How Do I Budget a Dialysis or Infusion Center Buildout?

Curated by Kory White · Fractional CRO, CRO Syndicate

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📅 Published Jun 21, 2026

Don’t get screwed.</text><text x="58" y="258" font-family="Arial,Helvetica,sans-serif" font-size="30" font-weight="600" fill="#6b5b4d">Leases, TI, NNN & buildouts — negotiated in your favor</text><g transform="translate(1010,86)" fill="none" stroke="#C0531F" stroke-width="9" stroke-linejoin="round"><rect x="20" y="40" width="150" height="130"/><line x1="20" y1="40" x2="95" y2="6"/><line x1="170" y1="40" x2="95" y2="6"/><rect x="50" y="80" width="36" height="36"/><rect x="104" y="80" width="36" height="36"/><rect x="74" y="128" width="42" height="42"/></g></svg>

How Do I Budget a Dialysis or Infusion Center Buildout?

Direct Answer

Budget a dialysis center buildout at $150–$300 per square foot and an infusion center at $120–$250 per square foot, because both are water- and utility-intensive medical uses that dwarf a normal office fit-out. The line that separates dialysis from almost every other medical buildout is the water treatment room: a multi-station unit needs a reverse-osmosis system, carbon tanks, softeners, and a distribution loop that runs $120,000–$350,000 installed for a 12–20 chair clinic, plus a dedicated room of 200–400 square feet with floor drains, backflow prevention, and AAMI/ISO 23500 water-quality compliance.

Infusion centers skip the RO plant but still need medical-gas or at minimum oxygen provisions, USP-797/800 compliant drug-prep areas if they compound, and individual power and nurse-call at every chair. The single biggest money move is to lease a second-generation dialysis or medical space with the water room, slab drains, and electrical service already in place — that alone can save you $60–$120 per square foot versus building the water and plumbing infrastructure into raw shell.

For a typical 6,000–10,000 square foot dialysis clinic, plan a hard-cost budget of $900,000–$3,000,000 plus stations and equipment of $25,000–$45,000 per dialysis station. Do not accept a landlord's $40–$60 per square foot TI allowance as adequate; for these uses it covers a fraction of the real cost, and the gap is yours unless you negotiate it up or amortize it knowingly.

Confirm in writing that the building's water service, sanitary capacity, and electrical service can carry your load before you sign, because retrofitting a 4-inch sanitary main or upsizing the electrical service after lease execution is six figures you will be fighting the landlord to pay.

Why These Uses Cost So Much

Dialysis and infusion are not "doctor's offices with chairs." They are mini industrial-medical plants. For dialysis, the cost drivers are water and drains. Each station consumes large volumes of treated water, so you need the RO plant, a recirculating distribution loop in PVDF or similar piping, and a floor drain at or near every chair for spill and bleach management.

That means saw-cutting the slab for drain runs at $3,500–$9,000 per run, an epoxy or sheet-vinyl seamless floor at $8–$16 per square foot, and a dedicated water room with its own ventilation and acid-neutralization. Add medical-grade electrical — every chair needs isolated, surge-protected power for the dialysis machine — plus emergency power provisions.

For infusion, the heavyweight items shift. You may need a USP-800 hazardous-drug compounding room with a negative-pressure anteroom and a biosafety cabinet if you mix chemotherapy, which alone adds $60,000–$200,000 in containment, HVAC, and monitoring. Even non-compounding infusion suites need individual nurse-call, oxygen and suction at chairs, comfortable HVAC with good filtration, and private or semi-private bays for immunocompromised patients.

Both uses live and die on HVAC: plan MERV 13+ filtration, dedicated exhaust for the water/compounding rooms, and cooling sized at 350–450 square feet per ton because the equipment throws heat.

Build Your Number From the Ground Up

Build it bottom-up so you can defend it. For a 15-chair, 8,000 square foot dialysis center in second-generation medical space:

General conditions/supervision: $60,000–$120,000 (7–10% of hard cost).
Demolition: $4–$9 per square foot = $32,000–$72,000.
Framing, drywall, doors, finishes: $30–$55 per square foot = $240,000–$440,000.
Water treatment room and RO plant: $120,000–$350,000.
Plumbing — chair drains, sinks, distribution loop: $120,000–$300,000.
HVAC and exhaust: $80,000–$220,000.
Electrical, isolated power, emergency power, nurse-call: $120,000–$300,000.
Seamless flooring: $8–$16 per square foot = $64,000–$128,000.
Permits, design, engineering, state licensure prep: $60,000–$160,000.

