Dialysis is one of the very few medical treatments in the United States that has a real published national price. Medicare sets a single per-treatment base rate for outpatient dialysis, finalizes it in the Federal Register every autumn, and applies it every January. Almost nothing else in American healthcare works that way.
That number is a floor, not a ceiling. What a dialysis center actually collects per treatment is higher, what it bills an uninsured patient before any discount is higher still, and the kidney doctor bills separately on top of all of it. This guide walks through the 2026 Medicare rate, what centers really collect, what each modality costs over a year, and the coverage rule that matters more than any price on this page. Every figure was verified on September 3, 2026.
What Does Dialysis Cost Without Insurance?
The anchor is the CMS End-Stage Renal Disease Prospective Payment System. For calendar year 2026, CMS finalized an ESRD PPS base rate of $281.71 per treatment, an increase of $7.89 over the CY2025 rate of $273.82. CMS has since proposed $299.55 for CY2027, so the 2026 figure is current through December.
| Item | Low | Typical | High |
|---|---|---|---|
| Medicare ESRD PPS base rate, one treatment (CY2026) | $281.71 | $281.71 | $281.71 |
| What a national chain actually collects per treatment (Q2 2026) | $277.40 (its cost) | $415.87 | $415.87 |
| In-center hemodialysis, 156 treatments a year, at those two rates | $43,947 | $64,876 | |
| Nephrologist’s separate monthly fee, in-center (CPT 90960) | $347.44 allowed | $769.66 billed | |
| Nephrologist’s separate monthly fee, home dialysis (CPT 90966) | $283.39 allowed | $665.84 billed | |
| Home and self-dialysis training add-on, per training treatment (CY2026) | $95.60 | $95.60 | $95.60 |
| Total Medicare cost of care, in-center hemodialysis, per person per year (2023) | $103,127 | $103,127 | $103,127 |
| Total Medicare cost of care, peritoneal dialysis, per person per year (2023) | $87,750 | $87,750 | $87,750 |
| AV fistula creation (CPT 36821), facility fee, ASC vs. hospital outpatient (CY2026) | $1,623.69 | $3,225.87 | |
| AV fistula creation, bundled cash price | $3,401 | $9,266 | $11,437 |
A few notes on where those come from. The $415.87 is DaVita’s reported average patient service revenue per treatment for the quarter ended June 30, 2026, across every payer it bills, against patient care costs of $277.40 per treatment. The per-person-per-year figures are inflation-adjusted 2023 Medicare fee-for-service costs from the USRDS 2025 Annual Data Report, and they cover all care for a person with kidney failure, not the dialysis line alone. USRDS notes that home hemodialysis was consistently the most expensive modality of all.
The nephrologist’s fee is separate and easy to miss. CMS claims data for 2024 shows the monthly capitation code for an adult on in-center dialysis with four or more physician visits (CPT 90960) carried an average submitted charge of $769.66 and an average Medicare allowed amount of $347.44. That is a bill every month, on top of the treatments.
Sources disagree sharply on what vascular access surgery costs a cash payer. Sidecar Health’s cash-price data puts AV fistula creation at $3,401 at a surgery center and $5,189 at an outpatient hospital, while MDsave’s bundled national range for the same procedure is $7,252 to $11,437 with a $9,266 average, both read on September 3, 2026. Medicare’s own CY2026 facility rates sit below both: $1,623.69 in an ambulatory surgery center and $3,225.87 in a hospital outpatient department.
What Drives the Price
Modality. Peritoneal dialysis is done at home, usually nightly, and cost Medicare $87,750 per person in 2023 against $103,127 for in-center hemodialysis. Home hemodialysis was the most expensive of the three in USRDS data, largely because most people on it dialyze four or more times a week rather than three.
Facility and patient adjustments. The $281.71 base rate is a starting point. CMS adjusts it for local wages (with a wage-index floor of 0.6000 and a 5% cap on year-over-year decreases for CY2026), for patient characteristics, and for outlier cases. Two people at two centers can generate very different bills for an identical session.
Whether the doctor is billing separately. Almost always, yes. The dialysis facility bills the treatment, the nephrologist bills a monthly capitation fee, and a self-pay patient gets both.
Vascular access surgery. Before hemodialysis starts, most people need an access created. That is a one-time surgical cost that lands in the same window as everything else. Medicare’s 2024 claims data shows surgeons submitted an average charge of $2,286.55 for the professional side of an AV fistula creation and were allowed $604.20; the facility fee is on top.
Everything around the treatment. Labs, anemia and bone-mineral drugs, transportation three days a week, and hospital admissions when access fails. This is why the all-in per-person figures run so much higher than the per-session ones. Budget separately using our blood work cost guide if you are paying for monitoring labs out of pocket.
Medicare Covers Dialysis at Any Age
This is the single most valuable thing on this page, and most people do not know it.
