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{"sheet":"Instructions","index":0,"n_rows":107,"n_cols":2,"rows_kept":107,"cut":false,"hidden":false,"merged":[[75,0,76,5],[99,0,100,5],[64,0,65,5],[54,0,55,5],[0,0,1,5],[5,0,6,4],[35,0,36,5]]}
["BEFORE YOU BEGIN!!"]
[]
["Click the highlighted yellow bar at the top of the page"]
["on the EXP BASED COST & CA tab to enable Macros. "]
[]
["COMPLETING THE SUMMARY TAB"]
[]
[]
["Step 1: Complete the Project Information"]
[]
["Step 2: Complete the salary amount for the personnel that will work on the project.  If multiple staff are on the project, use the highest salary among the staff."]
["Step 3: The Fringe Rate is a tiered calculation."]
[]
["Personnel Costs Notes:"]
[null,"Effort is a calculation based on the information provided on the \"Effort\" tab.  This field is not editable and will populate from providing the information on the effort tab."]
[null,"The costs section will calculate after the \"Effort\" tab is complete"]
[]
[]
[]
["Clinical Study Costs Summary Notes:"]
[null,"No data entry is required. "]
[null,"Subtotal Startup pulls from \"Startup & Inv.\" tab cell D18"]
[null,"Subtotal Invoiceable pulls from \"Startup & Inv.\" tab cell D44"]
[null,"Total Direct Cost is a sum of Startup Costs and Invoiceable Costs "]
[null,"Subtotal Effort Based Per Patient Costs is a sum of (estimated #hrs x hourly salary rates)"]
[null,"Subtotal Expensed Based Per Patient Costs is a sum of totals on row 38 of the \"Cost-Expenses\" tab."]
[null,"Total Direct Per Patient Costs is (Effort+Expense Based per patient costs)*(number of expected patients)"]
[null,"Total Indirect Cost is (L30+L34)* Indirect Cost Rate"]
[null,"Total Direct Costs for R&A is a sum of Startup Costs and Total Direct Per Patient Costs. This total should be used on your R&A form. "]
[null,"Total Indirect Costs for R&A is Total Direct Costs for R&A * Indirect Cost Rate"]
[null,"Total Costs for R&A is a sum of Total Direct Costs for R&A and Total Indirect Costs for R&A"]
[null,"Total Anticipated Study Costs is a sum of (L30+L33+L34)"]
["Step 4: Enter the amount funded by the sponsor. "]
[null,"Study Revenue will be a positive number and show as green; Study Deficit will be a negative number and show as red"]
[]
["COMPLETING COVERAGE ANALYSIS TAB"]
[]
[]
["Adding Rows and Columns:"]
[null,"Using the Macro keys at the top will add rows and columns to the end of each section."]
[]
[]
["Entering Protocol Activities:"]
[null,"You can find activities utilizing the drop down menus or by directly typing into the Procedures/Activities Column"]
[null,"A location must be selected for every item listed."]
[null,"A CPT code must be listed for every item that is not identified as a \"non-billable\""]
[null,"A justification must be provided for each item marked as Standard of Care (SOC)"]
[]
["Selecting Coverage Type:"]
[null,"A non-billable item is one that will not appear in the GE Centricity billing system."]
[null,"NB-Cost for Research is a non-billable item that will still be invoiced on a per-patient basis to the resarch account (eg. Department set room charge)"]
[null,"RES identifies a billable procedure that will appear in the GE Centricity billing system that needs to be charged to the research account."]
[null,"SOC identifies a standard of care procedure that will be billed to the patient/patient's insurance."]
[]
["COMPLETING EFFORT TAB"]
[]
[]
["Adding Personnel:"]
[null,"Personnel are automatically populated from the Summary tab.  Please add additional personnel on the Summary tab."]
[]
["Inputing Time and Effort:"]
[null,"In the upper table input the total estimated time that the individual is expected to devote for a single patient at each visit.  "]
[null,"The lower table automatically calulates the hourly rate for each individual based on the information from the Summary Tab."]
[]
["COMPLETING COST-EXPENSES TAB"]
[]
[]
["Update Table:"]
[null,"The table does not automatically update.  If changes are made to the coverage analysis tab, then you will need to click on the Update Table Macro."]
[]
["Adding Pricing:"]
[null,"For each item marked as RES or NB-Cost for Research, the cell will unlock and turn yellow.  "]
[null,"Input the unit price for each.  Remember that some procedures are split into a technical fee from MHHS and professional fee from UTP."]
[null,"Each column will automatically subtotal and calculate the IDC for the entire visit."]
[]
["COMPLETING START UP AND INVOICEABLES TAB"]
[]
[]
["Startup Time and Effort:"]
[null,"Scroll down to Rows 54-60."]
[null,"The personnel will automatically pull from the summary tab  Add additional personnel on the Summary tab first."]
[null,"For each startup activity listed, provide the total amount of time each individual is expected to spend on that activity in the available yellow box."]
[null,"To the right, total effort will be calculated based on a standard 40 hour work week during a single calendar year."]
[]
["Other Startup Costs:"]
[null,"Scroll up to the top of the tab."]
[null,"For each other additional startup costs (not effort based) provide a brief description in the Start Up Costs column."]
[null,"For each item provide the price prior to IDC.  (do not put what you are charging the sponsor, but the actual cost that will hit the account before IDC)."]
[null,"For IRB costs select the appropriate review cost and delete the one that is not needed."]
[null,"All IDC costs will automatically calculate."]
[null,"Total Startups and IDC will automatically calculate at the bottom of the table."]
[]
["Invoiceable Costs:"]
[null,"Provide a brief description of the invoiceable in the Invoiceable Procedue column."]
[null,"Provide the price that will be paid from the research account in the Unit Price column (do not put what you are charging the sponsor, but the actual cost of the item)"]
[null,"Under Quantity put the maximum number you are allowed to invoice for per the sponsor, if this is unlimited you can estimate how many you may see during the life of the trial."]
[]
[]
[]
["COMPLETING QQBR TAB"]
[]
[]
["YOU ONLY NEED TO COMPLETE THE SECTIONS THAT APPLY TO YOUR STUDY"]
[]
["For device studies answer the questions in the top section."]
["For drug/biologic/behavioral studies answer the questions in the bottom section."]
["Once all questions have been answered have the PI sign the certification at the bottom of the page."]

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["The University of Texas Health Science Center at Houston"]
["Clinical Trials Detailed Budget Worksheet "]
["THIS FILE IS FOR INTERNAL USE ONLY. CONTACT CRF@uth.tmc.edu WITH ANY COMMENTS OR QUESTIONS"]
["Version  11/25/2024"]
["Date:"]
["Coverage Analysis Complete By:",null,null,null,null,null,"Complexity","low",null,"Email:"]
["Budget Complete By:",null,null,null,null,null,"Phone",null,null,"Email:"]
["PROJECT INFORMATION:  Enter the information below.",null,null,null,null,null,null,null,null,null,null,null,null,"What does SC Administrative  time cover?"]
["Project Title:"]
["Principal Investigator:",null,null,null,null,null,"Department:"]
["Sponsor/CRO:",null,null,null,null,null,"Project Period:",null,null,null,null,null,null,"Organizing and upkeep of Subject files"]
["CPHS Study Number:",null,null,null,null,null,"Coordinator:",null,null,null,null,null,null,"Update PI and/or Sponsor on enrollment progress"]
["ClinicalTrials.gov # / NCT #:",null,null,null,null,null,"IDE #:",null,null,null,null,null,null,"Discussing study with collaborating researchers and PI (CO Is, Radiology, MHH, CRU, etc.)"]
["EXPECTED # OF PATIENTS:",null,null,null,null,null,"IDC RATE: ",null,0.3,"Non-negotiable for all industry sponsors.",null,null,null,"Pre-screening (review ERM and clinic  schedules to see if patient is eligible for screening visit and upcoming clinic visits)"]
["PERSONNEL COSTS:  These are required for the UTH internal budget, but are not always included in the sponsor's budget;  personnel costs are included in effort-based costs below; the PI's effort must be at least 2%.",null,null,null,null,null,null,null,null,null,null,null,null,"Phone calls with study subjects"]
["SALARIES:  Enter salary (REG + LONG + AUG) for the PI and others.  Or, for staff, choose a salary from the range for that position.",null,null,null,null,null,null,null,null,null,null,null,null,"Protocol amendment submission to IRB"]
["Position",null,"Name",null,"Salary",null,"% Effort","Request",null,"Fringe Rate","Fringe $","Total"]
["PI",null,{"$f":"C10","v":0},null,null,null,{"$f":"$D$14*Effort!M20","v":0},{"$f":"SUM(E18*G18)","v":0},null,{"$f":"IF($E18<40000, x!$C$3, IF(AND($E18>39999,$E18<70000), x!$C$4, IF(AND($E18>69999,$E18<150000), x!$C$5, IF(AND($E18>149999,$E18<230000), x!$C$6, IF(AND($E18>229999,$E18<500000), x!$C$7, IF($E18>499999, x!$C$8))))))*1","v":0.44},{"$f":"SUM(H18*J18)","v":0},{"$f":"SUM(H18+K18)","v":0},null,null,"Industry studies "]
["PI Oversight",null,{"$f":"C18","v":0},null,{"$f":"E18","v":0},null,0.02,{"$f":"SUM(E19*G19)","v":0},null,{"$f":"IF($E19<40000, x!$C$3, IF(AND($E19>39999,$E19<70000), x!$C$4, IF(AND($E19>69999,$E19<150000), x!$C$5, IF(AND($E19>149999,$E19<230000), x!$C$6, IF(AND($E19>229999,$E19<500000), x!$C$7, IF($E19>499999, x!$C$8))))))*1","v":0.44},{"$f":"SUM(H19*J19)","v":0},{"$f":"SUM(H19+K19)","v":0},null,null,"Regulatory binder preparation and ongoing maintenance  (IRB approvals, monitoring reports, IND reports etc.)"]
