statements from period to period, and the primary factors that accounted for those changes.

Data for the three and nine months ended September 30, 2024 and 2023 has been derived from our unaudited condensed financial statements included in Part I, Item 1 of this Quarterly Report on Form 10-Q.

Overview

We are a leading diagnostic solutions company with a focus on lung disease. By combining a multi-omic approach with a holistic view of the patient’s disease state, we believe our solutions provide physicians with greater insights to help personalize their patient’s care and meaningfully improve disease detection, evaluation, and treatment. Our unique approach to precision medicine provides timely and actionable clinical information, which we believe helps improve overall patient outcomes and lowers the overall healthcare cost by reducing the use of ineffective and unnecessary treatments and procedures. In addition to our diagnostic tests, we provide biopharmaceutical companies with services that include diagnostic research, clinical trial testing, and the discovery, development, and commercialization of companion diagnostics. We also recognize revenue from other services, including amounts derived from licensing our technologies.

Our core belief is that no single technology will answer all clinical questions that we encounter. Therefore, we employ multiple technologies, including genomics, transcriptomics, proteomics, radiomics, and artificial intelligence enabled informatics to discover innovative diagnostic tests for potential clinical use. Our multi-omic approach is designed to enable us to discover diagnostic tests that answer critical clinical questions faced by physicians, researchers, and biopharmaceutical companies.

We regularly engage with our customers, key opinion leaders, and scientific experts to stay ahead of the rapidly evolving diagnostic treatment landscape to identify additional clinical unmet needs where a diagnostic test could help improve patient care. Additionally, we incorporate clinical and molecular profiling data from our commercial clinical testing, research studies, clinical trials, and biopharmaceutical customers or other collaborative partnerships, to continue to advance our platform. We have a variety of samples with associated data in our biobank, including tumor profiles and immune profiles, which are used for both internal and external research and development initiatives.

We have commercialized five diagnostic tests for our lung diagnostic business, each of which have Medicare coverage, which are currently available for use by physicians. Our Nodify CDT and Nodify XL2 tests, marketed as Nodify Lung Nodule Risk Assessment, assess the risk of lung cancer to help identify the most appropriate treatment pathway. The Nodify CDT and XL2 tests have an established average turnaround time of one and five business days, respectively, from receipt of the blood sample, providing physicians with timely results to guide diagnostic planning. The Nodify Lung Nodule Risk Assessment has resulted in a change in the calculated risk of malignancy in 80-85% of the cases. We believe we are the only company to offer two commercial blood-based tests to help physicians reclassify risk of malignancy in patients with suspicious lung nodules. Our GeneStrat ddPCR, GeneStrat NGS, and VeriStrat tests, marketed as the IQLung testing strategy, are used following diagnosis of lung cancer to measure the presence of mutations in the tumor and the state of the patient’s immune system to establish the patient’s prognosis and help guide treatment decisions. The GeneStrat targeted tumor profiling test and the VeriStrat immune profiling test have an established average turnaround time of two business days. The GeneStrat NGS test is our blood-based NGS test and has an established average turnaround time of three business days. The 52-gene panel includes guideline recommended mutations to help physicians treating advanced-stage lung cancer patients identify all four major mutation classes and genes, such as EGFR, ALK, KRAS, MET, NTRK, ERBB2, and others, and delivers them in an expedited timeframe so patient treatment can begin sooner.

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In addition to the five diagnostic tests currently on the market, we offer a broad range of assays for research use as part of our laboratory services which have been used by over 65 biopharmaceutical companies and academic partners. All of our diagnostic and services testing is performed at one of our two accredited, high-complexity clinical laboratories in Louisville, Colorado and De Soto, Kansas.

Since our inception, we have performed over 600,000 clinical diagnostic tests and continue to generate a large and growing body of clinical evidence consisting of over 300 clinical and scientific peer-reviewed publications, presentations, and abstracts. Through ongoing study of each of our tests, we continue to grow our depth of understanding of disease biology and the broad utility of each of our tests. We believe we are poised for rapid growth by leveraging our scientific and clinical development and laboratory operations expertise along with our commercial infrastructure which includes sales, marketing, reimbursement, and regulatory affairs.

In the United States, we market our tests to clinical customers through our direct sales organization, which includes sales representatives that are engaged in sales efforts and promotional activities primarily to pulmonologists, oncologists, cancer centers and nodule clinics. We market our tests and services to biopharmaceutical companies globally through our targeted business development team, which promotes the broad utility of our tests and testing capabilities throughout drug development and commercialization which is of value to pharmaceutical companies and their drug-development process.

Factors Affecting Our Performance

We believe there are several important factors that have impacted our operating performance and results of operations, including:

Historically, we have experienced situations where commercial payers proactively reduced the amounts they were willing to reimburse for our tests, and in other situations, commercial payers have determined that the amounts they previously paid were too high and have sought to recover those perceived excess payments by deducting such amounts from payments otherwise being made. When we contract to serve as a participating provider, reimbursements are made pursuant to a negotiated fee schedule and are limited to only covered indications. Becoming a participating provider generally results in higher reimbursement for covered indications and lack of reimbursement for non-covered indications. As a result, the impact of becoming a participating provider with a specific payer will vary. If we are not able to obtain or maintain coverage and adequate reimbursement from third-party payers, we may not be able to effectively increase our testing volume and revenue as expected. Additionally, retrospective reimbursement adjustments can negatively impact our revenue and cause our financial results to fluctuate.

On July 6, 2023, the Company announced that the Centers for Medicare & Medicaid Services (CMS) has designated the Nodify CDT Test as an Advanced Diagnostic Laboratory Test (ADLT) effective June 30, 2023. Obtaining ADLT status is a recognition that the Nodify CDT test meets the stringent criteria established under the Protecting Access to Medicare Act of 2014. ADLT status is reserved for innovative tests with Medicare coverage that provide new clinical diagnostic information that cannot be obtained from any other test or combination of tests. Nodify CDT joins our Nodify XL2 and VeriStrat tests with the ADLT designation.

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The ongoing INSIGHT study was designed to expand our clinical understanding of the predictive and prognostic value of the VeriStrat test. On June 27, 2023, we completed enrollment of 5,000 patients with non-small cell lung cancer. All study participants currently enrolled in the study are expected to complete study follow-up by 2026. The participant data will be monitored, and sites will be closed accordingly throughout 2025.

On July 12, 2023, we announced the prospective, real-world ORACLE study (An Observational Registry Study to Evaluate the Performance of the Nodify XL2 Test) achieved the primary endpoint of a statistically significant change in the proportion of benign lung nodules managed by Nodify XL2 experiencing invasive procedures. The ORACLE study showed patients with benign nodules managed with the Nodify XL2 test were 74% less likely to undergo an unnecessary invasive procedure compared to the control group. Additionally, the proportion of patients sent to CT surveillance with malignant nodules did not differ between the Nodify XL2 group and the control group. The ORACLE study officially closed on May 28, 2024.

The ALTITUDE study is a randomized control study, launched during the fourth quarter 2020, seeking to further demonstrate the utility of the Nodify CDT and XL2 tests.

On October 8, 2024, at the CHEST Annual Meeting, the Company presented the experience of healthcare providers using the Nodify Lung Nodule Risk Assessment in over 35,000 patients consecutively tested in a real-world clinical setting. The Company also announced a new clinical study, CLARIFY, that will collect patient outcomes and other clinical information on a subset of the patients featured in the CHEST presentation. CLARIFY is designed to confirm performance of the Nodify CDT and Nodify XL2 tests in diverse patient subgroups through a retrospective chart review of up to 4,000 patients that were tested in a real-world clinical setting. The study's intent is to expand the extensive evidence characterizing the validation and utility of Nodify Lung testing.

Our clinical research has resulted in approximately 90 peer-reviewed publications for our tests. In addition to clinical studies, we are collaborating with investigators from multiple academic cancer centers. On June 3, 2022, we announced the intent to develop a new novel molecular minimal residual disease (MRD) test as a part of a master sponsored research agreement (MSRA) with Memorial Sloan Kettering Cancer Center (MSK). In addition, the MSRA between MSK and the Company also includes the potential future development of other diagnostic tests aimed at improving the treatment of cancer. On March 25, 2024, we announced a new master collaborative research agreement (MCRA) with MSK under which the teams will collaborate on a development plan for diagnostic tests aimed at improving the treatment of cancer. Biodesix will utilize its array of genomics, proteomics, and data mining capabilities with the aim of developing and commercializing oncology biomarker assays in collaboration with MSK. Bio-Rad will provide its industry-leading digital PCR assay technology in support of this important work. We believe these studies and collaborative arrangements are critical to gaining physician adoption and driving favorable coverage decisions by payers and expect our investments in research and development to increase. Further we also expect to increase our research and development expenses to fund further innovation and develop new clinically relevant tests.

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While each of these areas present significant opportunities for us, they also pose significant risks and challenges that we must address. See Part II, Item 1A. “Risk Factors” within this Form 10-Q and Item 1A. “Risk Factors” of Part I of our Annual Report on Form 10-K for the year ended December 31, 2023 for more information.

Third Quarter 2024 Financial and Operational Highlights

The following were significant developments affecting our business, capital structure and liquidity during the three months ended September 30, 2024 as compared to the same period in 2023 unless otherwise noted:

Components of Operating Results

Revenues

We derive our revenue from two primary sources: (i) providing diagnostic testing in the clinical setting (Diagnostic Tests); and (ii) providing biopharmaceutical companies with services that include diagnostic research, clinical research, clinical trial testing, development and testing services generally provided outside the clinical setting and governed by individual contracts with third parties as well as development and commercialization of companion diagnostics. We also recognize revenue from other services, including amounts derived from licensing our technologies (Biopharmaceutical Services and other).

Diagnostic Tests

Diagnostic test revenue is generated from delivery of results from our diagnostic tests. In the United States, we performed tests as both an in-network and out-of-network service provider depending on the test performed and the contracted status of the insurer. We consider diagnostic testing to be completed upon the delivery of test results to our customer, either the prescribing physician or third-party to which we contracted for services to be performed, which is considered the performance obligation. The fees for such services are billed either to a third party such as Medicare, medical facilities, commercial insurance payers, or to the patient. We determine the transaction price related to our contracts by considering the nature of the payer, test type, the historical amount of time until payment by a payer and historical price concessions granted to groups of customers.

Biopharmaceutical Services and other

Biopharmaceutical Services revenue is generated from the delivery of our on-market tests, pipeline tests, custom diagnostic testing, and other scientific services for a purpose as defined by any individual customer. At times we collaborate with large biopharmaceutical companies in an attempt to discover biomarkers that would be helpful in their drug development or marketing. The performance

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obligations and related revenue for these sales is defined by a written agreement between us and our customer. These services are generally completed upon the delivery of testing results, or other contractually defined milestone(s), to the customer, which is considered the performance obligation. Customers for these services are typically large pharmaceutical companies where collectability is reasonably assured and therefore revenue is accrued upon completion of the performance obligations. Revenue derived from services is often unpredictable and can cause significant swings in our overall net revenue line from quarter to quarter.

In addition, other revenue includes amounts derived from licensing our digital sequencing technologies to our international laboratory partners. We are compensated through royalty-based payments for the licensed technology, and depending on the nature of the technology licensing arrangements, and considering factors including, but not limited to: enforceable right to payment and payment terms, and if an asset with alternative use is created, these revenues are recognized in the period when royalty-bearing sales occur.

Operating Expenses

Direct costs and expenses

Cost of diagnostic testing generally consists of cost of materials, direct labor, including bonuses, employee benefits, share-based compensation, equipment and infrastructure expenses associated with acquiring and processing test samples, including sample accessioning, test performance, quality control analyses, charges to collect and transport samples; curation of test results for physicians; and in some cases, license or royalty fees due to third parties. Costs associated with performing our tests are recorded as the tests are processed regardless of whether revenue was recognized with respect to the tests. Infrastructure expenses include allocated depreciation of laboratory equipment, rent costs, amortization of leasehold improvements and information technology costs. Royalties for licensed technology are calculated as a percentage of revenues generated using the associated technology and recorded as expense at the time the related revenue is recognized. One-time royalty payments related to signing of license agreements or other milestones, such as issuance of new patents, are amortized to expense over the expected useful life of the patents. While we do not believe the technologies underlying these licenses are necessary to permit us to provide our tests, we do believe these technologies are potentially valuable and of possible strategic importance to us or our competitors. Under these license agreements, we are obligated to pay aggregate royalties ranging from 1% to 8% of sales in which the patents or know-how are used in the product or service sold, sometimes subject to minimum annual royalties or fees in certain agreements.

We expect the aggregate cost of diagnostic testing to increase in line with the increase in the number of tests we perform, but the cost per test to decrease modestly over time due to the efficiencies we may gain as test volume increases, and from automation and other cost reductions. Cost of services includes costs incurred for the performance of development services requested by our customers. Costs of development services will vary depending on the nature, timing and scope of customer projects.

Research and development

Research and development expenses consist of costs incurred to develop technology and include salaries, share-based compensation and benefits, reagents and supplies used in research and development laboratory work, clinical trials infrastructure expenses, including allocated facility occupancy and information technology costs, contract services, quality and regulatory support, other outside costs and costs to develop our technology capabilities. Research and development expenses account for a significant portion of our operating expenses and consist primarily of external and internal costs incurred in connection with the discovery and development of our product candidates.

External expenses include: (i) payments to third parties in connection with the clinical development of our product candidates, including contract research organizations and consultants; (ii) the cost of manufacturing products for use in our preclinical studies and clinical trials, including payments to contract manufacturing organizations (CMOs) and consultants; (iii) scientific development services, consulting research fees and for sponsored research arrangements with third parties; (iv) laboratory supplies; and (v) allocated facilities, depreciation and other expenses, which include direct or allocated expenses for IT, rent and maintenance of facilities. External expenses are recognized based on an evaluation of the progress to completion of specific tasks using information provided to us by our service providers or our estimate of the level of service that has been performed at each reporting date. We track external costs by the stage of program, clinical or preclinical.

Internal expenses include employee-related costs, including salaries, share-based compensation and related benefits for employees engaged in research and development functions. We do not track internal costs by product candidate because these costs are deployed across multiple programs and, as such, are not separately classified.

Research and development costs are expensed as incurred. Payments made prior to the receipt of goods or services to be used in research and development are deferred and recognized as expense in the period in which the related goods are received or services are rendered. Costs to develop our technology capabilities are recorded as research and development.

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We expect our research and development expenses to increase as we continue to innovate and develop additional products and expand our data management resources. As our services revenue grows, an increasing portion of research and development dollars are expected to be allocated to cost of services for biopharmaceutical service contracts. This expense, though expected to increase in dollars, is expected to decrease as a percentage of revenue in the long term, though it may fluctuate as a percentage of our revenues from period to period due to the timing and extent of these expenses.

Sales, marketing, general and administrative

Our sales and marketing expenses are expensed as incurred and include costs associated with our sales organization, including our direct sales force and sales management, client services, marketing, public relations, communications and reimbursement, as well as business development personnel who are focused on our biopharmaceutical customers. These expenses consist primarily of salaries, commissions, bonuses, employee benefits, share-based compensation, and travel, as well as marketing and educational activities and allocated overhead expenses. We expect our sales and marketing expenses to increase in dollars as we expand our sales force, increase our presence within the United States, and increase our marketing activities to drive further awareness and adoption of our tests and our future products and services. These expenses, though expected to increase in dollars, are expected to decrease as a percentage of revenue in the long term, though they may fluctuate as a percentage of our revenues from period to period due to the timing and nature of these expenses.

Our general and administrative expenses include costs for our executive, accounting, finance, legal and human resources functions. These expenses consist principally of salaries, bonuses, employee benefits, share-based compensation, and travel, as well as professional services fees such as consulting, audit, tax and legal fees, and general corporate costs and allocated overhead expenses. We expect that our general and administrative expenses will continue to increase in dollars, primarily due to increased headcount and costs associated with operating as a public company, including expenses related to legal, accounting, regulatory, maintaining compliance with exchange listing and requirements of the SEC, director and officer insurance premiums and investor relations. These expenses, though expected to increase in dollars, are expected to decrease as a percentage of revenue in the long term, though they may fluctuate as a percentage from period to period due to the timing and extent of these expenses.

Non-Operating Expenses

Interest expense and interest income

For the three and nine months ended September 30, 2024 and 2023, interest expense consists of cash and non-cash interest from the Perceptive Term Loan Facility and changes in the value of our contingent consideration associated with the passage of time subsequent to the achievement of the gross margin target in the second quarter 2021. Interest income, which is included in ‘Other income, net’ in the condensed statements of operations consists of income earned on our cash and cash equivalents.

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Results of Operations

The following table sets forth the significant components of our results of operations for the periods presented (in thousands, except percentages):

		Three Months Ended September 30,								Change								Nine Months Ended September 30,								Change
		2024				2023				$				%				2024				2023				$				%
Revenues		$	18,151			$	13,491			$	4,660				35	%		$	50,894			$	34,419			$	16,475				48	%
Operating expenses
Direct costs and expenses			4,179				3,229				950				29	%			11,231				9,636				1,595				17	%
Research and development			2,547				1,938				609				31	%			7,145				8,099				(954	)			(12	)%
Sales, marketing, general and administrative			20,016				15,496				4,520				29	%			60,232				51,136				9,096				18	%
Impairment loss on intangible assets			—				—				—				—	%			135				20				115				575	%
Total operating expenses			26,742				20,663				6,079				29	%			78,743				68,891				9,852				14	%
Loss from operations			(8,591	)			(7,172	)			(1,419	)			(20	)%			(27,849	)			(34,472	)			6,623				19	%
Other (expense) income
Interest expense			(2,041	)			(2,386	)			345				14	%			(6,506	)			(7,207	)			701				10	%
Loss on extinguishment of liabilities			—				—				—				—	%			(248	)			—				(248	)			(100	)%
Change in fair value of warrant liability, net			—				(1,393	)			1,393				100	%			—				(1,332	)			1,332				(100	)%
Other (expense) income, net			374				2				372				18,600	%			(77	)			4				(81	)			(2,025	)%
Total other expense			(1,667	)			(3,777	)			2,110				56	%			(6,831	)			(8,535	)			1,704				20	%
Net loss		$	(10,258	)		$	(10,949	)		$	691				6	%		$	(34,680	)		$	(43,007	)		$	8,327				19	%
Share-based compensation (1)		$	1,515			$	954			$	561				59	%		$	5,373			$	4,292			$	1,081				25	%

Revenues

We generate revenue by providing laboratory testing of our diagnostic tests and services. Our revenues for the periods indicated were as follows (in thousands, except percentages):

		Three Months Ended September 30,								Change								Nine Months Ended September 30,								Change
		2024				2023				$				%				2024				2023				$				%
Revenues
Diagnostic Testing revenue			17,168				12,301				4,867				40	%		$	47,503			$	32,395			$	15,108				47	%
Biopharmaceutical Services and other revenue			983				1,190				(207	)			(17	)%			3,391				2,024				1,367				68	%
Total revenues		$	18,151			$	13,491			$	4,660				35	%		$	50,894			$	34,419			$	16,475				48	%

Total revenue increased $4.7 million or 35%, and increased $16.5 million or 48% for the three and nine months ended September 30, 2024, respectively, compared to the same periods in 2023.

Diagnostic test revenue increased $4.9 million or 40%, and increased $15.1 million or 47% for the three and nine months ended September 30, 2024, respectively, compared to the same periods in 2023. The increases are primarily due to an increase of $4.7 million and $15.8 million, respectively, in the Nodify Lung Nodule Risk Assessment testing strategy driven by an increase in tests delivered as our sales efforts continue to focus on Nodify CDT and XL2 tests. The increase in revenue for the nine months ended September 30, 2024 was partially offset by a $0.7 million decrease in the IQLung testing strategy. The Company’s diagnostic testing sales efforts continued to gain momentum during the three and nine months ended September 30, 2024 as the number of tests delivered reached the highest in Company history for seven consecutive quarters.

Biopharmaceutical Services and other revenue decreased $0.2 million or 17%, and increased $1.4 million or 68% for the three and nine months ended September 30, 2024, respectively, compared to the same periods in 2023. The decrease in revenue for the three months ended September 30, 2024 was primarily due to the timing of sample receipts from certain biopharmaceutical partners, while the increase

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in revenue for the nine months ended September 30, 2024 was primarily a result of delivering against our expanding book of business and securing new agreements.

Operating Expenses

Direct costs and expenses

Direct costs and expenses related to revenue increased $1.0 million or 29%, and increased $1.6 million or 17% for the three and nine months ended September 30, 2024, respectively, compared to the same periods in 2023, primarily driven by the increase in testing volume compared to the same periods in 2023, partially offset by the optimization of testing workflows that resulted in improvements in costs per test.

Research and development

Research and development expenses increased $0.6 million or 31%, and decreased $1.0 million or 12% for the three and nine months ended September 30, 2024, respectively, compared to the same periods in 2023. The increase in costs for the three months ended September 30, 2024 was due primarily to an increase in internal expenses associated with compensation and benefit costs resulting from an increase in headcount, while the decrease for the nine months ended September 30, 2024 was primarily a result of a decrease in external costs associated with clinical trials and data acquisition costs.

The following table summarizes our external and internal costs for the three and nine months ended September 30, 2024 and 2023 (in thousands, except percentages):

		Three Months Ended September 30,								Change								Nine Months Ended September 30,								Change
		2024				2023				$				%				2024				2023				$				%
External expenses:
Clinical trials and associated costs		$	268			$	393			$	(125	)			(32	)%		$	911			$	1,609			$	(698	)			(43	)%
Other external costs			730				563				167				30	%			2,044				2,230				(186	)			(8	)%
Total external costs			998				956				42				4	%			2,955				3,839				(884	)			(23	)%
Internal expenses			1,549				982				567				58	%			4,190				4,260				(70	)			(2	)%
Total research and development expenses		$	2,547			$	1,938			$	609				31	%		$	7,145			$	8,099			$	(954	)			(12	)%

Sales, marketing, general and administrative

Sales, marketing, general and administrative expenses increased $4.5 million or 29%, and increased $9.1 million or 18% for the three and nine months ended September 30, 2024, respectively, compared to the same periods in 2023. The increase for the three and nine months ended September 30, 2024 was driven primarily by increases in employee compensation and benefits associated with an increase in headcount and variable compensation as well as increases in non-employee costs associated with increased spending on various sales meetings and sales fulfillment during 2024 as compared to 2023. Of the $4.5 million and $9.1 million increase, $0.7 million and $2.1 million, respectively, is associated with the increase in depreciation expense related to the leasehold improvements in our new Louisville headquarters and laboratory.

Non-operating Expenses

Interest expense

Interest expense decreased $0.3 million or 14%, and decreased $0.7 million or 10% for the three and nine months ended September 30, 2024, respectively, compared to the same periods in 2023. The decrease in interest expense for the three and nine months ended September 30, 2024 was primarily related to the interest associated with the declining contingent consideration balance as the remaining Milestone Payments and final exit fee payment were made.

Loss on extinguishment of liabilities

Loss on extinguishment of liabilities increased $0.2 million or 100% for the nine months ended September 30, 2024, compared to the same period in 2023. On April 22, 2024, the Company obtained consent from Perceptive and prepaid the July 1, 2024 contingent consideration Milestone Payment of $8.4 million to Indi. As a result of prepaying the Milestone Payment, the Company performed a fair value analysis through April 22, 2024 and recorded a loss on early extinguishment of $0.2 million.