That lands hard cost around $900,000–$2,000,000, or $112–$250 per square foot, before stations. Dialysis stations (chair plus machine) run $25,000–$45,000 each, so 15 stations is another $375,000–$675,000 in equipment financed separately. Hold a 12–18% contingency — these projects find conditions behind every wall, and a failed water-quality validation can stall your opening for weeks.

flowchart TD A[Dialysis/Infusion Buildout] --> B[Water & Plumbing] A --> C[HVAC & Containment] A --> D[Electrical & Power] A --> E[Finishes & Flooring] B --> B1[RO Plant 120k-350k] B --> B2[Chair Drains 3.5k-9k/run] B --> B3[Distribution Loop] C --> C1[MERV 13+ Filtration] C --> C2[USP-800 Neg-Pressure Room] D --> D1[Isolated Power per Chair] D --> D2[Emergency Power] E --> E1[Seamless Floor 8-16/sf]

How To Not Get Screwed

These are the highest-stakes medical buildouts in the retail/medical leasing world, and that means the most places to get burned.

The utility-capacity ambush. Dialysis and infusion need water volume, large sanitary capacity, and a beefy electrical service. If the building cannot deliver it, you are looking at a $100,000+ utility upgrade. Make capacity a condition of the lease: require the landlord to confirm, in a delivery exhibit, the available water service size, sanitary main capacity, and electrical service amperage to your suite — and put the cost of any shortfall on the landlord as a base-building item.

Owners who skip this discover during permitting that they are paying to bring a new electrical service or water tap to the building.

The TI allowance that covers a third of the job. A landlord touting $50 per square foot TI on a use that costs $150–$300 per square foot is offering you a fig leaf. Negotiate the allowance up to $75–$120 per square foot in exchange for a longer term (10–15 years is normal for dialysis), insist it pays as reimbursement against paid invoices, and if any portion is amortized, treat that as a 8–10% loan and price it into your rent comparison.

Demand the right to apply unused allowance to your first months' rent rather than forfeiting it.

The contractor without medical-water experience. RO plants, USP-800 rooms, and isolated power are specialty scopes. A generalist GC will sub them out blind and pad the markup. Bid three GCs with documented dialysis or USP-800 infusion experience, get a fixed-price (stipulated sum) contract, cap change-order markup at 10–15%, hold 10% retainage until water-quality validation passes, and never release final payment before your state survey and licensure inspection clear.

sequenceDiagram participant T as You (Tenant) participant L as Landlord participant GC as General Contractor participant S as State Surveyor T->>L: Require delivery exhibit (water/sanitary/electrical capacity) L->>T: Confirm capacity or fund base-building upgrade T->>GC: Bid to 3 medical-water GCs (fixed price) GC->>T: Sign with 10% retainage + validation hold GC->>T: Build, then validate water quality (AAMI/ISO 23500) T->>S: Schedule state licensure survey S->>T: Pass survey T->>GC: Release retainage after pass

Timeline, Licensure, and Cash Flow

A dialysis or infusion buildout runs 16–28 weeks of construction after permits, longer than most medical fit-outs because of the water plant, USP rooms, and the state survey that gates your opening. Permitting and any Certificate of Need (CON) process — required for dialysis in many states — can add 2–12 months before you ever break ground, so confirm CON status before you sign a lease.

Every week empty burns rent: an 8,000 square foot suite at $32 per square foot annual costs roughly $4,900 per week sitting dark. Negotiate a 6–9 month rent-free buildout and survey window, because if you only get 90 days you will pay rent for months on a clinic that cannot legally open until the surveyor signs off.

Finance equipment separately from the construction loan, and keep a 15% liquid contingency outside the loan for the water-validation and survey punch-list items that always appear.

FAQ

How much does a dialysis center buildout cost per square foot? Plan $150–$300 per square foot for dialysis and $120–$250 per square foot for infusion. The water-treatment plant ($120,000–$350,000), per-chair drains, isolated power, and seamless flooring are what push these far above a normal medical office.

What makes dialysis more expensive than infusion? The water-treatment room. Dialysis needs a reverse-osmosis plant, a recirculating distribution loop, and a floor drain near every chair, all validated to AAMI/ISO 23500. Infusion's heavyweight cost is instead a USP-800 negative-pressure compounding room ($60,000–$200,000) only if you mix hazardous drugs.