["Coordinator",null,{"$f":"I12","v":0},null,null,null,{"$f":"$D$14*Effort!M21","v":0},0,null,{"$f":"IF($E20<40000, x!$C$3, IF(AND($E20>39999,$E20<70000), x!$C$4, IF(AND($E20>69999,$E20<150000), x!$C$5, IF(AND($E20>149999,$E20<230000), x!$C$6, IF(AND($E20>229999,$E20<500000), x!$C$7, IF($E20>499999, x!$C$8))))))*1","v":0.44},0,0,null,null,"Delegation of authority log upkeep"]
["Coordinator Admin ",null,{"$f":"C20","v":0},null,{"$f":"E20","v":0},null,{"$f":"IF((D14<20),0.05,(IF(D14<30,0.1,(IF(D14<40,0.15,IF(D14<40,0.15,IF(D14<50,0.2,IF(D14<60,0.25,IF(D14<70,0.3,IF(D14<80,0.35,IF(D14<90,0.4,IF(D14<100,0.45,IF(D14<110,0.5,IF(D14<120,0.55,IF(D14<130,0.6,IF(D14<140,0.65,IF(D14<150,0.7,IF(D14<160,0.75))))))))))))))))))","v":0.05},0,null,{"$f":"IF($E21<40000, x!$C$3, IF(AND($E21>39999,$E21<70000), x!$C$4, IF(AND($E21>69999,$E21<150000), x!$C$5, IF(AND($E21>149999,$E21<230000), x!$C$6, IF(AND($E21>229999,$E21<500000), x!$C$7, IF($E21>499999, x!$C$8))))))*1","v":0.44},0,0,null,null,"Answering data base queries from sponsor"]
["Finanical Management",null,null,null,null,null,{"$f":"$D$14*Effort!M23","v":0},0,null,{"$f":"IF($E22<40000, x!$C$3, IF(AND($E22>39999,$E22<70000), x!$C$4, IF(AND($E22>69999,$E22<150000), x!$C$5, IF(AND($E22>149999,$E22<230000), x!$C$6, IF(AND($E22>229999,$E22<500000), x!$C$7, IF($E22>499999, x!$C$8))))))*1","v":0.44},0,0]
[null,null,null,null,null,null,{"$f":"$D$14*Effort!M24","v":0},0,null,{"$f":"IF($E23<40000, x!$C$3, IF(AND($E23>39999,$E23<70000), x!$C$4, IF(AND($E23>69999,$E23<150000), x!$C$5, IF(AND($E23>149999,$E23<230000), x!$C$6, IF(AND($E23>229999,$E23<500000), x!$C$7, IF($E23>499999, x!$C$8))))))*1","v":0.44},0,0]
[null,null,null,null,null,null,{"$f":"$D$14*Effort!M25","v":0},0,null,{"$f":"IF($E24<40000, x!$C$3, IF(AND($E24>39999,$E24<70000), x!$C$4, IF(AND($E24>69999,$E24<150000), x!$C$5, IF(AND($E24>149999,$E24<230000), x!$C$6, IF(AND($E24>229999,$E24<500000), x!$C$7, IF($E24>499999, x!$C$8))))))*1","v":0.44},0,0]
[null,null,null,null,null,null,{"$f":"$D$14*Effort!M26","v":0},{"$f":"SUM(E25*G25)","v":0},null,{"$f":"IF($E25<40000, x!$C$3, IF(AND($E25>39999,$E25<70000), x!$C$4, IF(AND($E25>69999,$E25<150000), x!$C$5, IF(AND($E25>149999,$E25<230000), x!$C$6, IF(AND($E25>229999,$E25<500000), x!$C$7, IF($E25>499999, x!$C$8))))))*1","v":0.44},0,0]
["Sponsored Projects",null,null,null,70000,null,{"$f":"$D$14*Effort!M27","v":0},0,null,{"$f":"IF($E26<40000, x!$C$3, IF(AND($E26>39999,$E26<70000), x!$C$4, IF(AND($E26>69999,$E26<150000), x!$C$5, IF(AND($E26>149999,$E26<230000), x!$C$6, IF(AND($E26>229999,$E26<500000), x!$C$7, IF($E26>499999, x!$C$8))))))*1","v":0.3},0,0]
["Study/Project  Personnel Costs",null,null,null,null,null,null,{"$f":"SUM(H18:H26)","v":0},null,null,{"$f":"SUM(K18:K26)","v":0},{"$f":"SUM(L18:L26)","v":0}]
["Clinical Study Costs Summary"]
[]
["Subtotal Startup Costs (Excluding IDC)",null,null,null,null,null,null,null,null,null,null,{"$f":"'Start up and Invoiceables'!D18","v":6007.8846153846152},null,"What does PI oversight  time cover?"]
["Subtotal Invoiceable Costs (Excluding IDC) not included in total",null,null,null,null,null,{"$f":"'Start up and Invoiceables'!D44","v":1000}]
["Subtotal Effort  Costs for 1 patient  (excluding IDC)",null,null,null,null,null,null,null,null,{"$f":"L27/D14","v":{"$error":"#DIV/0!"}}]
["Subtotal Expense Costs for 1 patient (excluding IDC)",null,null,null,null,null,null,null,null,{"$f":"SUM('Cost-Expenses'!C40:BE40)","v":0},null,null,null,"Ensure informed consent, IRB approval, and participant safety throughout the study."]
["Study/Project Direct Expenses  (excluding IDC and personnel expenses)",null,null,null,null,null,null,null,null,null,null,{"$f":"J33*D14","v":0},null,"Strictly follow the approved protocol and maintain complete, accessible records for regulatory review."]
["Sub Total Direct Costs  Personnel + Expenses+ Startup",null,null,null,null,null,null,null,null,null,null,{"$f":"L34+L30+L27","v":6007.8846153846152},null,"Hire qualified staff, verify credentials, and provide ongoing supervision and training."]
["Total Indirect Costs",null,null,null,null,null,null,null,null,null,null,{"$f":"L35*I14","v":1802.3653846153845},null,"Control drug handling per protocol and ensure accurate, reliable data collection."]
["START Proposal:Total Direct Costs  (Enter into START) ",null,null,null,null,null,null,{"$f":"H39/(1+I14)","v":0},null,null,null,null,null,"Provide timely reports to sponsors and regulatory bodies, and maintain open team communication."]
["START Proposal:Total Indirect Costs   (autopopulates in START)",null,null,null,null,null,null,{"$f":"H39-H37","v":0}]
["START Proposal: Total Costs  (autopopulates in START)",null,null,null,null,null,null,{"$f":"G41","v":0}]
["Total Anticipated Internal Study Costs",null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(L35:L36)","v":7810.25}]
["Total Anticipated Revenue"]
["Study Revenue or Deficit ",null,null,null,null,null,{"$f":"G41-L40","v":-7810.25}]
["COMMENTS:"]
[]
["See notes to right for calculating Total anticpated revenue N37.   STUDY TEAM you should leave relevent notes in this section to help expedite Proposal record budget reivew.  (This note can be deleted prior to adding study team notes)"]
[]
[]
[]
[]
[]
["Note for Principal Investigator: The  final copy of  this budget/CA is attached to the proposal record in START.  By signing the START proposal reocord you are certifying that  the   coverage analysis internal budget (CAIB) tool attached  accurately reflects the billing determinations and anticpated costs to conduct the study. Per institutional policy (HOOP 214) The PI is responsible for assigning staff to ensure the charges are billed in accordence with the coverage analysis."]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"**Please note, salary recharge is based on the information provided in this table."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"SPA will combine SC per visit and SC administrative effort when calculating salary expenses"]
["PI Signature: ",null,null,null,null,null,"Date: "]
[]
[null,null,null,null,null,null,null,null,null,null,null,null," For Industry initiated studies  you will enter I35 under M&O in START  (IDC and Grand total will auto populate/calculate in START.) See CT  guidence document for more details "]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"**Total Anticipated Revenue is calculated as follows: Total per patient amount multiplied by # of anticipated patients (inclusive of OH), PLUS invoiceable items that are certain to be invoiced/paid."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"***Do not include the invoiceable items that may not occur (e.g., Clinical procedures that are done only if certain criteria is met, SAE reporting, Monitoring visit payments, etc.)."]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Example: Start up invoicables and Close out invoicables are certain to be invoiced/paid."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Some contracts are set up to include many items that are certain to be invoiced/paid as invoicables. Each contract is unique."]

