Start here if you're new
what it is
Exagen makes AVISE blood tests that help doctors sort out lupus, rheumatoid arthritis, and similar autoimmune lookalikes.
how it gets paid
Last year Exagen made $67M in revenue. Connective tissue disease tests was the main engine at $31M, or 46% of sales.
why it's growing
Revenue grew 20% last year to a record $66.6M, driven by 11% test volume growth and higher average selling prices. Gross margin was 58.3% for the year.
what just happened
Exagen posted $16.6M in Q4 revenue and a $0.20 loss per share.
At a glance
C++ balance sheet — some cracks in the foundation
45/100 earnings predictability — expect surprises
-$0.83 fy2024 eps est
$56M fy2024 rev est
-21.2% operating margin
xvary composite: 42/100 — below average
What they do
Exagen makes AVISE blood tests that help doctors sort out lupus, rheumatoid arthritis, and similar autoimmune lookalikes.
AVISE is one brand, and it produced $67M in annual revenue. Gross margin → money left after test costs → 58.3% means 58 cents of every dollar stays before overhead. Contrast that with the -21.2% operating margin, and you see the real business: decent test economics, then a heavy corporate bill.
How they make money
$67M
annual revenue · their business grew +19.7% last year
Connective tissue disease tests
$31M
+11.0%
Lupus-related tests
$16M
+19.7%
Rheumatoid arthritis tests
$12M
+19.7%
Other autoimmune tests
$8M
+19.7%
The products that matter
autoimmune blood testing
AVISE CTD Testing
$66.6M · 91% of revenue
This is the entire investment case right now. Test volume grew over 11% in 2025 and helped push company revenue to a record $66.6M, but lower average selling prices pulled gross margin down to 58%.
11%+ volume growth
non-core revenue
Other Revenue
$0.4M · 0.6% of revenue
At $0.4M, this is too small to matter yet. That is useful context because it means you do not have a second engine if AVISE stumbles.
immaterial today
Key numbers
$67M
annual revenue
That is the size of the whole business, and it grew 19.7% vs. prior year.
58.3%
gross margin
You keep 58 cents of every dollar before overhead, which is the only part that looks healthy.
-21.2%
operating margin
This says headquarters still burns cash after gross profit.
$25M
debt load
Debt is 25% of capital, so the balance sheet is not carrying the company for free.
Financial health
C++
strength
- balance sheet grade C++ — below average — limited financial resources
- risk rank 3 — safer than 50% of stocks
- price stability 5 / 100
- long-term debt $25M (25% of capital)
C++ — below average. watch for debt servicing and cash burn.
Total return vs. market
Return history isn't available for XGN right now.
source: institutional data · return history unavailable
What just happened
missed estimates
Exagen posted $16.6M in Q4 revenue, up 21% from last year, and a $0.20 loss per share.
Q4 revenue grew 21% as test volume and pricing both improved. Gross margin was 58.3% for the full year, which kept the lab economics ahead of the overhead bill.
$16.6M
revenue
-$0.20
eps
58.3%
gross margin
revenue
Full-year revenue hit a record $66.6M, up 20%, driven by 11% test volume growth and a 7% increase in average selling price to $441 per test.
source: company earnings report, 2026
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What could go wrong
The #1 risk here is reimbursement and pricing pressure on AVISE CTD testing. Exagen is growing volume, but lower average selling prices already pushed gross margin down to 58% from 60%.
med
Pricing pressure hits the only engine that matters
AVISE CTD testing produced $66.6M of revenue, or 99.4% of the total. When one product funds the whole story, even a two-point gross margin drop has outsized impact.
Impact: gross margin already fell to 58% from 60%. Another step down would make profitable scaling harder, not easier.
med
Losses can outlast investor patience
The latest quarter still showed a $0.20 per share loss. Pair that with a C++ balance sheet and $25M of long-term debt, and you get a company that needs cleaner execution than a stronger balance sheet would require.
Impact: debt equals 25% of capital and about one-third of market cap. If profitability stays distant, financing risk stops being theoretical.
med
This is still a one-franchise business
Other revenue was just $0.4M. There is no second segment here to absorb an operational stumble, reimbursement setback, or slower physician adoption in the core test menu.
Impact: 99.4% revenue concentration means almost every downside scenario runs through the same door.
The combined risk picture is simple: when 99.4% of revenue comes from one testing franchise, 58% gross margin and $70M–$73M guidance are not side notes. They are the whole stock.
source: institutional data · regulatory filings · risk analysis
Pay attention to
the number that mattered
Gross margin needs to stop sliding
58% is still respectable. The problem is direction. If the next few quarters do not stabilize after the drop from 60%, revenue growth will keep feeling lower quality.
calendar
First read on 2026 guidance execution
Management guided for $70M–$73M in 2026 revenue. The next quarterly print matters because you need to see whether that pace is real early, not after the year is half over.
trend
Volume versus price
Test volume grew over 11% in 2025. Watch whether pricing pressure keeps offsetting that gain. More tests are good. Better economics are what count.
balance sheet
Debt matters more at this size
$25M of long-term debt does not sound huge until you put it next to a $74M market cap. Small companies do not get many bad quarters before financing starts to dominate the conversation.
Analyst rankings
earnings predictability
45 / 100
Results are harder to model here than in mature diagnostics names. In human-speak, analysts do not fully trust the quarter-to-quarter cadence yet.
risk rank
3
This sits around the middle of the pack on broad risk scoring. That sounds calmer than the stock feels because company-specific execution risk is doing most of the work.
beta
0.95
Beta measures how the stock moves versus the market. At 0.95, it tracks the market roughly one-for-one. In reality, results and guidance probably matter more than the S&P 500 here.
source: institutional data
Institutional activity
institutional ownership data for XGN is being compiled.
source: institutional data
Price targets
3-5 year target range
n/a
n/a
$3
current price
n/a
target midpoint · n/a from current
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