Is Xtant Medical Holdings, Inc. overvalued or undervalued?

As of 15 May 2024, the valuation grade for Xtant Medical Holdings, Inc. has moved from fair to risky, indicating a deterioration in its investment appeal. The company appears to be overvalued given its negative performance metrics, including a Price to Book Value of 2.21 and an EV to Sales ratio of 1.03, which suggest that investors are paying a premium despite the company’s losses. Additionally, the ROE stands at -27.33%, highlighting significant inefficiencies in generating returns for shareholders.
In comparison to its peers, Xtant Medical's EV to EBITDA ratio of -38.64 is notably worse than Bioventus, Inc., which has a more favorable EV to EBITDA of 9.72, and Axogen, Inc., which shows a significantly negative P/E of -146.35. The stock has outperformed the S&P 500 with a year-to-date return of 48.98% compared to the index's 12.22%, but this short-term performance does not mitigate the overall valuation concerns.