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Change in fair value of warrant liability, net

During the three and nine months ended September 30, 2024, the Company recorded no change in fair value of warrant liability in the condensed statements of operations. The Tranche C loan had a commitment date through September 30, 2024 and, as of that date, the Company did not exercise its ability to draw the Tranche C loan. Therefore, the associated Tranche C Warrants expired and are no longer exercisable. During the three and nine months ended September 30, 2023, the Company recorded a $1.4 million and $1.3 million net loss, respectively, as a change in fair value through the condensed statements of operations due to changes in unobservable inputs. This was a result of changes in the probability of our ability to draw on Tranche B and C loans.

Other (expense) income, net

During the three and nine months ended September 30, 2024, the Company recorded other income, net of $0.4 million and other expense, net of $0.1 million, respectively. The other income, net for the three months ended September 30, 2024 was comprised primarily of interest income. The other expense, net for the nine months ended September 30, 2024 primarily consisted of deferred offering costs of approximately $0.7 million as a result of changes in the probability of our ability to fully utilize the LPC Facility prior to the termination date, offset by $0.6 million of interest and other income.

Liquidity and Capital Resources

We are an emerging growth company and, as such, have yet to generate positive cash flows from operations. We have funded our operations to date principally from net proceeds from the sale of our common stock, the sale of convertible preferred stock, revenue from diagnostic testing and services, and the incurrence of indebtedness.

The Company amended the Indi APA agreement in April 2022 in which all parties agreed to restructure the Milestone Payments whereby the Company will make five quarterly installments of $2.0 million each beginning in April 2022, three quarterly installments of $3.0 million beginning in July 2023, one installment of $5.0 million in April 2024, and one installment of approximately $8.4 million in July 2024. In addition, the Company agreed to an exit fee of approximately $6.1 million in October 2024. Interest shall accrue on the difference between the payment schedule as agreed in the August 2021 amendment and the April 2022 amended payment schedule, at an aggregate per annum rate equal to 10%, with such interest to be payable quarterly on the following installment payment date. Our ability to make these payments is subject to ongoing compliance under the Perceptive Term Loan and commencing January 1, 2024, consent from Perceptive. On April 22, 2024, the Company obtained consent from Perceptive and prepaid the July 1, 2024 Milestone Payment of $8.4 million to Indi. On September 30, 2024, the Company obtained consent from Perceptive and prepaid the October 1, 2024 exit fee of $6.1 million to Indi. The Company has no remaining obligations to Indi.

On November 21, 2022, the Company entered into a Credit Agreement and Guaranty (the Credit Agreement) with Perceptive Credit Holdings IV, LP (Perceptive) as lender and administrative agent (the Lender) for up to $50.0 million, with funding of $30.0 million and the issuance of warrants exercisable into 3,000,000 shares of the Company’s common stock occurring on November 21, 2022, and two additional contingently issuable tranches of $10.0 million each subject to certain terms and conditions, including revenue milestones. The Tranche C loan had a commitment date through September 30, 2024 and, as of that date, the Company did not exercise its ability to draw the Tranche C loan.

On April 7, 2023, the Company entered into a limited waiver under which the Lender agreed to waive the minimum revenue requirement for the three months ended March 31, 2023 (Limited Waiver). In addition, on May 10, 2023, the Company entered into the First Amendment to the Credit Agreement (First Amendment) with Perceptive as lender and administrative agent and the Company, as borrower, whereby subject to the terms and conditions of the First Amendment, the Minimum Net Revenue Covenant, as defined in the Credit Agreement, was modified to reduce the threshold through the twelve month period ended March 31, 2024.

On August 3, 2023, the Company entered into subscription agreements (the Subscription Agreements) with all of the members of our Board of Directors, all Section 16 officers, and additional members of the Biodesix leadership team for the issuance and sale by the Company of an aggregate of 16,975,298 of the Company’s common stock for an aggregate purchase price of approximately $27.5 million. During the three months ended September 30, 2023, the Company received $15.3 million in proceeds and issued 9,454,927 shares of common stock. On September 27, 2023, the Company entered into an amendment to delay final closing on one subscription agreement. The remaining $12.2 million in proceeds was received and 7,520,371 shares of common stock was issued during the three months ended December 31, 2023.

On August 4, 2023, the Company entered into the Second Amendment to the Credit Agreement (the Second Amendment) with Perceptive as lender and administrative agent and the Company, as borrower, whereby subject to the terms and conditions of the Second Amendment, the Minimum Net Revenue Covenant (as defined in the Credit Agreement) was amended to reduce the relevant threshold as of the last day of each fiscal quarter commencing on the fiscal quarter ending June 30, 2024 through and including the fiscal quarter ending December 31, 2025.

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Pursuant to the original terms of the Credit Agreement entered into on November 21, 2022, the Perceptive Term Loan Facility includes an additional Tranche B Loan, in an aggregate amount of up to $10.0 million, which is accessible by the Company so long as the Company satisfies certain customary conditions precedent, including revenue milestones. Under the terms of the Second Amendment, the conditions precedent for drawing on the Tranche B Loan were amended to (i) reduce the trailing twelve-month revenue milestone and (ii) add the receipt of aggregate cash proceeds of at least $27.5 million from an equity offering of the Company's common stock. During the three months ended December 31, 2023, the Company met the remaining conditions precedent associated with the Tranche B Loan and, on December 15, 2023, the Company exercised its ability to draw the Tranche B loan for $10.0 million (the Tranche B Loan).

On February 29, 2024 (the Third Amendment Effective Date), the Company entered into the Third Amendment to the Credit Agreement (the Third Amendment) with Perceptive as lender and administrative agent and the Company, as borrower, whereby subject to the terms and conditions of the Third Amendment, the Minimum Net Revenue Covenant (as defined in the Credit Agreement) was amended to reduce the relevant threshold as of the last day of each fiscal quarter commencing on the fiscal quarter ending March 31, 2024 through and including the fiscal quarter ending December 31, 2025.

On April 9, 2024, the Company closed an underwritten offering of common stock and a concurrent private placement. Collectively, the Company raised net proceeds of approximately $51.3 million.

As of September 30, 2024, the Company had remaining available capacity for share issuances of up to $46.9 million under the LPC Facility, subject to the restrictions and limitations of the underlying facilities. On April 5, 2024, the Company filed Supplement No. 1 to the ATM Prospectus Supplement dated December 22, 2021. To comply with volume limitations under applicable SEC rules and regulations, Supplement No. 1 reduced the aggregate offering price to up to $100,000 of shares in order to maximize the amount the Company could offer under the April 2024 Offering. Following the successful completion of the Company’s April 2024 Offering, the Company is no longer subject to volume limitations under applicable SEC rules and regulations that limit their availability as sources of funding. On August 7, 2024, the Company filed Supplement No. 2 to the ATM Prospectus Supplement dated December 22, 2021 to increase the aggregate offering price under the ATM facility up to the original $50.0 million of shares. As of September 30, 2024, the Company had remaining available capacity for share issuances of up to $28.2 million under the ATM facility. On November 1, 2024, the Company expects to file a shelf registration statement on Form S-3 and enter into a new sales agreement with a financial institution, pursuant to which the Company may issue and sell, from time to time, shares of its common stock having an aggregate offering price of up to $50.0 million, subject to terms and conditions (the 2024 ATM Program). The shares of common stock offered pursuant to the 2024 ATM Program will be offered and sold by the Company pursuant to its registration statement on Form S-3 once declared effective by the SEC. Sales of common stock under the 2024 ATM Program, if any, will be made at market prices by methods deemed to be an “at-the-market offering” as defined in Rule 415 promulgated under the Securities Act of 1933, as amended, including sales made directly on the NASDAQ Global Market, or any other existing trading market for our common stock. In connection with establishing the 2024 ATM Program, the Company terminated its prior $50.0 million ATM program established in November 2021, and no additional stock can be issued thereunder.

As of September 30, 2024, we maintained cash and cash equivalents of $31.4 million and we have $40.0 million in outstanding aggregate principal amount on our Perceptive Term Loan Facility. We have incurred significant losses since inception and, as a result, we have funded our operations to date primarily through the sale of common stock, the sale of convertible preferred stock, the issuance of notes payable, and from our two primary revenue sources: (i) diagnostic testing, which includes lung diagnostic testing and (ii) providing biopharmaceutical companies with development and testing services and licensing our technologies. In accordance with Accounting Standards Update 2014-15 (ASC Topic 205-40), Presentation of Financial Statements - Going Concern: Disclosure of Uncertainties about an Entity’s Ability to Continue as a Going Concern, the Company is required to evaluate whether there is substantial doubt about its ability to continue as a going concern each reporting period, including interim periods. In evaluating the Company’s ability to continue as a going concern, management projected its cash flow sources and evaluated the conditions and events that could raise substantial doubt about the Company’s ability to continue as a going concern within one year after the date that these financial statements were issued. Management considered the Company’s current projections of future cash flows, our ability to execute our current operating plan, current financial condition, sources of liquidity and debt obligations for at least one year from the date of issuance of this Form 10-Q in considering whether it has the ability to meet its obligations.

Our ability to meet our obligations as they come due may be impacted by our ability to remain compliant with financial covenants in our Perceptive Term Loan Facility or to obtain waivers or amendments that impact the related covenants. As of September 30, 2024, the Company was in compliance with all restrictive and financial covenants associated with its borrowings. In addition, on October 30, 2024, the Company entered into the Fourth Amendment to the Credit Agreement (the Fourth Amendment), whereby, subject to the terms and conditions of the Fourth Amendment, the Minimum Net Revenue Covenant (as defined in the Credit Agreement) was amended to reduce the relevant threshold as of the last day of each fiscal quarter commencing on the fiscal quarter ending June 30, 2025 through and including the fiscal quarter ending December 31, 2027.

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Our ability to maintain our financial covenants under our Perceptive Term Loan Facility during the next twelve months is, in part, dependent upon executing our current operating plan. If we do not execute our current operating plan and maintain our financial covenants, this could result in an Event of Default (as defined in the Perceptive Term Loan Facility), causing an acceleration and repayment of the outstanding balances. The Perceptive Term Loan Facility requires the Company to meet certain Minimum Net Revenue threshold amounts agreed to between the Company and Perceptive as of the last day of each fiscal quarter, which commenced with the fiscal quarter ending March 31, 2023. We have taken steps to improve our liquidity through raising debt and equity capital and have also undertaken several proactive measures including, among other things, the reduction of planned capital expenditures and certain operating expenses. If we do not execute our current operating plan, we may need to consider further measures to reduce our operating expenses. These measures would limit or reduce our operations and could include a hiring freeze, reductions in our workforce, reduction in cash compensation, deferring capital expenditures, and reducing other operating costs.

If we do not execute our current operating plan we may need to continue to raise additional funds from external sources, such as through the issuance of debt or equity securities. We may also raise additional capital to restructure our existing debt or for general working capital purposes, or both. If we raise additional capital through debt financing, we may be subject to covenants limiting or restricting our ability to take specific actions, such as incurring additional debt, making capital expenditures or declaring dividends. If we do raise additional capital through equity offerings, the ownership interest of our existing stockholders will be diluted, and the terms of these securities may include liquidation or other preferences that adversely affect our existing stockholders’ rights. There can be no assurance that additional capital will be available to us or, if available, will be available in sufficient amounts or on terms acceptable to us or on a timely basis.

We expect to continue to incur operating losses in the near term while we make investments to support our anticipated growth. Our ability to maintain our financial covenants is, in part, dependent upon executing our current operating plan and, along with the items noted above, raises substantial doubt about the Company’s ability to continue as a going concern within one year after the date the financial statements are issued. Our unaudited financial statements have been prepared assuming we will continue as a going concern and do not include any adjustments that might be necessary should we be unable to continue as a going concern.

Cash Flows

The following summarizes our cash flows for the periods indicated (in thousands):

		Nine Months Ended September 30,
		2024				2023
Net cash flows provided by (used in):
Operating activities		$	(44,553	)		$	(10,587	)
Investing activities			(2,556	)			(20,061	)
Financing activities			52,231				7,401
Net increase (decrease) in cash and cash equivalents and restricted cash		$	5,122			$	(23,247	)

 

Our cash flows resulted in a net increase in cash and cash equivalents and restricted cash of $5.1 million during the nine months ended September 30, 2024 as compared to the net decrease in cash of $23.2 million for the nine months ended September 30, 2023. For the nine months ended September 30, 2024, net cash used in operating activities totaled $44.6 million, an increase of approximately $34.0 million compared to the same period in 2023 primarily due to unfavorable changes in net working capital of $40.4 million, which includes $23.2 million of payments made for contingent consideration during the nine months ended September 30, 2024 and an $18.3 million decrease in tenant improvement allowances received for capital expenditures and leasehold improvements related to the CVP Lease. This is partially offset by a year-over-year decrease in net loss from operations of $8.3 million.

Net cash used in investing activities during the nine months ended September 30, 2024 totaled $2.6 million, a decrease of $17.5 million compared to the same period in 2023. The decrease in net cash used in investing activities was primarily due to decreases in purchases of property and equipment and capital expenditures primarily for leasehold improvements related to the CVP Lease. These leasehold improvements were tenant improvements and were reimbursed from the Landlord.

Net cash provided by financing activities during the nine months ended September 30, 2024 totaled $52.2 million, an increase of $44.8 million compared to the same period in 2023. The net cash provided by financing activities for the nine months ended September 30, 2024 primarily resulted from $51.3 million in net proceeds from the issuance of common stock from an underwritten offering of common stock and a concurrent private placement, $0.6 million from the issuance of common stock from our ATM facility, and $0.3 million from our ESPP. The net cash provided by financing activities for the nine months ended September 30, 2023 primarily resulted from $15.3 million net proceeds from the issuance of common stock from the Subscription Agreements, partially offset by milestone payments to Indi of $7.6 million and payments of debt issuance costs of $0.8 million.

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Contractual Obligations and Commitments

The following table summarizes our non-cancelable contractual obligations and commitments as of September 30, 2024 (in thousands):

		Payments due by period (1)
		Total				Less than 1 year				1 to 3 years				4 to 5 years				More than 5 years
Borrowings and interest (2)		$	57,835			$	5,650			$	11,246			$	40,939			$	—
Operating lease obligations			45,103				3,535				8,283				8,349				24,936
Finance lease obligations			1,022				624				398				—				—
Total		$	103,960			$	9,809			$	19,927			$	49,288			$	24,936

 

There have been no other significant changes to our future contractual obligations as disclosed in our Annual Report on Form 10-K for the year ended December 31, 2023.

Off-Balance Sheet Arrangements

As of September 30, 2024, we have not entered into any off-balance sheet arrangements.

Critical Accounting Policies and Significant Judgments and Estimates

In accordance with accounting principles generally accepted in the United States, we are required to make estimates and assumptions that affect the amounts reported in the condensed financial statements and accompanying notes. Certain of these estimates significantly influence the portrayal of our financial condition and results of operations and require us to make difficult, subjective or complex judgments. Our critical accounting policies are described in greater detail below and in Note 2 to our condensed financial statements in Part 1 of this Quarterly Report on Form 10-Q as well as Part II, Item 8 of our Annual Report on Form 10-K for the year ended December 31, 2023, which was filed on March 1, 2024.

Revenue Recognition

We recognize revenue when our customers obtain control of promised goods or services, in an amount that reflects the consideration which we expect to receive in exchange for our goods or services. To determine revenue recognition for our arrangements with our customers, we perform a five-step process, which includes: (i) identifying the contract(s) with a customer; (ii) identifying the performance obligations in the contract; (iii) determining the transaction price; (iv) allocating the transaction price to the performance obligations in the contract; and (v) recognizing revenue when (or as) we satisfy our performance obligations. The Company generates revenues from (i) Diagnostic Tests and (ii) assay development, testing services, and licensing our technologies (Biopharmaceutical Services and other revenue).

The Company recognizes revenues related to blood-based lung diagnostic billings based on estimates of the amounts ultimately expected to be collected from customers on a portfolio approach. In determining the amount to accrue for a delivered test, the Company considers factors such as test type, payment history, payer coverage, whether there is a reimbursement contract between the payer and the Company, payment as a percentage of agreed upon rate (if applicable), amount paid per test and any current developments or changes that could impact reimbursement. Variable consideration, if any, is estimated based on an analysis of historical experience and adjusted as better estimates become available. These estimates require significant judgment by management.

The Company also provides services to patients with whom the Company does not have contracts as defined in Financial Accounting Standards Board (FASB) Accounting Standards Codification 606 (ASC 606). The Company recognizes revenue for these patients when contracts, as defined in ASC 606, are established at the amount of consideration to which it expects to be entitled, or when the Company receives substantially all of the consideration subsequent to satisfaction and delivery of the performance obligations.

In addition, other revenue includes amounts derived from licensing our PCR technologies to our international laboratory partners. We are compensated through royalty-based payments for the licensed technology and, depending on the nature of the technology licensing arrangements and considering factors including but not limited to enforceable right to payment and payment terms, and if an asset with alternative use is created, these revenues are recognized in the period when royalty-bearing sales occur.

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Implications of Being an Emerging Growth Company and Smaller Reporting Company

We are an “emerging growth company” within the meaning of the Jumpstart Our Business Startups Act (JOBS Act). As an emerging growth company, we may take advantage of certain exemptions from various public company reporting requirements, including the requirement that our internal control over financial reporting be audited by our independent registered public accounting firm pursuant to Section 404 of the Sarbanes-Oxley Act of 2002 (the “Sarbanes-Oxley Act”), certain requirements related to the disclosure of executive compensation in our periodic reports and proxy statements, the requirement that we hold a nonbinding advisory vote on executive compensation and any golden parachute payments. We may take advantage of these exemptions until we are no longer an emerging growth company. Section 107 of the JOBS Act provides that an emerging growth company can take advantage of the extended transition period provided in Section 7(a)(2)(B) of the Securities Act, for complying with new or revised accounting standards. In other words, an emerging growth company can delay the adoption of certain accounting standards until those standards would otherwise apply to private companies.

We have elected to take advantage of the extended transition period to comply with new or revised accounting standards and to adopt certain of the reduced disclosure requirements available to emerging growth companies. As a result of the accounting standards election, we will not be subject to the same implementation timing for new or revised accounting standards as other public companies that are not emerging growth companies, which may make comparison of our financials to those of other public companies more difficult.

We will remain an emerging growth company until the earliest to occur of (i) the last day of the fiscal year in which we have more than $1.24 billion in annual revenue; (ii) the date we qualify as a “large accelerated filer,” with at least $700 million of equity securities held by non-affiliates; (iii) the date on which we have issued, in any three-year period, more than $1.0 billion in non-convertible debt securities; and (iv) until December 31, 2025 (the year ended December 31st following the fifth anniversary of our initial public offering).

Additionally, we are a “smaller reporting company” as defined in Item 10(f)(1) of Regulation S-K. Smaller reporting companies may take advantage of certain reduced disclosure obligations, including, among other things, providing only two years of audited financial statements. We will remain a smaller reporting company until the last day of the fiscal year in which: (i) the market value of our common shares held by non-affiliates exceeds $250 million as of the end of that year’s second fiscal quarter, or (ii) our annual revenues exceeded $100 million during such completed fiscal year and the market value of our common shares held by non-affiliates exceeds $700 million as of the end of that year’s second fiscal quarter.

Item 3. Quantitative and Qualitative Disclosures About Market Risk.

We are exposed to market risk in the ordinary course of our business. Market risk represents the risk of loss that may impact our financial position due to adverse changes in financial market prices and rates.

Interest Rate Risk

We are exposed to market risk for changes in interest rates related primarily to our cash and cash equivalents, marketable securities and our indebtedness, including our outstanding Perceptive Term Loan. As of September 30, 2024, we had $40.0 million outstanding on the Perceptive Term Loan Facility which has an annual rate equal to the greater of (a) forward-looking one-month term SOFR as posted by CME Group Inc. and (b) 3.0% per annum, plus an applicable margin of 9.0%. Historically, we have not entered into derivative agreements such as interest rate caps and swaps to manage our floating interest rate exposure.

Periodically throughout the year, we have maintained balances in various operating accounts in excess of federally insured limits. Our cash and cash equivalents are funds held in checking and bank savings accounts, primarily at one U.S. financial institution. We consider all highly liquid instruments purchased with an original maturity of three months or less to be cash equivalents. We continually monitor our positions with, and the credit quality of, the financial institutions with which we invest.

As of September 30, 2024, a hypothetical 100 basis point increase in interest rates would have an estimated $0.4 million impact per year on our financial position and results of operations, based on the current Perceptive Term Loan principal remaining outstanding through maturity.

Item 4. Controls and Procedures.

Evaluation of Disclosure Controls and Procedures

We maintain "disclosure controls and procedures," as such term is defined in Rule 13a-15(e) under the Securities Exchange Act of 1934, or Exchange Act, that are designed to ensure that information required to be disclosed by us in reports that we file or submit under the Exchange Act is recorded, processed, summarized, and reported within the time periods specified in Securities and Exchange Commission rules and forms, and that such information is accumulated and communicated to our management, including our Chief Executive Officer and Chief Financial Officer, as appropriate, to allow timely decisions regarding required disclosure. In designing and evaluating our disclosure controls and procedures, management recognized that disclosure controls and procedures, no matter how well

---

conceived and operated, can provide only reasonable, not absolute, assurance that the objectives of the disclosure controls and procedures are met. Our disclosure controls and procedures have been designed to meet reasonable assurance standards. Additionally, in designing disclosure controls and procedures, our management necessarily was required to apply its judgment in evaluating the cost-benefit relationship of possible disclosure controls and procedures. The design of any disclosure controls and procedures also is based in part upon certain assumptions about the likelihood of future events, and there can be no assurance that any design will succeed in achieving its stated goals under all potential future conditions.

Based on their evaluation as of the end of the period covered by this Quarterly Report on Form 10-Q, our Chief Executive Officer and Chief Financial Officer have concluded that, as of such date, our disclosure controls and procedures were effective at the reasonable assurance level.

There were no changes to our internal control over financial reporting during the three months ended September 30, 2024 that have materially affected, or are reasonable likely to materially effect, our internal controls over financial reporting.

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PART II—OTHER INFORMATION

Item 1. Legal Proceedings.

From time to time, we may become involved in legal proceedings or investigations which could have an adverse impact on our reputation, business and financial condition and divert the attention of our management from the operation of our business. We are not presently a party to any legal proceedings that, if determined adversely to us, would individually or taken together have a material adverse effect on our business, results of operations, financial condition, or cash flows.

Item 1A. Risk Factors.

“Item 1A. Risk Factors” of our Annual Report on Form 10-K as of and for the year ended December 31, 2023, filed March 1, 2024, and subsequent quarterly reports on Form 10-Q, if applicable, include a discussion of our risk factors. The information presented below updates, and should be read in conjunction with, the risk factors and information we previously disclosed and, except as presented below, there have been no material changes from the risk factors described in our Annual Report on Form 10-K and subsequent quarterly reports on Form 10-Q. These risk factors may not describe every risk facing us. Additional risks and uncertainties not currently known to us or that we currently deem to be immaterial could materially and adversely affect our business, financial condition and results of operations.