{"sheet":"x","index":2,"n_rows":37,"n_cols":7,"rows_kept":37,"cut":false,"hidden":true,"merged":[[0,0,0,2],[0,4,0,6]]}
["FY25 Benefit Tiers",null,null,null,"FY25 Benefit Tiers - Students"]
["min ","max","rate",null,"min ","max","rate"]
[0,39999,0.44,null,0,4999,0.1]
[40000,69999,0.37,null,5000,24999,0.42]
[70000,149999,0.3,null,25000,"+",0.27]
[150000,229999,0.25]
[230000,499999,0.2]
[500000,"+",0.13]
[]
["Project Staff"]
["PI"]
["Staff"]
["Study Coordinator"]
[" "]
[]
["Administrative fee"]
["    Low intensity (0-4 hours)",300]
["    Moderate intensity (5-9 hours)",675]
["    High intensity (10+ hours)",1100]
[]
["Protocol submission fee"]
["    Low intensity (0-8 hours)",650]
["    Moderate intensity (8-20 hours)",1300]
["    High intensity (20+ hours)",2600]
[]
["Research vs. SOC"]
["Research"]
["SOC"]
[]
["Study Type"]
["Device"]
["Drug"]
["HUD"]
[]
["YES/NO"]
["Yes"]
["No"]

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[]
[{"$f":"Summary!A9","v":"Project Title:"},null,{"$f":"Summary!B9","v":0}]
[{"$f":"Summary!A10","v":"Principal Investigator:"},null,{"$f":"Summary!C10","v":0}]
[{"$f":"Summary!A11","v":"Sponsor/CRO:"},null,{"$f":"Summary!C11","v":0}]
[{"$f":"Summary!A12","v":"CPHS Study Number:"},null,{"$f":"Summary!C12","v":0}]
[{"$f":"Summary!A13","v":"ClinicalTrials.gov # / NCT #:"},null,{"$f":"Summary!D13","v":0},null,null,null,null,null,null,null,null,null,"Version Date:",{"$f":"LastSavedTimeStamp()","v":{"$error":"#NAME?"}}]
[]
["Category ","Procedures/ Activities","Location ","CPT Code","CDM Code",null,null,null,null,null,null,null,null,"Justifications "]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["NOT LISTED IN PROTOCOL SCHEDULE "]
[]
[null,"CRF Data Entry",null,{"$f":"IF(ISNA(VLOOKUP(B32,'CA Data-Validation'!$A$121:$B$489,2,FALSE)),\"\",VLOOKUP(B32,'CA Data-Validation'!$A$121:$B$489,2,FALSE))","v":""}]
[null,"Chart set up",null,{"$f":"IF(ISNA(VLOOKUP(B33,'CA Data-Validation'!$A$121:$B$489,2,FALSE)),\"\",VLOOKUP(B33,'CA Data-Validation'!$A$121:$B$489,2,FALSE))","v":""}]
[null,"Schedule next visit",null,{"$f":"IF(ISNA(VLOOKUP(B34,'CA Data-Validation'!$A$121:$B$489,2,FALSE)),\"\",VLOOKUP(B34,'CA Data-Validation'!$A$121:$B$489,2,FALSE))","v":""}]
[null,"Describe Study drug",null,{"$f":"IF(ISNA(VLOOKUP(B35,'CA Data-Validation'!$A$121:$B$489,2,FALSE)),\"\",VLOOKUP(B35,'CA Data-Validation'!$A$121:$B$489,2,FALSE))","v":""}]

{"sheet":"CA Data-Validation","index":4,"n_rows":489,"n_cols":21,"rows_kept":489,"cut":false,"hidden":true,"merged":[]}
["Patient Payment","Visits","Labs        ","Anesthesiology","XRay Imaging","Tissue ","Ultrasound ","CT","MRI MRA","Nuclear Radiology","EKG ECHO","Pulmonary","Pharmacy","Parking","Cardiac","OR","Biopsy","Fluoroscopy","PET","Neurophysiology","Other"]
["Patient Payment","Clinic Visit_Est. Patient Level 1","Albumin Serum","Anes Endotracheal Tube","Abdomen Acute Series Complete","Research Handling Fee- blocks","US Abdomen Complete","Creatinine Blood Non OPID-*only use with Contrast for CT","Creatinine Blood Non OPID-*only use with Contrast for MRI","Bone Density DXA Axial Skelet","Cable ECG 12 V Lead","6 min walk","New Study Set-Up / Administrative Fee (Inpatient Study)","CRU Parking ","Angio Coronary w/o Heart Cath","Cable ECG 12 V Lead","EKG Hourly Monitor Charge","Fluoro Local  NDL Biopsy/ Aspiration","CT Thorax W/O Contrast","13 or more Nerve Conduct","Other"]
[null,"Clinic Visit_New Patient Level 2","Alk Phosphatase","Anes srvs General 1st 30 min","Abdomen AP View","Research Unstained Slides","US Abdomen Limited","OPID CT Omnipaque 300ML 10-*only use with CT and Angio Contrast","IV START PAK-*only use with Contrast for MRI","Bone Scan Three Phase Study","ECG 12/15 Lead","Alprazolam 1 MG Tab","New Study Set-Up / Administrative Fee  (Outpatient Study)",null,"Blood O2 Saturation only","Cardiac Output Measurement","Conscious Sedation> 5 years old, first 30 min",null,"PET Brain Imaging Met Eval"]
[null,"Clinic Visit_New Patient Level 3","Alpha -fetoprotein","Anes srvs General add 15 mins","Ankle 2 Views Bilateral",null,"US Brain Scan","Iodixanol 320MG/ML INJ(200ML)- *only use with CT and Angio Contrast","Electrode MRI ECG Quatrade-*only use with Contrast for MRI","Bone Scan Tomogram Spect","12 Lead ECG CPT (Tracing & Interpretation only)","Blood Gas","Annual Refrig Storage Fee",null,"Cath Lab Treatment Room","Cath 8F Cardiac Output","Skin biopsy + add  Lesion",null,"PET CT Tumor Image Skull MIDTH"]
[null,"Clinic Visit_ Est. Patient Level 4","ALT (SGPT)","Desflurane Per case","Ankle 2 Views Unilateral",null,"US Chest","Injection Kit Dual Syringe-*only use with Contrast for CT","Monitor Non-Invasive","Bone Scan Whole Body","ECG Rhythym Strip","Blood O2 Saturation","Annual Study Maintenance Fee",null,"DSA Analysis Coronary","Drape Intraop Probe SM T TIP","Oxygen ",null,"PET CT Tumor Imaging LTD area"]
[null,"Clinic Visit_ Est. Patient Level 5","Amplified Probe(MSRA)","Invasive Pressure Monitor","Ankle Complete 3+V Uni",null,"US Duplex Abd/Pel/Scrot/Kid","CT Abdomen w/Contrast","MRI Kit-*only use with Contrast for MRI","Bone Scan Whole Body","Echo 2D M Mode Comp w/Color Fl","Bronchoscopy w/Biopsy","Miscellaneous IDS FEE 15 min",null,"DSA Analysis LV Gram","Dressing Bio Patch","Biopsy Tray",null,"PET CT Tumor Imaging Whole BD"]
[null,"Room Charge","AST (SGOT)","Kit Transd 3 ml 12 in 72 in TB","Bone Density DXA Axial Skelet",null,"US Duplex Ext Veins Bilat","CT Abdomen w/out Contrast","GADOBENATE 1ML VL(7935MG/15ML)-*(contrast x 15 (qty 15= qty is equal to 1ML VL (7935MG/15ML) per 150 lb patient)  only use with Contrast for MRI","Bone Scan, Multiple Area","Echo 2D M Mode Complete","Bronchoscopy w/Bronchial Lavag","Patient Randomization",null,"Injection Venous Bypass Grafts","Injection IV Push 1st drug","Universal Precautions",null,"PET Myocard Imag Metabolic Eval"]
[null,"Venipuncture","Basic Metabolic Panel","Oximeter P/Day","Bone Survey Complete",null,"US Pelvis Complete","CT Abodomen w/out - w/Contrast","MRA Abdomen w/Contrast","Brain Scan Spect","Echo 2D M Mode Limited","Bronchoscopy w/Brushing","Per Dose RX Dispensing Fee",null,"Left & Right Heart Cath","Kit Perc Intro 8.5 FR","Pulse Oximeter",null,"PET Myocard Imag Metabolic Eval"]
[null,null,"Beta-Natriuretic Peptide (BNP)",null,"Both Knees standing anteroposterior",null,"US Retroperitoneal Limited","CT Angio Abdomen","MRA Abdomen w/out Contrast","Cardiac Scan Gated Multi(MUGA)","Echo Doppler Complete","Cardiac Output Measurement","Storage Of Used Study Medication",null,"Procedure Prep","Minor Proc Recovery  1 st hour","Biopsy Lung perc",null,"PET Tumor Image Skull Midthigh"]
[null,null,"Bicarbonate(CO2)",null,"Chest AP w/Fluoro",null,"US Scrotum & Contents","CT Angio Aorta w/Fem Runoff","MRA Abdoment w/out - w/Contrast","Cold Pyrophosphate per dose","Echo Doppler Limited","D5W 500 ml Bag","Study Annual Documentation Fee",null,"S&I Abdominal Aortagram","Minor Proc Recovery  add 30 minutes ","Skin biopsy Single Lesion",null,"PET Tumor Imaging"]
[null,null,"Bilirubin Direct",null,"Chest AP w/Lordotic",null,"US Transpl Kidney w/ Dop","CT Angio Chest w/o - w/Contrast","MRA Chest w/Contrast","Lung Perfusion Scan","Echo Follow-Up Congenital","Diffusion Capacity (DLCO)",null,null,"S&I Arterial /Vent/Angio ( Pedi)","Oxi Adult Sensor","Kit Bone Biopsy",null,"PET Tumor Imaging Limited area"]
[null,null,"Bilirubin Total",null,"Chest 2 view AP & Lateral",null,"US Transpl Kidney w/out Dop","CT Angio Extr Lower w/Contrast Uni","MRA Chest w/out - w/Contrast","TC-99M Sulfur Colloid Per Dose","Echo Follow-Up/Limited","Fentanyl 100 MCG/2 ml Vl",null,null,"S&I Cor/Pulm/Aort Angio","Pack Line Linen","Pressure bag vital signs",null,"PET Tumor Imaging Whole Body"]
[null,null,"Blood Culture",null,"Chest AP Single View",null,"US Transrectal","CT Angio Extr Lower w/o - w/Bi","MRA Head w/Contrast",null,"Echo w/Contrast","Injection  Internal Mammary",null,null,null,"Phase 2 PACU Ea Add 30 min-Rout","IV Catheter #18-24"]
