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Risk: Regulatory pricing pressures remain the primary headwind, though offset by durable scale advantages.
Valuation: Shares are undervalued, supported by a $226.02 composite midpoint tightly aligned with the $223.25 internal valuation cross-checks.
Quest Diagnostics is a mature, highly cash-generative leader in the US diagnostic testing market. Its robust national network provides durable scale advantages, supporting consistent free cash flow generation and a reliable, growing dividend. With an implied ~19.4x forward P/E, DGX is positioned as a defensive healthcare compounding asset.
Quest Diagnostics is a mature, highly cash-generative leader in the US diagnostic testing market. Its robust national network provides durable scale advantages, supporting consistent free cash flow generation and a reliable, growing dividend. With an implied ~19.4x forward P/E, DGX is positioned as a defensive healthcare compounding asset.
Unmatched national laboratory network lowers per-test processing costs.
Deep integration with hospital IT systems and payer networks.
Valuation: Shares are undervalued, supported by a $226.02 composite midpoint tightly aligned with the $223.25 internal valuation cross-checks.
Buy. Shares trade at a discount to our $226.02 fair value midpoint, offering defensive compounding and structural free cash flow yield.
Quest Diagnostics Incorporated provides diagnostic testing and services in the United States. The company develops and delivers diagnostic information services, such as routine, non-routine and advanced clinical testing, anatomic pathology testing, and other diagnostic information services. It also provides services under the Quest Diagnostics brand, as well as under the AmeriPath, Dermpath Diagnostics, ExamOne, and Quanum brands to physicians, hospitals, patients and consumers, health plans, government agencies, employers, retailers, pharmaceutical companies and insurers commercial clinical laboratories, and accountable care organizations through a network of laboratories, patient service centers, phlebotomists in physician offices, call centers and mobile phlebotomists, nurses, and other health and wellness professionals. In addition, the company offers services for the life insurance industry; healthcare IT healthcare providers and payers; testing and medical director services at hospital laboratories; test offerings in cardiometabolic and endocrine; cancer; clinical drug monitoring and toxicology; infectious disease, including autoimmune; neurology diagnostics, including Alzheimer's disease; and women's health, such as prenatal genetic; workplace drug testing, testing urine, hair, and oral fluid specimens services; and employer population health services, including biometric screenings, flu shots, and related preventative services. Further, it provides population health solutions; extended care services; develops in vitro diagnostic tests; laboratory diagnostic information and digital health connectivity systems; underwriting support services, including data gathering, paramedical examinations, and clinical laboratory testing and analytics; and national specimen collection and health data solutions. Quest Diagnostics Incorporated was founded in 1967 and is headquartered in Secaucus, New Jersey.
A combined scenario of PAMA reimbursement cuts and labor inflation tests the margin structure. The model withstands moderate pressure given scale efficiencies, but operating margins structurally compressing below 13.0% would invalidate the current valuation.
Scale Advantage: Unmatched national laboratory network lowers per-test processing costs.
Switching Costs: Deep integration with hospital IT systems and payer networks.
Economic profit is supported when reported returns exceed the company cost-of-capital hurdle.
Unavailable
FCFF DCF remains positive at the base case: base FCFF $1.3B after capex $496.6M, with terminal value at 70.6% of enterprise value. No FCF cliff is projected unless capex/ or materially resets.
If operating margins exceed 14.5%, the bull case is strengthened. If margins compress below 13.0%, review the thesis for structural deterioration.
If operating margins exceed 14.5%, the bull case is strengthened. If margins compress below 13.0%, review the thesis for structural deterioration.
If operating margins exceed 14.5%, the is strengthened. If margins compress below 13.0%, review the thesis for structural deterioration.
Heavy, continuous replacement capital expenditure cycle, yet structural depreciation add-backs exceed maintenance capex, ensuring robust free cash flow.
Aging demographics and increased focus on preventative care drive persistent routine testing volume growth.
Regulatory pricing pressure and hospital budget constraints limit realization of test pricing power.
Heavy, continuous replacement capital expenditure cycle, yet structural depreciation add-backs exceed maintenance capex, ensuring robust free cash flow.
Core holding suitable for defensive, income-oriented allocations.
Valuation: Shares are undervalued, supported by a $226.02 composite midpoint tightly aligned with the $223.25 internal valuation cross-checks.
Buy. The valuation synthesis, anchored by FCFF and Forward Earnings, justifies an $226.02 fair value.