FDA is phasing out its general policy of enforcement discretion and will regulate laboratory developed tests as medical devices.

On September 29, 2023, FDA announced a proposed rule to amend its regulations to explicitly regulate laboratory developed tests (LDTs) as in vitro diagnostic tests in accordance with the agency’s regulatory authority over medical devices. The FDA finalized its rule on May 6, 2024 and announced that the agency will phase-out its LDT enforcement discretion policy in gradual stages over a total period of four years. LDTs that fall within targeted enforcement discretion policies may be exempt from some of these requirements.

Under the final rule, our tests that are currently offered as LDTs could become subject to certain statutory and regulatory provisions that are applicable to medical devices, including but not limited to, medical device reporting and correction and removal reporting requirements, quality systems regulations, registration and listing requirements, and premarket review requirements. Laboratories offering “high-risk tests that will be subject to premarket authorization application requirements or licensure under Section 351 of the Public Health Service Act, will need to ensure that the appropriate submission is received by the FDA before November 6, 2027. Laboratories offering “moderate-risk” or “low-risk” tests that will be subject to De Novo authorization or premarket notification submissions will need to ensure that the appropriate submission is received by the FDA before May 6, 2028. Other regulatory requirements will be gradually phased in beginning on May 6, 2025.

Failure to comply with applicable requirements under the relevant timeframes could cause us to lose the ability to perform our tests, experience disruptions to our business, or become subject to administrative or judicial enforcement actions, which in turn may have an adverse impact on our business, financial condition, and results of operations. For more information regarding these risks, see Item 1A “Risk Factors” of Part I of our Annual Report on Form 10-K for the year ended December 31, 2023, which was filed on March 1, 2024, under the heading "— Risks Related to our Governmental Regulation—Our current line of diagnostic tests is covered under CLIA and CMS, but the FDA may end its general policy of enforcement discretion and regulate laboratory developed tests as medical devices. Changes in the way the FDA regulates tests performed by laboratories like ours could result in delay or additional expense in offering our tests and tests that we may develop in the future."

Legal challenges have been filed in federal district court over the agency’s authority to regulate LDTs as medical devices, and the outcome of such litigation and its impact on FDA’s plan to implement the requirements are uncertain. Congress has also considered legislation to establish a new comprehensive regulatory framework that would provide oversight over LDTs.

Item 2. Unregistered Sales of Equity Securities and Use of Proceeds.

On April 5, 2024, we entered into the Securities Purchase Agreements, pursuant to which we sold 760,857 shares of our Series A Preferred Stock, which, subject to stockholder approval and certain beneficial ownership limitations set by each holder pursuant to the Series A Certificate of Designation, would automatically convert into 40 shares of Common Stock for each share of Series A Preferred Stock, for an aggregate of up to 30,434,280 shares of our common stock and an aggregate purchase price of $35.0 million. The Private Placement Preferred Shares were offered and sold in transactions exempt from registration under the Securities Act, in reliance on Section 4(a)(2) thereof. Each of the investors represented that it was an “accredited investor,” as defined in Regulation D, and acquired the securities for investment only and not with a view towards, or for resale in connection with, the public sale or distribution thereof. The Private Placement Preferred Shares have not been registered under the Securities Act and such securities may not be offered or sold in the United States absent registration or an exemption from registration under the Securities Act and any applicable state securities laws. The Company expects to use the net proceeds from the Concurrent Private Placement for commercial expansion of sales, supporting its product pipeline, research and development and for general corporate purposes.

---

In connection with the Concurrent Private Placement, the Company also entered into a Registration Rights Agreement, dated April 5, 2024 (the Registration Rights Agreement), with the Investors, which provides that the Company will register the resale of the shares of Common Stock issuable upon conversion of the Preferred Stock. Pursuant to the Registration Rights Agreement, the Company was required to prepare and file an initial registration statement with the SEC as soon as reasonably practicable, but in no event later than April 23, 2024 (the Filing Deadline), and to use reasonable best efforts to have the registration statement declared effective within 50 days after the closing of the Concurrent Private Placement, subject to the approval of the conversion of the Concurrent Private Placement Shares being received at the Company’s 2024 annual meeting of stockholders.

On May 21, 2024, the Company held its 2024 annual meeting of stockholders in which the Conversion Proposal and Issuance Proposal were approved by the Company's stockholders. Upon approval, each share of Series A Preferred Stock automatically converted into 40 shares of Common Stock and, on May 23, 2024, the Company issued 30,434,280 shares of Common Stock in exchange for all Series A Preferred Stock.

Item 3. Defaults Upon Senior Securities.

None.

Item 4. Mine Safety Disclosures.

Not applicable.

Item 5. Other Information.

None of our directors or officers adopted, modified, or terminated a Rule 10b5-1 trading arrangement during the quarter ended September 30, 2024.

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Item 6. Exhibits.

 

Exhibit Number		Description
10.1*		Fourth Amendment to Credit Agreement and Guaranty, dated October 30, 2024, by and between the Company and Perceptive Credit Holdings IV, LP.
31.1*		Certification of Principal Executive Officer Pursuant to Rules 13a-14(a) and 15d-14(a) under the Securities Exchange Act of 1934, as Adopted Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.
31.2*		Certification of Principal Financial Officer Pursuant to Rules 13a-14(a) and 15d-14(a) under the Securities Exchange Act of 1934, as Adopted Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.
32.1**		Certification of Principal Executive Officer Pursuant to 18 U.S.C. Section 1350, as Adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
32.2**		Certification of Principal Financial Officer Pursuant to 18 U.S.C. Section 1350, as Adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
101.INS*		Inline XBRL Instance Document – the instance document does not appear in the Interactive Data File because XBRL tags are embedded within the Inline XBRL document.
101.SCH*		Inline XBRL Taxonomy Extension Schema with Embedded Linkbase Documents
104		Cover Page Interactive Data File (embedded within the Inline XBRL document)

 

* Filed herewith.

** Furnished herewith.

*** Previously filed.

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SIGNATURE

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

 

		Biodesix, Inc.
Date: November 1, 2024		By:	/s/ CHRISTOPHER C. VAZQUEZ
			Christopher C. Vazquez
			Chief Accounting Officer
			(Principal Accounting Officer)

 

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Fourth Amendment to Credit Agreement and Guaranty

 

This Fourth Amendment to Credit Agreement and Guaranty (herein, this “Agreement”) is entered into as of October 30, 2024 (the “Fourth Amendment Effective Date”), by and among Biodesix, Inc., a Delaware corporation (the “Borrower”), the Lenders party hereto constituting Majority Lenders and Perceptive Credit Holdings IV, LP, a Delaware limited partnership, as administrative agent for the Lenders (in such capacity, together with its successors and assigns, the “Administrative Agent”).

Recitals:

A. The Lenders have extended credit to the Borrower on the terms and conditions set forth in that certain Credit Agreement and Guaranty, dated as of November 16, 2022 (as amended pursuant to that certain First Amendment to Credit Agreement and Guaranty, dated as of May 10, 2023, as amended pursuant to that certain Second Amendment to Credit Agreement and Guaranty, dated as of August 4, 2023, as amended pursuant to that certain Third Amendment to Credit Agreement and Guaranty, dated as of February 29, 2024, and as further amended, restated, supplemented or otherwise modified prior to the Fourth Amendment Effective Date, the “Existing Credit Agreement”; the Existing Credit Agreement as amended by this Agreement, the “Credit Agreement”).

B. The Borrower has requested that the Administrative Agent and the Lenders agree to amend certain provisions of the Existing Credit Agreement.

C. The parties hereto agree to amend the Existing Credit Agreement pursuant to the terms of this Agreement.

Now, Therefore, for good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties hereto agree as follows:

 

 

 

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[Signature Pages to Follow]

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IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be duly executed and delivered by their respective officers thereunto duly authorized as of the date first written above.

 

Biodesix, Inc., as Borrower
By:	/s/ ROBIN HARPER COWIE
Name:	Robin Harper Cowie
Title:	Chief Financial Officer

 

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PERCEPTIVE CREDIT HOLDINGS IV, LP, as Agent and Lender
By:	Perceptive Credit Opportunities GP, LLC, its general partner
By:	/s/ SANDEEP DIXIT
Name:	Sandeep Dixit
Title:	Chief Credit Officer
By:	/s/ SAM CHAWLA
Name:	Sam Chawla
Title:	Portfolio Manager

 

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ANNEX A

 

Conformed Credit Agreement

 

(Fourth Amendment – Marked Version)

 

See attached.

 

 

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ANNEX B

 

Conformed Credit Agreement

 

(Fourth Amendment – Clean Version)

 

See attached.

 

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SECTION 302 CERTIFICATION

I, Scott Hutton, certify that:

 

Date: November 1, 2024	By:	/s/ Scott Hutton
		Scott Hutton
		Chief Executive Officer

 

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SECTION 302 CERTIFICATION

I, Robin Harper Cowie, certify that:

 

Date: November 1, 2024	By:	/s/ Robin Harper Cowie
		Robin Harper Cowie
		Chief Financial Officer

 

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CERTIFICATION PURSUANT TO

18 U.S.C. SECTION 1350, AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report of Biodesix, Inc. (the “Company”) on Form 10-Q for the period ending September 30, 2024 as filed with the Securities and Exchange Commission on the date hereof (the “Report”), I certify, pursuant to 18 U.S.C. § 1350, as adopted pursuant to § 906 of the Sarbanes-Oxley Act of 2002, that, to my knowledge:

(1) The Report fully complies with the requirements of section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

(2) The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company.

 

Date: November 1, 2024		By:	/s/ Scott Hutton
			Scott Hutton
			Chief Executive Officer

 

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CERTIFICATION PURSUANT TO

18 U.S.C. SECTION 1350, AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report of Biodesix, Inc. (the “Company”) on Form 10-Q for the period ending September 30, 2024 as filed with the Securities and Exchange Commission on the date hereof (the “Report”), I certify, pursuant to 18 U.S.C. § 1350, as adopted pursuant to § 906 of the Sarbanes-Oxley Act of 2002, that, to my knowledge:

(1) The Report fully complies with the requirements of section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

(2) The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company.

 

Date: November 1, 2024		By:	/s/ Robin Harper Cowie
			Robin Harper Cowie
			Chief Financial Officer

 

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v3.24.3

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2024	Oct. 25, 2024
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2024
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q3
Entity Central Index Key	0001439725
Current Fiscal Year End Date	--12-31
Document Transition Report	false
Entity File Number	001-39659
Entity Registrant Name	BIODESIX, INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	20-3986492
Entity Address, Address Line One	919 West Dillon Rd
Entity Address, City or Town	Louisville
Entity Address, State or Province	CO
Entity Address, Postal Zip Code	80027
City Area Code	303
Local Phone Number	417-0500
Title of 12(b) Security	Common Stock, par value $0.001 per share
Trading Symbol	BDSX
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	true
Entity Ex Transition Period	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		145,467,295

v3.24.3

Condensed Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Current assets
Cash and cash equivalents	$ 31,406	$ 26,284
Accounts receivable, net of allowance for credit losses of $246 and $65	8,036	7,679
Other current assets	4,575	5,720
Total current assets	44,017	39,683
Non‑current assets
Property and equipment, net	28,683	27,867
Intangible assets, net	6,438	7,911
Operating lease right-of-use assets	1,918	1,745
Goodwill	15,031	15,031
Other long-term assets	6,656	6,859
Total non‑current assets	58,726	59,413
Total assets	102,743	99,096
Current liabilities
Accounts payable	2,537	2,929
Accrued liabilities	8,553	7,710
Deferred revenue	676	324
Current portion of operating lease liabilities	624	252
Current portion of contingent consideration		21,857
Current portion of notes payable	29	51
Other current liabilities	544	293
Total current liabilities	12,963	33,416
Non‑current liabilities
Long‑term notes payable, net of current portion	36,112	35,225
Long-term operating lease liabilities	25,191	25,163
Other long-term liabilities	620	712
Total non‑current liabilities	61,923	61,100
Total liabilities	74,886	94,516
Commitments and contingencies
Stockholders' equity
Preferred stock, $0.001 par value, 5,000,000 authorized; 0 (2024 and 2023) issued and outstanding
Common stock, $0.001 par value, 200,000,000 authorized; 145,465,941 (2024) and 96,235,883 (2023) shares issued and outstanding	145	96
Additional paid‑in capital	481,958	424,050
Accumulated deficit	(454,246)	(419,566)
Total stockholders' equity	27,857	4,580
Total liabilities and stockholders' equity	$ 102,743	$ 99,096

v3.24.3

Condensed Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Allowance for credit losses	$ 246	$ 65
Preferred stock, par value	$ 0.001	$ 0.001
Preferred stock, authorized	5,000,000	5,000,000
Preferred stock, issued	0	0
Preferred stock, outstanding	0	0
Common stock, par value	$ 0.001	$ 0.001
Common stock, authorized	200,000,000	200,000,000
Common stock, issued	145,465,941	96,235,883
Common stock, outstanding	145,465,941	96,235,883

v3.24.3

Condensed Statements of Operations - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Income Statement [Abstract]
Revenues	$ 18,151	$ 13,491	$ 50,894	$ 34,419
Operating expenses:
Direct costs and expenses	4,179	3,229	11,231	9,636
Research and development	2,547	1,938	7,145	8,099
Sales, marketing, general and administrative	20,016	15,496	60,232	51,136
Impairment loss on intangible assets			135	20
Total operating expenses	26,742	20,663	78,743	68,891
Loss from operations	(8,591)	(7,172)	(27,849)	(34,472)
Other (expense) income:
Interest expense	(2,041)	(2,386)	(6,506)	(7,207)
Loss on extinguishment of liabilities			(248)
Change in fair value of warrant liability, net		(1,393)		(1,332)
Other income (expense), net	374	2	(77)	4
Total other expense	(1,667)	(3,777)	(6,831)	(8,535)
Net loss	$ (10,258)	$ (10,949)	$ (34,680)	$ (43,007)
Net loss per share, basic	$ (0.07)	$ (0.14)	$ (0.28)	$ (0.55)
Net loss per share, diluted	$ (0.07)	$ (0.14)	$ (0.28)	$ (0.55)
Weighted-average shares outstanding, basic	146,296	79,709	123,634	78,672
Weighted-average shares outstanding, diluted	146,296	79,709	123,634	78,672

v3.24.3

Condensed Statements of Stockholders' Equity (Deficit) - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock	Additional Paid-In Capital	Accumulated Deficit
Balances at Dec. 31, 2022	$ 20,606	$ 78	$ 387,948	$ (367,420)
Common Stock Balance, Shares at Dec. 31, 2022		77,614
Issuance of common stock, net	(61)		(61)
Issuance of common stock under employee stock purchase plan	420		420
Issuance of common stock under employee stock purchase plan, Shares		270
Exercise of stock options	6		6
Exercise of stock options, shares		9
Release of restricted stock units, shares		86
Share-based compensation	2,281		2,281
Net Income (Loss)	(18,702)			(18,702)
Balances at Mar. 31, 2023	4,550	$ 78	390,594	(386,122)
Common Stock Balance, Shares at Mar. 31, 2023		77,979
Balances at Dec. 31, 2022	20,606	$ 78	387,948	(367,420)
Common Stock Balance, Shares at Dec. 31, 2022		77,614
Net Income (Loss)	(43,007)
Balances at Sep. 30, 2023	(1,446)	$ 88	408,893	(410,427)
Common Stock Balance, Shares at Sep. 30, 2023		88,316
Balances at Mar. 31, 2023	4,550	$ 78	390,594	(386,122)
Common Stock Balance, Shares at Mar. 31, 2023		77,979
Exercise of stock options	81		81
Exercise of stock options, shares		107
Release of restricted stock units	1	$ 1
Release of restricted stock units, shares		525
Issuance of warrants	674		674
Share-based compensation	1,057		1,057
Net Income (Loss)	(13,356)			(13,356)
Balances at Jun. 30, 2023	(6,993)	$ 79	392,406	(399,478)
Common Stock Balance, Shares at Jun. 30, 2023		78,611
Issuance of common stock, net	15,316	$ 9	15,307
Issuance of common stock, net, Shares		9,455
Issuance of common stock under employee stock purchase plan	223		223
Issuance of common stock under employee stock purchase plan, Shares		167
Exercise of stock options	3		3
Exercise of stock options, shares		6
Release of restricted stock units, shares		77
Share-based compensation	954		954
Net Income (Loss)	(10,949)			(10,949)
Balances at Sep. 30, 2023	(1,446)	$ 88	408,893	(410,427)
Common Stock Balance, Shares at Sep. 30, 2023		88,316
Balances at Dec. 31, 2023	4,580	$ 96	424,050	(419,566)
Common Stock Balance, Shares at Dec. 31, 2023		96,236
Issuance of common stock, net	607	$ 1	606
Issuance of common stock, net, Shares		314
Issuance of common stock under employee stock purchase plan	282		282
Issuance of common stock under employee stock purchase plan, Shares		216
Exercise of stock options	3		3
Exercise of stock options, shares		6
Release of restricted stock units, shares		387
Share-based compensation	2,640		2,640
Net Income (Loss)	(13,614)			(13,614)
Balances at Mar. 31, 2024	(5,502)	$ 97	427,581	(433,180)
Common Stock Balance, Shares at Mar. 31, 2024		97,159
Balances at Dec. 31, 2023	$ 4,580	$ 96	424,050	(419,566)
Common Stock Balance, Shares at Dec. 31, 2023		96,236
Exercise of stock options, shares	27
Net Income (Loss)	$ (34,680)
Balances at Sep. 30, 2024	27,857	$ 145	481,958	(454,246)
Common Stock Balance, Shares at Sep. 30, 2024		145,466
Balances at Mar. 31, 2024	(5,502)	$ 97	427,581	(433,180)
Common Stock Balance, Shares at Mar. 31, 2024		97,159
Conversion of preferred stock liabilities to common stock, net	33,150	$ 31	33,119
Conversion of preferred stock liabilities to common stock, net, Shares		30,435
Issuance of common stock, net	18,198	$ 17	18,181
Issuance of common stock, net, Shares		17,392
Exercise of stock options	4		4
Exercise of stock options, shares		8
Release of restricted stock units, shares		156
Share-based compensation	1,218		1,218
Net Income (Loss)	(10,808)			(10,808)
Balances at Jun. 30, 2024	36,260	$ 145	480,103	(443,988)
Common Stock Balance, Shares at Jun. 30, 2024		145,150
Issuance of common stock, net	(15)		(15)
Issuance of common stock under employee stock purchase plan	343		343
Issuance of common stock under employee stock purchase plan, Shares		255
Exercise of stock options	12		12
Exercise of stock options, shares		13
Release of restricted stock units, shares		48
Share-based compensation	1,515		1,515
Net Income (Loss)	(10,258)			(10,258)
Balances at Sep. 30, 2024	$ 27,857	$ 145	$ 481,958	$ (454,246)
Common Stock Balance, Shares at Sep. 30, 2024		145,466

v3.24.3

Condensed Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Cash flows from operating activities
Net loss	$ (34,680)	$ (43,007)
Adjustments to reconcile net loss to net cash, cash equivalents, and restricted cash used in operating activities
Depreciation and amortization	4,324	2,351
(Accretion) amortization of lease right-of-use assets	(266)	1,851
Loss on extinguishment of liabilities	248
Share-based compensation expense	5,373	4,292
Change in fair value of warrant liability, net		1,332
Provision for doubtful accounts	453	467
Accrued interest, amortization of debt issuance costs and other	2,167	3,954
Inventory excess and obsolescence	20	115
Impairment loss on intangible assets	135	20
Changes in operating assets and liabilities:
Accounts receivable	(810)	(1,178)
Other current assets	778	1,798
Other long-term assets	49	(26)
Accounts payable and other accrued liabilities	(57)	(247)
Deferred revenue	273	(395)
Contingent consideration	(23,242)
Tenant improvement allowances received		18,323
Current and long-term operating lease liabilities	682	(237)
Net cash and cash equivalents and restricted cash used in operating activities	(44,553)	(10,587)
Cash flows from investing activities
Purchase of property and equipment	(2,391)	(19,935)
Patent costs and intangible asset acquisition, net	(165)	(126)
Net cash and cash equivalents and restricted cash used in investing activities	(2,556)	(20,061)
Cash flows from financing activities
Proceeds from the issuance of common stock	55,625	15,316
Proceeds from issuance of common stock under employee stock purchase plan	624	643
Proceeds from exercise of stock options	19	90
Payment of contingent consideration		(7,591)
Repayment of term loan and notes payable	(38)	(36)
Payment of debt issuance costs	(38)	(833)
Equity financing costs	(3,685)	(61)
Other	(276)	(127)
Net cash and cash equivalents and restricted cash provided by financing activities	52,231	7,401
Net increase (decrease) in cash and cash equivalents and restricted cash	5,122	(23,247)
Cash, cash equivalents, and restricted cash ‑ beginning of period	26,371	43,174
Cash, cash equivalents, and restricted cash ‑ end of period	31,493	19,927
Supplemental cash flow information:
Issuance of Perceptive Warrants		674
Operating lease right-of-use asset obtained in exchange for lease liabilities	281	867
Finance lease right-of-use assets obtained in exchange for lease liabilities	514	773
Cash paid for interest	4,443	3,241
Purchases of property & equipment included in accounts payable and accrued liabilities	$ 526	$ 824

v3.24.3

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023
Pay vs Performance Disclosure
Net Income (Loss)	$ (10,258)	$ (10,808)	$ (13,614)	$ (10,949)	$ (13,356)	$ (18,702)	$ (34,680)	$ (43,007)

v3.24.3

Insider Trading Arrangements	9 Months Ended
	Sep. 30, 2024
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Rule 10b51 Arr Modified Flag	false

v3.24.3

Organization and Description of Business	9 Months Ended
	Sep. 30, 2024
Organization And Description Of Business [Abstract]
Organization and Description of Business	Note 1 – Organization and Description of Business Biodesix, Inc. (the “Company,” “Biodesix,” “we,” “us” and “our”), formerly Elston Technologies, Inc., was incorporated in Delaware in 2005. The Company’s headquarters are in Colorado and the Company performs its blood-based diagnostic tests in its laboratory facilities which are located in Louisville, Colorado and De Soto, Kansas. The Company conducts all of its operations within a single legal entity. Biodesix is a leading diagnostic solutions company with a focus in lung disease. The Company develops diagnostic tests using a multi-omic approach to harness the strengths of different technologies that are best suited to address important clinical questions. We derive our revenue from two sources: (i) providing diagnostic testing services associated with five blood-based lung tests (Diagnostic Tests) and (ii) providing biopharmaceutical companies with services that include diagnostic research, clinical research, development and testing services generally provided outside the clinical setting and governed by individual contracts with third parties as well as development and commercialization of companion diagnostics. We also recognize revenue from other services, including amounts derived from licensing our technologies (Biopharmaceutical Services and other). Blood-Based Lung Tests The Company offers five Medicare-covered blood-based lung cancer tests across the lung cancer continuum of care to support treatment decisions across all stages of lung cancer: Diagnosis • Nodify CDT® and Nodify XL2® tests, marketed as Nodify Lung® Nodule Risk Assessment, assess a suspicious lung nodule's risk of lung cancer to help identify the most appropriate treatment pathway. The Nodify CDT and XL2 tests have an established average turnaround time of one and five business days, respectively, from receipt of the blood sample, providing physicians with timely results to guide diagnostic planning. The Nodify CDT test is a blood-based test that detects the presence of seven autoantibodies associated with the presence of tumors. Elevated levels of the autoantibodies in patients with lung nodules indicate an increased risk of lung cancer to help identify patients that may benefit from timely intervention. The Nodify XL2 test is a blood-based proteomic test that evaluates the likelihood that a lung nodule is benign to help identify patients that may benefit from surveillance imaging. We believe we are the only company to offer two commercial blood-based tests to help physicians reclassify risk of malignancy in patients with suspicious lung nodules. Treatment & Monitoring • GeneStrat® ddPCR, GeneStrat NGS® and VeriStrat® tests, marketed as part of our IQLung™ testing strategy, are used following diagnosis of lung cancer to detect the presence of mutations in the tumor and the state of the patient’s immune system to help guide treatment decisions. The GeneStrat ddPCR tumor genomic profiling test and the VeriStrat immune profiling test have established an average turnaround time of two business days from receipt of the blood sample, and the GeneStrat NGS test has an established average turnaround time of three business days from receipt of the blood sample, providing physicians with timely results to facilitate treatment decisions. The GeneStrat ddPCR test evaluates the presence of actionable mutations in lung cancer. The test is covered independent of stage and can be used multiple times per patient to monitor changes in mutation status. The GeneStrat NGS test is a broad 52 gene panel, including guideline recommended mutations that help identify advanced stage patients eligible for targeted therapy or clinical trial enrollment. The VeriStrat test is a blood-based proteomic test that provides a personalized view of each patient’s immune response to their lung cancer. In developing the Company's products, we have developed or designed a regulatory strategy resulting in approvals, product development and clinical acumen, biorepositories, proprietary and patented technologies, specimen collection kit manufacturing capabilities, and bioinformatics methods that it believes are important to the development of new targeted therapies, determining clinical trial eligibility, and guiding treatment selection. The Company’s testing services are made available through its clinical laboratories.

