we perform all of our avise ® tests in our approximately 8,000 square foot clinical laboratory , which is certified by clia and accredited by cap , and located in vista , california . our laboratory is certified for performance of high-complexity testing by cms in accordance with clia . we are approved to offer our products in all 50 states . our clinical laboratory reports all avise ® testing product results within five business days . in the fourth quarter of 2020 , we completed the build-out of approximately 2,000 additional square feet to our clinical laboratory . 77 we market our avise ® testing products using our specialized salesforce . unlike many diagnostic salesforces that are trained only to understand the comparative benefits of their tests , the specialized backgrounds of our salesforce coupled with our comprehensive training enables our sales representatives to interpret results from our de-identified patient test reports and provide unique insights in a highly tailored discussion with rheumatologists . our integrated testing and therapeutics strategy results in a unique opportunity to promote and sell targeted therapies in patient focused sales calls with rheumatologists , including those with whom we have a longstanding relationship and history using our portfolio of testing products . reimbursement for our testing services comes from several sources , including commercial third-party payors , such as insurance companies and health maintenance organizations , government payors , such as medicare , and patients . reimbursement rates vary by product and payor . we continue to focus on expanding coverage among existing contracted rheumatologists and to achieve coverage with commercial payors , laboratory benefit managers and evidence review organizations . since inception we have devoted substantially all our efforts developing and marketing products for the diagnosis , prognosis and monitoring of autoimmune diseases . although our revenue has increased sequentially year over year , we have never been profitable and , as of december 31 , 2020 we had an accumulated deficit of $ 181.3 million . we incurred net losses of $ 16.7 million and $ 12.0 million for the years ended december 31 , 2020 and 2019 , respectively . we expect to continue to incur operating losses in the near term as our operating expenses will increase to support the growth of our business , as well as additional costs associated with being a public company . we have funded our operations primarily through equity and debt financings and revenue from sales of our products . through the date of our initial public offering ( ipo ) in september 2019 , our operations were financed primarily from sales of our common and redeemable convertible preferred stock and borrowings under various debt financings . in september 2019 , we completed our ipo of 4,140,000 shares of our common stock at a price to the public of $ 14.00 per share , including the exercise in full by the underwriters of their option to purchase 540,000 additional shares of our common stock . including the option exercise , the aggregate net proceeds to us from the offering was approximately $ 50.4 million , net of underwriting discounts , commissions and other offering expenses , for aggregate expenses of approximately $ 7.5 million . as of december 31 , 2020 , we had $ 57.4 million of cash and cash equivalents . impact of covid-19 the current covid-19 worldwide pandemic has presented substantial public health challenges and is affecting our employees , patients , physicians and other healthcare providers , communities and business operations , as well as the u.s. and global economies and financial markets . international and u.s. governmental authorities in impacted regions are taking actions in an effort to slow the spread of covid-19 , including issuing varying forms of `` stay-at-home `` orders , restricting business functions outside of one 's home , restricting gatherings , restricting travel , and mandating social distancing and face coverings . certain jurisdictions have begun re-opening only to return to restrictions due to increases in new covid-19 cases . even in areas where `` stay-at-home `` restrictions have been lifted and the number of covid-19 cases have declined , many individuals remain cautious about resuming activities such as preventative-care medical visits . as a result of covid-19 related limitations and reordering of priorities across the u.s. healthcare system , a reduction in patient flow occurred and our test volumes began to decrease in the second half of march 2020. we experienced an avise ® ctd volume decrease of approximately 5 % in the year ended december 31 , 2020 as compared to 2019. by the end of the third quarter of 2020 , the number of avise ® ctd tests delivered substantially recovered to pre-covid-19 avise ® ctd tests reported in the first quarter of 2020 , and in the fourth quarter of 2020 , the number of avise ® ctd delivered exceeded our pre-covid-19 avise ® ctd tests reported in the first quarter of 2020. for the three months ended december 31 , 2020 as compared to the same period in 2019 , we experienced a avise ® ctd volume increase of approximately 5 % . however , the continued spread of covid-19 may adversely affect testing volumes in future periods , the extent of which is highly uncertain . in addition , we believe there are several other important factors that have impacted , and that we expect will impact our operating performance and results of operations , including shutdowns of our facilities and operations as well as those of our suppliers and courier services , disruptions to the supply chain of material needed for our tests , our sales and commercialization activities and our ability to receive specimens and perform or deliver the results from our tests , delays in reimbursement and coverage decisions from medicare and third-party payors and in interactions with regulatory authorities , as well as our inability to achieve volume-based pricing discounts with our key suppliers story_separator_special_tag as a result , our costs of revenue as a percentage of revenue may vary significantly from period to period due to the composition of payors for each month 's billings . assuming future testing volumes are not negatively impacted by the spread of covid-19 , we expect that our costs of revenue will increase in absolute dollars as the number of tests we perform increases . however , we expect that the cost per test will decrease over time due to volume discounts on materials and shipping costs and other volume efficiencies we may gain as the number of tests we perform increases . as discussed above , the continued spread of covid-19 may adversely affect testing volumes which may result in an increase in cost per test due to our inability to realize volume efficiencies . selling , general and administrative expenses selling , general and administrative expenses consist of personnel costs , including stock-based compensation expense , direct marketing expenses , accounting and legal expenses , consulting costs , and allocated overhead including rent , information technology , depreciation and utilities . we expect that our selling , general and administrative expenses will increase in absolute dollars in 2021 as compared to 2020 , as we continue to evaluate the reach and frequency of our sales and sales support functions , expected additions to headcount and increases for personnel costs , including stock-based compensation . research and development expenses research and development expenses include costs incurred to develop our technology , testing products and product candidates , collect clinical specimens and conduct clinical studies to develop and support our testing products and product candidates . these costs consist of personnel costs , including stock-based compensation expense , materials , laboratory supplies , consulting costs , costs associated with setting up and conducting clinical studies and allocated overhead including rent and utilities . we expense all research and development costs in the periods in which they are incurred . we expect that our research and development expenses will increase in absolute dollars in 2021 as compared to 2020 , as we continue to invest in research and development activities related to our existing testing products and product candidates , expected additions to headcount and increases for personnel costs , including stock-based compensation . interest expense interest expense consists of cash and non-cash interest expense associated with our financing arrangements , including the borrowings under our amended loan agreement with innovatus . we expect interest expense to remain consistent in 2021 as compared to 2020 , and remain consistent thereafter until 2023. change in fair value of financial instruments prior to the completion of our ipo , we classified our outstanding warrants to purchase shares of our redeemable convertible preferred stock as liabilities on our balance sheets at their estimated fair value since the underlying redeemable convertible preferred stock was classified as temporary equity . at the end of each reporting period , changes in the estimated fair value during the period were recorded as a component of other income ( expense ) . 82 in connection with the completion of our ipo in september 2019 , all outstanding warrants to purchase shares of our redeemable convertible preferred stock either terminated or were converted into warrants to purchase shares of our common stock and accordingly , will no longer be subject to measurement . other income , net other income , net , consists primarily of interest income earned on our cash and cash equivalents and an amount received under the cares act . income tax benefit ( expense ) income taxes include federal and state income taxes in the united states . results of operations comparison of the years ended december 31 , 2020 and 2019 : replace_table_token_3_th revenue revenue increased $ 1.6 million , or 3.9 % , for the year ended december 31 , 2020 compared to the year ended december 31 , 2019 , primarily due to an increase in revenue to approximately $ 5.1 million from the co-promotion of simponi ® for the year ended december 31 , 2020 compared to approximately $ 1.5 million for the year ended december 31 , 2019. the increase in revenue was partially offset by a decrease in the number of diagnostic tests delivered due in part to impacts of the covid-19 pandemic , coupled with a decrease in average reimbursement per avise ® ctd test . the number of avise ® ctd tests , which accounted for 70 % of revenue for the year ended december 31 , 2020 , decreased to 100,450 tests delivered in the year ended december 31 , 2020 compared to 105,370 tests delivered in the same 2019 period . the number of avise ® ctd tests increased to 28,601 for the three months ended december 31 , 2020 compared to 27,133 tests delivered in the same 2019 period . the adoption of the avise ® ctd test by rheumatologists for the year ended december 31 , 2020 increased to 2,500 ordering healthcare providers as compared to 2,389 ordering healthcare providers in the same 2019 period . the number of ordering healthcare providers decreased to 1,690 for the three months ended december 31 , 2020 compared to 1,707 in the same 2019 period . costs of revenue costs of revenue decreased $ 2.2 million , or 12.0 % , for the year ended december 31 , 2020 compared to the year ended december 31 , 2019. this decrease was primarily due to decreased direct costs such as materials and 83 supplies associated with the decrease in test volume and decreased royalty costs associated with the expiration of a royalty on our cb-caps technology for the year ended december 31 , 2020 compared to the same 2019 period . selling , general and administrative expenses selling , general and administrative expenses increased $ 8.3 million , or 29.0 % , for the year ended december 31 , 2020 compared to the year ended december

liquidity and capital resources we have incurred net losses since our inception . for the years ended december 31 , 2020 and 2019 , we incurred a net loss of $ 16.7 million and $ 12.0 million , respectively , and we expect to incur additional losses and increased operating expenses in future periods . as of december 31 , 2020 , we had an accumulated deficit of $ 181.3 million . to date , we have generated only limited revenue , and we may never achieve revenue sufficient to offset our expenses . through the date of our ipo in september 2019 , our operations were financed primarily from sales of our common and redeemable convertible preferred stock and borrowings under various debt financings . in september 2019 , we completed our ipo of 4,140,000 shares of its common stock at a price to the public of $ 14.00 per share , including the exercise in full by the underwriters of their option to purchase 540,000 additional shares of our common stock . including the option exercise , the aggregate net proceeds to us from the offering was approximately $ 50.4 million , net of underwriting discounts , commissions and other offering expenses , for aggregate expenses of approximately $ 7.5 million . as of december 31 , 2020 , we had $ 57.4 million of cash and cash equivalents . cash in excess of immediate requirements is invested in accordance with our investment policy , primarily with a view to liquidity and capital preservation . currently , our funds are held in cash and money market funds . 84 in september 2017 , we entered into the loan and security agreement with innovatus under which we immediately drew down $ 20.0 million . in december 2018 , we borrowed an additional $ 5.0 million under the loan agreement . in november 2019 , we amended the loan and security agreement with innovatus , which we collectively refer to as the amended loan agreement .


 Write a concise suspicious activity report of the following text delimited by triple backquotes. Return your response as a formal report which covers the key points highlighting the location,dates,entity names and account holder information in chronological order of the text.
     ```liquidity and capital resources we have incurred net losses since our inception . for the years ended december 31 , 2020 and 2019 , we incurred a net loss of $ 16.7 million and $ 12.0 million , respectively , and we expect to incur additional losses and increased operating expenses in future periods . as of december 31 , 2020 , we had an accumulated deficit of $ 181.3 million . to date , we have generated only limited revenue , and we may never achieve revenue sufficient to offset our expenses . through the date of our ipo in september 2019 , our operations were financed primarily from sales of our common and redeemable convertible preferred stock and borrowings under various debt financings . in september 2019 , we completed our ipo of 4,140,000 shares of its common stock at a price to the public of $ 14.00 per share , including the exercise in full by the underwriters of their option to purchase 540,000 additional shares of our common stock . including the option exercise , the aggregate net proceeds to us from the offering was approximately $ 50.4 million , net of underwriting discounts , commissions and other offering expenses , for aggregate expenses of approximately $ 7.5 million . as of december 31 , 2020 , we had $ 57.4 million of cash and cash equivalents . cash in excess of immediate requirements is invested in accordance with our investment policy , primarily with a view to liquidity and capital preservation . currently , our funds are held in cash and money market funds . 84 in september 2017 , we entered into the loan and security agreement with innovatus under which we immediately drew down $ 20.0 million . in december 2018 , we borrowed an additional $ 5.0 million under the loan agreement . in november 2019 , we amended the loan and security agreement with innovatus , which we collectively refer to as the amended loan agreement .