End-stage renal disease is one of a tiny number of conditions that qualifies a person for Medicare regardless of age. Medicare.gov states that you can get Medicare no matter how old you are if all of the following apply: your kidneys no longer work, you need regular dialysis or have had a kidney transplant, and you have worked the required amount of time under Social Security, the Railroad Retirement Board, or as a government employee, or you are already getting or are eligible for those benefits, or you are the spouse or dependent child of someone who is.
There is a waiting period, and it has an exception worth real money:
- The default. Medicare coverage usually starts on the first day of the fourth month of your dialysis treatments. Medicare.gov notes that this four-month clock starts running even if you have not signed up yet.
- The home dialysis training exception. Coverage can begin as early as the first month of a regular course of dialysis if you take part in a home dialysis training program at a Medicare-certified training facility during your first three months, your doctor expects you to finish training and dialyze at home, and you keep up a regular course of dialysis through the period that would otherwise apply.
- Retroactive coverage. If you are eligible based on ESRD and do not sign up right away, Medicare.gov says your coverage could start up to 12 months before the month you apply. Someone who becomes eligible in February but applies in November still gets coverage back to February.
Coverage based on ESRD is not permanent. It ends 12 months after the month you stop dialysis treatments, or 36 months after the month of a kidney transplant.
You sign up through your local Social Security office, and Medicare.gov states that if you are approved because of ESRD you can enroll in Part B without a late enrollment penalty. You need both Part A and Part B to get the full set of dialysis and transplant benefits.
Cash Price vs. Insurance
Dialysis is the rare case where “just pay cash” is almost never the right answer. The annual cost is far too large for a discount to close the gap, and a program exists specifically to move you onto coverage. The correct move for an uninsured person facing dialysis is to get insured, not to negotiate a per-session rate.
That said, the gap between what a center is paid and what it charges is real. Medicare paid a base of $281.71 per treatment in 2026 and DaVita collected an average of $415.87 across all payers, while an uninsured patient billed at gross charges is looking at a number with no relationship to either. If you are already holding bills from before coverage started, that gap is your negotiating room. Ask for an itemized bill first, then work the number down using our negotiation guide and the negotiation script.
DaVita’s own insurance page notes that under the No Surprises Act, providers including DaVita must give uninsured and self-pay patients a Good Faith Estimate of expected charges. Ask for one in writing before you start, and hold the final bill against it.
How to Pay Less
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Apply for Medicare immediately, and ask about home dialysis training. The four-month waiting period is the most expensive stretch of the whole process for an uninsured person. Home dialysis training during the first three months can erase it entirely. CMS pays facilities a separate $95.60 add-on per training treatment in CY2026 (proposed to rise to $138.22 in CY2027), so centers have their own reason to offer it.
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Apply to the American Kidney Fund’s Health Insurance Premium Program. AKF’s HIPP pages list eligibility as receiving dialysis in the U.S. or its territories, household income no higher than 500% of the federal poverty level, and liquid assets excluding retirement accounts no higher than $30,000. Enrollment in LIHEAP, TANF, HUD housing assistance, or SNAP makes you automatically eligible. Grants can cover Medicare Part B, Medigap, Medicare Advantage, marketplace, employer group, and COBRA premiums.
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Use the social worker at the dialysis center. Both DaVita and Fresenius Kidney Care point uninsured patients to the center’s social worker as the first stop for assistance, and DaVita publishes a patient advocate helpline for people with kidney disease who have not yet started dialysis. This is a real, staffed function, not a brush-off.
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Price the vascular access surgery separately, and ask for a surgery center. Access creation is the one part of this that behaves like a normal shoppable procedure. Medicare’s CY2026 facility rate for AV fistula creation is $1,623.69 in an ambulatory surgery center against $3,225.87 in a hospital outpatient department, and Sidecar Health’s cash data shows the same pattern ($3,401 at a surgery center versus $5,189 at an outpatient hospital). Check any quote against our fair price checker.
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File for hospital charity care on anything hospital-based. Access surgeries, admissions for a clotted fistula, and hospital-based dialysis all fall under nonprofit hospital financial assistance policies. Our hospital charity care guide and the charity care checker walk through eligibility, which often reaches well into middle incomes.
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Ask whether peritoneal or home dialysis fits. This is a clinical decision, not a financial one, so raise it with the nephrologist rather than deciding on price. But peritoneal dialysis cost Medicare $87,750 per person in 2023 against $103,127 for in-center hemodialysis, and home dialysis training is the lever that shortens the Medicare waiting period.
Bottom Line
The honest per-session number for dialysis in 2026 is $281.71 to about $416, and the honest annual number for in-center hemodialysis is roughly $44,000 to $65,000 for the treatments alone, with total cost of care running past $100,000 a year once drugs, labs, and hospital stays are counted.
No uninsured person pays that out of pocket for long, and the system knows it. Kidney failure is a Medicare-qualifying condition at any age, the four-month waiting period has a home-training exception, and the American Kidney Fund exists specifically to keep premiums paid. If you or someone you know is starting dialysis without coverage, the first two phone calls are Social Security and the center’s social worker, in that order. If the road here ran through stones or a bladder workup, our kidney stone surgery cost guide and cystoscopy cost guide cover what those cost on their own.