v3.24.3

Summary of Significant Accounting Policies	9 Months Ended
	Sep. 30, 2024
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	Note 2 – Summary of Significant Accounting Policies Basis of Presentation The accompanying unaudited condensed financial statements have been prepared in accordance with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X for interim financial information and reflect all adjustments necessary to state fairly the Company’s financial position, results of operations and cash flows for the interim periods presented. All such adjustments are of a normal recurring nature. Results for interim periods are not indicative of the results for the entire fiscal year. The accompanying unaudited condensed financial statements should be read in conjunction with the audited financial statements included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2023. Certain information and footnote disclosures, including significant accounting policies, normally included in fiscal year financial statements prepared in accordance with accounting principles generally accepted in the U.S. (GAAP) have been condensed or omitted. The condensed balance sheet as of December 31, 2023 was derived from the audited financial statements. Liquidity and Capital Resources As of September 30, 2024, we maintained cash and cash equivalents of $31.4 million and we have $40.0 million in outstanding aggregate principal amount on our Perceptive Term Loan Facility (see Note 6 – Debt). We have incurred significant losses since inception and, as a result, we have funded our operations to date primarily through the sale of common stock, the sale of convertible preferred stock, the issuance of notes payable, and from our two primary revenue sources: (i) diagnostic testing, which includes lung diagnostic testing and (ii) providing biopharmaceutical companies with development and testing services and licensing our technologies. In accordance with Accounting Standards Update 2014-15 (ASC Topic 205-40), Presentation of Financial Statements - Going Concern: Disclosure of Uncertainties about an Entity’s Ability to Continue as a Going Concern, the Company is required to evaluate whether there is substantial doubt about its ability to continue as a going concern each reporting period, including interim periods. In evaluating the Company’s ability to continue as a going concern, management projected its cash flow sources and evaluated the conditions and events that could raise substantial doubt about the Company’s ability to continue as a going concern within one year after the date that these financial statements were issued. Management considered the Company’s current projections of future cash flows, our ability to execute our current operating plan, current financial condition, sources of liquidity and debt obligations for at least one year from the date of issuance of this Form 10-Q in considering whether it has the ability to meet its obligations. Our ability to meet our obligations as they come due may be impacted by our ability to remain compliant with financial covenants in our Perceptive Term Loan Facility (see Note 6 – Debt) or to obtain waivers or amendments that impact the related covenants. As of September 30, 2024, the Company was in compliance with all restrictive and financial covenants associated with its borrowings. Our ability to maintain our financial covenants under our Perceptive Term Loan Facility during the next twelve months is, in part, dependent upon executing our current operating plan. If we do not execute our current operating plan and maintain our financial covenants, this could result in an Event of Default (as defined in the Perceptive Term Loan Facility), causing an acceleration and repayment of the outstanding balances. The Perceptive Term Loan Facility requires the Company to meet certain minimum net revenue threshold amounts agreed to between the Company and Perceptive as of the last day of each fiscal quarter, which commenced with the fiscal quarter ending March 31, 2023. During 2023, the Company entered into various amendments to the Perceptive Term Loan Facility to reduce the relevant Minimum Net Revenue thresholds. On February 29, 2024, the Company entered into a third amendment to the Perceptive Term Loan Facility, whereby, subject to the terms and conditions of the third amendment, the Minimum Net Revenue Covenant was amended to reduce the relevant threshold through the fiscal quarter ended December 31, 2025 (see Note 6 – Debt). During the three months ended June 30, 2024, the Company completed an underwritten offering of common stock and a concurrent private placement (the April 2024 Offering). Collectively, the Company raised net proceeds of approximately $51.3 million (see Note 8 – Equity). We have taken steps to improve our liquidity through raising debt and equity capital and have also undertaken several proactive measures including, among other things, the reduction of planned capital expenditures and certain operating expenses as previously disclosed. If we do not execute our current operating plan, we may need to consider further measures to reduce our operating expenses. These measures would limit or reduce our operations and could include a hiring freeze, reductions in our workforce, reduction in cash compensation, deferring capital expenditures, and reducing other operating costs. If we do not execute our current operating plan we may need to continue to raise additional funds from external sources, such as through the issuance of debt or equity securities. We may also raise additional capital to restructure our existing debt or for general working capital purposes, or both. If we raise additional capital through debt financing, we may be subject to covenants limiting or restricting our ability to take specific actions, such as incurring additional debt, making capital expenditures or declaring dividends. If we do raise additional capital through equity offerings, the ownership interest of our existing stockholders will be diluted, and the terms of these securities may include liquidation or other preferences that adversely affect our existing stockholders’ rights. There can be no assurance that additional capital will be available to us or, if available, will be available in sufficient amounts or on terms acceptable to us or on a timely basis. We expect to continue to incur operating losses in the near term while we make investments to support our anticipated growth. Our ability to maintain our financial covenants is, in part, dependent upon executing our current operating plan and, along with the items noted above, raises substantial doubt about the Company’s ability to continue as a going concern within one year after the date the financial statements are issued. Our unaudited financial statements have been prepared assuming we will continue as a going concern and do not include any adjustments that might be necessary should we be unable to continue as a going concern. Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, the disclosure of contingent assets and liabilities at the balance sheet date and the reported amounts of revenue and expenses during the reporting periods. Actual results could differ from those estimates. Concentrations of Credit Risk and Other Uncertainties Substantially all of the Company’s cash and cash equivalents are deposited with one major financial institution in the United States. The Company continually monitors its positions with, and the credit quality of, the financial institution with which it holds cash. Periodically throughout the year, the Company has maintained balances in various operating and money market accounts in excess of federally insured limits. The Company has not experienced any losses on its deposits of cash and cash equivalents. Several of the components for certain of the Company's sample collection kits, test reagents, and test systems are obtained from single-source suppliers. If these single-source suppliers fail to satisfy the Company's requirements on a timely basis, the Company could suffer delays in being able to deliver its diagnostic solutions, a possible loss of revenue, or incur higher costs, any of which could adversely affect its operating results. For a discussion of credit risk concentration of accounts receivable as of September 30, 2024 and December 31, 2023, see Note 9 – Revenue and Accounts Receivable Credit Concentration. Restricted Cash Restricted cash consists of deposits related to the Company’s corporate credit card. For both of the periods ended September 30, 2024 and December 31, 2023, the Company had $0.1 million restricted cash, respectively, which was included in ‘Other current assets’ in the accompanying condensed balance sheets. Inventory Inventory consists primarily of material supplies, which are consumed in the performance of testing services and charged to ‘Direct costs and expenses’. Inventory is stated at cost and reported within ‘Other current assets’ in the condensed balance sheets and was $1.2 million and $1.4 million as of September 30, 2024 and December 31, 2023, respectively. The Company recorded a reserve for excess inventory of zero and $0.1 million as of September 30, 2024 and December 31, 2023, respectively. During the nine months ended September 30, 2024 and 2023, the Company recorded an insignificant amount and $0.1 million, respectively, to the condensed statements of operations for excess and obsolete inventory. Other Assets The Company has a $5.0 million cash refundable deposit to secure the performance of the Company’s obligations associated with the operating lease agreement with Centennial Valley Properties I, LLC and subsequently assigned to CVP I Owner LLC (see Note 7 – Leases). As of September 30, 2024 and December 31, 2023, the $5.0 million refundable deposit is reported within 'Other long-term assets' in the condensed balance sheets. Fair Value of Financial Instruments U.S. GAAP for fair value establishes a hierarchy that prioritizes fair value measurements based on the types of inputs used for the various valuation techniques (market approach, income approach and cost approach). We utilize a combination of market and income approaches to value our financial instruments. Our financial assets and liabilities are measured using inputs from the three levels of the fair value hierarchy. Fair value measurements are categorized within the fair value hierarchy based upon the lowest level of the most significant inputs used to determine fair value. The three levels of the hierarchy and the related inputs are as follows: Level   Inputs 1   Unadjusted quoted prices in active markets for identical assets and liabilities. 2   Unadjusted quoted prices in active markets for similar assets and liabilities;     Unadjusted quoted prices for identical or similar assets or liabilities in markets that are not active; or     Inputs other than quoted prices that are observable for the asset or liability. 3   Unobservable inputs for the asset or liability. The carrying amounts of certain financial instruments including cash and cash equivalents, accounts receivable, prepaid expenses and other current assets, other long-term assets, accounts payable and accrued liabilities approximate fair value due to their relatively short maturities. See Note 4 — Fair Value for further discussion related to estimated fair value measurements.

v3.24.3

Recently Issued Accounting Standards	9 Months Ended
	Sep. 30, 2024
Accounting Standards Update and Change in Accounting Principle [Abstract]
Recently Issued Accounting Standards	Note 3 - Recently Issued Accounting Standards Standards Being Evaluated In November 2023, the FASB issued ASU No. 2023-07, Segment Reporting: Improvements to Reportable Segment Disclosures (ASC Topic 280). This ASU requires all public entities to provide additional disclosures about the entity's reportable segments and more detailed information about a reportable segment's expenses. This guidance will become effective for the Company for the annual period beginning on January 1, 2024, and interim periods beginning on January 1, 2025. The Company is currently evaluating this guidance and assessing the overall impact on its financial statements. In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures. This ASU improves the transparency of income tax disclosures by requiring consistent categories and greater disaggregation of information in the rate reconciliation and income taxes paid by jurisdiction. This guidance will become effective for the Company beginning January 1, 2025, with early adoption permitted. The Company is currently evaluating this guidance and assessing the overall impact on its financial statements.

v3.24.3

Fair Value	9 Months Ended
	Sep. 30, 2024
Fair Value Disclosures [Abstract]
Fair Value	Note 4 - Fair Value Recurring Fair Value Measurements Our borrowing instruments are recorded at their carrying values in the condensed balance sheets, which may differ from their respective fair values. The fair value of borrowings as of September 30, 2024 is primarily associated with the Perceptive Term Loan Facility entered into with Perceptive Credit Holdings IV, LP, in November 2022 and was determined using a discounted cash flow analysis, excluding the fair value of the Perceptive Warrant (as defined below) issued in conjunction with the transaction. The carrying value of outstanding borrowings approximates the fair value as of September 30, 2024 and December 31, 2023. The table below presents the carrying and fair values of outstanding borrowings, which are classified as Level 2, as of the dates indicated (in thousands):     As of     September 30, 2024     December 31, 2023       Carrying Value     Fair Value     Carrying Value     Fair Value   Borrowings   $ 36,141     $ 36,550     $ 35,276     $ 35,506   The financial liabilities that are measured and recorded at estimated fair value on a recurring basis consist of our contingent consideration associated with our previous acquisition of Indi, the warrant liabilities granted as consideration for the Perceptive Term Loan Facility (see Note 6 - Debt), and contingent value rights granted to certain holders of our previously converted Series F Preferred Stock, which were accounted for as liabilities and remeasured through our condensed statements of operations. The table below presents the reported fair values of contingent consideration and warrant liabilities, which are classified as Level 3 in the fair value hierarchy, as of the dates indicated (in thousands):   As of    Description   September 30, 2024     December 31, 2023   Contingent consideration   $ —     $ 21,857   Warrant liabilities   $ —     $ —   Contingent value rights   $ —     $ —   The following table presents the changes in contingent consideration for the dates indicated (in thousands):     For the nine months ended September 30, 2024   Level 3 Rollforward   Contingent Consideration   Balance - January 1, 2024   $ 21,857   Interest expense     1,137   Loss on extinguishment of liabilities     248   Payments     (23,242 ) Balance - September 30, 2024   $ —     The following table presents the changes in contingent consideration and warrant liabilities for the dates indicated (in thousands):     For the nine months ended September 30, 2023   Level 3 Rollforward   Contingent Consideration     Warrant Liabilities   Beginning balances - January 1, 2023   $ 28,986     $ 61   Changes in fair value, net     —       1,332   Interest expense     3,094       —   Payments     (7,591 )     —   Ending balances - September 30, 2023   $ 24,489     $ 1,393   Contingent Consideration In connection with the acquisition of Indi in 2018, the Company recorded contingent consideration for amounts contingently payable to Indi's selling shareholders pursuant to the terms of the asset purchase agreement (the Indi APA). The contingent consideration arrangement requires additional consideration to be paid by the Company to such shareholders upon attainment of a three-consecutive month gross margin target of $2.0 million within the seven-year period after the acquisition date, which was achieved during the three months ended June 30, 2021. Under the terms of the original agreement, when the gross margin target was achieved, the Company was required to issue 2,520,108 shares of common stock. For the six months following the achievement of the gross margin target, Indi had the option to require the Company to redeem these common shares for $37.0 million in cash over eight equal quarterly installments. If Indi elected to not exercise its option, the Company had 12 months to repurchase the common stock in two equal and consecutive quarterly cash installments totaling $37.0 million. In August 2021, the Company entered into an amendment to the original agreement in which all parties agreed to forgo the issuance of common stock and agreed that the Company would, in lieu thereof, make six quarterly installments of approximately $4.6 million each beginning in January 2022 and a final payment of approximately $9.3 million in July 2023 for a total of $37.0 million (the Milestone Payments and each individually a Milestone Payment). The aggregate amount of payments owed by the Company under this amendment is the same as if Indi had exercised the put right or the Company had exercised the call right provided for in the original agreement. On April 7, 2022, the Company entered into Amendment No. 3 to the Indi APA, in which the parties agreed to restructure the Milestone Payments. The Company made five quarterly installments of $2.0 million each beginning in April 2022, three quarterly installments of $3.0 million which began in July 2023, one installment of $5.0 million in April 2024, and one installment of $8.4 million in July 2024. In addition, the Company agreed to an exit fee of approximately $6.1 million to be paid in October 2024. Interest shall accrue on the difference between the payment schedule as agreed in the August 2021 amendment and the April 2022 amended payment schedule, at an aggregate per annum rate equal to 10%, with such interest to be payable quarterly on the following installment payment date. Our ability to make these payments was subject to ongoing compliance under the Perceptive Term Loan Facility. On September 30, 2024, the Company obtained consent from Perceptive and prepaid the October 1, 2024 exit fee of $6.1 million to Indi. The contingent consideration liability was accounted for at fair value and subject to certain unobservable inputs. The significant unobservable inputs used in the measurement of the fair value included the probability of successful achievement of the specified product gross margin targets, the period in which the targets were expected to be achieved, and discount rates which ranged from 11% to 16%. As a result of the achievement of the gross margin target, the only remaining significant unobservable input used in the measurement of fair value included the discount rate since all other inputs became fixed and determinable. Subsequent changes to the contingent consideration following the achievement of the gross margin target were recorded as ‘Interest expense’ in the condensed statements of operations resulting from the passage of time and fixed payment schedule. During the three and nine months ended September 30, 2024, the Company recorded $0.2 million and $1.1 million, respectively, compared to $1.0 million and $3.1 million during the three and nine months ended September 30, 2023, respectively, in interest expense due to the passage of time and fixed payment schedule. In accordance with ASC 230, Statement of Cash Flows, cash paid to settle the contingent consideration liability recognized at fair value as of the acquisition date (including measurement-period adjustments) should be reflected as a cash outflow for financing activities while the remaining portion of the amount paid should be reflected as a cash outflow from operating activities in the statements of cash flows. All 2024 Milestone Payments are classified as cash outflows from operating activities in the Company's statements of cash flows. Warrant Liabilities On November 21, 2022, as consideration for the Perceptive Term Loan Facility (see Note 6 - Debt), the Company issued Perceptive a warrant to purchase up to 5,000,000 shares of the Company's common stock (the Perceptive Warrant), including Initial Warrants (as defined in Note 8 - Equity below) and Tranche B and C Warrants. The Initial Warrants are equity classified (see Note 8 - Equity) while the Tranche B and C Warrants were initially classified as liabilities and recognized at fair value. On December 15, 2023 (the Tranche B Borrowing Date), the Company exercised its ability to draw the Tranche B loan (see Note 6 – Debt). In connection with the Tranche B draw, the Company remeasured the Tranche B Warrants through the Tranche B Borrowing Date and recorded the change in fair value through the statements of operations and, subsequently, reclassified the fair value to additional paid-in capital (see Note 8 – Equity). The fair value of the Tranche C Warrants was determined using a Black-Scholes model and subject to certain unobservable inputs. The significant unobservable inputs used in the measurement of the fair value included the fair value of the Company's common stock, risk-free rate, the volatility of common stock, and the probability of the expected borrowing. The Tranche C loan had a commitment date through September 30, 2024 and, as of that date, the Company did not exercise its ability to draw the Tranche C loan. Therefore, the associated Tranche C Warrants expired and are no longer exercisable. During the three and nine months ended September 30, 2024, the Company recorded zero as a change in fair value through the condensed statements of operations. During the three and nine months ended September 30, 2023, the Company recorded a $1.4 million and $1.3 million loss, respectively, as a change in fair value through the condensed statements of operations due to changes in unobservable inputs. This is a result of changes in the probability of our ability to draw on Tranche B and C loans. Contingent Value Rights In January 2016, the Company issued shares of Series F Preferred Stock (the Series F Offering) that were subsequently converted into common stock in connection with the Company's initial public offering in October 2020. In connection with the Series F Offering, investors who purchased more than their pro-rata amount in the financing received a calculated number of contingent value rights (CVRs). One CVR represents 0.00375% of the Company’s interest in the drug ficlatuzumab, which began a Phase 3 clinical trial in January 2024 (see Note 13 - Commitments and Contingencies below). In January 2016, the Company issued 3,999 CVRs, or 15% interest in the drug ficlatuzumab, originally valued at $0.5 million. The initial estimated value of the CVRs were recorded as a liability and as a reduction to the Series F proceeds. Subsequent to recoupment of our initial co-development costs, upon receipt of a milestone, royalty, or any other type of payment from the Company’s ownership rights in the drug, the Company is required to make a cash payment to the CVR holders equal to 15% of net proceeds, as defined. During the three and nine months ended September 30, 2024 and 2023, the Company recorded zero as a change in fair value through the condensed statements of operations due to the probability of receiving net proceeds in excess of our initial co-development costs.