Upside case: Risk: Regulatory pricing pressures remain the primary headwind, though offset by durable scale advantages. Downside case: Valuation: Shares are undervalued, supported by a $226.02 composite midpoint tightly aligned with the $223.25 internal valuation cross-checks.
Capture your own thesis, position size, and follow-up questions. Stays on this device, only you can see it.
Reimbursement pressure from PAMA regulations, increased competition from specialized upstarts, and lower routine testing volumes compress margins and stunt long-term cash flow generation.
Aggressive legislative changes to PAMA cause unexpected, steep cuts to clinical lab fee schedules, significantly compressing gross margins.
Technological advancements enable hospitals to profitably internalize testing, shrinking the addressable outsourced laboratory market.
Persistent wage inflation for specialized lab technicians outpaces pricing power, structurally shifting operating margins below 13.0%.
The five developments that would weaken our investment case.
A healthy operating cash conversion multiple confirms that diagnostic testing billings convert into real liquidity. Declining conversion metrics signal customer collection challenges or unbilled revenue buildup, constraining organic cash available for debt service and dividend distributions.
Current:1.901 as of the 2026-05-13 analysis date
Alert ifFalls below 1.5x over any trailing twelve-month period
Clinical diagnostic laboratories operate with substantial fixed costs in personnel and regional testing hubs. If specialized technician wage inflation or regulatory reimbursement cuts overwhelm pricing power, operating margins compress, reducing operating profit and lowering returns on invested capital.
Current:14.1% for the period ended 2025-12-31
Alert ifCompresses below 13.0% over two consecutive quarters
National health plan contracts provide essential patient access and specimen volume to diagnostic testing networks. Losing in-network status with a major national insurer would direct routine patient testing to competitors, causing immediate revenue loss and severe fixed-cost deleveraging.
Current:11.8% for the period ended 2025-12-31
Alert ifDecelerates below 3.0% year-over-year over two consecutive quarters
Specialized molecular and esoteric diagnostics generate significantly higher contribution margins than commoditized routine blood panels. If hospital insourcing or lab reimbursement reductions erode esoteric testing volumes, overall gross margins shrink, impairing overall operating profitability.
Current:33.2% for the period ended 2025-12-31
Alert ifFalls below 30.0% over any four-quarter measurement window
Elevated capital spending on laboratory automation or facility footprint expansion without corresponding revenue gains inflates the asset base. Sub-par returns relative to the cost of capital depress valuation multiples and signal inefficient capital redeployment.
Current:9.2% as of the 2026-05-13 analysis date
Alert ifFalls below 7.5% over any trailing twelve-month period
Each lens answers a different valuation question. Only included lenses set Fair value; floors and diagnostics provide context.
Apply a terminal P/E to the dated forward EPS path, then discount that future share value back to the analysis date.
Convert the revenue and margin path into after-tax free cash flow, discount the annual per-share amounts and at , then adjust for signed per current share.
Discount the explicit dividend path and its Gordon-growth terminal value at cost of equity.
Solve for the growth rate that makes the model value equal the report-date share price.
Accretive hospital lab system acquisitions, expansion in advanced and esoteric testing (e.g., Alzheimer's, cancer), and continued realization of cost synergies lead to margin expansion and faster-than-expected organic growth.
Quest Diagnostics is a mature, highly cash-generative leader in the US diagnostic testing market. Its robust national network provides durable scale advantages, supporting consistent free cash flow generation and a reliable, growing dividend.
If operating margins exceed 14.5%, the bull case is strengthened. If margins compress below 13.0%, review the thesis for structural deterioration.
Warning level: Falls below 1.5x over any trailing twelve-month period. A healthy operating cash conversion multiple confirms that diagnostic testing billings convert into real liquidity. Declining conversion metrics signal customer collection challenges or unbilled revenue buildup, constraining organic cash available for debt service and dividend distributions.
Warning level: Compresses below 13.0% over two consecutive quarters. Clinical diagnostic laboratories operate with substantial fixed costs in personnel and regional testing hubs. If specialized technician wage inflation or regulatory reimbursement cuts overwhelm pricing power, operating margins compress, reducing operating profit and lowering returns on invested capital.
Warning level: Decelerates below 3.0% year-over-year over two consecutive quarters. National health plan contracts provide essential patient access and specimen volume to diagnostic testing networks. Losing in-network status with a major national insurer would direct routine patient testing to competitors, causing immediate revenue loss and severe fixed-cost deleveraging.