Will the landlord cover the buildout? Only partially. A typical $40–$60 per square foot TI allowance covers a fraction of a $150–$300 per square foot job. Push for $75–$120 per square foot on a 10–15 year term, paid as invoice reimbursement, and make the landlord fund any water, sanitary, or electrical capacity upgrade as a base-building cost.

How long until I can open? Expect 16–28 weeks of construction plus permitting, and a state licensure survey before you can treat patients. Many states also require a Certificate of Need that adds 2–12 months up front. Negotiate a 6–9 month rent-free window so you are not paying rent on a clinic that cannot legally operate yet.

Sources

CBRE, "U.S. Healthcare Real Estate: Outpatient and Dialysis Cost Trends" (2025).
JLL, "Healthcare and Life Sciences Fit-Out Cost Guide" (2025).
Cushman & Wakefield, "Outpatient and Specialty Medical Facility Outlook" (2025).
RSMeans / Gordian, "Building Construction Costs With RSMeans Data — Healthcare Occupancy" (2025).
AAMI / ISO 23500, "Water for Hemodialysis and Related Therapies" standards.
USP General Chapters <797> and <800>, "Pharmaceutical Compounding — Sterile and Hazardous Drugs."
Facility Guidelines Institute (FGI), "Guidelines for Design and Construction of Outpatient Facilities" (2022 edition).
NAIOP, "Medical Tenant Improvement and Specialty Use Allowance Benchmarks" (2025).

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<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 1200 340" role="img" aria-label="How Do I Budget a Dialysis or Infusion Center Buildout? — PULSE Buildouts"><rect width="1200" height="340" fill="#EBE9DE"/><rect width="14" height="340" fill="#C0531F"/><text x="58" y="116" font-family="Arial,Helvetica,sans-serif" font-size="32" font-weight="800" letter-spacing="3" fill="#C0531F">PULSE BUILDOUTS · COMMERCIAL REAL ESTATE</text><text x="56" y="198" font-family="Arial,Helvetica,sans-serif" font-size="60" font-weight="800" fill="#2b2b2b">Save money. Don&#8217;t get screwed.</text><text x="58" y="258" font-family="Arial,Helvetica,sans-serif" font-size="30" font-weight="600" fill="#6b5b4d">Leases, TI, NNN &amp; buildouts — negotiated in your favor</text><g transform="translate(1010,86)" fill="none" stroke="#C0531F" stroke-width="9" stroke-linejoin="round"><rect x="20" y="40" width="150" height="130"/><line x1="20" y1="40" x2="95" y2="6"/><line x1="170" y1="40" x2="95" y2="6"/><rect x="50" y="80" width="36" height="36"/><rect x="104" y="80" width="36" height="36"/><rect x="74" y="128" width="42" height="42"/></g></svg>

# How Do I Budget a Dialysis or Infusion Center Buildout?

## Direct Answer

Budget a dialysis center buildout at **$150–$300 per square foot** and an infusion center at **$120–$250 per square foot**, because both are water- and utility-intensive medical uses that dwarf a normal office fit-out. The line that separates dialysis from almost every other medical buildout is the **water treatment room**: a multi-station unit needs a reverse-osmosis system, carbon tanks, softeners, and a distribution loop that runs **$120,000–$350,000** installed for a **12–20 chair** clinic, plus a dedicated room of **200–400 square feet** with floor drains, backflow prevention, and **AAMI/ISO 23500** water-quality compliance. Infusion centers skip the RO plant but still need medical-gas or at minimum oxygen provisions, USP-797/800 compliant drug-prep areas if they compound, and individual power and nurse-call at every chair. The single biggest money move is to lease a **second-generation dialysis or medical space** with the water room, slab drains, and electrical service already in place — that alone can save you **$60–$120 per square foot** versus building the water and plumbing infrastructure into raw shell. For a typical **6,000–10,000 square foot** dialysis clinic, plan a hard-cost budget of **$900,000–$3,000,000** plus stations and equipment of **$25,000–$45,000 per dialysis station**. Do not accept a landlord's **$40–$60 per square foot** TI allowance as adequate; for these uses it covers a fraction of the real cost, and the gap is yours unless you negotiate it up or amortize it knowingly. Confirm in writing that the building's **water service, sanitary capacity, and electrical service** can carry your load before you sign, because retrofitting a 4-inch sanitary main or upsizing the electrical service after lease execution is six figures you will be fighting the landlord to pay.