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 Suspicious Activity Report : we perform all of our avise ® tests in our approximately 8,000 square foot clinical laboratory , which is certified by clia and accredited by cap , and located in vista , california . our laboratory is certified for performance of high-complexity testing by cms in accordance with clia . we are approved to offer our products in all 50 states . our clinical laboratory reports all avise ® testing product results within five business days . in the fourth quarter of 2020 , we completed the build-out of approximately 2,000 additional square feet to our clinical laboratory . 77 we market our avise ® testing products using our specialized salesforce . unlike many diagnostic salesforces that are trained only to understand the comparative benefits of their tests , the specialized backgrounds of our salesforce coupled with our comprehensive training enables our sales representatives to interpret results from our de-identified patient test reports and provide unique insights in a highly tailored discussion with rheumatologists . our integrated testing and therapeutics strategy results in a unique opportunity to promote and sell targeted therapies in patient focused sales calls with rheumatologists , including those with whom we have a longstanding relationship and history using our portfolio of testing products . reimbursement for our testing services comes from several sources , including commercial third-party payors , such as insurance companies and health maintenance organizations , government payors , such as medicare , and patients . reimbursement rates vary by product and payor . we continue to focus on expanding coverage among existing contracted rheumatologists and to achieve coverage with commercial payors , laboratory benefit managers and evidence review organizations . since inception we have devoted substantially all our efforts developing and marketing products for the diagnosis , prognosis and monitoring of autoimmune diseases . although our revenue has increased sequentially year over year , we have never been profitable and , as of december 31 , 2020 we had an accumulated deficit of $ 181.3 million . we incurred net losses of $ 16.7 million and $ 12.0 million for the years ended december 31 , 2020 and 2019 , respectively . we expect to continue to incur operating losses in the near term as our operating expenses will increase to support the growth of our business , as well as additional costs associated with being a public company . we have funded our operations primarily through equity and debt financings and revenue from sales of our products . through the date of our initial public offering ( ipo ) in september 2019 , our operations were financed primarily from sales of our common and redeemable convertible preferred stock and borrowings under various debt financings . in september 2019 , we completed our ipo of 4,140,000 shares of our common stock at a price to the public of $ 14.00 per share , including the exercise in full by the underwriters of their option to purchase 540,000 additional shares of our common stock . including the option exercise , the aggregate net proceeds to us from the offering was approximately $ 50.4 million , net of underwriting discounts , commissions and other offering expenses , for aggregate expenses of approximately $ 7.5 million . as of december 31 , 2020 , we had $ 57.4 million of cash and cash equivalents . impact of covid-19 the current covid-19 worldwide pandemic has presented substantial public health challenges and is affecting our employees , patients , physicians and other healthcare providers , communities and business operations , as well as the u.s. and global economies and financial markets . international and u.s. governmental authorities in impacted regions are taking actions in an effort to slow the spread of covid-19 , including issuing varying forms of `` stay-at-home `` orders , restricting business functions outside of one 's home , restricting gatherings , restricting travel , and mandating social distancing and face coverings . certain jurisdictions have begun re-opening only to return to restrictions due to increases in new covid-19 cases . even in areas where `` stay-at-home `` restrictions have been lifted and the number of covid-19 cases have declined , many individuals remain cautious about resuming activities such as preventative-care medical visits . as a result of covid-19 related limitations and reordering of priorities across the u.s. healthcare system , a reduction in patient flow occurred and our test volumes began to decrease in the second half of march 2020. we experienced an avise ® ctd volume decrease of approximately 5 % in the year ended december 31 , 2020 as compared to 2019. by the end of the third quarter of 2020 , the number of avise ® ctd tests delivered substantially recovered to pre-covid-19 avise ® ctd tests reported in the first quarter of 2020 , and in the fourth quarter of 2020 , the number of avise ® ctd delivered exceeded our pre-covid-19 avise ® ctd tests reported in the first quarter of 2020. for the three months ended december 31 , 2020 as compared to the same period in 2019 , we experienced a avise ® ctd volume increase of approximately 5 % . however , the continued spread of covid-19 may adversely affect testing volumes in future periods , the extent of which is highly uncertain . in addition , we believe there are several other important factors that have impacted , and that we expect will impact our operating performance and results of operations , including shutdowns of our facilities and operations as well as those of our suppliers and courier services , disruptions to the supply chain of material needed for our tests , our sales and commercialization activities and our ability to receive specimens and perform or deliver the results from our tests , delays in reimbursement and coverage decisions from medicare and third-party payors and in interactions with regulatory authorities , as well