v3.24.3

Supplementary Balance Sheet Information	9 Months Ended
	Sep. 30, 2024
Balance Sheet Related Disclosures [Abstract]
Supplementary Balance Sheet Information	Note 5 – Supplementary Balance Sheet Information Property and equipment consist of the following (in thousands):     As of       September 30, 2024     December 31, 2023   Lab equipment   $ 5,877     $ 6,089   Leasehold improvements     28,165       24,713   Computer equipment     1,307       1,221   Furniture and fixtures     1,073       1,034   Software     325       325   Vehicles     97       97   Construction in process     88       —       36,932       33,479   Less accumulated depreciation     (8,249 )     (5,612 )    Total property and equipment, net   $ 28,683     $ 27,867   Depreciation expense for the three and nine months ended September 30, 2024 was $1.0 million and $2.8 million, respectively, compared to $0.3 million and $0.9 million for the three and nine months ended September 30, 2023, respectively. Intangible assets, excluding goodwill, consist of the following (in thousands):     September 30, 2024     December 31, 2023       Cost     Accumulated Amortization     Net Carrying Value     Cost     Accumulated Amortization     Net Carrying Value   Intangible assets subject to amortization                                     Patents   $ 2,000     $ (843 )   $ 1,157     $ 1,975     $ (752 )   $ 1,223   Purchased technology     16,900       (11,736 )     5,164       16,900       (10,328 )     6,572   Intangible assets not subject to     amortization                                     Trademarks     117       —       117       116       —       116      Total   $ 19,017     $ (12,579 )   $ 6,438     $ 18,991     $ (11,080 )   $ 7,911   Amortization expense related to definite-lived intangible assets was $0.5 million and $1.5 million for both the three and nine months ended September 30, 2024 and 2023, respectively. Future estimated amortization expense of intangible assets is (in thousands):   As of September 30, 2024   Remainder of 2024   $ 501   2025     2,000   2026     1,979   2027     1,021   2028     73   2029 and thereafter     747   Total   $ 6,321   Accrued liabilities consist of the following (in thousands):     As of       September 30, 2024     December 31, 2023   Compensation related accruals   $ 4,958     $ 3,855   Accrued clinical trial expense     940       983   Other expenses     2,655       2,872       Total accrued liabilities   $ 8,553     $ 7,710

v3.24.3

Debt	9 Months Ended
	Sep. 30, 2024
Debt Disclosure [Abstract]
Debt	Note 6 – Debt Our long-term debt primarily consists of notes payable associated with our Perceptive Term Loan Facility which is described in further detail below. Long-term notes payable were as follows (in thousands):     As of       September 30, 2024     December 31, 2023   Perceptive Term Loan Facility   $ 40,000     $ 40,000   Other     40       78   Unamortized debt discount and debt issuance costs     (3,899 )     (4,802 )     36,141       35,276   Less: current maturities     29       51   Long-term notes payable   $ 36,112     $ 35,225   Perceptive Term Loan Facility On November 16, 2022 (the Closing Date), the Company entered into a Credit Agreement and Guaranty (the Credit Agreement) with Perceptive Credit Holdings IV, LP as lender and administrative agent (the Lender). The Credit Agreement provides for a senior secured delayed draw term loan facility with Perceptive Advisors LLC (Perceptive) (the Perceptive Term Loan Facility). The Tranche A Loan, in an aggregate amount of up to $30.0 million (the Tranche A Loan), was funded under the Perceptive Term Loan Facility on November 21, 2022 (the Funding Date). The Company's net proceeds from the Tranche A Loan were approximately $27.9 million, after deducting debt issuance costs and expenses. In addition to the Tranche A Loan, the Perceptive Term Loan Facility included an additional Tranche B Loan, in an aggregate amount of up to $10.0 million, and an additional Tranche C Loan, in an aggregate amount of up to $10.0 million, which were accessible by the Company so long as the Company satisfied certain customary conditions precedent, including revenue milestones. On December 15, 2023, the Company exercised its ability to draw the Tranche B loan for $10.0 million. The Tranche C loan had a commitment date through September 30, 2024 and, as of that date, the Company did not exercise its ability to draw the Tranche C loan. The Perceptive Term Loan Facility has a maturity date of November 21, 2027 (the Maturity Date) and provides for an interest-only period during the term of the loan with principal due at the Maturity Date. Interest Rate The Perceptive Term Loan Facility will accrue interest at an annual rate equal to the greater of (a) forward-looking one-month term SOFR as posted by CME Group Inc. and (b) 3.0% per annum, plus an applicable margin of 9.0%. As of September 30, 2024, the stated interest rate was approximately 13.9%. Amortization and Prepayment On the Maturity Date, the Company is required to pay the Lender the aggregate outstanding principal amount underlying the Perceptive Term Loan Facility and any accrued and unpaid interest thereon. Prior to the Maturity Date, there will be no scheduled principal payments under the Perceptive Term Loan Facility. The Perceptive Term Loan Facility may be prepaid at any time, subject to a prepayment premium equal to 2% to 10% of the aggregate outstanding principal amount being prepaid, depending on the date of prepayment. Security Instruments and Warrants Pursuant to a Security Agreement, dated as of the Funding Date (the Security Agreement), between the Company and the Lender, substantially all of the Company’s obligations under the Credit Agreement are secured by a first lien perfected security interest on all of the Company’s assets, subject to customary exceptions. As consideration for the Credit Agreement, the Company has issued, on the Funding Date, the Perceptive Warrant of up to 5,000,000 shares of the Company's common stock, including the Initial Warrants which are equity classified at a per share exercise price equal to $1.0648 which is equal to the 10-day volume weighted average price (VWAP) of the Company’s common stock, on the business day immediately prior to the Closing Date of the Tranche A Loan. In connection with the Tranche B borrowing, additional warrants became exercisable into 1,000,000 shares of common stock with a per share exercise price equal to $1.0648, which is equal to the Initial Warrant exercise price and expire on December 15, 2033 (the Tranche B Warrants). In addition to the Initial and Tranche B Warrants, additional warrants would become exercisable into 1,000,000 shares of common stock concurrently with the borrowing date of the Tranche C Loan (the Tranche C Warrants).The Company accounted for the Tranche C Warrants as liabilities as the Tranche C Warrants did not meet the criteria for equity treatment (see Note 4 – Fair Value). The Tranche C loan was not drawn by the loan commitment date and the associated Tranche C Warrants expired and are no longer exercisable. Representations, Warranties, Covenants, and Events of Default The Credit Agreement contains certain representations and warranties, affirmative covenants, negative covenants, financial covenants, and conditions that are customarily required for similar financings. The affirmative covenants, among other things, require the Company to undertake various reporting and notice requirements, maintain insurance and maintain in full force and effect all Regulatory Approvals, Material Agreements, Material Intellectual Property (each as defined in the Credit Agreement) and other rights, interests or assets (whether tangible or intangible) reasonably necessary for the operations of the Company’s business. The negative covenants restrict or limit the ability of the Company to, among other things and subject to certain exceptions contained in the Credit Agreement, incur new indebtedness; create liens on assets; engage in certain fundamental corporate changes, such as mergers or acquisitions, or changes to the Company’s business activities; make certain Investments or Restricted Payments (each as defined in the Credit Agreement); change its fiscal year; pay dividends; repay other certain indebtedness; engage in certain affiliate transactions; or enter into, amend or terminate any other agreements that has the impact of restricting the Company’s ability to make loan repayments under the Credit Agreement. In addition, the Company must (i) at all times prior to the Maturity Date maintain a minimum cash balance of $2.5 million; and (ii) as of the last day of each fiscal quarter commencing on the fiscal quarter ending March 31, 2023, meet certain minimum net revenue threshold amounts agreed to between the Company and Perceptive. On May 10, 2023, the Company entered into the First Amendment with the Lender, whereby subject to the terms and conditions of the First Amendment, the Minimum Net Revenue Covenant (as defined in the Credit Agreement) was amended to reduce the relevant threshold of each fiscal quarter commencing on the fiscal quarter ending June 30, 2023 through and including the fiscal quarter ending March 31, 2024. As consideration for the First Amendment, the Company agreed to issue to Perceptive a warrant to purchase up to 500,000 shares of the Company’s common stock (the First Amendment Warrants) which are equity classified at a per share exercise price equal to $1.6254 (see Note 8 - Equity). On August 4, 2023 (the Second Amendment Effective Date), the Company entered into the Second Amendment to the Credit Agreement and Guaranty (the Second Amendment) with Perceptive as lender and administrative agent and the Company, as borrower, whereby subject to the terms and conditions of the Second Amendment, the Minimum Net Revenue Covenant (as defined in the Credit Agreement) was amended to reduce the relevant threshold as of the last day of each fiscal quarter commencing on the fiscal quarter ending June 30, 2024 through and including the fiscal quarter ending December 31, 2025. Under the terms of the Second Amendment, the conditions precedent for drawing on the Tranche B Loan were amended to (i) reduce the trailing twelve-month revenue milestone and (ii) add the receipt of aggregate cash proceeds of at least $27.5 million from an equity offering of the Company's common stock. During the three months ended December 31, 2023, the amended conditions precedent were met and on December 15, 2023, the Company exercised its ability to draw the Tranche B loan for $10.0 million. On February 29, 2024 (the Third Amendment Effective Date), the Company entered into the Third Amendment to the Credit Agreement and Guaranty (the Third Amendment) with Perceptive as lender and administrative agent and the Company, as borrower, whereby subject to the terms and conditions of the Third Amendment, the Minimum Net Revenue Covenant (as defined in the Credit Agreement) was amended to reduce the relevant threshold as of the last day of each fiscal quarter commencing on the fiscal quarter ending March 31, 2024 through and including the fiscal quarter ending December 31, 2025. The Credit Agreement also contains certain customary Events of Default which include, among others, non-payment of principal, interest, or fees, violation of covenants, inaccuracy of representations and warranties, bankruptcy and insolvency events, material judgments, cross-defaults to material contracts, certain regulatory-related events and events constituting a change of control. As of September 30, 2024, the Company was in compliance with all restrictive and financial covenants associated with its borrowings. The occurrence of an Event of Default could result in, among other things, the declaration that all outstanding principal and interest under the Perceptive Term Loan Facility are immediately due and payable in whole or in part. On the Closing Date, the Initial Warrants and Additional Warrants were valued at $2.9 million and $0.1 million, respectively, using the Black-Scholes option-pricing model, estimated settlement probabilities and estimated exercise prices. As a result of the fees paid to Perceptive and the value of the Perceptive Warrant, the Company recognized a discount on the Perceptive Term Loan in the amount of $5.2 million. The First Amendment Warrants were valued at $0.7 million using the Black-Scholes option-pricing model which the recognized as a discount on the Perceptive Term Loan Facility. The Company recorded the debt discount as a reduction to the principal amount of the debt and is amortized as interest expense over the life of the debt. Scheduled principal repayments (maturities) of long-term obligations were as follows (in thousands):     As of September 30, 2024   Remainder of 2024   $ 13   2025     21   2026     6   2027 and thereafter     40,000   Total   $ 40,040

v3.24.3

Leases	9 Months Ended
	Sep. 30, 2024
Leases [Abstract]
Leases	Note 7 – Leases Operating Leases The Company acts as a lessee under all its lease agreements. In January 2024 the Company relocated its corporate headquarters and laboratory facilities to Louisville, Colorado. The Company also leases laboratory and office space in De Soto, Kansas, under a non-cancelable lease agreement for approximately 9,066 square feet that is set to expire in October 2026. The Company De Soto lease agreement was amended on April 12, 2024 to include an additional 1,772 square feet of office space. The Company also holds various copier and equipment leases under non-cancelable lease agreements that expire in the next one to three years. Centennial Valley Properties I, LLC Lease Agreement On March 11, 2022, the Company entered into a Lease Agreement (the Lease) with Centennial Valley Properties I, LLC and subsequently assigned to CVP I Owner LLC, a Colorado limited liability company (the Landlord) for office and laboratory space in Louisville, Colorado (the Leased Premises). The initial term of the Lease is twelve years (the Initial Term) from the commencement date, which was April 1, 2023 (the Commencement Date). The Company has two renewal options to extend the term of the Lease for an additional seven- or ten-year terms for each renewal. Under the Lease, the Company is leasing approximately 79,980 square feet at the Leased Premises. The Company will pay base rent over the life of the Lease beginning at approximately $227,000 per month and escalating, based on fixed escalation provisions, to approximately $326,000 per month, plus certain operating expenses and taxes. The Company's obligation to pay base rent shall be abated, commencing as of the Commencement Date and ending on March 31, 2024 (the Abated Rent Period). Further, the Company's obligation to pay base rent with respect to a portion of the area of the Lease Premises equal to 19,980 square feet shall be abated (the Partial Abated Rent), commencing as of April 1, 2024 and ending on March 31, 2025 (the Partial Abated Rent Period). Pursuant to a work letter entered by the parties in connection with the Lease, the Landlord contributed an aggregate of $18.8 million toward the cost of construction and improvements for the Leased Premises and the Company exercised its option for an additional tenant improvement allowance of $2.0 million (the Extra Allowance Amount). The Company will repay the Extra Allowance Amount actually funded by the Landlord in equal monthly payments with an interest rate of 6% per year over the Initial Term excluding any part of the Abated Rent Period or Partial Abated Rent Period, which shall start to accrue on the date that the Landlord first disburses the Extra Allowance Amount. The Company made an accounting policy election to reduce the right-of-use asset and lease liability at lease commencement because the Lease specifies a maximum level of reimbursement for tenant improvements which are probable of being incurred and within the Company's control. Due to the tenant improvement allowances at the accounting lease commencement date and rent abatement periods described above, the Company expects the lease liability to accrete to approximately $25.5 million by March 2025. The Company utilized the total $20.8 million in tenant improvement allowances for capital expenditures for leasehold improvements throughout the year ended December 31, 2023. The Lease includes various covenants, indemnities, defaults, termination rights, and other provisions customary for lease transactions of this nature. During the three months ended September 30, 2022, a $5.0 million cash collateralized letter of credit under the operating lease agreement was released and the funds were subsequently transferred to the Landlord as a refundable deposit (subject to contingent reduction over the term of the lease) to secure the performance of the Company’s obligations. The $5.0 million refundable deposit is included within 'Other long-term assets' in the condensed balance sheet as of September 30, 2024. Operating lease expense for all operating leases was $0.6 million and $1.7 million for the three and nine months ended September 30, 2024, respectively, compared to $1.1 million and $3.3 million for the three and nine months ended September 30, 2023, respectively. As of September 30, 2024, the weighted-average remaining lease term and discount rate associated with our operating leases were 10.3 years and 11.4%, respectively. Future minimum lease payments associated with our operating leases were as follows (in thousands):     As of September 30, 2024   Remainder of 2024   $ 696   2025     3,909   2026     4,171   2027     4,063   2028     4,151   2029 and thereafter     28,113   Total future minimum lease payments     45,103   Less amount representing interest     (19,288 ) Total lease liabilities   $ 25,815

v3.24.3

Equity	9 Months Ended
	Sep. 30, 2024
Stockholders' Equity Note [Abstract]
Equity	Note 8 – Equity Equity Financing Programs The Company maintains two facilities that enable equity financing on an ongoing basis at the Company’s discretion, our at-the-market (ATM) offering and our common stock purchase agreement with Lincoln Park Capital Fund, LLC (Lincoln Park). In November 2021, the Company entered into a sales agreement with a financial institution, pursuant to which the Company may issue and sell, from time to time, shares of its common stock having an aggregate offering price of up to $50.0 million (the ATM Shares), subject to terms and conditions. The ATM Shares will be offered and sold by the Company pursuant to its previously filed and currently effective registration statement on Form S-3, and sales of common stock, if any, will be made at market prices by methods deemed to be an “at-the-market offering” as defined in Rule 415 promulgated under the Securities Act of 1933, as amended, including sales made directly on the NASDAQ Global Market, or any other existing trading market for our common stock. On March 7, 2022 (the LPC Effective Date), the Company entered into a purchase agreement with Lincoln Park Capital Fund, LLC (the Purchase Agreement), pursuant to which Lincoln Park has committed to purchase up to $50.0 million of the Company's common stock (the LPC Facility). Under the terms and subject to the conditions of the Purchase Agreement, the Company has the right, but not the obligation, to sell to Lincoln Park, and Lincoln Park is obligated to purchase up to $50.0 million of the Company’s common stock. Such sales of common stock by the Company, if any, will be subject to certain limitations, and may occur from time to time, at the Company’s sole discretion, over the 36-month period commencing on the LPC Effective Date. The Purchase Agreement may be terminated by the Company at any time, at its sole discretion, without any cost or penalty, by giving one business day notice to Lincoln Park to terminate the Purchase Agreement. Lincoln Park has covenanted not to cause or engage in any manner whatsoever, any direct or indirect short selling or hedging of the common stock. On the LPC Effective Date, the Company issued 184,275 shares of common stock to Lincoln Park as a commitment fee (the Initial Commitment Shares) for which the Company did not receive consideration and, upon the available amount being reduced to an amount equal to or less than $20.0 million, the Company will be required to issue 61,425 shares (the Additional Commitment Shares and together with the Initial Commitment Shares, collectively, the Commitment Shares). The Initial Commitment Shares issued were valued at $0.6 million and, together with due diligence expenses and legal fees of $0.1 million, reflect deferred offering costs of $0.7 million, were included on the condensed balance sheet in 'Other long-term assets'. The deferred offering costs were charged against 'Additional paid-in capital' based upon proceeds from the sale of common stock under the Purchase Agreement. During the three and nine months ended September 30, 2024 and 2023, there were no deferred offering costs charged against 'Additional paid-in capital'. During the three and nine months ended September 30, 2024, the Company expensed zero and $0.7 million, respectively, of deferred offering costs to 'Other (expense) income, net' in the condensed statements of operations as a result of changes in the probability of our ability to fully utilize the LPC Facility prior to the termination date. As of September 30, 2024, zero deferred offering costs remain. As of September 30, 2024, the Company had remaining available capacity for share issuances of up to $46.9 million under the LPC facility, subject to the restrictions and limitations of the underlying facilities. During the nine months ended September 30, 2024, the Company raised approximately $0.6 million ($0.6 million after deducting underwriting discounts and commissions and offering expenses payable), in gross proceeds from the sale of 313,928 common shares at a weighted average price per share of $1.99 under the ATM facility. On April 5, 2024, the Company filed Supplement No. 1 to the ATM Prospectus Supplement dated December 22, 2021. To comply with volume limitations under applicable SEC rules and regulations, Supplement No. 1 reduced the aggregate offering price to up to $100,000 of shares in order to maximize the amount the Company could offer under the April 2024 Offering (defined below). Following the successful completion of the Company’s April 2024 Offering, the Company is no longer subject to volume limitations under applicable SEC rules and regulations that limit their availability as sources of funding. On August 7, 2024, the Company filed Supplement No. 2 to the ATM Prospectus Supplement dated December 22, 2021 to increase the aggregate offering price under the ATM facility up to $50.0 million of shares. As of September 30, 2024, the Company had remaining available capacity for share issuances of up to $28.2 million under the ATM facility. April 2024 Offering Summary On April 9, 2024, the Company closed an underwritten offering of common stock and a concurrent private placement. Collectively, the Company raised net proceeds of approximately $51.3 million. Underwritten Offering On April 9, 2024, the Company closed an underwritten offering (the Offering) of 17,391,832 shares of its common stock (the Common Stock). The Common Stock was issued and sold pursuant to an underwriting agreement (the Underwriting Agreement), dated April 5, 2024, by and between the Company and TD Securities (USA) LLC, William Blair & Company, L.L.C., and Canaccord Genuity LLC as representatives of the underwriters (the Underwriters), at a price to the public of $1.15 per share. The Company received net proceeds of approximately $18.3 million from the Offering after deducting underwriting discounts and commissions and estimated offering expenses payable by the Company. The Underwriting Agreement contains customary representations, warranties and agreements by the Company, customary conditions to closing, indemnification obligations of the Company and the Underwriters, including for liabilities under the Securities Act, other obligations of the parties and termination provisions. The Underwriting Agreement also includes lock up restrictions that will be in effect during the period ending 90 days subsequent to April 5, 2024. The representations, warranties, and agreements contained in the Underwriting Agreement were made only for purposes of such agreement and as of specific dates, were solely for the benefit of the parties to such agreement, and may be subject to limitations agreed upon by the contracting parties. The Offering was made pursuant to the Company’s effective Registration Statement on Form S-3 (File No. 333-261095) previously filed with the SEC on November 29, 2021 and a prospectus supplement, dated April 5, 2024 relating to the Offering. Concurrent Private Placement On April 5, 2024, the Company entered into securities purchase agreements (the Securities Purchase Agreements) with various investors, including certain members of management, certain of its directors and funds affiliated with those directors (the Investors) for the issuance and sale by the Company of an aggregate of 760,857 shares of Series A Non-Voting Convertible Preferred Stock, par value $0.001 per share (the Series A Preferred Stock) in an offering (the Concurrent Private Placement). The Preferred Stock was issued to the Investors pursuant to an exemption from the registration requirements of the Securities Act of 1933, as amended (the Securities Act) afforded by Section 4(a)(2) of the Securities Act. Pursuant to the terms of the Securities Purchase Agreements, the Company agreed to submit to its stockholders the approval of the (i) conversion of the Preferred Stock into shares of Common Stock in accordance with Nasdaq Stock Market Rules (the Conversion Proposal) and (ii) the issuance of Series A Preferred Stock to certain members of management, certain of its directors and funds affiliated with those directors (the Issuance Proposal) at its 2024 annual meeting of stockholders. The Securities Purchase Agreements include customary representations, warranties and covenants by the parties to the agreement. Pursuant to the Securities Purchase Agreements, the Investors purchased the Preferred Stock at a purchase price of $46.00 per share for an aggregate purchase price of approximately $35.0 million. Registration Rights Agreement In connection with the Concurrent Private Placement, the Company also entered into a Registration Rights Agreement, dated April 5, 2024 (the Registration Rights Agreement), with the Investors, which provides that the Company will register the resale of the shares of Common Stock issuable upon conversion of the Preferred Stock. Pursuant to the Registration Rights Agreement, the Company was required to prepare and file an initial registration statement with the SEC as soon as reasonably practicable, but in no event later than April 23, 2024 (the Filing Deadline), and to use reasonable best efforts to have the registration statement declared effective within 50 days after the closing of the Concurrent Private Placement, subject to the approval of the conversion of the Private Placement Shares being received at the Company’s 2024 annual meeting of stockholders. On April 8, 2024, the Company filed a Certificate of Designations of Preferences, Rights and Limitations of the Series A Non-Voting Convertible Preferred Stock with the Secretary of State of the State of Delaware (the Certificate of Designations) in connection with the Concurrent Private Placement. The Certificate of Designations provided for the issuance of up to 760,857 shares of the Series A Preferred Stock. Following stockholder approval of the Conversion Proposal, each share of Series A Preferred Stock automatically converted into 40 shares of Common Stock, subject to certain limitations, including that a holder of Series A Preferred Stock was prohibited from converting shares of Series A Preferred Stock into shares of Common Stock if, as a result of such conversion, such holder, together with its affiliates, would beneficially own more than a specified percentage (established by the holder between 0% and 19.9%) of the total number of shares of Common Stock issued and outstanding immediately after giving effect to such conversion. On May 21, 2024, the Company held its 2024 annual meeting of stockholders in which the Conversion Proposal and Issuance Proposal were approved by the Company's stockholders. Upon approval, each share of Series A Preferred Stock automatically converted into 40 shares of Common Stock and, on May 23, 2024, the Company issued 30,434,280 shares of Common Stock in exchange for all Series A Preferred Stock. Warrants During 2018, the Company issued warrants to purchase shares of convertible preferred stock in conjunction with the sale of certain convertible preferred shares and issuance of debt. The Company issued to the lender a warrant to purchase 613,333 shares of Series G convertible preferred stock, at an exercise price of $0.75 per share, subject to adjustment upon specified dilutive issuances. The warrant was immediately exercisable upon issuance and expires on February 23, 2028. Through the effective date of the Company’s initial public offering (IPO) in October 2020, the Series G warrants were remeasured to an estimate of fair value using a Black-Scholes pricing model. As a result of the Company’s IPO, the preferred stock warrants were automatically converted to warrants to purchase 103,326 shares of common stock with a weighted average exercise price of $4.46 and were also transferred to additional paid-in capital. All common stock warrants remain outstanding as of September 30, 2024. On November 21, 2022, as consideration for the Perceptive Term Loan Facility (see Note 6 – Debt), the Company issued the Perceptive Warrant to purchase up to 5,000,000 shares of the Company's common stock, including the Initial Warrants. The per share exercise price for the Initial Warrants is equal to $1.0648, which is equal to the lower of (A) the 10-day VWAP of the Company’s common stock on the business day immediately prior to the Closing Date of the Tranche A Loan or (B) the public offering price per share of common stock of $1.15. The Initial Warrants are equity classified and were immediately exercisable upon issuance and expire on November 21, 2032. The Initial Warrants were valued at $2.9 million using the Black-Scholes option-pricing model assuming an expected term of 10 years, a volatility of 81.3%, a dividend yield of 0% and a risk-free interest rate of 3.67%. All Initial Warrants remain outstanding as of September 30, 2024. On May 10, 2023, as consideration for the First Amendment (see Note 6 – Debt), the Company agreed to issue to Perceptive a warrant to purchase up to 500,000 shares of the Company’s common stock (the First Amendment Warrants) at a per share exercise price equal to $1.6254, which is equal to the 10-day VWAP of the Company’s common stock ending on the business day immediately prior to the First Amendment Effective Date. The First Amendment Warrants are equity classified and immediately exercisable upon issuance and expire on May 10, 2033. The First Amendment Warrants were valued at $0.7 million using the Black-Scholes option-pricing model assuming an expected term of 10 years, a volatility of 78.7%, a dividend yield of 0% and a risk-free interest rate of 3.49%. All First Amendment Warrants remain outstanding as of September 30, 2024. On December 15, 2023 (the Tranche B Borrowing Date), the Company exercised its ability to draw the Tranche B loan (see Note 8 – Debt). In connection with the Tranche B draw, the Company remeasured the Tranche B Warrants through the Tranche B Borrowing Date and recorded the change in fair value through the statements of operations and, subsequently, reclassified the fair value to additional paid-in capital. The Tranche B Warrants are now equity classified and immediately exercisable upon issuance and expire on December 15, 2033. The Tranche B Warrants were valued at $1.3 million using the Black-Scholes option-pricing model assuming an expected term of 10 years, a volatility of 76.2%, a dividend yield of 0% and a risk-free interest rate of 3.91%. All Tranche B Warrants remain outstanding as of September 30, 2024.

