Understanding the per-SF range

Medical and dental tenant improvements in DFW suburbs run roughly $175–$450 per square foot in construction hard costs. The wide range is honest — a basic primary-care practice is very different from an oral surgery suite with cone-beam CT. The most useful tool isn't the full range; it's the worked examples.

The full commercial DFW market runs $175–$650/SF across all building types, with cost growth slowing to 3–4% in 2026 after rising 12–18% from 2023 to 2026. Healthcare consistently lands in the upper half of that range due to MEP density, specialty requirements, and regulatory compliance.

Worked example: 5,000 SF dental practice in Plano

A 5,000 SF mid-complexity dental practice in Plano — four to six operatories, one panoramic X-ray room, standard finishes — is one of the most common projects Pereff prices. Here's what the numbers look like:

• Hard construction: $225–$280/SF × 5,000 SF = $1.125M–$1.4M.
• Soft costs (design, permits, engineering, insurance): typically 15–20% of hard costs, add $170K–$280K.
• FF&E (dental chairs, sterilizers, cabinetry, imaging unit): budget separately — often $200K–$350K for a full mid-size practice.
• Contingency: plan 8–10% on a medical TI; 12%+ if renovating an occupied space.

Real example: KVC Pediatric Dentistry at $141/SF

KVC Pediatric Dentistry — Dr. Velasquez and Dr. Chen — needed a 3,000 SF pediatric dental office in Little Elm, TX. The project came in at $423,000 — roughly $141/SF — achieved through true value engineering in the design-build process. The doctors had previously hired a dental consulting firm that was failing to produce a competitive architect or builder. Pereff replaced the consulting firm at no charge, compressed the permit to 1 month against an 8-month city backlog, and delivered the project in 3 months from groundbreaking.

The three cost drivers that matter most

In every medical and dental project Pereff has priced, three line items separate the bottom of the range from the top. Everything else is secondary.

1. Imaging and radiation shielding

Lead-lined rooms for X-ray, panoramic, or cone-beam CT are the single largest cost driver. Shielding involves structural coordination, a radiation shielding report, and extended city plan review. A single shielded X-ray room adds $40K–$100K+, depending on modality and room size. If your program includes CT, budget the higher end and commission a shielding design early. [DFW medical/dental vertical knowledge base, 2026]

2. Plumbing density (operatories)

Each operatory requires dedicated water supply, vacuum lines, compressed air, and drain. A six-op suite has substantially more rough-in than a three-op suite. Cost compounds if the existing slab rough-in doesn't match your layout, requiring saw-cutting and re-routing. Count your operatories and confirm slab conditions before design. [DFW medical/dental vertical knowledge base, 2026]

3. Sterile-environment HVAC

Medical and surgical spaces require dedicated HVAC zoning, higher air-change rates, and in some cases negative or positive pressure differentials. Sterile-environment HVAC can cost two to three times the same square footage in standard office TI. For dental practices, HVAC is typically the third-largest line item after imaging and plumbing. [DFW medical/dental vertical knowledge base, 2026]

What's not in the per-SF number

The per-SF figure covers hard construction costs. Three categories sit on top — together adding 25–45% to total project cost:

• Soft costs (design, permits, engineering, inspections, insurance) — typically 15–30% of hard costs.
• FF&E and equipment — dental chairs, imaging units, sterilizers, casework — often $200K–$400K for a mid-size practice, always budgeted separately.
• Contingency — plan 8–12% on a new medical TI; 12–15% or more if renovating an occupied space or the shell has unknown conditions.

How to read your bank's pro forma

Healthcare lenders underwrite your project against a total-cost-of-project (TCP) figure that includes every line above. Banks that specialize in healthcare lending — which Pereff's bank facilitation relationships connect you to — build the pro forma alongside the design. This is one of the most practical benefits of Pereff's design-build-finance model: the bank's numbers and the construction documents are developed together, so the loan amount you're approved for matches the project you actually intend to build.

Five questions determine where a project lands in the range — and which design decisions move it most: (1) What type of practice? (2) How many operatories or exam rooms? (3) What imaging? (4) Ground-up shell or existing TI space? (5) What's your target open date? A 30-minute preconstruction conversation answers all five with a directional range you can actually use for feasibility.