Warning level: Falls below 30.0% over any four-quarter measurement window. Specialized molecular and esoteric diagnostics generate significantly higher contribution margins than commoditized routine blood panels. If hospital insourcing or lab reimbursement reductions erode esoteric testing volumes, overall gross margins shrink, impairing overall operating profitability.
Warning level: Falls below 7.5% over any trailing twelve-month period. Elevated capital spending on laboratory automation or facility footprint expansion without corresponding revenue gains inflates the asset base. Sub-par returns relative to the cost of capital depress valuation multiples and signal inefficient capital redeployment.
| $10.79B |
| $9.88B |
| $9.25B |
| $9.87B |
| $11.04B |
| +0.6% |
| Gross profit | $4.21B | $3.43B | $3.05B | $3.24B | $3.67B | -3.4% |
| Operating income | $2.75B | $1.38B | $1.29B | $1.40B | $1.60B | -12.7% |
| Net income | $2.00B | $946.0M | $854.0M | $871.0M | $992.0M | -16.0% |
| EPS (diluted) | $15.55 | $7.97 | $7.49 | $7.69 | $8.75 | -13.4% |
| EBITDA | $3.16B | $1.82B | $1.73B | $1.89B | $2.17B | -9.0% |
| R&D | — | — | — | — | — | — |
| SG&A | $1.73B | $1.87B | $1.64B | $1.77B | $1.97B | +3.3% |
Capital allocation should be evaluated against reinvestment needs, balance-sheet strength, and shareholder returns.
| Revenue | 11,035,000,000 |
|---|---|
| Cost of revenue | 7,370,000,000 |
| Gross profit | 3,665,000,000 |
| Operating expenses | 2,109,000,000 |
| Operating income | 1,556,000,000 |
| Non-operating items and tax | -564,000,000 |
| Net income | 992,000,000 |
| Total assets | 16,225,000,000 |
|---|---|
| Cash | 420,000,000 |
| Current assets | 2,378,000,000 |
| Total liabilities | 8,939,000,000 |
| Current liabilities | 2,278,000,000 |
| Shareholders’ equity | 7,170,000,000 |
Point-in-time financial data used in the 2026-05-13 analysis.
| Period | Revenue | EBITDA | Net income | Operating cash flow | Free cash flow | Capex | Depreciation and amortization | Stock-based compensation | Share repurchases | Dividends paid | Net debt issuance | Investing cash flow | Financing cash flow | Beginning cash | Ending cash | Cash and investments | Total debt | Operating margin | ROIC | WACC | ROIC − WACC spread |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2021-12-31 | 10.8B | 3.2B | 2B | 2.2B | 1.8B | 403M | 408M | 79M | 2.2B | 309M | -2M | — | — | — | — | 872M | 4.8B | 22.1% | — | 5.9% | — |
| 2022-12-31 | 9.9B | 1.8B | 946M | 1.7B | 1.3B | 404M | 437M | 77M | 1.4B | 305M | -2M | — | — | — | — | 315M | 4.7B | 14.4% | — | 7.7% | — |
| 2023-12-31 | 9.3B | 1.7B | 854M | 1.3B | 864M | 408M | 439M | 77M | 275M | 314M | 748M | — | — | — | — | 686M | 5.5B | 13.6% | — | 7.3% | — |
| 2024-12-31 | 9.9B | 1.9B | 871M | 1.3B | 909M | 425M | 493M | 88M | 151M | 331M | 1.5B | — | — | — | — | 549M | 7.1B | 13.6% | — | 7.7% | — |
| 2025-12-31 | 11B | 2.2B | 992M | 1.9B | 1.4B | 527M | 570M | 88M | 450M | 353M | -602M | — | — | — | — | 420M | 6.6B | 14.1% | — | 6.2% | — |
DGX trades at 16.3x forward earnings against a peer median of 18.3x; EV/EBITDA of 12.3x against a peer median of 18.4x; 6 peers.
| DHR |
| Danaher Corporation |
| 18.3x |
| 4.7x |
| 16.6x |
| 7.1% |
| 22.9% |
| IDXX | IDEXX Laboratories Inc. | 32.4x | 9.5x | 27.8x | 72.9% | 31.8% |
| WAT | Waters Corporation | 21.2x | 9.1x | 26.8x | 5.2% | 11.7% |
| A | Agilent Technologies Inc. | 17.2x | 4.5x | 16.9x | 19.9% | 22.9% |