[null,null,"BUN",null,"Knee 1 or 2 views",null,"US Transvaginal","CT Angio Extr Upper w/Contrast Bi","MRA Head w/out - w/Contrast",null,"Holter Analysis","Injection Pulmonary",null,null,null,"Preoperative Assessment","Conscious Sedation> 5 years old, each add 15 mins"]
[null,null,"Calcium Ionized",null,"Knee 3 views",null,null,"CT Angio Extr Upper w/Contrast Uni","MRA Head w/out Contrast",null,"Holter Placement 24 Hour","Midazolam 1 MG vl (2mg/2ml)",null,null,null,"Pressure Infuse disposable","Monitors electrodes"]
[null,null,"Calcium, Total",null,"Knee complete 4 views",null,null,"CT Angio Head w/out - w/Contrast","MRA Neck w/Contrast",null,"Stress Echo","NACL 0.9%  100 ML Bag",null,null,null,"Procedure Prep","Kit Bone Biopsy 11 ga"]
[null,null,"CBC  w/platelets no diff",null,"Pelvis 1-2 Views",null,null,"CT Angio Neck w/out - w/Contrast","MRA Neck w/out - w/Contrast",null,"Transesophageal Echo","NACL 0.9% 500 ML IV",null,null,null,"Safeset 60/SS/MAC Mon -kit","Non Invasive blood pressure monitor"]
[null,null,"CBC diff, w/platelets, automated",null,"Spine Cervical 1V",null,null,"CT Angio Pelvis w/out - w/Contrast","MRA Neck w/out Contrast",null,null,"Nitroglycerin 0.6 Mg Tab",null,null,null,"Tray Custom Adult Cardiac","Post Procedure recovery room + 30 mins"]
[null,null,"CD4 count or T cell Absolute",null,"Spine Cervical 2-3V",null,null,"CT Cervical Spine w/Contrast","MRA Neck w/out Contrast",null,null,"O2 Uptake and CO2 Output",null,null,null,null,"Post Procedure recovery room first hour"]
[null,null,"Chloride",null,null,null,null,"CT Cervical Spine w/out - w/Contrast","MRA Pelvis w/ or w/out Contrast",null,null,"Plenty Lung Volumes Airwy Rest"]
[null,null,"Cholesterol",null,null,null,null,"CT Cervical Spine w/out Contrast","MRA Pelvis w/Contrast",null,null,"Prednisone 5 MG tab(20 mg)"]
[null,null,"Complement AG EA Component",null,null,null,null,"CT Chest w/Contrast","MRA Pelvis w/out Contrast",null,null,"Propofol 200 MG/20ml VL"]
[null,null,"Comprehensive metabolic panel",null,null,null,null,"CT Chest w/out - w/Contrast","MRI Abdomen w/Contrast",null,null,"Pulmonary Stress Test Complex"]
[null,null,"C-Peptide",null,null,null,null,"CT Chest w/out Contrast","MRI Abdomen w/out - w/Contrast",null,null,"Pulse Oximeter Multiple Determ"]
[null,null,"CPK Total",null,null,null,null,"CT Head or Brain w/Contrast","MRI Abdomen w/out Contrast",null,null,"Spirometry"]
[null,null,"C-Reactive Protein",null,null,null,null,"CT Head or Brain w/out - w/Contrast","MRI Brain w/Contrast",null,null,"Versed Per 1 MG"]
[null,null,"C-Reactive Protein High Sens",null,null,null,null,"CT Head or Brain w/out Contrast","MRI Brain w/out - w/Contrast",null,null,"Vital Capacity Total"]
[null,null,"Creatinine",null,null,null,null,"CT L-Spine w/Contrast","MRI Brain w/out Contrast"]
[null,null,"DAT (COOMBS Direct)",null,null,null,null,"CT L-Spine w/out - w/Contrast","MRI Cardiac Function Complete"]
[null,null,"DNA Antibody Double Strand",null,null,null,null,"CT L-Spine w/out Contrast","MRI Chest w/Contrast"]
[null,null,"Electrolyte Panel",null,null,null,null,"CT Pelvis w/Contrast","MRI Chest w/out - w/Contrast"]
[null,null,"ESR (sedimentation rate)",null,null,null,null,"CT Pelvis w/out - w/Contrast","MRI Chest w/out Contrast"]
[null,null,"Estradiol",null,null,null,null,"CT Pelvis w/out Contrast","MRI C-Spine w/Contrast"]
[null,null,"F IX inhibitor and F IX C level",null,null,null,null,"CT T-Spine w/Contrast","MRI C-Spine w/out - w/Contrast"]
[null,null,"Factor VIII Assay (Test code: 26-00140)",null,null,null,null,"CT T-Spine w/out - w/Contrast","MRI C-Spine w/out Contrast"]
[null,null,"Factor VIII Inhibitor Assay: Human (Test code: 26-00310)",null,null,null,null,"CT T-Spine w/out Contrast","MRI L-Spine w/Contrast"]
[null,null,"Factor VIII Inhibitor Assay: Porcine (Test code: 26-00320)",null,null,null,null,null,"MRI L-Spine w/out - w/Contrast"]
[null,null,"Factor VIII Inhibitor Screen (Test code: 26-00290)",null,null,null,null,null,"MRI L-Spine w/out Contrast"]
[null,null,"Fibrin Split Product",null,null,null,null,null,"MRI Pelvis w/ Contrast"]
[null,null,"Fibrinogen Activity",null,null,null,null,null,"MRI Pelvis w/out  contrast"]
[null,null,"FSH-Follicle Stimulating Hormone",null,null,null,null,null,"MRI Pelvis w/out-w contrast"]
[null,null,"Gammaglobulin IGA,IGD,IGG,IGM",null,null,null,null,null,"MRI T-Spine w/Contrast"]
[null,null,"GGTP",null,null,null,null,null,"MRI T-Spine w/out - w/Contrast"]
[null,null,"Glucose Blood",null,null,null,null,null,"MRI T-Spine w/out Contrast"]
[null,null,"HbA1C/glycosylated hemoglobin"]
[null,null,"HCG Pregnancy Test Urine"]
[null,null,"HCG Qualitative Serum"]
[null,null,"Hematocrit"]
[null,null,"Hemoglobin"]
[null,null,"Hepatic Function Panel"]
[null,null,"Hepatitis A Antibody ( HAAb)"]
[null,null,"Hepatitis B Core Antibody (HBcAB)"]
[null,null,"Hepatitis B surface antibody ( HBsAB)"]
[null,null,"Hepatitis C antibody"]
[null,null,"HIV Antibody Confirmatory"]
[null,null,"HLA B 27"]
[null,null,"HTLV-1"]
[null,null,"HTLV-II"]
[null,null,"Inorganic Phosphorus"]
[null,null,"Insulin Total"]
[null,null,"LDH"]
[null,null,"LDH Isoenzymes"]
[null,null,"Lipid Panel"]
[null,null,"Luteinizing Hormone"]
[null,null,"Magnesium"]
[null,null,"Nicotine"]
[null,null,"Phosphorus Inorganic"]
[null,null,"Platelet Count"]
[null,null,"Potassium-serum"]
[null,null,"Protein C Functional"]
[null,null,"Protein S Free"]
[null,null,"Protein Total Urine"]
[null,null,"Protime (PT)"]
[null,null,"PTT"]
[null,null,"Quantiferon"]
[null,null,"Renal Function Panel"]
[null,null,"Sodium"]
[null,null,"Somatomedin (IGF -1) insulin growth factor"]
[null,null,"Syphilis Test Qualitative"]
[null,null,"T B Screening"]
[null,null,"Total Protein"]
[null,null,"Triglyceride"]
[null,null,"TSH"]
[null,null,"Uric Acid"]
[null,null,"Urinalysis - Automated w Micro"]
[null,null,"Urinalysis - Automated w/out Micro"]
[null,null,"Urine Culture and Sensitivity Test"]
[]
["Category"]
["Patient Payment",null,"Central Lab"]
["Visits",null,"CRU"]
["Labs        ",null,"MHHS ",null,"Yes","Research"]
["Anesthesiology",null,"UTP Clinic",null,"No","NB"]
["XRay Imaging",null,"Other",null,null,"SOC"]
["Tissue ",null,"MHHS Clinic",null,null,"NB- Costs for Research"]
["Ultrasound ",null,null,null,null,"X"]
["CT"]
["MRI MRA"]
["Nuclear Radiology"]
["EKG ECHO"]
["Pulmonary"]
["Pharmacy"]
["Parking"]
["Cardiac"]
["OR"]
["Biopsy"]
["Fluoroscopy"]
["PET"]
["Neurophysiology"]
["Other"]
[]
[]
[]
[]
[]
[]
[]
[]
["Service Description/Procedures","CPT","CDM"]
["E&M Services"]
["Clinic Visit_New Patient Level 1",99201]
["Clinic Visit_New Patient Level 2",99202]
["Clinic Visit_New Patient Level 3",99203]
["Clinic Visit_New Patient Level 4",99204]
["Clinic Visit_New Patient Level 5",99205]
["Clinic Visit_Est. Patient Level 1",99211]
["Clinic Visit_ Est. Patient Level 2",99212]
["Clinic Visit_ Est. Patient Level 3",99213]
["Clinic Visit_ Est. Patient Level 4",99214]
["Clinic Visit_ Est. Patient Level 5",99215]
["Venipuncture",36415]
["Labs        "]
["Comprehensive metabolic panel",80053,60400965]
["Albumin Serum",82040,60401969]
["Alk Phosphatase",84075,60400164]
["BUN",84520,60403252]
["Creatinine",82565,60400911]
["Calcium, Total",82310,60400490]
["Glucose Blood",82947,60442014]
["Total Protein",84155,60340587]
["AST (SGOT)",84450,60403163]
["ALT (SGPT)",84460,60403198]
["Bilirubin Total",82247,60400407]
["Sodium",84295,60402892]
["Potassium-serum",84132,60402388]
["Chloride",82435,60400733]
["Bicarbonate(CO2)",82374,60434086]
["Alpha -fetoprotein",82105]
["Amplified Probe(MSRA)",87641,60508137]
["Basic Metabolic Panel",80047,60400959]
["Beta-Natriuretic Peptide (BNP)",83880,60402938]
["Bilirubin Direct",82248,60400377]
["Blood Culture",87040,60503044]
["CBC  w/platelets no diff",85027,60301360]
["CBC diff, w/platelets, automated",85025,60301395]
["Hemoglobin",85018,60307671]
["Hematocrit",85014,60307662]
["Platelet Count",85049,60300887]
["Calcium Ionized",82330,60402051]
["CD4 count or T cell Absolute",86361,60433879]
["Cholesterol",82465,60400768]
