Intuitive Surgical, Inc. ISRG
ISRG remains a hold—exceptional FY2025 fundamentals (revenue up 20.5% to $10.06B, 28.4% net margin, $2.49B FCF at a 24.75% FCF margin) are offset by a demanding valuation and deteriorating technicals. The stock trades at a P/S of 11.93, roughly 264% above the peer median, and EV/EBITDA of 28.60, 53% above median, at a time when recent news flags procedure guidance as underwhelming and the stock is having its worst year since 2008.
At $372.60, ISRG sits below both its 50-day MA ($384.21) and 200-day MA ($468.57) with a negative MACD histogram, while persistent insider selling—$151.6M net over 24 months including the CEO's $4M sale on August 11—adds caution despite a best-in-class franchise with minimal debt.
What could go wrong
- Procedure growth deceleration. Recent quarter revenue growth of approximately 19% (per news) lagged FY2025's 20.5%, and full-year procedure guidance was flagged as underwhelming.
- Valuation compression. P/S at 264% above peer median and EV/EBITDA at 53% above leave minimal room for execution misses; P/E of 42.10 is roughly in line with the 42.88 peer median.
- Persistent insider selling. Net $151.6M in insider dispositions over 24 months with 259 sales vs 165 acquisitions signals limited internal conviction at current levels.
- Technical breakdown deepening. Stock trading below both 50-day and 200-day MAs with bearish MACD histogram of -1.63 could trigger further institutional outflows.
What would change my mind
Where this comes from: FMP FY2025 annual and derived_metrics · peer_relative composite · technicals as of 2026-08-28 · insider transaction filings. Orin's read on ISRG; not advice.
Twelve months actual closes to 2026-09-24 · actual filings
50-day average 200-day average · volume below
On file
All ISRG filingsLargest holders · 13F Q2 2026
Money flow| Filer | Position | Of fund |
|---|---|---|
| Vanguard Capital Management | $9.2B | 0.2% of fund |
| State Street | $6.4B | 0.2% of fund |
| Invesco | $4.7B | 0.4% of fund |
| Price T Rowe Associates /Md/ | $4.5B | 0.4% of fund |
| Geode Capital Management | $3.4B | 0.2% of fund |
| Capital World Investors | $3.1B | 0.4% of fund |
143 filers · quarter ended Q2 2026 · positions, not flows
Insiders, last 24 months: 433 Form 4 filings, net −$151.9M. Of the 50 on hand, 0 were open-market purchases and 26 sales— the rest are grants, option exercises and tax withholding.
Ask Orin about ISRG
Orin answers questions about ISRG from its filings, transcripts and numbers — with the source behind every claim. Your own desk starts with 3 free days, card required.
Start 3 free days →Where it trades
| Metric | Now | Own median | Sector |
|---|---|---|---|
| P/E | 45.1× | 71.4× | 26.4× |
| EV/EBITDA | 30.7× | 55.0× | — |
| P/S | 12.79× | 20.08× | — |
| P/B | 7.8× | 10.7× | — |
Its P/E sits below all 5 of the last 5 years (−5.90σ from its own mean).
21.9%
free-cash-flow growth every year for 10 years, discounted at 10%, is what today’s price implies — starting from $2.5B of trailing free cash flow. It is an assumption the market is making, not a forecast Orin is making.
What Wall Street published
$491
$357 – $651 · +22% against today's price
- 40 buy or overweight
- 12 hold
- 5 underweight or sell
The analysts’ consensus and their own ratings, not Orin’s. A target is a twelve-month opinion published by the firm that wrote it.
Against the companies it is compared to
| Company | Market cap | P/E | EV/EBITDA | Gross | Net | ROE |
|---|---|---|---|---|---|---|
| ISRGIntuitive Surgical, Inc. | $141B | 45.1× | 30.7× | 66.7% | 28.4% | 18% |
| BAXBaxter International Inc. | $12B | — | 26.2× | 30.1% | -9.3% | -17% |
| BDXBecton, Dickinson and Company | $49B | 54.0× | 16.8× | 46.1% | 4.5% | 4% |
| COOThe Cooper Companies, Inc. | $11B | 18.9× | 14.5× | 63.6% | 13.5% | 7% |
| RMDResMed Inc. | $32B | 21.3× | 14.7× | 61.2% | 26.9% | 24% |
| WSTWest Pharmaceutical Services, Inc. | $26B | 47.5× | 31.8× | 36.8% | 17.0% | 19% |
The median is of the 4 peers listed above and nothing else — check it against the column. This company trades 31.4% above it. The peer set is the vendor’s, so a company can appear here that a person would not have chosen.
What it has traded at
What its sector has traded at
Two scales, drawn separately on purpose: a sector median and one company’s multiple are not the same number and putting them on one axis invites a comparison neither series supports.
Discounted cash flow
| Model | Fair value | Against | Computed |
|---|---|---|---|
| Standard DCF | $116 | $417.30 · −72% | 2026-06-10 |
| Levered DCF | $133 | $417.30 · −68% | 2026-06-10 |
The vendor’s intrinsic-value models. Treat them as a low-growth anchor — for a fast grower the market routinely pays well above a DCF. These were computed against the price in the “against” column, not today’s.
Every estimate on one scale
The vertical rule is the current price. Ranges and point estimates are the backend’s, published as they were calculated; an arrow means the estimate sits beyond this scale, and its number is on the right.