v3.24.3

Revenue and Accounts Receivable Credit Concentration	9 Months Ended
	Sep. 30, 2024
Revenue from Contract with Customer [Abstract]
Revenue and Accounts Receivable Credit Concentration	Note 9 – Revenue and Accounts Receivable Credit Concentration We derive our revenue from two primary sources: (i) providing diagnostic testing in the clinical setting (Diagnostic Tests); and (ii) providing biopharmaceutical companies with services that include diagnostic research, clinical research, clinical trial testing, development and testing services provided outside the clinical setting and governed by individual contracts with third parties as well as development and commercialization of companion diagnostics. We also recognize revenue from other services, including amounts derived from licensing our technologies (Biopharmaceutical Services and other). Diagnostic test revenues consist of blood-based lung tests which are recognized in the amount expected to be received in exchange for diagnostic tests when the diagnostic tests are delivered. The Company conducts diagnostic tests and delivers the completed test results to the prescribing physician or patient, as applicable. The fees for diagnostic tests are billed either to a third party such as Medicare, medical facilities, commercial insurance payers, or to the patient. The Company determines the transaction price related to its diagnostic test contracts by considering the nature of the payer, test type, and historical price concessions granted to groups of customers. For diagnostic test revenue, the Company estimates the transaction price, which is the amount of consideration it expects to be entitled to receive in exchange for providing services based on its historical collection experience, using a portfolio approach. The Company recognizes revenues for diagnostic tests upon delivery of the tests to the physicians requesting the tests or patient, as applicable. Services revenue consists of on-market tests, pipeline tests, custom diagnostic testing, and other scientific services for a purpose as defined by any individual customer, which is often with biopharmaceutical companies. The performance obligations and related revenue for these sales is defined by a written agreement between the Company and the customer. These services are generally completed upon the delivery of testing results, or other contractually defined milestone(s), to the customer. Revenue for these services is recognized upon delivery of the completed test results, or upon completion of the contractual milestone(s). In addition, other revenue includes amounts derived from licensing our digital sequencing technologies to our international laboratory partners. We are compensated through royalty-based payments for the licensed technology, and depending on the nature of the technology licensing arrangements and considering factors including but not limited to enforceable right to payment and payment terms, and if an asset with alternative use is created, these revenues are recognized in the period when royalty-bearing sales occur. Revenues consisted of the following (in thousands):     Three Months Ended September 30,     Nine Months Ended September 30,       2024     2023     2024     2023   Diagnostic Tests   $ 17,168     $ 12,301     $ 47,503     $ 32,395   Biopharmaceutical Services and other     983       1,190       3,391       2,024   Total revenue   $ 18,151     $ 13,491     $ 50,894     $ 34,419   Deferred Revenue Deferred revenue consists of cash payments from customers received in advance of delivery. As test results are delivered, the Company recognizes the deferred revenue in ‘Revenues’ in the condensed statements of operations. The Company had $0.3 million in ‘Deferred revenue’ recorded in the condensed balance sheet as of December 31, 2023 and $0.9 million was added throughout 2024 to ‘Deferred revenue’ for up-front cash payments while $0.5 million was recognized in revenues during the nine months ended September 30, 2024. The ‘Deferred revenue’ of $0.7 million recorded in the condensed balance sheet as of September 30, 2024 is expected to be recognized in revenues over the next twelve months as test results are delivered and services are performed. As of September 30, 2024 and December 31, 2023, the Company had $0.3 million in non-current deferred revenue, respectively, recorded within ‘Other long-term liabilities’ in the condensed balance sheets which represent amounts to be recognized in excess of twelve months from the respective balance sheet date. The Company’s customers in excess of 10% of total revenue and their related revenue as a percentage of total revenue were as follows:     Three Months Ended September 30,     Nine Months Ended September 30,       2024     2023     2024     2023   United Healthcare     7 %     10 %     8 %     10 % In addition to the above table, we collect reimbursement on behalf of customers covered by Medicare, which accounted for 40% of the Company’s total revenue for both the three and nine months ended September 30, 2024 compared to 41% and 45% for the three and nine months ended September 30, 2023, respectively. The Company is subject to credit risk from its accounts receivable related to services provided to its customers. The Company’s third-party payors and other customers in excess of 10% of accounts receivable, and their related accounts receivable as a percentage of total accounts receivable were as follows:     As of       September 30, 2024     December 31, 2023   Medicare     26 %     21 %

v3.24.3

Share-Based Compensation	9 Months Ended
	Sep. 30, 2024
Share-Based Payment Arrangement [Abstract]
Share-Based Compensation	Note 10 – Share-Based Compensation The Company’s share-based compensation awards are issued under the 2020 Equity Incentive Plan (2020 Plan), the predecessor 2016 Equity Incentive Plan (2016 Plan) and 2006 Equity Incentive Plan (2006 Plan). Any awards that expire or are forfeited under the 2016 Plan or 2006 Plan become available for issuance under the 2020 Plan. As of September 30, 2024, 809,163 shares of common stock remained available for future issuance under the 2020 Plan. Share-Based Compensation Expense Share-based compensation expense reported in the Company’s condensed statements of operations was (in thousands):     Three Months Ended September 30,     Nine Months Ended September 30,       2024     2023     2024     2023   Direct costs and expenses   $ 20     $ 17     $ 54     $ 41   Research and development     110       68       240       249   Sales, marketing, general and administrative     1,385       869       5,079       4,002   Total   $ 1,515     $ 954     $ 5,373     $ 4,292   The unrecognized remaining share-based compensation expense for options and RSUs was approximately $6.5 million as of September 30, 2024 and is expected to be amortized to expense over the next 2.2 years. Stock Options Stock option activity during the nine months ended September 30, 2024, excluding the Bonus Option Program described below, was (in thousands, except weighted average exercise price and weighted average contractual life):     Number of Options     Weighted Average Exercise Price     Weighted Average Contractual Life (Years)     Aggregate Intrinsic Value   Outstanding - January 1, 2024     2,041     $ 3.36       6.9     $ 964   Granted     2,226       1.67       —       —   Forfeited/canceled     (221 )     1.96       —       —   Exercised     (27 )     0.72       —       —   Outstanding ‑ September 30, 2024     4,019     $ 2.52       7.9     $ 1,250   Exercisable ‑ September 30, 2024     1,719     $ 3.48       6.2     $ 822   Restricted Stock Unit Activity Restricted stock unit activity during the nine months ended September 30, 2024 was (in thousands, except weighted average grant date fair value per share):     Number of Shares     Weighted Average Grant Date Fair Value Per Share   Outstanding ‑ January 1, 2024     2,729     $ 1.91   Granted     1,670       1.81   Forfeited/canceled     (15 )     1.92   Released     (591 )     2.01   Outstanding ‑ September 30, 2024     3,793     $ 1.85   Bonus-to-Options Program The Company also has a Bonus-to-Options Program (the Bonus Option Program) which allows participants who so elect to convert a portion of their annual cash bonus into fully vested, non-qualified stock options to purchase shares of common stock. Participation is limited to the Chief Executive Officer, direct reports to the Chief Executive Officer and Vice Presidents of the Company. As part of the Bonus Option Program, the Company recorded the following activity during the nine months ended September 30, 2024 (in thousands, excepted weighted average exercise price and weighted average contractual life):     Number of Options     Weighted Average Exercise Price     Weighted Average Contractual Life (Years)     Aggregate Intrinsic Value   Outstanding ‑ January 1, 2024     1,050     $ 2.81       8.4     $ 22   Granted     341       1.46       —       —   Forfeited/canceled     (27 )     24.34       —       —   Exercised     —       —       —       —   Outstanding ‑ September 30, 2024     1,364     $ 2.04       8.2     $ 129   Exercisable ‑ September 30, 2024     1,364     $ 2.04       8.2     $ 129   The Company recorded $0.3 million and $0.7 million for the three and nine months ended September 30, 2024, respectively, compared to an insignificant amount and $0.2 million for the three and nine months ended September 30, 2023, respectively, related to the estimate of the Bonus Option Program. Options granted, if any, pertaining to the performance of the Bonus Option Program are typically approved and granted in first quarter of the year following completion of the fiscal year. Employee Stock Purchase Plan The ESPP provides for successive six-month offering periods beginning on September 1st and March 1st of each year. During the nine months ended September 30, 2024, 471,843 shares were issued under the ESPP leaving 175,275 shares reserved for future issuance.

v3.24.3

Net Loss per Common Share	9 Months Ended
	Sep. 30, 2024
Earnings Per Share [Abstract]
Net Loss per Common Share	Note 11 – Net Loss per Common Share Basic net loss per share excludes dilution and is computed by dividing net loss attributable to the common stockholders by the weighted-average shares outstanding during the period. Diluted net loss per common share reflects the potential dilution that could occur if securities or other contracts to issue common stock were exercised, resulting in the issuance of shares of common stock that would then share in the earnings or losses of the Company. Basic and diluted loss per share for the three and nine months ended September 30, 2024 and 2023 were (in thousands, except per share amounts):     Three Months Ended September 30,     Nine Months Ended September 30,       2024     2023     2024     2023   Numerator                         Net loss attributable to common stockholders   $ (10,258 )   $ (10,949 )   $ (34,680 )   $ (43,007 )                         Denominator                         Weighted-average shares outstanding used    in computing net loss per share, basic and diluted     146,296       79,709       123,634       78,672   Net loss per share, basic and diluted   $ (0.07 )   $ (0.14 )   $ (0.28 )   $ (0.55 ) The following outstanding common stock equivalents were excluded from diluted net loss attributable to common stockholders for the periods presented because inclusion would be anti-dilutive (in thousands):     Three Months Ended September 30,     Nine Months Ended September 30,       2024     2023     2024     2023   Options to purchase common stock     5,383       3,262       5,383       3,262   Shares committed under ESPP     22       17       22       17   Warrants     4,603       5,603       4,603       5,603   Restricted stock units     3,793       2,769       3,793       2,769   Total     13,801       11,651       13,801       11,651

v3.24.3

Income Taxes	9 Months Ended
	Sep. 30, 2024
Income Tax Disclosure [Abstract]
Income Taxes	Note 12 – Income Taxes Since inception, the Company has incurred net taxable losses, and accordingly, no provision for income taxes has been recorded. There was no cash paid for income taxes during the three and nine months ended September 30, 2024 and 2023.

v3.24.3

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2024
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Note 13 – Commitments and Contingencies Co-Development Agreement In April 2014 and amended in October 2016, the Company entered into a worldwide agreement with AVEO to develop and commercialize AVEO's hepatocyte growth factor inhibitory antibody ficlatuzumab with the Company's proprietary companion diagnostic test, BDX004, a version of the Company’s serum protein test that is commercially available to help physicians guide treatment decisions for patients with advanced non-small cell lung cancer (NSCLC). Under the terms of the agreement, AVEO conducted a proof of concept (POC) clinical study of ficlatuzumab for NSCLC in which BDX004 was used to select clinical trial subjects (the NSCLC POC Trial). Under the agreement, the Company and AVEO shared equally in the costs of the NSCLC POC Trial, and each were responsible for 50% of development and regulatory costs associated with all future clinical trials agreed upon by the Company and AVEO. In September 2020, the Company exercised its opt-out right with AVEO for the payment of 50% of development and regulatory costs for ficlatuzumab effective December 2, 2020 (the AVEO Effective Date). Following the AVEO Effective Date, the Company is entitled to a 10% royalty of net sales of ficlatuzumab and 25% of license income generated from the licensing of ficlatuzumab from AVEO. In September 2021, AVEO announced that the FDA has granted Fast Track Designation (FTD) to ficlatuzumab for the treatment of patients with relapsed or recurrent head and neck squamous cell carcinoma. In November 2021 AVEO also announced plans to initiate a registrational Phase 3 clinical trial for ficlatuzumab which began in January 2024. There were no royalties received or expenses related to this agreement for the three and nine months ended September 30, 2024 and 2023 and the Company has no obligations related to the AVEO agreement as of September 30, 2024. License Agreements In August 2019, we entered into a non-exclusive license agreement with Bio-Rad Laboratories, Inc. (Bio-Rad) (the Bio-Rad License). Under the terms of the Bio-Rad License, the Company received a non-exclusive license, without the right to grant sublicenses, to utilize certain of Bio-Rad’s intellectual property, machinery, materials, reagents, supplies and know-how necessary for the performance of Droplet Digital PCR™ (ddPCR) in cancer detection testing for third parties in the United States. The Company also agreed to purchase all of the necessary supplies and reagents for such testing exclusively from Bio-Rad, pursuant to a separately executed supply agreement (the Supply Agreement) with Bio-Rad. The Bio-Rad License was set to expire in August 2024. In May 2024, the Company amended the agreement to extend the Supply Agreement to August 2026. Either party may terminate for the other’s uncured material breach or bankruptcy events. Bio-Rad may terminate the Bio-Rad License if the Company does not purchase licensed products under the Supply Agreement for a consecutive twelve-month period or for any material breach by us of the Supply Agreement. On May 13, 2021 (the CellCarta Effective Date), we reached agreement with CellCarta Biosciences Inc. (formerly “Caprion Biosciences, Inc.”) (the CellCarta License) on a new royalty bearing license agreement for the Nodify XL2 test. The parties agreed to terminate all prior agreements and replace with this new arrangement, which has a 1% fee on net sales made from the first commercial sale of the Nodify XL2 test to the CellCarta Effective Date as an upfront make-good payment covering past royalties due and a royalty rate of 0.675% on future Nodify XL2 test net sales worldwide for 15 years from the first commercial sale, ending in 2034. Royalty expense under the CellCarta License was $0.1 million and $0.2 million for the three and nine months ended September 30, 2024, respectively, and $0.1 million for both the three and nine months ended September 30, 2023, respectively. On October 31, 2019, we completed an acquisition of Freenome's United States operations (formerly "Oncimmune USA" or "Oncimmune") including its COLA/CLIA lab in De Soto, Kansas and its pulmonary nodule malignancy test, then marketed in the United States as the EarlyCDT Lung® test. We renamed and relaunched the test on February 28, 2020 as the Nodify CDT test. As part of the acquisition of the assets of Oncimmune, the Company entered into several agreements to govern the relationship between the parties. The Company agreed to a license agreement and royalty payment related to the Nodify CDT test of 8% of recognized revenue for non-screening tests up to an annual minimum volume and 5% thereafter. Royalty expenses were $0.5 million and $1.1 million for the three and nine months ended September 30, 2024, respectively, compared to $0.2 million and $0.6 million for the three and nine months ended September 30, 2023, respectively. Litigation, Claims and Assessments From time to time, we may become involved in legal proceedings or investigations which could have an adverse impact on our reputation, business and financial condition and divert the attention of our management from the operation of our business. We are not presently a party to any legal proceedings that, if determined adversely to us, would individually or taken together have a material adverse effect on our business, results of operations, financial condition, or cash flows.

v3.24.3

Subsequent Events	9 Months Ended
	Sep. 30, 2024
Subsequent Events [Abstract]
Subsequent Events	Note 14 – Subsequent Events On October 30, 2024 (the Fourth Amendment Effective Date), the Company entered into the Fourth Amendment to the Credit Agreement and Guaranty (the Fourth Amendment) with Perceptive, as lender and administrative agent, and the Company, as borrower, whereby subject to the terms and conditions of the Fourth Amendment, the Minimum Net Revenue Covenant (as defined in the Credit Agreement) was amended to reduce the relevant threshold as of the last day of each fiscal quarter commencing on the fiscal quarter ending June 30, 2025 through and including the fiscal quarter ending December 31, 2027. On November 1, 2024, the Company expects to file a shelf registration statement on Form S-3 and enter into a new sales agreement with a financial institution, pursuant to which the Company may issue and sell, from time to time, shares of its common stock having an aggregate offering price of up to $50.0 million, subject to terms and conditions (the 2024 ATM Program). The shares of common stock offered pursuant to the 2024 ATM Program will be offered and sold by the Company pursuant to its registration statement on Form S-3 once declared effective by the SEC. Sales of common stock under the 2024 ATM Program, if any, will be made at market prices by methods deemed to be an “at-the-market offering” as defined in Rule 415 promulgated under the Securities Act of 1933, as amended, including sales made directly on the NASDAQ Global Market, or any other existing trading market for our common stock. In connection with establishing the 2024 ATM Program, the Company terminated its prior $50.0 million ATM program established in November 2021, and no additional stock can be issued thereunder.

v3.24.3

Summary of Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2024
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The accompanying unaudited condensed financial statements have been prepared in accordance with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X for interim financial information and reflect all adjustments necessary to state fairly the Company’s financial position, results of operations and cash flows for the interim periods presented. All such adjustments are of a normal recurring nature. Results for interim periods are not indicative of the results for the entire fiscal year. The accompanying unaudited condensed financial statements should be read in conjunction with the audited financial statements included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2023. Certain information and footnote disclosures, including significant accounting policies, normally included in fiscal year financial statements prepared in accordance with accounting principles generally accepted in the U.S. (GAAP) have been condensed or omitted. The condensed balance sheet as of December 31, 2023 was derived from the audited financial statements. Liquidity and Capital Resources As of September 30, 2024, we maintained cash and cash equivalents of $31.4 million and we have $40.0 million in outstanding aggregate principal amount on our Perceptive Term Loan Facility (see Note 6 – Debt). We have incurred significant losses since inception and, as a result, we have funded our operations to date primarily through the sale of common stock, the sale of convertible preferred stock, the issuance of notes payable, and from our two primary revenue sources: (i) diagnostic testing, which includes lung diagnostic testing and (ii) providing biopharmaceutical companies with development and testing services and licensing our technologies. In accordance with Accounting Standards Update 2014-15 (ASC Topic 205-40), Presentation of Financial Statements - Going Concern: Disclosure of Uncertainties about an Entity’s Ability to Continue as a Going Concern, the Company is required to evaluate whether there is substantial doubt about its ability to continue as a going concern each reporting period, including interim periods. In evaluating the Company’s ability to continue as a going concern, management projected its cash flow sources and evaluated the conditions and events that could raise substantial doubt about the Company’s ability to continue as a going concern within one year after the date that these financial statements were issued. Management considered the Company’s current projections of future cash flows, our ability to execute our current operating plan, current financial condition, sources of liquidity and debt obligations for at least one year from the date of issuance of this Form 10-Q in considering whether it has the ability to meet its obligations. Our ability to meet our obligations as they come due may be impacted by our ability to remain compliant with financial covenants in our Perceptive Term Loan Facility (see Note 6 – Debt) or to obtain waivers or amendments that impact the related covenants. As of September 30, 2024, the Company was in compliance with all restrictive and financial covenants associated with its borrowings. Our ability to maintain our financial covenants under our Perceptive Term Loan Facility during the next twelve months is, in part, dependent upon executing our current operating plan. If we do not execute our current operating plan and maintain our financial covenants, this could result in an Event of Default (as defined in the Perceptive Term Loan Facility), causing an acceleration and repayment of the outstanding balances. The Perceptive Term Loan Facility requires the Company to meet certain minimum net revenue threshold amounts agreed to between the Company and Perceptive as of the last day of each fiscal quarter, which commenced with the fiscal quarter ending March 31, 2023. During 2023, the Company entered into various amendments to the Perceptive Term Loan Facility to reduce the relevant Minimum Net Revenue thresholds. On February 29, 2024, the Company entered into a third amendment to the Perceptive Term Loan Facility, whereby, subject to the terms and conditions of the third amendment, the Minimum Net Revenue Covenant was amended to reduce the relevant threshold through the fiscal quarter ended December 31, 2025 (see Note 6 – Debt). During the three months ended June 30, 2024, the Company completed an underwritten offering of common stock and a concurrent private placement (the April 2024 Offering). Collectively, the Company raised net proceeds of approximately $51.3 million (see Note 8 – Equity). We have taken steps to improve our liquidity through raising debt and equity capital and have also undertaken several proactive measures including, among other things, the reduction of planned capital expenditures and certain operating expenses as previously disclosed. If we do not execute our current operating plan, we may need to consider further measures to reduce our operating expenses. These measures would limit or reduce our operations and could include a hiring freeze, reductions in our workforce, reduction in cash compensation, deferring capital expenditures, and reducing other operating costs. If we do not execute our current operating plan we may need to continue to raise additional funds from external sources, such as through the issuance of debt or equity securities. We may also raise additional capital to restructure our existing debt or for general working capital purposes, or both. If we raise additional capital through debt financing, we may be subject to covenants limiting or restricting our ability to take specific actions, such as incurring additional debt, making capital expenditures or declaring dividends. If we do raise additional capital through equity offerings, the ownership interest of our existing stockholders will be diluted, and the terms of these securities may include liquidation or other preferences that adversely affect our existing stockholders’ rights. There can be no assurance that additional capital will be available to us or, if available, will be available in sufficient amounts or on terms acceptable to us or on a timely basis. We expect to continue to incur operating losses in the near term while we make investments to support our anticipated growth. Our ability to maintain our financial covenants is, in part, dependent upon executing our current operating plan and, along with the items noted above, raises substantial doubt about the Company’s ability to continue as a going concern within one year after the date the financial statements are issued. Our unaudited financial statements have been prepared assuming we will continue as a going concern and do not include any adjustments that might be necessary should we be unable to continue as a going concern.
Use of Estimates	Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, the disclosure of contingent assets and liabilities at the balance sheet date and the reported amounts of revenue and expenses during the reporting periods. Actual results could differ from those estimates.
Concentrations of Credit Risk and Other Uncertainties	Concentrations of Credit Risk and Other Uncertainties Substantially all of the Company’s cash and cash equivalents are deposited with one major financial institution in the United States. The Company continually monitors its positions with, and the credit quality of, the financial institution with which it holds cash. Periodically throughout the year, the Company has maintained balances in various operating and money market accounts in excess of federally insured limits. The Company has not experienced any losses on its deposits of cash and cash equivalents. Several of the components for certain of the Company's sample collection kits, test reagents, and test systems are obtained from single-source suppliers. If these single-source suppliers fail to satisfy the Company's requirements on a timely basis, the Company could suffer delays in being able to deliver its diagnostic solutions, a possible loss of revenue, or incur higher costs, any of which could adversely affect its operating results. For a discussion of credit risk concentration of accounts receivable as of September 30, 2024 and December 31, 2023, see Note 9 – Revenue and Accounts Receivable Credit Concentration.
Restricted Cash	Restricted Cash Restricted cash consists of deposits related to the Company’s corporate credit card. For both of the periods ended September 30, 2024 and December 31, 2023, the Company had $0.1 million restricted cash, respectively, which was included in ‘Other current assets’ in the accompanying condensed balance sheets.
Inventory	Inventory Inventory consists primarily of material supplies, which are consumed in the performance of testing services and charged to ‘Direct costs and expenses’. Inventory is stated at cost and reported within ‘Other current assets’ in the condensed balance sheets and was $1.2 million and $1.4 million as of September 30, 2024 and December 31, 2023, respectively. The Company recorded a reserve for excess inventory of zero and $0.1 million as of September 30, 2024 and December 31, 2023, respectively. During the nine months ended September 30, 2024 and 2023, the Company recorded an insignificant amount and $0.1 million, respectively, to the condensed statements of operations for excess and obsolete inventory.
Other Assets	Other Assets The Company has a $5.0 million cash refundable deposit to secure the performance of the Company’s obligations associated with the operating lease agreement with Centennial Valley Properties I, LLC and subsequently assigned to CVP I Owner LLC (see Note 7 – Leases). As of September 30, 2024 and December 31, 2023, the $5.0 million refundable deposit is reported within 'Other long-term assets' in the condensed balance sheets.
Fair Value of Financial Instruments	Fair Value of Financial Instruments U.S. GAAP for fair value establishes a hierarchy that prioritizes fair value measurements based on the types of inputs used for the various valuation techniques (market approach, income approach and cost approach). We utilize a combination of market and income approaches to value our financial instruments. Our financial assets and liabilities are measured using inputs from the three levels of the fair value hierarchy. Fair value measurements are categorized within the fair value hierarchy based upon the lowest level of the most significant inputs used to determine fair value. The three levels of the hierarchy and the related inputs are as follows: Level   Inputs 1   Unadjusted quoted prices in active markets for identical assets and liabilities. 2   Unadjusted quoted prices in active markets for similar assets and liabilities;     Unadjusted quoted prices for identical or similar assets or liabilities in markets that are not active; or     Inputs other than quoted prices that are observable for the asset or liability. 3   Unobservable inputs for the asset or liability. The carrying amounts of certain financial instruments including cash and cash equivalents, accounts receivable, prepaid expenses and other current assets, other long-term assets, accounts payable and accrued liabilities approximate fair value due to their relatively short maturities. See Note 4 — Fair Value for further discussion related to estimated fair value measurements.
Recently Issued Accounting Standards	Standards Being Evaluated In November 2023, the FASB issued ASU No. 2023-07, Segment Reporting: Improvements to Reportable Segment Disclosures (ASC Topic 280). This ASU requires all public entities to provide additional disclosures about the entity's reportable segments and more detailed information about a reportable segment's expenses. This guidance will become effective for the Company for the annual period beginning on January 1, 2024, and interim periods beginning on January 1, 2025. The Company is currently evaluating this guidance and assessing the overall impact on its financial statements. In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures. This ASU improves the transparency of income tax disclosures by requiring consistent categories and greater disaggregation of information in the rate reconciliation and income taxes paid by jurisdiction. This guidance will become effective for the Company beginning January 1, 2025, with early adoption permitted. The Company is currently evaluating this guidance and assessing the overall impact on its financial statements.