["Complement AG EA Component",86160,60442048]
["CPK Total",82550,60400881]
["C-Reactive Protein",86140,60409206]
["C-Reactive Protein High Sens",86141,60409207]
["C-Peptide",84681,60401528]
["DAT (COOMBS Direct)",86880,60101213]
["DNA Antibody Double Strand",86225,60601304]
["Electrolyte Panel",80051,60400963]
["ESR (sedimentation rate)",85651,60301303]
["Estradiol",82670,60401504]
["F IX inhibitor and F IX C level",85250,60307830]
["Factor VIII Assay (Test code: 26-00140)",85240,60302626]
["Factor VIII Inhibitor Assay: Human (Test code: 26-00310)",85335,60307830]
["Factor VIII Inhibitor Assay: Porcine (Test code: 26-00320)",85335,60307830]
["Factor VIII Inhibitor Screen (Test code: 26-00290)",85335,60307830]
["Fibrin Split Product",82784,60301727]
["Fibrinogen Activity",85384,60300461]
["FSH-Follicle Stimulating Hormone",83001,60401506]
["Gammaglobulin IGA,IGD,IGG,IGM",82784,60408084]
["GGTP",82977,60407908]
["HbA1C/glycosylated hemoglobin",83036,60402997]
["HCG Qualitative Serum",84702,60404127]
["HCG Pregnancy Test Urine",84703,60700435]
["Hepatic Function Panel",80076,60400968]
["Hepatitis B Core Antibody (HBcAB)",86704,60403096]
["Hepatitis B surface antibody ( HBsAB)",86706,60407341]
["Hepatitis A Antibody ( HAAb)",86708]
["Hepatitis C antibody",86803,60403173]
["HIV Antibody Confirmatory",86701,60601320]
["HTLV-1",86687]
["HTLV-II",86688]
["HLA B 27",86812,60309579]
["Inorganic Phosphorus",84100,60402329]
["Insulin Total",83525,60401512]
["LDH",83615,60401810]
["LDH Isoenzymes",83625,60405654]
["Lipid Panel",80061,60408785]
["Luteinizing Hormone",83002,60401508]
["Magnesium",83735,60402116]
["Nicotine",80302,60401070]
["Phosphorus Inorganic",84100,60402329]
["Protein C Functional",85303,60307523]
["Protein S Free",85306,60307531]
["Protein Total Urine",84155,60400302]
["Protime (PT)",85610,60300941]
["PTT",85730,60300852]
["Quantiferon",86480,3481116]
["Renal Function Panel",80069,60400976]
["Somatomedin (IGF -1) insulin growth factor",84305,60434275]
["Syphilis Test Qualitative",86780,60601429]
["TSH",84443,60408041]
["Triglyceride",84478,60403945]
["T B Screening",86580,66181184]
["Uric Acid",84550,60403287]
["Urinalysis - Automated w Micro",81001,60701032]
["Urinalysis - Automated w/out Micro",81000,60701423]
["Urine Culture and Sensitivity Test",87088,60508283]
["Research Handling Fee- blocks",99000,60299999]
["Research Unstained Slides",99000,60299997]
["Anesthesiology"]
["Oximeter P/Day",94760,67341120]
["Kit Transd 3 ml 12 in 72 in TB",86480,67300144]
["Desflurane Per case","anesthesia drug",67301630]
["Anes Endotracheal Tube","varies per dept",67300211]
["Anes srvs General 1st 30 min","varies per dept",67341126]
["Anes srvs General add 15 mins","varies per dept",67300076]
["Invasive Pressure Monitor",93610,67300838]
["Diagnostic Imaging "]
["X-ray Abdomen Acute Series Complete",74022,65140901]
["X-ray Abdomen AP & Oblique Views",74000,65105054]
["X-ray Ankle Complete 3+Views Uni",73630,65100282]
["X-ray Ankle 2 Views Bilateral",73620,65100254]
["X-ray Ankle 2 Views Unilateral",73620,65105046]
["Bone Density DXA Axial Skelet",77080,65120103]
["Bone Survey Complete",77075,65111535]
["Chest AP Single View",71010,65100649]
["X-ray Chest AP w/Fluoro",71023,65100703]
["X-ray Chest AP w/Lordotic",71021,65106795]
["Chest 2 View AP & Lateral",71020,65100673]
["MRA Neck w/out Contrast",70547,65104200]
["X-ray Knee 1 or 2 views",73560]
["X-ray Knee 3 views",73562]
["X-ray Knee complete 4 views or more",73564]
["X-ray Both Knees standing anteroposterior",73565]
["X-ray Pelvis 1-2 Views",72170,65107457]
["X-ray Spine Cervical 1View",72020,65120412]
["X-ray Spine Cervical 2-3 Views",72040,65120025]
["Ultrasound "]
["US Abdomen Complete",76700,65600080]
["US Abdomen Limited (single organ, quadrant, follow-up)",76705,65600356]
["US Brain Scan",76506,65600420]
["US Chest",76604,65602082]
["US Duplex Abd/Pel/Scrot/Kid",93975,65600865]
["US Duplex Ext Veins Bilat",93970,65602211]
["US Pelvis Complete",76856,65600250]
["US Retroperitoneal Limited",76775,65601406]
["US Scrotum & Contents",76870,65600064]
["US Transrectal",76872,65600129]
["US Transvaginal",76830,65600471]
["US Transpl Kidney w/ Dop",76776,65601408]
["US Transpl Kidney w/out Dop",76775]
["Computed Tomography  (yellow highlights are all associated charges for all CT with contrast)"]
["Injection Kit Dual Syringe-*only use with Contrast for CT",null,65700124]
["Creatinine Blood Non OPID-*only use with Contrast for CT",null,65700035]
["OPID CT Omnipaque 300ML 10-*only use with CT and Angio Contrast",null,65709992]
["Iodixanol 320MG/ML INJ(200ML)- *only use with CT and Angio Contrast",null,66185004]
["CT Abdomen w/Contrast",74160,65700697]
["CT Abdomen w/out Contrast",74150,65700360]
["CT Abodomen w/out - w/Contrast",74170,65700580]
["CT Angio Abdomen",74175,65701332]
["CT Angio Aorta w/Fem Runoff",75635,65701336]
["CT Angio Chest w/o - w/Contrast",71275,65701328]
["CT Angio Extr Lower w/Contrast Uni",73706,65701340]
["CT Angio Extr Lower w/o - w/Bi","73706-50",65702254]
["CT Angio Extr Upper w/Contrast Bi","73206-50",65702246]
["CT Angio Extr Upper w/Contrast Uni",73206,65701338]
["CT Angio Head w/out - w/Contrast",70496,65701326]
["CT Angio Neck w/out - w/Contrast",70498,65701330]
["CT Angio Pelvis w/out - w/Contrast",72191,65701334]
["CT Cervical Spine w/Contrast",72126,65700816]
["CT Cervical Spine w/out Contrast",72125,65700115]
["CT Cervical Spine w/out - w/Contrast",72127,65701342]
["CT Chest w/Contrast",71260,65700506]
["CT Chest w/out Contrast",71250,65700514]
["CT Chest w/out - w/Contrast",71270,65700586]
["CT Head or Brain w/Contrast",70460,65700018]
["CT Head or Brain w/out Contrast",70450,65700026]
["CT Head or Brain w/out - w/Contrast",70470,65700344]
["CT Pelvis w/Contrast",72193,65700387]
["CT Pelvis w/out Contrast",72192,65700336]
["CT Pelvis w/out - w/Contrast",72194,65700592]
["CT T-Spine w/out Contrast",72128,65702028]
["CT T-Spine w/Contrast",72129,65700820]
["CT T-Spine w/out - w/Contrast",72130,65701346]
["CT L-Spine w/out Contrast",72131,65700116]
["CT L-Spine w/Contrast",72132,65700822]
["CT L-Spine w/out - w/Contrast",72133,65701344]
["Magnetic Resonance Imaging (Yellow highlights are all associated charges for all MRA/MRI with contrast)"]
["MRI Kit-*only use with Contrast for MRI",null,65802180]
["Creatinine Blood Non OPID-*only use with Contrast for MRI",null,65800035]
["IV START PAK-*only use with Contrast for MRI",null,59060947]
["Electrode MRI ECG Quatrade-*only use with Contrast for MRI",null,65803330]
["GADOBENATE 1ML VL(7935MG/15ML)-*(contrast x 15 (qty 15= qty is equal to 1ML VL (7935MG/15ML) per 150 lb patient)  only use with Contrast for MRI",null,66001125]
["Monitor Non-Invasive",null,65803038]
["MRA Abdomen w/Contrast",74185,65802500]
["MRA Abdomen w/out Contrast",74185,65802502]
["MRA Abdoment w/out - w/Contrast",74185,65802504]
["MRA Chest w/Contrast",71555,65802518]
["MRA Chest w/out - w/Contrast",71555,65802522]
["MRA Head w/Contrast",70545,65800723]
["MRA Head w/out Contrast",70544,65801000]
["MRA Head w/out - w/Contrast",70546,65800725]
["MRA Neck w/Contrast",70548,65800719]
["MRA Neck w/out Contrast",70547,65800612]
["MRA Neck w/out - w/Contrast",70549,65800721]
["MRA Pelvis w/ or w/out Contrast",72198,65800904]
["MRA Pelvis w/Contrast",72198,65800900]
["MRA Pelvis w/out Contrast",72198,65800902]
["MRI Abdomen w/Contrast",74182,65801012]
["MRI Abdomen w/out Contrast",74181,65802040]
["MRI Abdomen w/out - w/Contrast",74183,65800110]
["MRI Brain w/Contrast",70552,65801485]
["MRI Brain w/out Contrast",70551,65800063]
["MRI Brain w/out - w/Contrast",70553,65801469]
["MRI Cardiac Function Complete",75561,65803006]
["MRI Chest w/Contrast",71551,65800071]
["MRI Chest w/out Contrast",71550,65801038]
["MRI Chest w/out - w/Contrast",71552,65800077]
["MRI C-Spine w/out Contrast",72141,65800012]
["MRI C-Spine w/Contrast",72142,65801004]
["MRI C-Spine w/out - w/Contrast",72156,65801388]
["MRI T-Spine w/out Contrast",72146,65800160]