## Why These Uses Cost So Much

Dialysis and infusion are not "doctor's offices with chairs." They are mini industrial-medical plants. For **dialysis**, the cost drivers are water and drains. Each station consumes large volumes of treated water, so you need the RO plant, a recirculating distribution loop in PVDF or similar piping, and a **floor drain at or near every chair** for spill and bleach management. That means saw-cutting the slab for drain runs at **$3,500–$9,000 per run**, an epoxy or sheet-vinyl seamless floor at **$8–$16 per square foot**, and a dedicated water room with its own ventilation and acid-neutralization. Add **medical-grade electrical** — every chair needs isolated, surge-protected power for the dialysis machine — plus emergency power provisions.

For **infusion**, the heavyweight items shift. You may need a **USP-800 hazardous-drug compounding room** with a negative-pressure anteroom and a biosafety cabinet if you mix chemotherapy, which alone adds **$60,000–$200,000** in containment, HVAC, and monitoring. Even non-compounding infusion suites need individual nurse-call, oxygen and suction at chairs, comfortable HVAC with good filtration, and private or semi-private bays for immunocompromised patients. Both uses live and die on HVAC: plan **MERV 13+** filtration, dedicated exhaust for the water/compounding rooms, and cooling sized at **350–450 square feet per ton** because the equipment throws heat.

## Build Your Number From the Ground Up

Build it bottom-up so you can defend it. For a **15-chair, 8,000 square foot dialysis center** in second-generation medical space:

- **General conditions/supervision:** **$60,000–$120,000** (7–10% of hard cost).
- **Demolition:** **$4–$9 per square foot** = **$32,000–$72,000**.
- **Framing, drywall, doors, finishes:** **$30–$55 per square foot** = **$240,000–$440,000**.
- **Water treatment room and RO plant:** **$120,000–$350,000**.
- **Plumbing — chair drains, sinks, distribution loop:** **$120,000–$300,000**.
- **HVAC and exhaust:** **$80,000–$220,000**.
- **Electrical, isolated power, emergency power, nurse-call:** **$120,000–$300,000**.
- **Seamless flooring:** **$8–$16 per square foot** = **$64,000–$128,000**.
- **Permits, design, engineering, state licensure prep:** **$60,000–$160,000**.

That lands hard cost around **$900,000–$2,000,000**, or **$112–$250 per square foot**, before stations. Dialysis stations (chair plus machine) run **$25,000–$45,000 each**, so 15 stations is another **$375,000–$675,000** in equipment financed separately. Hold a **12–18% contingency** — these projects find conditions behind every wall, and a failed water-quality validation can stall your opening for weeks.

```mermaid
flowchart TD
  A[Dialysis/Infusion Buildout] --> B[Water & Plumbing]
  A --> C[HVAC & Containment]
  A --> D[Electrical & Power]
  A --> E[Finishes & Flooring]
  B --> B1[RO Plant 120k-350k]
  B --> B2[Chair Drains 3.5k-9k/run]
  B --> B3[Distribution Loop]
  C --> C1[MERV 13+ Filtration]
  C --> C2[USP-800 Neg-Pressure Room]
  D --> D1[Isolated Power per Chair]
  D --> D2[Emergency Power]
  E --> E1[Seamless Floor 8-16/sf]
```

## How To Not Get Screwed

These are the highest-stakes medical buildouts in the retail/medical leasing world, and that means the most places to get burned.

**The utility-capacity ambush.** Dialysis and infusion need water volume, large sanitary capacity, and a beefy electrical service. If the building cannot deliver it, you are looking at a **$100,000+** utility upgrade. Make capacity a **condition of the lease**: require the landlord to confirm, in a delivery exhibit, the available water service size, sanitary main capacity, and electrical service amperage to your suite — and put the cost of any shortfall on the landlord as a base-building item. Owners who skip this discover during permitting that they are paying to bring a new electrical service or water tap to the building.

**The TI allowance that covers a third of the job.** A landlord touting **$50 per square foot** TI on a use that costs **$150–$300 per square foot** is offering you a fig leaf. Negotiate the allowance up to **$75–$120 per square foot** in exchange for a longer term (**10–15 years** is normal for dialysis), insist it pays as reimbursement against paid invoices, and if any portion is amortized, treat that as a **8–10% loan** and price it into your rent comparison. Demand the right to apply unused allowance to your first months' rent rather than forfeiting it.