v3.24.3

Fair Value (Tables)	9 Months Ended
	Sep. 30, 2024
Fair Value Disclosures [Abstract]
Summary of Fair Value of Outstanding Borrowings	The table below presents the carrying and fair values of outstanding borrowings, which are classified as Level 2, as of the dates indicated (in thousands):     As of     September 30, 2024     December 31, 2023       Carrying Value     Fair Value     Carrying Value     Fair Value   Borrowings   $ 36,141     $ 36,550     $ 35,276     $ 35,506
Schedule of Reported Fair values of Contingent Consideration and Warrant Liabilities	The table below presents the reported fair values of contingent consideration and warrant liabilities, which are classified as Level 3 in the fair value hierarchy, as of the dates indicated (in thousands):   As of    Description   September 30, 2024     December 31, 2023   Contingent consideration   $ —     $ 21,857   Warrant liabilities   $ —     $ —   Contingent value rights   $ —     $ —
Schedule of Changes in Contingent Consideration and Warrant Liabilities	The following table presents the changes in contingent consideration for the dates indicated (in thousands):     For the nine months ended September 30, 2024   Level 3 Rollforward   Contingent Consideration   Balance - January 1, 2024   $ 21,857   Interest expense     1,137   Loss on extinguishment of liabilities     248   Payments     (23,242 ) Balance - September 30, 2024   $ —     The following table presents the changes in contingent consideration and warrant liabilities for the dates indicated (in thousands):     For the nine months ended September 30, 2023   Level 3 Rollforward   Contingent Consideration     Warrant Liabilities   Beginning balances - January 1, 2023   $ 28,986     $ 61   Changes in fair value, net     —       1,332   Interest expense     3,094       —   Payments     (7,591 )     —   Ending balances - September 30, 2023   $ 24,489     $ 1,393

v3.24.3

Supplementary Balance Sheet Information (Tables)	9 Months Ended
	Sep. 30, 2024
Balance Sheet Related Disclosures [Abstract]
Schedule of Property and Equipment	Property and equipment consist of the following (in thousands):     As of       September 30, 2024     December 31, 2023   Lab equipment   $ 5,877     $ 6,089   Leasehold improvements     28,165       24,713   Computer equipment     1,307       1,221   Furniture and fixtures     1,073       1,034   Software     325       325   Vehicles     97       97   Construction in process     88       —       36,932       33,479   Less accumulated depreciation     (8,249 )     (5,612 )    Total property and equipment, net   $ 28,683     $ 27,867
Schedule of Intangible Assets, Excluding Goodwill	Intangible assets, excluding goodwill, consist of the following (in thousands):     September 30, 2024     December 31, 2023       Cost     Accumulated Amortization     Net Carrying Value     Cost     Accumulated Amortization     Net Carrying Value   Intangible assets subject to amortization                                     Patents   $ 2,000     $ (843 )   $ 1,157     $ 1,975     $ (752 )   $ 1,223   Purchased technology     16,900       (11,736 )     5,164       16,900       (10,328 )     6,572   Intangible assets not subject to     amortization                                     Trademarks     117       —       117       116       —       116      Total   $ 19,017     $ (12,579 )   $ 6,438     $ 18,991     $ (11,080 )   $ 7,911
Schedule of Future Estimated Amortization Expense of Intangible Assets	Future estimated amortization expense of intangible assets is (in thousands):   As of September 30, 2024   Remainder of 2024   $ 501   2025     2,000   2026     1,979   2027     1,021   2028     73   2029 and thereafter     747   Total   $ 6,321
Schedule of Accrued Liabilities	Accrued liabilities consist of the following (in thousands):     As of       September 30, 2024     December 31, 2023   Compensation related accruals   $ 4,958     $ 3,855   Accrued clinical trial expense     940       983   Other expenses     2,655       2,872       Total accrued liabilities   $ 8,553     $ 7,710

v3.24.3

Debt (Tables)	9 Months Ended
	Sep. 30, 2024
Debt Disclosure [Abstract]
Summary of Long-term Notes Payable	Long-term notes payable were as follows (in thousands):     As of       September 30, 2024     December 31, 2023   Perceptive Term Loan Facility   $ 40,000     $ 40,000   Other     40       78   Unamortized debt discount and debt issuance costs     (3,899 )     (4,802 )     36,141       35,276   Less: current maturities     29       51   Long-term notes payable   $ 36,112     $ 35,225
Scheduled Principal Repayments (Maturities) of Long-term Obligations	Scheduled principal repayments (maturities) of long-term obligations were as follows (in thousands):     As of September 30, 2024   Remainder of 2024   $ 13   2025     21   2026     6   2027 and thereafter     40,000   Total   $ 40,040

v3.24.3

Leases (Tables)	9 Months Ended
	Sep. 30, 2024
Leases [Abstract]
Summary of Future Minimum Lease Payments for Operating Leases	Future minimum lease payments associated with our operating leases were as follows (in thousands):     As of September 30, 2024   Remainder of 2024   $ 696   2025     3,909   2026     4,171   2027     4,063   2028     4,151   2029 and thereafter     28,113   Total future minimum lease payments     45,103   Less amount representing interest     (19,288 ) Total lease liabilities   $ 25,815

v3.24.3

Revenue and Accounts Receivable Credit Concentration (Tables)	9 Months Ended
	Sep. 30, 2024
Revenue from Contract with Customer [Abstract]
Summary of Revenue	Revenues consisted of the following (in thousands):     Three Months Ended September 30,     Nine Months Ended September 30,       2024     2023     2024     2023   Diagnostic Tests   $ 17,168     $ 12,301     $ 47,503     $ 32,395   Biopharmaceutical Services and other     983       1,190       3,391       2,024   Total revenue   $ 18,151     $ 13,491     $ 50,894     $ 34,419
Summary of Revenue and Accounts Receivable by Third-party Payors and Other Customers	The Company’s customers in excess of 10% of total revenue and their related revenue as a percentage of total revenue were as follows:     Three Months Ended September 30,     Nine Months Ended September 30,       2024     2023     2024     2023   United Healthcare     7 %     10 %     8 %     10 % The Company’s third-party payors and other customers in excess of 10% of accounts receivable, and their related accounts receivable as a percentage of total accounts receivable were as follows:     As of       September 30, 2024     December 31, 2023   Medicare     26 %     21 %

v3.24.3

Share-Based Compensation (Tables)	9 Months Ended
	Sep. 30, 2024
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Summary of Share-based Compensation Expense	Share-based compensation expense reported in the Company’s condensed statements of operations was (in thousands):     Three Months Ended September 30,     Nine Months Ended September 30,       2024     2023     2024     2023   Direct costs and expenses   $ 20     $ 17     $ 54     $ 41   Research and development     110       68       240       249   Sales, marketing, general and administrative     1,385       869       5,079       4,002   Total   $ 1,515     $ 954     $ 5,373     $ 4,292
Summary of Stock Option Activity	Stock option activity during the nine months ended September 30, 2024, excluding the Bonus Option Program described below, was (in thousands, except weighted average exercise price and weighted average contractual life):     Number of Options     Weighted Average Exercise Price     Weighted Average Contractual Life (Years)     Aggregate Intrinsic Value   Outstanding - January 1, 2024     2,041     $ 3.36       6.9     $ 964   Granted     2,226       1.67       —       —   Forfeited/canceled     (221 )     1.96       —       —   Exercised     (27 )     0.72       —       —   Outstanding ‑ September 30, 2024     4,019     $ 2.52       7.9     $ 1,250   Exercisable ‑ September 30, 2024     1,719     $ 3.48       6.2     $ 822
Summary of Restricted Stock Units Activity	Restricted stock unit activity during the nine months ended September 30, 2024 was (in thousands, except weighted average grant date fair value per share):     Number of Shares     Weighted Average Grant Date Fair Value Per Share   Outstanding ‑ January 1, 2024     2,729     $ 1.91   Granted     1,670       1.81   Forfeited/canceled     (15 )     1.92   Released     (591 )     2.01   Outstanding ‑ September 30, 2024     3,793     $ 1.85
Bonus-To-Options Program
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Summary of Stock Option Activity	As part of the Bonus Option Program, the Company recorded the following activity during the nine months ended September 30, 2024 (in thousands, excepted weighted average exercise price and weighted average contractual life):     Number of Options     Weighted Average Exercise Price     Weighted Average Contractual Life (Years)     Aggregate Intrinsic Value   Outstanding ‑ January 1, 2024     1,050     $ 2.81       8.4     $ 22   Granted     341       1.46       —       —   Forfeited/canceled     (27 )     24.34       —       —   Exercised     —       —       —       —   Outstanding ‑ September 30, 2024     1,364     $ 2.04       8.2     $ 129   Exercisable ‑ September 30, 2024     1,364     $ 2.04       8.2     $ 129

v3.24.3

Net Loss per Common Share (Tables)	9 Months Ended
	Sep. 30, 2024
Earnings Per Share [Abstract]
Schedule of Computation of Basic and Diluted Loss per Share Attributable to Stockholders	Basic and diluted loss per share for the three and nine months ended September 30, 2024 and 2023 were (in thousands, except per share amounts):     Three Months Ended September 30,     Nine Months Ended September 30,       2024     2023     2024     2023   Numerator                         Net loss attributable to common stockholders   $ (10,258 )   $ (10,949 )   $ (34,680 )   $ (43,007 )                         Denominator                         Weighted-average shares outstanding used    in computing net loss per share, basic and diluted     146,296       79,709       123,634       78,672   Net loss per share, basic and diluted   $ (0.07 )   $ (0.14 )   $ (0.28 )   $ (0.55 )
Schedule of Common Stock Equivalents Excluded from Diluted Net Loss Attributable to Common Stockholders	The following outstanding common stock equivalents were excluded from diluted net loss attributable to common stockholders for the periods presented because inclusion would be anti-dilutive (in thousands):     Three Months Ended September 30,     Nine Months Ended September 30,       2024     2023     2024     2023   Options to purchase common stock     5,383       3,262       5,383       3,262   Shares committed under ESPP     22       17       22       17   Warrants     4,603       5,603       4,603       5,603   Restricted stock units     3,793       2,769       3,793       2,769   Total     13,801       11,651       13,801       11,651

v3.24.3

Organization and Description of Business - Additional Information (Details)	9 Months Ended
	Sep. 30, 2024 Test
Organization And Description Of Business [Abstract]
Number of blood based lung cancer test	5
Number of commercial blood-based test	2

v3.24.3

Summary of Significant Accounting Policies - Additional Information (Details) - USD ($) $ in Thousands		9 Months Ended
	Apr. 09, 2024	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Summary Of Significant Accounting Policies [Line Items]
Cash and cash equivalents		$ 31,406		$ 26,284
Reserve for inventory		0		100
Restricted cash		$ 100		$ 100
Restricted Cash, Current, Statement of Financial Position [Extensible Enumeration]		Other Assets, Current		Other Assets, Current
Excess and obsolete inventory		$ 20	$ 115
April 2024 Offering
Summary Of Significant Accounting Policies [Line Items]
Private placement in net equity proceeds	$ 51,300
Other Current Assets
Summary Of Significant Accounting Policies [Line Items]
Inventory		1,200		$ 1,400
Other Long-term Assets
Summary Of Significant Accounting Policies [Line Items]
Refundable deposit		5,000		$ 5,000
Perceptive Term Loan Facility | April 2024 Offering
Summary Of Significant Accounting Policies [Line Items]
Private placement in net equity proceeds	$ 51,300
Perceptive Term Loan
Summary Of Significant Accounting Policies [Line Items]
Cash and cash equivalents		31,400
Principal balance outstanding		$ 40,000

v3.24.3

Fair Value - Summary of Fair Value of Outstanding Borrowings (Details) - Fair Value, Recurring - Level 2 - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Carrying Value
Fair Value Liabilities Measured On Recurring Basis [Line Items]
Borrowings	$ 36,141	$ 35,276
Fair Value
Fair Value Liabilities Measured On Recurring Basis [Line Items]
Borrowings	$ 36,550	$ 35,506

v3.24.3

Fair Value - Schedule of Reported Fair values of Contingent Consideration and Warrant Liabilities (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Fair Value, Recurring | Contingent Consideration | Level 3
Fair Value Liabilities Measured On Recurring Basis [Line Items]
Current portion of contingent consideration	$ 21,857

v3.24.3

Fair Value - Schedule of Changes in Contingent Consideration and Warrant Liabilities (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Loss on extinguishment of liabilities	$ 248
Fair Value, Recurring | Level 3 | Contingent Consideration
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Balance	21,857	$ 28,986
Interest expense	1,137	3,094
Loss on extinguishment of liabilities	248
Payments	(23,242)	(7,591)
Balance	$ 0	24,489
Fair Value, Recurring | Level 3 | Warrant Liabilities
Fair Value Liabilities Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Balance		61
Changes in fair value, net		1,332
Balance		$ 1,393

v3.24.3

Fair Value - Additional Information (Details) $ in Thousands				1 Months Ended					3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2024 USD ($) shares	Jul. 31, 2023 USD ($) Installment	Apr. 07, 2022	Oct. 31, 2024 USD ($)	Jul. 31, 2024 USD ($)	Apr. 30, 2024 USD ($) Installment	Apr. 30, 2022 USD ($) Installment	Jan. 31, 2016 USD ($) shares	Sep. 30, 2024 USD ($) shares	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) shares	Sep. 30, 2023 USD ($)	Dec. 31, 2018 USD ($) Installment shares	Nov. 21, 2022 shares
Fair Value Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Change in fair value of warrant liability										$ 1,393		$ 1,332
Loss on debt extinguishment											$ (248)
2018 Notes | Series G Preferred Stock
Fair Value Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Warrant issued to purchase shares | shares	613,333								613,333		613,333
Contingent Consideration
Fair Value Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest expense due to passage of time and fixed payment schedule									$ 200	1,000	$ 1,100	3,100
Contingent Consideration | Third Amendment to APA Agreement
Fair Value Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Milestone payment					$ 8,400
Warrant Liabilities
Fair Value Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Warrant issued to purchase shares | shares														5,000,000
Change in fair value of warrant liability									0	1,400	0	1,300
Contingent Value Rights | Series F Preferred Stock
Fair Value Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Change in fair value of warrant liability									$ 0	$ 0	$ 0	$ 0
Percentage of net proceeds								15.00%
Contingent Value Rights | Series F Preferred Stock | Ficlatuzumab
Fair Value Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent value rights interest rate								0.00375%
Shares issued | shares								3,999
Drug interest rate percentage								15.00%
Contingent value rights								$ 500
Integrated Diagnostics, Inc
Fair Value Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Exit fee payment	$ 6,100
Integrated Diagnostics, Inc | Contingent Consideration
Fair Value Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Business acquisition description											requires additional consideration to be paid by the Company to such shareholders upon attainment of a three-consecutive month
Business acquisition contingent consideration gross margin target													$ 2,000
Business acquisition contingent consideration gross margin target period													7 years
Integrated Diagnostics, Inc | Contingent Consideration | Third Amendment to APA Agreement
Fair Value Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration number of installments | Installment		3				1	5
Milestone payment		$ 3,000				$ 5,000	$ 2,000
Percentage of interest on installment payments			10.00%
Integrated Diagnostics, Inc | Contingent Consideration | Subsequent Event | Third Amendment to APA Agreement
Fair Value Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Exit fee payment				$ 6,100
Integrated Diagnostics, Inc | Common Stock | Contingent Consideration
Fair Value Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Business acquisition description											If Indi elected to not exercise its option, the Company had 12 months to repurchase the common stock in two equal and consecutive quarterly cash installments totaling $37.0 million.
Contingent consideration shares | shares													2,520,108
Contingent consideration number of installments | Installment													8
Contingent consideration arrangements, common shares, redemption amount											$ 4,600		$ 37,000
Repayments of debt											9,300
Business combination contingent consideration final payment											$ 37,000
Contingent consideration cash payment													$ 37,000
Investment, Type [Extensible Enumeration]													Repurchase [Member]
Minimum | Contingent Consideration
Fair Value Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Percentage of probabilities of contingent consideration successful achievement of specified product gross margin targets discount rates range											11.00%
Maximum | Contingent Consideration
Fair Value Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Percentage of probabilities of contingent consideration successful achievement of specified product gross margin targets discount rates range											16.00%

v3.24.3

Supplementary Balance Sheet Information - Property and Equipment (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 36,932	$ 33,479
Less accumulated depreciation	(8,249)	(5,612)
Total property and equipment, net	28,683	27,867
Lab Equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	5,877	6,089
Leasehold Improvements
Property, Plant and Equipment [Line Items]
Property and equipment, gross	28,165	24,713
Computer Equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	1,307	1,221
Furniture and Fixtures
Property, Plant and Equipment [Line Items]
Property and equipment, gross	1,073	1,034
Software
Property, Plant and Equipment [Line Items]
Property and equipment, gross	325	325
Vehicles
Property, Plant and Equipment [Line Items]
Property and equipment, gross	97	$ 97
Construction in Process
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 88

v3.24.3

Supplementary Balance Sheet Information - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Property Plant And Equipment [Line Items]
Depreciation expense	$ 1.0	$ 0.3	$ 2.8	$ 0.9
Amortization expense of definite-lived intangible assets	$ 0.5	$ 1.5	$ 0.5	$ 1.5

v3.24.3

Supplementary Balance Sheet Information - Intangible Assets, Excluding Goodwill (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Finite Lived Intangible Assets [Line Items]
Intangible assets subject to amortization, Net Carrying Value	$ 6,321
Intangible assets, Cost	19,017	$ 18,991
Intangible assets, Accumulated Amortization	(12,579)	(11,080)
Intangible assets, Net Carrying Value	6,438	7,911
Trademarks
Finite Lived Intangible Assets [Line Items]
Intangible assets not subject to amortization, Cost	117	116
Intangible assets not subject to amortization, Net Carrying Value	117	116
Patents
Finite Lived Intangible Assets [Line Items]
Intangible assets subject to amortization, Cost	2,000	1,975
Intangible assets subject to amortization, Accumulated Amortization	(843)	(752)
Intangible assets subject to amortization, Net Carrying Value	1,157	1,223
Purchased Technology
Finite Lived Intangible Assets [Line Items]
Intangible assets subject to amortization, Cost	16,900	16,900
Intangible assets subject to amortization, Accumulated Amortization	(11,736)	(10,328)
Intangible assets subject to amortization, Net Carrying Value	$ 5,164	$ 6,572

v3.24.3

Supplementary Balance Sheet Information - Schedule of Amortization Related to Remaining Net Intangible Assets Schedule to Amortize (Details) $ in Thousands	Sep. 30, 2024 USD ($)
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract]
Remainder of 2024	$ 501
2025	2,000
2026	1,979
2027	1,021
2028	73
2029 and thereafter	747
Intangible assets subject to amortization, Net Carrying Value	$ 6,321

v3.24.3

Supplementary Balance Sheet Information - Accrued Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Balance Sheet Related Disclosures [Abstract]
Compensation related accruals	$ 4,958	$ 3,855
Accrued clinical trial expense	940	983
Other expenses	2,655	2,872
Total accrued liabilities	$ 8,553	$ 7,710

v3.24.3

Debt - Summary of Long-term Notes Payable (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Unamortized debt discount and debt issuance costs	$ (3,899)	$ (4,802)
Notes payable, total	36,141	35,276
Less: current maturities	29	51
Long-term notes payable	36,112	35,225
Perceptive Term Loan Facility
Debt Instrument [Line Items]
Notes/Loan payable	40,000	40,000
Other
Debt Instrument [Line Items]
Notes/Loan payable	$ 40	$ 78