["MRI T-Spine w/Contrast",72147,65801006]
["MRI L-Spine w/out - w/Contrast",72157,65801434]
["MRI L-Spine w/out Contrast",72148,65800179]
["MRI L-Spine w/Contrast",72149,65803032]
["MRI T-Spine w/out - w/Contrast",72158,65801418]
["MRI Pelvis w/out  contrast",72195,65800083]
["MRI Pelvis w/ Contrast",72196,65803034]
["MRI Pelvis w/out-w contrast",72197,65802046]
["Nuclear Medicine "]
["Cold Pyrophosphate per dose","A9560",65900149]
["TC-99M Sulfur Colloid Per Dose","A9541",65903022]
["Bone Density DXA Axial Skelet",77080,65905000]
["Bone Scan Three Phase Study",78315,65900769]
["Bone Scan Tomogram Spect",78320,65902052]
["Bone Scan Whole Body",78306,65900041]
["Bone Scan Whole Body",78306,65900044]
["Bone Scan, Multiple Area",78305,65904762]
["Brain Scan Spect",78607,65902036]
["Lung Perfusion Scan",78597,65905076]
["Cardiac Scan Gated Multi(MUGA)",78473,65900173]
["Non-Invasive Cardiology "]
["ECG Rhythym Strip",93005,62000139]
["ECG 12/15 Lead",93010,62000236]
["12 Lead ECG CPT (Tracing & Interpretation only)",93018]
["Cable ECG 12 V Lead",93000,51074310]
["Echo Doppler Complete",93306,62000112]
["Echo Doppler Limited",93307,62000510]
["Echo Follow-Up Congenital",93308,62001366]
["Echo Follow-Up/Limited",93304,62001369]
["Echo w/Contrast",93306,62001312]
["Echo 2D M Mode Complete",93307,62000163]
["Echo 2D M Mode Limited",93308,62000147]
["Echo 2D M Mode Comp w/Color Fl",93325,62003306]
["Stress Echo",93350,62000351]
["Transesophageal Echo",93318,62001089]
["Holter Placement 24 Hour",93224,68009323]
["Holter Analysis",96226,62000260]
["Pulmonary (Yellow highlights are all associated charges for a standard PFT)"]
["Blood Gas with O2 saturation",82805,68009540]
["Blood Gas with 2 or more analytics ph, pC02, p02, CO2, HCO3",82803]
["Bronchoscopy w/Biopsy",31625,64002706]
["Bronchoscopy w/Bronchial Lavag",31624,64002704]
["Bronchoscopy w/Brushing",31623,64002702]
["Spirometry",94010,64000438]
["Plethysmography Lung Volumes Airwy Rest",94726,64004726]
["Diffusion Capacity (DLCO) add on code for codes 94010, 94060, 94070, 94375, 94726-94728",94729,64004729]
["Vital Capacity Total",94150,64000942]
["O2 Uptake and CO2 Output",94681,64000124]
["Pulmonary Stress Test Complex",94621,64000110]
["Pulse Oximeter Multiple Determ",94761,41102116]
["Blood O2 Saturation",82805,64200038]
["Cardiac Output Measurement",93461,64200143]
["Injection  Internal Mammary",19030,64217398]
["6 min walk",94620]
["IDS Pharmacy"]
["New Study Set-Up / Administrative Fee  (Outpatient Study)","Start-up",66300618]
["New Study Set-Up / Administrative Fee (Inpatient Study)","Start-up",66300620]
["Annual Study Maintenance Fee","Invoice",66300746]
["Annual Refrig Storage Fee","Invoice",66300610]
["Miscellaneous IDS FEE 15 min","Invoice",66301030]
["Study Annual Documentation Fee","Invoice",66300611]
["Patient Randomization","Per patient",66300612]
["Per Dose RX Dispensing Fee","Per-patient",66300616]
["Storage Of Used Study Medication","Per-patient/ invoice",66300604]
["Parking"]
["CRU Parking ",null,40201272]
["Cardiac Invasive Lab"]
["Blood O2 Saturation only",null,64200038]
["Cath Lab Treatment Room",null,64202097]
["Procedure Prep",null,64200577]
["S&I Abdominal Aortagram",null,64200488]
["DSA Analysis LV Gram",null,64200518]
["DSA Analysis Coronary",null,64200526]
["S&I Cor/Pulm/Aort Angio",null,64217342]
["S&I Arterial /Vent/Angio ( Pedi)",null,64217349]
["Injection Venous Bypass Grafts",null,64201301]
["Angio Coronary w/o Heart Cath",null,64211184]
["Left & Right Heart Cath",null,64202049]
["Respiratory Therapy"]
["Blood Gases",null,68009540]
["Day Surgery"]
["Preoperative Assessment",null,51601386]
["Operating Room (Supplies)"]
["Cable ECG 12 V Lead",null,51074310]
["Cardiac Output Measurement",null,64200143]
["Drape Intraop Probe SM T TIP",null,51001240]
["Procedure Prep",null,64200577]
["Safeset 60/SS/MAC Mon -kit",null,59070570]
["Pack Line Linen",null,59071380]
["Cath 8F Cardiac Output",null,59070390]
["Pressure Infuse disposable",null,59009729]
["Tray Custom Adult Cardiac",null,59071626]
["Dressing Bio Patch",null,59020631]
["Kit Perc Intro 8.5 FR",null,59000685]
["Oxi Adult Sensor",null,59002100]
["3 Jones MED/SURG"]
["Room Charge",null,41200110]
["NACL 0.9% IRRG 1000 ml",null,59209809]
["Day Surgery"]
["Injection IV Push 1st drug",null,51600786]
["Phase 2 PACU Ea Add 30 min-Rout",null,51605276]
["Anesthesiology"]
["Drugs"]
["Alprazolam 1 MG Tab",null,66028062]
["Fentanyl 100 MCG/2 ml Vl",null,66142426]
["Propofol 200 MG/20ml VL",null,66130517]
["Prednisone 5 MG tab(20 mg)",null,66006015]
["NACL 0.9% 500 ML IV",null,66500594]
["NACL 0.9%  100 ML Bag",null,66500552]
["D5W 500 ml Bag",null,66500128]
["Midazolam 1 MG vl (2mg/2ml)",null,66004904]
["Nitroglycerin 0.6 Mg Tab",null,66191378]
["Versed Per 1 MG",null,65109084]
["Vascular Radiology"]
["IV Catheter #18-24",null,65509839]
["EKG Hourly Monitor Charge",null,65503618]
["Conscious Sedation> 5 years old, first 30 min",null,65501144]
["Conscious Sedation> 5 years old, each add 15 mins",null,65502145]
["Kit Bone Biopsy",null,65505200]
["Kit Bone Biopsy 11 ga",null,65501358]
["Monitors electrodes",null,65500086]
["Non Invasive blood pressure monitor",null,65503638]
["Universal Precautions",null,65509836]
["Oxygen ",null,65501174]
["Pressure bag vital signs",null,65504322]
["Post Procedure recovery room first hour",null,65503648]
["Post Procedure recovery room + 30 mins",null,65503650]
["Biopsy Lung perc",null,65502531]
["Skin biopsy Single Lesion",null,65500392]
["Skin biopsy + add  Lesion",null,65500394]
["Biopsy Tray",null,65500132]
["Pulse Oximeter",null,65501171]
["Diagnostic Radiology"]
["Fluoro Local  NDL Biopsy/ Aspiration",null,65102194]
["Nuclear Radiology"]
["PET Tumor Imaging",null,65950811]
["PET CT Tumor Image Skull MIDTH",null,65952815]
["CT Chest w/con",null,65751260]
["PET CT Tumor Imaging Whole BD",null,65951816]
["PET Brain Imaging Met Eval",null,65950608]
["PET Tumor Imaging Whole Body",null,65952813]
["PET Myocard Imag Metabolic Eval",null,65950514]
["CT Thorax W/O Contrast",null,77700006]
["PET Tumor Imaging Limited area",null,65950811]
["PET Tumor Image Skull Midthigh",null,65951812]
["PET CT Tumor Imaging LTD area",null,65951814]
["PET Myocard Imag Metabolic Eval",null,65950516]
["Neurophysiology"]
["13 or more Nerve Conduct",null,63000017]
["Reference Lab"]
["TB Cell Immunity Response S/O",null,60861998]
["Medical ICU-2WC"]
["Room Charge- ICU Adult Level 1",null,46200201]
["Recovery Room"]
["Minor Proc Recovery  1 st hour",null,52000258]
["Minor Proc Recovery  add 30 minutes ",null,52000261]

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[{"$f":"Summary!A9","v":"Project Title:"},null,{"$f":"Summary!B9","v":0}]
[{"$f":"Summary!A10","v":"Principal Investigator:"},null,{"$f":"Summary!C10","v":0}]
[{"$f":"Summary!A11","v":"Sponsor/CRO:"},null,{"$f":"Summary!C11","v":0}]
[{"$f":"Summary!A12","v":"CPHS Study Number:"},null,{"$f":"Summary!C12","v":0}]
[]
["Position ",null,"Name ",null,"Hourly Rate"]
[]
[{"$f":"Summary!A18","v":"PI"},null,{"$f":"IF(Summary!C18=0,\"\",Summary!C18)","v":""},null,{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*#REF!","v":{"$error":"#REF!"}}]
[{"$f":"Summary!A19","v":"PI Oversight"},null,{"$f":"IF(Summary!C19=0,\"\",Summary!C19)","v":""},null,{"$f":"((Summary!$E$19+ (Summary!$E$19*Summary!$J$19))/2080)","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*#REF!","v":{"$error":"#REF!"}}]
[{"$f":"Summary!A20","v":"Coordinator"},null,{"$f":"IF(Summary!C20=0,\"\",Summary!C20)","v":""},null,{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*#REF!","v":{"$error":"#REF!"}}]
[{"$f":"Summary!A21","v":"Coordinator Admin "},null,{"$f":"IF(Summary!C21=0,\"\",Summary!C21)","v":""},null,{"$f":"((Summary!$E$21+ (Summary!$E$21*Summary!$J$21))/2080)","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*#REF!","v":{"$error":"#REF!"}},null,"Note-- Effort  per person for each visit should include visit preparation and visit administration time and effort too."]