**The contractor without medical-water experience.** RO plants, USP-800 rooms, and isolated power are specialty scopes. A generalist GC will sub them out blind and pad the markup. Bid **three GCs with documented dialysis or USP-800 infusion experience**, get a **fixed-price (stipulated sum)** contract, cap change-order markup at **10–15%**, hold **10% retainage** until water-quality validation passes, and never release final payment before your state survey and licensure inspection clear.

```mermaid
sequenceDiagram
  participant T as You (Tenant)
  participant L as Landlord
  participant GC as General Contractor
  participant S as State Surveyor
  T->>L: Require delivery exhibit (water/sanitary/electrical capacity)
  L->>T: Confirm capacity or fund base-building upgrade
  T->>GC: Bid to 3 medical-water GCs (fixed price)
  GC->>T: Sign with 10% retainage + validation hold
  GC->>T: Build, then validate water quality (AAMI/ISO 23500)
  T->>S: Schedule state licensure survey
  S->>T: Pass survey
  T->>GC: Release retainage after pass
```

## Timeline, Licensure, and Cash Flow

A dialysis or infusion buildout runs **16–28 weeks** of construction after permits, longer than most medical fit-outs because of the water plant, USP rooms, and the state survey that gates your opening. Permitting and any **Certificate of Need (CON)** process — required for dialysis in many states — can add **2–12 months** before you ever break ground, so confirm CON status before you sign a lease. Every week empty burns rent: an **8,000 square foot** suite at **$32 per square foot annual** costs roughly **$4,900 per week** sitting dark. Negotiate a **6–9 month** rent-free buildout and survey window, because if you only get 90 days you will pay rent for months on a clinic that cannot legally open until the surveyor signs off. Finance equipment separately from the construction loan, and keep a **15% liquid contingency** outside the loan for the water-validation and survey punch-list items that always appear.

## FAQ

**How much does a dialysis center buildout cost per square foot?**
Plan **$150–$300 per square foot** for dialysis and **$120–$250 per square foot** for infusion. The water-treatment plant (**$120,000–$350,000**), per-chair drains, isolated power, and seamless flooring are what push these far above a normal medical office.

**What makes dialysis more expensive than infusion?**
The water-treatment room. Dialysis needs a reverse-osmosis plant, a recirculating distribution loop, and a floor drain near every chair, all validated to **AAMI/ISO 23500**. Infusion's heavyweight cost is instead a **USP-800** negative-pressure compounding room (**$60,000–$200,000**) only if you mix hazardous drugs.

**Will the landlord cover the buildout?**
Only partially. A typical **$40–$60 per square foot** TI allowance covers a fraction of a **$150–$300 per square foot** job. Push for **$75–$120 per square foot** on a 10–15 year term, paid as invoice reimbursement, and make the landlord fund any water, sanitary, or electrical capacity upgrade as a base-building cost.

**How long until I can open?**
Expect **16–28 weeks** of construction plus permitting, and a state licensure survey before you can treat patients. Many states also require a **Certificate of Need** that adds **2–12 months** up front. Negotiate a **6–9 month** rent-free window so you are not paying rent on a clinic that cannot legally operate yet.

## Sources

- CBRE, "U.S. Healthcare Real Estate: Outpatient and Dialysis Cost Trends" (2025).
- JLL, "Healthcare and Life Sciences Fit-Out Cost Guide" (2025).
- Cushman & Wakefield, "Outpatient and Specialty Medical Facility Outlook" (2025).
- RSMeans / Gordian, "Building Construction Costs With RSMeans Data — Healthcare Occupancy" (2025).
- AAMI / ISO 23500, "Water for Hemodialysis and Related Therapies" standards.
- USP General Chapters <797> and <800>, "Pharmaceutical Compounding — Sterile and Hazardous Drugs."
- Facility Guidelines Institute (FGI), "Guidelines for Design and Construction of Outpatient Facilities" (2022 edition).
- NAIOP, "Medical Tenant Improvement and Specialty Use Allowance Benchmarks" (2025).

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Related in the library

How Do I Budget a Dialysis or Infusion Center Buildout?

How Do I Budget a Dialysis or Infusion Center Buildout?

Direct Answer

Why These Uses Cost So Much

Build Your Number From the Ground Up

How To Not Get Screwed

Timeline, Licensure, and Cash Flow

FAQ

Sources

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