The Shell Game: Why Second-Generation Medical Space Is the Real Bargain

I've been in North Texas real estate for more than 23 years, and I've watched a lot of smart doctors make the same math mistake.

They look at a cold dark shell and a finished medical suite at roughly the same price per foot and assume the shell is the better deal because they get to build it their way.

It usually isn't. The shell price is just the cover charge.

What "Cold Dark Shell" Really Means

A cold dark shell is four walls, a roof and a slab. No interior walls, no plumbing to the exam rooms, no ceilings, no finished HVAC distribution. Some shells even come with dirt floors so the plumber can trench.

What It Actually Costs in Frisco and Prosper

In Frisco and Prosper right now, I'm seeing cold dark shell medical space trade around $400 to $500 a foot. Interior finish-out can easily add $150 a foot on top of that: exam-room sinks, dedicated circuits, extra HVAC zoning and procedure rooms add up fast.

That puts the hard costs alone at roughly $550 to $650 a foot. And that number has nothing to do with the interest you pay or the time it takes to get there. Those come next.

Exam room in Suite 210 with a wall-wide sunflower mural
Exam room, Suite 210: already built, already beautiful.

What Stacks on Top of the Hard Costs

Design and permits. Medical is the most expensive category for architects and engineers. Design fees typically run 10% to 18% of construction cost, before permits, project management and legal.

FF&E and equipment. Basic medical office furniture runs about $10 to $30/SF. Specialty practices commonly spend $50,000 to $150,000+ on equipment, plus $15,000 to $30,000 on technology.

Loan fees, interest and taxes. SBA 504 fixed rates priced in October 2026 were about 6.97% on 25-year debentures, and 504 fees run roughly 3% of the debt. With prime at 7.00%, the SBA 7(a) variable cap on loans over $350,000 is 10%. You pay that interest, plus property taxes and dues, the whole time you're building and not seeing patients.

The Clock Is the Biggest Cost

Here's a realistic path from shell to first patient, using published 2026 ranges:

  • Design and programming: 6 to 10 weeks
  • Picking a contractor and closing a construction loan: 4 to 8 weeks
  • Permits and plan review: 3 to 8 weeks in DFW (10 to 16 weeks in tougher markets)
  • Construction: 11 to 23 weeks
  • Equipment, IT, inspections and move-in: 4 to 6 weeks

That's roughly 7 to 13 months before you open the door. And DoctorsManagement notes that credentialing alone takes 3 to 6 months, so new practices should plan for 6 to 12 months of operating reserves.

Lost revenue is the line nobody puts in the budget. Run your own number: if your practice nets $50,000 a month, a 10-month build costs you $500,000, about $62/SF on 8,000 SF.

Side-by-Side: Cost per Square Foot (Estimates)

All figures are estimates in dollars per square foot on about 8,000 SF (8,044 SF). Shell and finish-out are my own market read for Frisco and Prosper; the add-ons are planning ranges built from the cited sources. None of it is a bid, and your numbers will vary.

Cost item Buy cold dark shell and build Buy second-gen (Suite 210)
Hard costs    
Cold dark shell purchase (my Frisco/Prosper market read) $400 to $500 $497 (asking, built)
Medical finish-out (my market read) Up to about $150 Built
Hard costs subtotal $550 to $650 $497
Add-ons on top (estimates)    
Design, engineering, permits (10% to 18% of finish-out) $15 to $27 None
FF&E, equipment, IT $20 to $50 $0 to $25 (refresh/add-ons)
Construction loan fees (2% to 3% of finish-out and soft costs) $3 to $5 None
Interest and property taxes during build (7 to 13 months at 7% to 10%) $22 to $68 About $0
Add-ons subtotal $60 to $150 $0 to $25
Estimated all-in total per SF $610 to $800 $497 to $522
Estimated all-in total on 8,044 SF $4.9M to $6.4M $4.0M to $4.2M
Time to first patient 7 to 13 months Weeks, after closing
Lost revenue during build (example: $50,000/month net, not in totals) About $44 to $81 About $0

Look at the hard-cost line first. Before a dollar of interest or a single month of waiting, shell plus finish-out runs $550 to $650 a foot, or about $4.4M to $5.2M on 8,044 SF. That's already more than Suite 210's asking price of about $497 a foot. Then the add-ons stack another $60 to $150 a foot on top, and the clock adds 7 to 13 months of lost revenue.

The Example: Suite 210, Panther Creek Medical Park

My listing at 13052 Dallas Parkway, Suite 210 (Building 200) in Frisco is exactly this kind of opportunity.

  • About 8,000 SF of fully built medical office (8,044 SF per the Collin Central Appraisal District).
  • Offered at $3,999,999 (about $497/SF) or for lease at $35/SF NNN, and demisable to about 4,000 SF.
  • Built in 2019, per the appraisal district. The suite's finish-out was registered with the state as a tenant finish-out of the core and shell, with construction starting in 2020.
  • 15 exam rooms, two procedure or surgical rooms, two labs with sub-waiting and draw areas, two nurse stations, medication and supply rooms, four private offices and seven restrooms.
  • Large waiting and reception area, break room, and a conference or education room.
  • Seven HVAC units in a floored attic, 8 parking spaces per 1,000 SF, and building and monument signage opportunities.
  • The MLS lists furniture among the inclusions. Ask me exactly what conveys.
One of two nurse stations in Suite 210
Nurse stations, Suite 210: the clinical core is already in place.

Here's the kicker: the appraisal district's 2026 certified market value is $4,417,003, about $549/SF. The asking price is below the county's number.

The location is hard to beat. It sits along the Dallas North Tollway, directly north of Texas Health Hospital Frisco and near the new Baylor Scott & White PGA Parkway campus. Frisco grew to about 237,000 people in 2025, and Collin County passed 1.29 million, up 21.7% since 2020. Patients are already here.

The suite is in use today on a short-term lease, so it's essentially move-in ready.

When Building From Shell Still Makes Sense

To be fair, there are times a shell is the right call: imaging suites with shielding, a very specific layout, or a long time horizon where the custom design pays you back. But for most practices, a recent, high-quality second-gen suite wins on price per foot and wins big on time.

Let's Talk

I work all over Texas, and I'd be glad to run these numbers for your practice, on this suite or any other.

Call or text me at 214-714-5638 or email dan@cooperlandcompany.com. I promise the only thing left for you to build is your patient list.

Related Reading

Sources

How the table was built (estimates): shell price and finish-out are my own current market read for Frisco and Prosper medical space (finish-out shown at up to $150/SF; lighter build-outs cost less); design and soft costs at 10% to 18% of finish-out per source 6; FF&E and equipment from sources 7 and 8, spread over 8,044 SF; build schedule from sources 5, 6 and 9; interest at 7% to 10% (sources 10 and 11) on the shell price for the full period and on half the finish-out and soft costs for half the period; property taxes at the 1.68% effective rate implied by the suite's MLS tax figure and appraised value (sources 2 and 3), on the shell price for the build period; loan fees at 2% to 3% on 90% of finish-out and soft costs (source 11); lost revenue is an illustration at $50,000/month net for 7 to 13 months and is not included in the totals.

Photos: Lobby (header), exam room and nurse stations of Suite 210, 13052 Dallas Parkway, Frisco (my Cooper Land Company listing), used with permission.

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