[{"$f":"Summary!A22","v":"Finanical Management"},null,{"$f":"IF(Summary!C22=0,\"\",Summary!C22)","v":""},null,{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*#REF!","v":{"$error":"#REF!"}},null,"Example- Chart set up, scheduling next visit, escorting participant for imaging, data entry into CRF, etc."]
[{"$f":"Summary!A23","v":0},null,{"$f":"IF(Summary!C23=0,\"\",Summary!C23)","v":""},null,{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*#REF!","v":{"$error":"#REF!"}}]
[{"$f":"Summary!A24","v":0},null,{"$f":"IF(Summary!C24=0,\"\",Summary!C24)","v":""},null,{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*#REF!","v":{"$error":"#REF!"}},null,"Financial Management - Minimum .5 per visit for invoicing and/or payment reconciliation & 3 hours for last visit  for study reconciliation. (In some cases this is also the study coordinator. However the time spent for financial management is separate from and in addition to the time and effort spent during study visits therefore needs to be captured separately. "]
[{"$f":"Summary!A25","v":0},null,{"$f":"IF(Summary!C25=0,\"\",Summary!C25)","v":""},null,{"$f":"((Summary!$E$24+ (Summary!$E$24*Summary!$J$24))/2080)","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*#REF!","v":{"$error":"#REF!"}},null,"Regulatory Management- Minimum .25 per visit and 3 hours for last study visit to capture continuing reviews, and amendment processing  . (In many cases the study coordinator also manages regulatory. However the time spent managing regulatory documents (SAE, Reg Binder, IND report management, IRB submissions) is separate from and in addition to the time and effort spent during study visits therefore needs to be captured separately.  "]
[{"$f":"Summary!A26","v":"Sponsored Projects"},null,{"$f":"IF(Summary!C26=0,\"\",Summary!C26)","v":""},null,{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)","v":43.75},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*#REF!","v":{"$error":"#REF!"}}]
[]
["Position ",null,"Name ",null,null,null,null,null,null,null,null,null,"Effort %"]
[null,null,null,null,{"$f":"'Coverage Analysis'!F8","v":0},{"$f":"'Coverage Analysis'!G8","v":0},{"$f":"'Coverage Analysis'!H8","v":0},{"$f":"'Coverage Analysis'!I8","v":0},{"$f":"'Coverage Analysis'!J8","v":0},{"$f":"'Coverage Analysis'!K8","v":0},{"$f":"'Coverage Analysis'!L8","v":0},{"$f":"'Coverage Analysis'!M8","v":0}]
[{"$f":"Summary!A18","v":"PI"},null,{"$f":"IF(Summary!C18=0,\"\",Summary!C18)","v":""},null,null,null,null,null,null,null,null,null,{"$f":"SUM(E20:L20) /2080","v":0}]
[{"$f":"Summary!A20","v":"Coordinator"},null,{"$f":"IF(Summary!C20=0,\"\",Summary!C20)","v":""},null,null,null,null,null,null,null,null,null,0]
[{"$f":"Summary!A21","v":"Coordinator Admin "},null,{"$f":"IF(Summary!C21=0,\"\",Summary!C21)","v":""},null,null,null,null,null,null,null,null,null,0]
[{"$f":"Summary!A22","v":"Finanical Management"},null,{"$f":"IF(Summary!C22=0,\"\",Summary!C22)","v":""},null,null,null,null,null,null,null,null,null,0]
[{"$f":"Summary!A23","v":0},null,{"$f":"IF(Summary!C23=0,\"\",Summary!C23)","v":""},null,null,null,null,null,null,null,null,null,{"$f":"SUM(E24:L24) /2080","v":0}]
[{"$f":"Summary!A24","v":0},null,{"$f":"IF(Summary!C24=0,\"\",Summary!C24)","v":""},null,null,null,null,null,null,null,null,null,0]
[{"$f":"Summary!A25","v":0},null,{"$f":"IF(Summary!C25=0,\"\",Summary!C25)","v":""},null,null,null,null,null,null,null,null,null,0]
[{"$f":"Summary!A26","v":"Sponsored Projects"},null,{"$f":"IF(Summary!C26=0,\"\",Summary!C26)","v":""},null,null,null,null,null,null,null,null,null,0]
["Total Number of Staff Hours:  ",null,null,null,{"$f":"SUM(E20:E27)","v":0},{"$f":"SUM(F20:F27)","v":0},0,0,0,0,0,0]
[]
[]
[null,null,null,null,"*Review visits on the Coverage Analysis tab to assses time and effort for  each visit per study team member"]
[]
[]
[{"$f":"Effort!A18","v":"Position "},null,{"$f":"Effort!C18","v":"Name "}]
[null,null,null,null,{"$f":"'Coverage Analysis'!F8","v":0},{"$f":"'Coverage Analysis'!G8","v":0},{"$f":"'Coverage Analysis'!H8","v":0},{"$f":"'Coverage Analysis'!I8","v":0},{"$f":"'Coverage Analysis'!J8","v":0},{"$f":"'Coverage Analysis'!K8","v":0},{"$f":"'Coverage Analysis'!L8","v":0},{"$f":"'Coverage Analysis'!M8","v":0}]
[{"$f":"Effort!A20","v":"PI"},null,{"$f":"IF(Summary!C18=0,\"\",Summary!C18)","v":""},null,{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*E20","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*F20","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*G20","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*H20","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*I20","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*J20","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*K20","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*L20","v":0}]
[{"$f":"Effort!A21","v":"Coordinator"},null,{"$f":"IF(Summary!C20=0,\"\",Summary!C20)","v":""},null,{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*E21","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*F21","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*G21","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*H21","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*I21","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*J21","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*K21","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*L21","v":0}]
[{"$f":"Effort!A22","v":"Coordinator Admin "},null,{"$f":"IF(Summary!C21=0,\"\",Summary!C21)","v":""},null,{"$f":"((Summary!$E$21+ (Summary!$E$21*Summary!$J$21))/2080)*E22","v":0},{"$f":"((Summary!$E$21+ (Summary!$E$21*Summary!$J$21))/2080)*F22","v":0},{"$f":"((Summary!$E$21+ (Summary!$E$21*Summary!$J$21))/2080)*G22","v":0},{"$f":"((Summary!$E$21+ (Summary!$E$21*Summary!$J$21))/2080)*H22","v":0},{"$f":"((Summary!$E$21+ (Summary!$E$21*Summary!$J$21))/2080)*I22","v":0},{"$f":"((Summary!$E$21+ (Summary!$E$21*Summary!$J$21))/2080)*J22","v":0},{"$f":"((Summary!$E$21+ (Summary!$E$21*Summary!$J$21))/2080)*K22","v":0},{"$f":"((Summary!$E$21+ (Summary!$E$21*Summary!$J$21))/2080)*L22","v":0}]
[{"$f":"Effort!A23","v":"Finanical Management"},null,{"$f":"IF(Summary!C22=0,\"\",Summary!C22)","v":""},null,{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*E23","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*F23","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*G23","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*H23","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*I23","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*J23","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*K23","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*L23","v":0}]
[{"$f":"Effort!A24","v":0},null,{"$f":"IF(Summary!C23=0,\"\",Summary!C23)","v":""},null,{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*E24","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*F24","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*G24","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*H24","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*I24","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*J24","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*K24","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*L24","v":0}]
[{"$f":"Effort!A25","v":0},null,{"$f":"IF(Summary!C24=0,\"\",Summary!C24)","v":""},null,{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*E25","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*F25","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*G25","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*H25","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*I25","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*J25","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*K25","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*L25","v":0}]
[{"$f":"Effort!A26","v":0},null,{"$f":"IF(Summary!C25=0,\"\",Summary!C25)","v":""},null,{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*E26","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*F26","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*G26","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*H26","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*I26","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*J26","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*K26","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*L26","v":0}]
[{"$f":"Effort!A27","v":"Sponsored Projects"},null,{"$f":"IF(Summary!C26=0,\"\",Summary!C26)","v":""},null,{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*E27","v":0},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*F27","v":0},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*G27","v":0},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*H27","v":0},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*I27","v":0},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*J27","v":0},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*K27","v":0},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*L27","v":0}]
["Total Effort Cost per Visit",null,null,null,{"$f":"SUM(E36:E43)","v":0},{"$f":"SUM(F36:F43)","v":0},0,0,0,0,0,{"$f":"SUM(L36:L43)","v":0}]
["Total Effort Cost per Visit plus IDC ",null,null,null,{"$f":"E44*1.3","v":0},{"$f":"F44*1.3","v":0},0,0,0,0,0,{"$f":"L44*1.3","v":0}]

{"sheet":"Cost-Expenses","index":6,"n_rows":47,"n_cols":10,"rows_kept":47,"cut":false,"hidden":false,"merged":[[4,0,4,1],[1,0,1,1],[2,0,2,1],[3,0,3,1]]}
[]
[{"$f":"Summary!A10","v":"Principal Investigator:"},null,{"$f":"Summary!C10","v":0}]
[{"$f":"Summary!A11","v":"Sponsor/CRO:"},null,{"$f":"Summary!C11","v":0}]
[{"$f":"Summary!A12","v":"CPHS Study Number:"},null,{"$f":"Summary!C12","v":0}]
[{"$f":"Summary!A13","v":"ClinicalTrials.gov # / NCT #:"},null,{"$f":"Summary!D13","v":0}]
[]
[]
[]
[]
[]
[null,"Clinical Cost"]
[null,"Procedures/Activities",{"$f":"'Coverage Analysis'!F8","v":0},{"$f":"'Coverage Analysis'!G8","v":0},{"$f":"'Coverage Analysis'!H8","v":0},{"$f":"'Coverage Analysis'!I8","v":0},{"$f":"'Coverage Analysis'!J8","v":0},{"$f":"'Coverage Analysis'!K8","v":0},{"$f":"'Coverage Analysis'!L8","v":0},{"$f":"'Coverage Analysis'!M8","v":0}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B9),\"\",'Coverage Analysis'!B9)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B10),\"\",'Coverage Analysis'!B10)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B11),\"\",'Coverage Analysis'!B11)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B12),\"\",'Coverage Analysis'!B12)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B13),\"\",'Coverage Analysis'!B13)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B14),\"\",'Coverage Analysis'!B14)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B15),\"\",'Coverage Analysis'!B15)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B16),\"\",'Coverage Analysis'!B16)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B17),\"\",'Coverage Analysis'!B17)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B18),\"\",'Coverage Analysis'!B18)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B19),\"\",'Coverage Analysis'!B19)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B20),\"\",'Coverage Analysis'!B20)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B21),\"\",'Coverage Analysis'!B21)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B22),\"\",'Coverage Analysis'!B22)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B23),\"\",'Coverage Analysis'!B23)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B24),\"\",'Coverage Analysis'!B24)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B25),\"\",'Coverage Analysis'!B25)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B26),\"\",'Coverage Analysis'!B26)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B27),\"\",'Coverage Analysis'!B27)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B28),\"\",'Coverage Analysis'!B28)","v":""}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B29),\"\",'Coverage Analysis'!B29)","v":""}]
[null,"NOT LISTED IN PROTOCOL SCHEDULE "]
[]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B32),,'Coverage Analysis'!B32)","v":"CRF Data Entry"}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B33),\"\",'Coverage Analysis'!B33)","v":"Chart set up"}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B34),\"\",'Coverage Analysis'!B34)","v":"Schedule next visit"}]
[null,{"$f":"IF(ISBLANK('Coverage Analysis'!B35),\"\",'Coverage Analysis'!B35)","v":"Describe Study drug"}]
[null,"Subtotal",{"$f":"SUBTOTAL(9,C13:C39)","v":0},0,0,0,{"$f":"SUBTOTAL(9,G13:G39)","v":0},{"$f":"SUBTOTAL(9,H13:H39)","v":0},{"$f":"SUBTOTAL(9,I13:I39)","v":0},0]
[null,"IDC",{"$f":"C40*(Summary!$I$14)","v":0},{"$f":"D40*(Summary!$I$14)","v":0},{"$f":"E40*(Summary!$I$14)","v":0},{"$f":"F40*(Summary!$I$14)","v":0},{"$f":"G40*(Summary!$I$14)","v":0},{"$f":"H40*(Summary!$I$14)","v":0},{"$f":"I40*(Summary!$I$14)","v":0},{"$f":"J40*(Summary!$I$14)","v":0}]
[null,"Grand Total",{"$f":"C40+C41","v":0},0,0,0,0,0,0,0]
[]
[null,null,null,null,"*Enter the costs   for the items highlighed green above"]
[]
[null,null,"All clinical services and procedures performed for research purposes will be charged to the Finanical account set up for this study."]