as our inability to achieve volume-based pricing discounts with our key suppliers story_separator_special_tag as a result , our costs of revenue as a percentage of revenue may vary significantly from period to period due to the composition of payors for each month 's billings . assuming future testing volumes are not negatively impacted by the spread of covid-19 , we expect that our costs of revenue will increase in absolute dollars as the number of tests we perform increases . however , we expect that the cost per test will decrease over time due to volume discounts on materials and shipping costs and other volume efficiencies we may gain as the number of tests we perform increases . as discussed above , the continued spread of covid-19 may adversely affect testing volumes which may result in an increase in cost per test due to our inability to realize volume efficiencies . selling , general and administrative expenses selling , general and administrative expenses consist of personnel costs , including stock-based compensation expense , direct marketing expenses , accounting and legal expenses , consulting costs , and allocated overhead including rent , information technology , depreciation and utilities . we expect that our selling , general and administrative expenses will increase in absolute dollars in 2021 as compared to 2020 , as we continue to evaluate the reach and frequency of our sales and sales support functions , expected additions to headcount and increases for personnel costs , including stock-based compensation . research and development expenses research and development expenses include costs incurred to develop our technology , testing products and product candidates , collect clinical specimens and conduct clinical studies to develop and support our testing products and product candidates . these costs consist of personnel costs , including stock-based compensation expense , materials , laboratory supplies , consulting costs , costs associated with setting up and conducting clinical studies and allocated overhead including rent and utilities . we expense all research and development costs in the periods in which they are incurred . we expect that our research and development expenses will increase in absolute dollars in 2021 as compared to 2020 , as we continue to invest in research and development activities related to our existing testing products and product candidates , expected additions to headcount and increases for personnel costs , including stock-based compensation . interest expense interest expense consists of cash and non-cash interest expense associated with our financing arrangements , including the borrowings under our amended loan agreement with innovatus . we expect interest expense to remain consistent in 2021 as compared to 2020 , and remain consistent thereafter until 2023. change in fair value of financial instruments prior to the completion of our ipo , we classified our outstanding warrants to purchase shares of our redeemable convertible preferred stock as liabilities on our balance sheets at their estimated fair value since the underlying redeemable convertible preferred stock was classified as temporary equity . at the end of each reporting period , changes in the estimated fair value during the period were recorded as a component of other income ( expense ) . 82 in connection with the completion of our ipo in september 2019 , all outstanding warrants to purchase shares of our redeemable convertible preferred stock either terminated or were converted into warrants to purchase shares of our common stock and accordingly , will no longer be subject to measurement . other income , net other income , net , consists primarily of interest income earned on our cash and cash equivalents and an amount received under the cares act . income tax benefit ( expense ) income taxes include federal and state income taxes in the united states . results of operations comparison of the years ended december 31 , 2020 and 2019 : replace_table_token_3_th revenue revenue increased $ 1.6 million , or 3.9 % , for the year ended december 31 , 2020 compared to the year ended december 31 , 2019 , primarily due to an increase in revenue to approximately $ 5.1 million from the co-promotion of simponi ® for the year ended december 31 , 2020 compared to approximately $ 1.5 million for the year ended december 31 , 2019. the increase in revenue was partially offset by a decrease in the number of diagnostic tests delivered due in part to impacts of the covid-19 pandemic , coupled with a decrease in average reimbursement per avise ® ctd test . the number of avise ® ctd tests , which accounted for 70 % of revenue for the year ended december 31 , 2020 , decreased to 100,450 tests delivered in the year ended december 31 , 2020 compared to 105,370 tests delivered in the same 2019 period . the number of avise ® ctd tests increased to 28,601 for the three months ended december 31 , 2020 compared to 27,133 tests delivered in the same 2019 period . the adoption of the avise ® ctd test by rheumatologists for the year ended december 31 , 2020 increased to 2,500 ordering healthcare providers as compared to 2,389 ordering healthcare providers in the same 2019 period . the number of ordering healthcare providers decreased to 1,690 for the three months ended december 31 , 2020 compared to 1,707 in the same 2019 period . costs of revenue costs of revenue decreased $ 2.2 million , or 12.0 % , for the year ended december 31 , 2020 compared to the year ended december 31 , 2019. this decrease was primarily due to decreased direct costs such as materials and 83 supplies associated with the decrease in test volume and decreased royalty costs associated with the expiration of a royalty on our cb-caps technology for the year ended december 31 , 2020 compared to the same 2019 period . selling , general and administrative expenses selling , general and administrative expenses increased $ 8.3 million , or 29.0 % , for the year ended december 31 , 2020 compared to the year ended december