v3.24.3

Debt - Additional Information (Details) - USD ($)				9 Months Ended
	Aug. 04, 2023	Nov. 21, 2022	Nov. 16, 2022	Sep. 30, 2024	Sep. 30, 2023	Dec. 15, 2023	May 10, 2023
Debt Instrument [Line Items]
Proceeds from the issuance of common stock				$ 55,625,000	$ 15,316,000
Amount withdrawn				$ 40,040,000
First Amendment
Debt Instrument [Line Items]
Warrant issued to purchase shares							500,000
Warrant, exercise price							$ 1.6254
Initial warrants amount							$ 700,000
2018 Notes | Series G Preferred Stock
Debt Instrument [Line Items]
Warrant issued to purchase shares				613,333
Warrant, exercise price				$ 0.75
Perceptive Term Loan Facility
Debt Instrument [Line Items]
Debt instrument maturity date			Nov. 21, 2027
Interest rate			3.00%
Applicable margin rate			9.00%
Effective interest rate				13.90%
Warrant, exercise price			$ 1.0648
Public offering price per share of common stock		$ 1.15
Minimum cash balance at maturity date				$ 2,500,000
Initial warrants amount		$ 2,900,000	$ 2,900,000
Additional warrants amount			100,000
Debt instrument, discount			5,200,000
Perceptive Term Loan Facility | Tranche A Loan
Debt Instrument [Line Items]
Net proceeds from debt, after deducting debt issuance costs and expenses			$ 27,900,000
Warrant, exercise price		$ 1.0648
Perceptive Term Loan Facility | Tranche B Loan
Debt Instrument [Line Items]
Warrant, exercise price			$ 1.0648
Additional warratns exercisable			1,000,000
Amount withdrawn						$ 10,000,000
Perceptive Term Loan Facility | Tranche C Loan
Debt Instrument [Line Items]
Additional warratns exercisable			1,000,000
Amount withdrawn				$ 0
Perceptive Term Loan Facility | Minimum
Debt Instrument [Line Items]
Prepayment premium percentage of aggregate outstanding principal amount			2.00%
Perceptive Term Loan Facility | Maximum
Debt Instrument [Line Items]
Prepayment premium percentage of aggregate outstanding principal amount			10.00%
Warrant issued to purchase shares		5,000,000	5,000,000
Perceptive Term Loan Facility | Maximum | Tranche A Loan
Debt Instrument [Line Items]
Debt instrument, aggregate principal amount		$ 30,000,000
Perceptive Term Loan Facility | Maximum | Tranche B Loan
Debt Instrument [Line Items]
Debt instrument, aggregate principal amount			$ 10,000,000
Perceptive Term Loan Facility | Maximum | Tranche C Loan
Debt Instrument [Line Items]
Debt instrument, aggregate principal amount			$ 10,000,000
Second Amendment | Tranche B Loan
Debt Instrument [Line Items]
Gross proceeds from sale of common shares	$ 27,500,000
Amount withdrawn						$ 10,000,000

v3.24.3

Debt - Scheduled Principal Repayments (Maturities) of Long-term Obligations (Details) $ in Thousands	Sep. 30, 2024 USD ($)
Maturities of Long-Term Debt [Abstract]
Remainder of 2024	$ 13
2025	21
2026	6
2027 and thereafter	40,000
Total	$ 40,040

v3.24.3

Leases - Additional Information (Details)		1 Months Ended		3 Months Ended		9 Months Ended
	Mar. 11, 2022 USD ($) ft² RenewalOption	Mar. 31, 2025 USD ($)	Sep. 30, 2024 USD ($) ft²	Sep. 30, 2024 USD ($) ft²	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) ft²	Sep. 30, 2023 USD ($)	Jun. 30, 2024 ft²	Dec. 31, 2023 USD ($)	Sep. 30, 2022 USD ($)
Lessee, Lease, Description [Line Items]
Operating lease expense				$ 600,000	$ 1,100,000	$ 1,700,000	$ 3,300,000
Operating leases, Weighted-average remaining lease term (in years)			10 years 3 months 18 days	10 years 3 months 18 days		10 years 3 months 18 days
Operating leases, Weighted-average discount rate			11.40%	11.40%		11.40%
Restricted Cash, Current, Statement of Financial Position [Extensible Enumeration]			Other current assets	Other current assets		Other current assets			Other current assets
Scenario Forecast
Lessee, Lease, Description [Line Items]
Accretion of lease liability		$ 25,500,000
Centennial Valley Properties I, LLC Lease Agreement
Lessee, Lease, Description [Line Items]
Lease description						The initial term of the Lease is twelve years (the Initial Term) from the commencement date, which was April 1, 2023 (the Commencement Date). The Company has two renewal options to extend the term of the Lease for an additional seven- or ten-year terms for each renewal.
Lease term	12 years
Lease commencement date	Apr. 01, 2023
Lease agreement number of options to extend | RenewalOption	2
Lease option to extend	true
Leased property building capacity | ft²	79,980
Base rent per month from commencement date	$ 227,000
Rent after fixed escalation provisions	$ 326,000
Area of leased premised obligated to pay base rent | ft²	19,980
Landlord contribution towards cost of construction and tenant improvements	$ 18,800,000
Additional Tenant improvement allowance			$ 2,000,000
Restricted Cash, Current, Statement of Financial Position [Extensible Enumeration]			Other long-term assets	Other long-term assets		Other long-term assets
Interest rate on extra allowance amount	6.00%
Capital expenditure for leasehold improvements related to leases premises which are tenant improvements									$ 20,800,000
Centennial Valley Properties I, LLC Lease Agreement | Letter of Credit | Cash Collateralized
Lessee, Lease, Description [Line Items]
Long-term Line of Credit										$ 5,000,000
Minimum
Lessee, Lease, Description [Line Items]
Operating lease, expiration term			1 year	1 year		1 year
Maximum
Lessee, Lease, Description [Line Items]
Operating lease, expiration term			3 years	3 years		3 years
Other Long-term Assets
Lessee, Lease, Description [Line Items]
Refundable deposit			$ 5,000,000	$ 5,000,000		$ 5,000,000			$ 5,000,000
Other Long-term Assets | Centennial Valley Properties I, LLC Lease Agreement
Lessee, Lease, Description [Line Items]
Refundable deposit			$ 5,000,000	$ 5,000,000		$ 5,000,000
KANSAS
Lessee, Lease, Description [Line Items]
Area of office space leased | ft²			9,066	9,066		9,066
Area of additional office space leased | ft²								1,772

v3.24.3

Leases - Summary of Future Minimum Lease Payments for Operating Leases (Details) $ in Thousands	Sep. 30, 2024 USD ($)
Lessee, Operating Lease, Liability, to be Paid, Fiscal Year Maturity [Abstract]
Operating leases, Remainder of 2024	$ 696
Operating leases, 2025	3,909
Operating leases, 2026	4,171
Operating leases, 2027	4,063
Operating leases, 2028	4,151
Operating leases, 2029 and thereafter	28,113
Operating leases, Total future minimum lease payments	45,103
Operating leases, Less amount representing interest	(19,288)
Operating lease liability	$ 25,815

v3.24.3

Equity - Additional Information (Details)							1 Months Ended	3 Months Ended					9 Months Ended		12 Months Ended
	May 23, 2024 shares	Apr. 09, 2024 USD ($) shares	Apr. 08, 2024 shares	Apr. 05, 2024 USD ($) $ / shares shares	Nov. 21, 2022 USD ($) $ / shares shares	Mar. 07, 2022 USD ($) shares	Nov. 30, 2021 USD ($)	Sep. 30, 2024 USD ($) $ / shares shares	Jun. 30, 2024 USD ($)	Mar. 31, 2024 USD ($)	Sep. 30, 2023 USD ($)	Mar. 31, 2023 USD ($)	Sep. 30, 2024 USD ($) Facility $ / shares shares	Sep. 30, 2023 USD ($)	Dec. 22, 2022 USD ($)	May 21, 2024 shares	Dec. 31, 2023 $ / shares	Dec. 15, 2023 USD ($)	May 10, 2023 USD ($) $ / shares shares	Nov. 16, 2022 USD ($) $ / shares shares
Class of Stock [Line Items]
Proceeds from the sale of common shares													$ 55,625,000	$ 15,316,000
Aggregate offering price								$ (15,000)	$ 18,198,000	$ 607,000	$ 15,316,000	$ (61,000)
Preferred stock, par value | $ / shares								$ 0.001					$ 0.001				$ 0.001
Warrants, expires period								Feb. 23, 2028					Feb. 23, 2028
Perceptive Term Loan Facility
Class of Stock [Line Items]
Public offering price per share of common stock | $ / shares					$ 1.15
Initial warrants amount					$ 2,900,000															$ 2,900,000
Warrants, expires period					Nov. 21, 2032
Warrant, exercise price | $ / shares																				$ 1.0648
Series G Preferred Stock | 2018 Notes
Class of Stock [Line Items]
Warrant issued to purchase shares | shares								613,333					613,333
Warrant, exercise price | $ / shares								$ 0.75					$ 0.75
Series A Preferred Stock
Class of Stock [Line Items]
Number of common shares issuable upon conversion of preferred stock | shares			40													40
Minimum
Class of Stock [Line Items]
Percentage of common stock issued and outstanding required for conversion of securities			0.00%
Maximum
Class of Stock [Line Items]
Aggregate offering price							$ 50,000,000
Percentage of common stock issued and outstanding required for conversion of securities			19.90%
Maximum | Perceptive Term Loan Facility
Class of Stock [Line Items]
Warrant issued to purchase shares | shares					5,000,000															5,000,000
Maximum | Series A Preferred Stock
Class of Stock [Line Items]
Issuance of common stock, net, Shares | shares			760,857
Tranche B Loan | Perceptive Term Loan Facility
Class of Stock [Line Items]
Warrants, expires period																				Dec. 15, 2033
Warrant, exercise price | $ / shares																				$ 1.0648
Tranche A Loan | Perceptive Term Loan Facility
Class of Stock [Line Items]
Warrant, exercise price | $ / shares					$ 1.0648
Equity Financing Programs
Class of Stock [Line Items]
Number of facility | Facility													2
Proceeds from the sale of common shares													$ 600,000
Equity Financing Programs | Lincoln Park
Class of Stock [Line Items]
Common stock issuable, committed to purchase						$ 600,000
Diligence expenses and legal fees						$ 100,000
Purchase agreement term						36 months
Shares issued as commitment fee | shares						184,275
Commitment shares issuable on conditional basis | shares						61,425
Adjustments to additional paid-in capital deferred offering costs								$ 0			$ 0		0	$ 0
Deferred offering costs						$ 700,000		0					0
Deferred offering costs								$ 0					700,000
Equity Financing Programs | Lincoln Park | Maximum
Class of Stock [Line Items]
Common stock issuable, committed to purchase						50,000,000
Shares issued as commitment fee, value						$ 20,000,000
At-The-Market Offering
Class of Stock [Line Items]
Net proceeds from sale of common shares after deducting underwriting discounts and commissions and offering expenses													$ 600,000
IPO
Class of Stock [Line Items]
Warrant issued to purchase shares | shares								103,326					103,326
Warrant, exercise price | $ / shares								$ 4.46					$ 4.46
April 2024 Offering
Class of Stock [Line Items]
Private placement in net equity proceeds		$ 51,300,000
Underwritten Offering
Class of Stock [Line Items]
Proceeds from the sale of common shares		$ 18,300,000
Issuance of common stock, net, Shares | shares		17,391,832
Price per share | $ / shares				$ 1.15
Expected Term | Perceptive Term Loan Facility
Class of Stock [Line Items]
Warrants expected term					10 years
Volatility | Perceptive Term Loan Facility
Class of Stock [Line Items]
Warrants and rights outstanding, measurement input					81.3
Dividend Yield | Perceptive Term Loan Facility
Class of Stock [Line Items]
Warrants and rights outstanding, measurement input					0
Risk-Free Interest Rate | Perceptive Term Loan Facility
Class of Stock [Line Items]
Warrants and rights outstanding, measurement input					3.67
Securities Purchase Agreements | Series A Preferred Stock
Class of Stock [Line Items]
Issuance of common stock, net, Shares | shares				760,857
Preferred stock, par value | $ / shares				$ 0.001
Price per share | $ / shares				$ 46
Private placement in net equity proceeds				$ 35,000,000
Registration Rights Agreement | Series A Preferred Stock
Class of Stock [Line Items]
Shares of common stock issued upon conversion of Series A preferred stock | shares	30,434,280
ATM Facility | Maximum
Class of Stock [Line Items]
Aggregate offering price															$ 50,000,000
Issuance of common stock, net, Shares | shares				100,000
ATM Facility | Equity Financing Programs
Class of Stock [Line Items]
Issuance of common stock, net, Shares | shares													313,928
Weighted Average Price Per Share | $ / shares													$ 1.99
ATM Facility | Equity Financing Programs | Maximum
Class of Stock [Line Items]
Line of Credit Facility, Remaining Borrowing Capacity								$ 28,200,000					$ 28,200,000
LPC Facility | Equity Financing Programs
Class of Stock [Line Items]
Line of Credit Facility, Remaining Borrowing Capacity								$ 46,900,000					$ 46,900,000
First Amendment
Class of Stock [Line Items]
Warrant issued to purchase shares | shares																			500,000
Initial warrants amount																			$ 700,000
Warrants, expires period																			May 10, 2033
Warrant, exercise price | $ / shares																			$ 1.6254
First Amendment | Expected Term
Class of Stock [Line Items]
Warrants expected term																			10 years
First Amendment | Volatility
Class of Stock [Line Items]
Warrants and rights outstanding, measurement input																			78.7
First Amendment | Dividend Yield
Class of Stock [Line Items]
Warrants and rights outstanding, measurement input																			0
First Amendment | Risk-Free Interest Rate
Class of Stock [Line Items]
Warrants and rights outstanding, measurement input																			3.49
Tranche B Warrants
Class of Stock [Line Items]
Initial warrants amount																		$ 1,300,000
Warrants, expires period																		Dec. 15, 2033
Tranche B Warrants | Expected Term
Class of Stock [Line Items]
Warrants expected term																		10 years
Tranche B Warrants | Volatility
Class of Stock [Line Items]
Warrants and rights outstanding, measurement input																		76.2
Tranche B Warrants | Dividend Yield
Class of Stock [Line Items]
Warrants and rights outstanding, measurement input																		0
Tranche B Warrants | Risk-Free Interest Rate
Class of Stock [Line Items]
Warrants and rights outstanding, measurement input																		3.91

v3.24.3

Revenue and Accounts Receivable Credit Concentration - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Disaggregation Of Revenue [Line Items]
Primary sources of revenue, description			We derive our revenue from two primary sources: (i) providing diagnostic testing in the clinical setting (Diagnostic Tests); and (ii) providing biopharmaceutical companies with services that include diagnostic research, clinical research, clinical trial testing, development and testing services provided outside the clinical setting and governed by individual contracts with third parties as well as development and commercialization of companion diagnostics. We also recognize revenue from other services, including amounts derived from licensing our technologies (Biopharmaceutical Services and other).
Revenue recognized			$ 500
Deferred revenue	$ 676		$ 676		$ 324
Revenue | Minimum | Customer Concentration Risk | Medicare
Disaggregation Of Revenue [Line Items]
Concentration risk, percentage	40.00%	41.00%	40.00%	45.00%
Up Front Cash Payments
Disaggregation Of Revenue [Line Items]
Deferred revenue	$ 900		$ 900
Other Long-term Liabilities
Disaggregation Of Revenue [Line Items]
Non-current deferred revenue	$ 300		$ 300		$ 300

v3.24.3

Revenue and Accounts Receivable Credit Concentration - Summary of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Disaggregation Of Revenue [Line Items]
Revenues	$ 18,151	$ 13,491	$ 50,894	$ 34,419
Diagnostic Tests
Disaggregation Of Revenue [Line Items]
Revenues	17,168	12,301	47,503	32,395
Biopharma Services and Other
Disaggregation Of Revenue [Line Items]
Revenues	$ 983	$ 1,190	$ 3,391	$ 2,024

v3.24.3

Revenue and Accounts Receivable Credit Concentration - Summary of Revenue and Accounts Receivable by Third-party Payors and Other Customers (Details) - Customer Concentration Risk - Minimum	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Revenue | United Healthcare
Concentration Risk [Line Items]
Concentration risk, percentage	7.00%	10.00%	8.00%	10.00%
Revenue | Medicare
Concentration Risk [Line Items]
Concentration risk, percentage	40.00%	41.00%	40.00%	45.00%
Accounts Receivable | Medicare
Concentration Risk [Line Items]
Concentration risk, percentage			26.00%		21.00%

v3.24.3

Share-Based Compensation - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Common stock remained available for future issuance	809,163		809,163
Stock compensation expense	$ 1,515	$ 954	$ 5,373	$ 4,292
Number of shares reserved for issuance	175,275		175,275
Shares issued			471,843
Description of offering period under plan			ESPP provides for successive six-month offering periods beginning on September 1st and March 1st of each year.
Options and Restricted Stock Units (RSUs)
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Remaining unrecognized share based compensation expense for options and restricted stock units	$ 6,500		$ 6,500
Amortized to expense period			2 years 2 months 12 days
Bonus-To-Options Program
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock compensation expense	$ 300	$ 200	$ 700	$ 200

v3.24.3

Share-Based Compensation - Summary of Share-based Compensation Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Total share-based compensation expense	$ 1,515	$ 954	$ 5,373	$ 4,292
Direct Costs and Expenses
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Total share-based compensation expense	20	17	54	41
Research and Development
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Total share-based compensation expense	110	68	240	249
Sales, Marketing, General and Administrative
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Total share-based compensation expense	$ 1,385	$ 869	$ 5,079	$ 4,002

v3.24.3

Share-Based Compensation - Summary of Stock Option Activity (Details) $ / shares in Units, shares in Thousands, $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2024 USD ($) $ / shares shares	Dec. 31, 2023 USD ($) $ / shares shares
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock Options, Outstanding - January 1, 2024 | shares	2,041
Stock Options, Granted | shares	2,226
Stock Options, Forfeited/canceled | shares	(221)
Stock Options, Exercised | shares	(27)
Stock Options, Outstanding - September 30, 2024 | shares	4,019	2,041
Stock Options Exercisable - September 30, 2024 | shares	1,719
Weighted Average Exercise Price, Outstanding - January 1, 2024 | $ / shares	$ 3.36
Weighted Average Exercise Price, Granted | $ / shares	1.67
Weighted Average Exercise Price, Forfeited/canceled | $ / shares	1.96
Weighted Average Exercise Price, Exercised | $ / shares	0.72
Weighted Average Exercise Price, Outstanding - September 30, 2024 | $ / shares	2.52	$ 3.36
Weighted Average Exercise Price, Exercisable - September 30, 2024 | $ / shares	$ 3.48
Weighted Average Contractual Life (Years), Outstanding	7 years 10 months 24 days	6 years 10 months 24 days
Weighted Average Contractual Life (Years), Exercisable - September 30, 2024	6 years 2 months 12 days
Aggregate Intrinsic Value, Outstanding - January 1, 2024 | $	$ 964
Aggregate Intrinsic Value, Outstanding - September 30, 2024 | $	1,250	$ 964
Aggregate Intrinsic Value, Exercisable - September 30, 2024 | $	$ 822
Bonus-To-Options Program
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock Options, Outstanding - January 1, 2024 | shares	1,050
Stock Options, Granted | shares	341
Stock Options, Forfeited/canceled | shares	(27)
Stock Options, Outstanding - September 30, 2024 | shares	1,364	1,050
Stock Options Exercisable - September 30, 2024 | shares	1,364
Weighted Average Exercise Price, Outstanding - January 1, 2024 | $ / shares	$ 2.81
Weighted Average Exercise Price, Granted | $ / shares	1.46
Weighted Average Exercise Price, Forfeited/canceled | $ / shares	24.34
Weighted Average Exercise Price, Outstanding - September 30, 2024 | $ / shares	2.04	$ 2.81
Weighted Average Exercise Price, Exercisable - September 30, 2024 | $ / shares	$ 2.04
Weighted Average Contractual Life (Years), Outstanding	8 years 2 months 12 days	8 years 4 months 24 days
Weighted Average Contractual Life (Years), Exercisable - September 30, 2024	8 years 2 months 12 days
Aggregate Intrinsic Value, Outstanding - January 1, 2024 | $	$ 22
Aggregate Intrinsic Value, Outstanding - September 30, 2024 | $	129	$ 22
Aggregate Intrinsic Value, Exercisable - September 30, 2024 | $	$ 129

v3.24.3

Share-Based Compensation - Summary of Restricted Stock Units Activity (Details) - Restricted Stock Units shares in Thousands	9 Months Ended
	Sep. 30, 2024 $ / shares shares
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Number of Shares, Outstanding - January 1, 2024 | shares	2,729
Number of Shares, Granted | shares	1,670
Number of Shares, Forfeited/canceled | shares	(15)
Number of Shares, Released | shares	(591)
Number of Shares, Outstanding - September 30, 2024 | shares	3,793
Weighted Average Grant Date Fair Value Per Share, January 1, 2024 | $ / shares	$ 1.91
Weighted Average Grant Date Fair Value Per Share, Granted | $ / shares	1.81
Weighted Average Grant Date Fair Value Per Share, Forefeited/canceled | $ / shares	1.92
Weighted Average Grant Date Fair Value Per Share, Released | $ / shares	2.01
Weighted Average Grant Date Fair Value Per Share, September 30, 2024 | $ / shares	$ 1.85

v3.24.3

Net Loss per Common Share - Schedule of Computation of Basic and Diluted Loss per Share Attributable to Stockholders (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023
Numerator
Net loss attributable to common stockholders	$ (10,258)	$ (10,808)	$ (13,614)	$ (10,949)	$ (13,356)	$ (18,702)	$ (34,680)	$ (43,007)
Denominator
Weighted-average shares outstanding, basic	146,296			79,709			123,634	78,672
Weighted-average shares outstanding, diluted	146,296			79,709			123,634	78,672
Net loss per share, basic	$ (0.07)			$ (0.14)			$ (0.28)	$ (0.55)
Net loss per share, diluted	$ (0.07)			$ (0.14)			$ (0.28)	$ (0.55)

v3.24.3

Net Loss per Common Share - Schedule of Common Stock Equivalents Excluded from Diluted Net Loss Attributable to Common Stockholders (Details) - shares shares in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Total	13,801	11,651	13,801	11,651
Options to Purchase Common Stock
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Total	5,383	3,262	5,383	3,262
Shares Committed Under ESPP
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Total	22	17	22	17
Warrants
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Total	4,603	5,603	4,603	5,603
Restricted Stock Units
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Total	3,793	2,769	3,793	2,769

v3.24.3

Income Taxes - Additional Information (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Income Tax Disclosure [Abstract]
Provision for income taxes			$ 0
Cash paid for income taxes	$ 0	$ 0	$ 0	$ 0

v3.24.3

Commitments and Contingencies - Additional Information (Details) - USD ($)			1 Months Ended	3 Months Ended		9 Months Ended
	May 13, 2021	Dec. 02, 2020	Sep. 30, 2020	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Oct. 31, 2016
Loss Contingencies [Line Items]
Research and development				$ 2,547,000	$ 1,938,000	$ 7,145,000	$ 8,099,000
Revenue Share Agreement | Oncimmune Limited
Loss Contingencies [Line Items]
Royalty expense				500,000	200,000	$ 1,100,000	600,000
Percentage of license agreement and royalty payment related to Nodify CDT test recognized revenue for non-screening tests						8.00%
Minimum annual volume percentage thereafter						5.00%
Bio-Rad License
Loss Contingencies [Line Items]
License expiry date						2024-08
CellCarta License
Loss Contingencies [Line Items]
Percentage of royalty payments on net revenue	0.675%
Percentage of fee payments on net sales	1.00%
Term of royalty payments from first commercial sale	15 years
Year of ending royalty payments from first commercial sale	2034
Royalty expense				100,000	100,000	$ 200,000	100,000
AVEO Oncology
Loss Contingencies [Line Items]
Research and development				0	$ 0	0	$ 0
Obligations related to agreement.				$ 0		$ 0
AVEO Oncology | Ficlatuzumab
Loss Contingencies [Line Items]
Percentage of development and regulatory costs exercised using opt-out right			50.00%
Percentage of royalty payments on net sales		10.00%
Percentage of license income generated from licensing		25.00%
AVEO Oncology | NSCLC POC Trial
Loss Contingencies [Line Items]
Responsible percentage of development and regulatory costs								50.00%

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