[null,null," Most often  a discounted rate for services and procedures performed for research purposes is provided. Communicate with apprpopriate billing staff to identify the exact dollar amount that will be charged."]

{"sheet":"Start up and Invoiceables","index":7,"n_rows":78,"n_cols":22,"rows_kept":78,"cut":false,"hidden":false,"merged":[[58,1,58,4],[9,0,9,2],[0,0,0,1],[0,2,0,9],[1,0,1,1],[1,2,1,9],[2,0,2,1],[2,2,2,9],[4,0,4,2],[5,0,5,2],[6,0,6,2],[7,0,7,2],[8,0,8,2],[55,1,55,4],[13,0,13,2],[11,0,11,2],[77,0,77,4],[71,1,71,4],[72,1,72,4],[73,1,73,4],[74,1,74,4],[75,1,75,4],[67,0,68,0],[67,1,68,4],[69,1,69,4],[70,1,70,4],[76,0,76,4],[62,0,62,1],[63,0,63,1],[64,0,64,1],[65,0,65,1],[66,0,66,1],[59,1,59,4],[59,20,59,21],[60,1,60,4],[60,20,60,21],[61,0,61,4],[55,20,55,21],[56,1,56,4],[56,20,56,21],[57,1,57,4],[57,20,57,21],[51,20,52,21],[53,1,53,4],[53,20,53,21],[54,1,54,4],[54,20,54,21],[12,0,12,2],[10,0,10,2],[51,0,52,0],[51,1,52,4],[43,0,43,2],[16,0,16,2],[17,0,17,2],[14,0,14,2],[15,0,15,2]]}
[{"$f":"Summary!A9","v":"Project Title:"},null,{"$f":"Summary!B9","v":0}]
[{"$f":"Summary!A10","v":"Principal Investigator:"},null,{"$f":"Summary!C10","v":0}]
[{"$f":"Summary!A12","v":"CPHS Study Number:"},null,{"$f":"Summary!C12","v":0}]
[]
["Start Up Costs",null,null,"Total ","Total W IDC"]
["Start Up Effort",null,null,{"$f":"IF(U77=0,\"\",U77)","v":962.5},{"$f":"IF(U78=0,\"\",U78)","v":1251.25}]
["IRB Review Fee - Local or Permission to Rely",null,null,2000,{"$f":"IF(D7=0, \"\",D7*1.3)","v":2600},null,null,"Coverage Analysis Fees -  for  Industry  and Departmentally Sponsored studies (inclusive of IDC)"]
["Coverage Analysis Fee",null,null,{"$f":"E8/1.3","v":1545.3846153846152},{"$f":"IF(Summary!H6='Start up and Invoiceables'!H8,'Start up and Invoiceables'!I8,IF(Summary!H6='Start up and Invoiceables'!H9,'Start up and Invoiceables'!I9,IF(Summary!H6='Start up and Invoiceables'!H10,'Start up and Invoiceables'!I10,\"\")))","v":2009},null,null,"Low",2009]
["Investigational Pharmacy Setup Fee (Delete if N/A)",null,null,null,null,null,null,"Medium",3348]
["MHH Adminsitrative Start up Fee (Delete if N/A)",null,null,null,{"$f":"IF(D10=0, \"\",D10*1.3)","v":""},null,null,"High",4151]
["Radiology Dept Setup Fee (Delete if N/A)",null,null,750,975,null,null,"Complex",4151]
["CRU Start up Fee (Delete if N/A)",null,null,null,""]
["Lab set up Fee (Delete if N/A)",null,null,null,""]
["Patient Population Assessment Fee",null,null,750,975,null,null," Effective 01/01/24  IRB fee is $2600  (inclusive of IDC)  regardless of whether or not the study is requesting full board review or requesting permission to rely on outside IRB"]
[null,null,null,null,"",null,null," Effective 09/01/25 Patient Population Assessment fee is $750  (w/o IDC)  for SBMI/EPIC IT to conduct feasability reports"]
[null,null,null,null,""]
[null,null,null,null,""]
["Total Start up Cost ",null,null,{"$f":"SUM(D6:D17)","v":6007.8846153846152},{"$f":"SUM(E6:E17)","v":7810.25}]
[null,null,null,null,{"$f":"SUM(E12:E18)","v":8785.25}]
["Invoiceable Procedures","Unit cost ","Quantity","Total ","Total W IDC"]
["IRB annual Review",1000,1,1000,{"$f":"D21*1.3","v":1300}]
[null,null,1,{"$f":"B22*C22","v":0},{"$f":"D22*1.3","v":0}]
[null,null,1,0,{"$f":"D23*1.3","v":0}]
[null,null,1,0,0]
[null,null,1,0,0]
[null,null,1,0,0]
[null,null,1,0,0]
[null,null,1,0,0]
[null,null,null,0,0]
[null,null,null,0,0]
[null,null,null,0,0]
[null,null,null,0,0]
[null,null,null,0,0]
[null,null,null,0,0]
[null,null,null,0,0]
[null,null,null,0,0]
[null,null,null,0,0]
[null,null,null,0,0]
[null,null,null,0,0]
[null,null,null,0,0]
[null,null,null,0,0]
[null,null,null,0,0]
[null,null,null,0,0]
["Total Invoiceable Costs ",null,null,{"$f":"SUM(D21:D43)","v":1000},{"$f":"SUM(E21:E43)","v":1300}]
[]
[]
[]
[]
["Start up time and effort"]
[]
[]
["Position ","Name ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Effort %"]
[null,null,null,null,null,"Protocol Review","Feasibility Assessment","Internal logistics /operational preparation","Complete Regulatory Documents","Coverage Analysis","Budget and Contract Negotiations","Prepare Source Documents and Study Files ","Submission of paperwork to IRB (Includes ICF preparation)","Protocol specific training and Protocol  in-service with study team and collaborators if applicable","CRF system training","Investigator meeting","Site Initiation Visit (include Site Feasibility Visit if applicable)","CRU coordination and Communication","MHH Protocol Submission  (Submission, submission follow up communications )","Study drug Coordination (Coordination and communication with MHH IDS  or communication and coordination for departmental storage.)"]
[{"$f":"Summary!A18","v":"PI"},{"$f":"IF(Summary!C18=0,\"\", Summary!C18)","v":""},null,null,null,3,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(F54:T54)/2080","v":1.4423076923076924E-3}]
[{"$f":"Summary!A20","v":"Coordinator"},{"$f":"IF(ISBLANK(Summary!C20), \"\", Summary!C20)","v":0},null,null,null,3,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(F55:T55)/2080","v":1.4423076923076924E-3}]
[{"$f":"Summary!A21","v":"Coordinator Admin "},{"$f":"IF(ISBLANK(Summary!C21), \"\", Summary!C21)","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[{"$f":"Summary!A22","v":"Finanical Management"},{"$f":"IF(ISBLANK(Summary!C22), \"\", Summary!C22)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[{"$f":"Summary!A23","v":0},{"$f":"IF(ISBLANK(Summary!C23), \"\", Summary!C23)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[{"$f":"Summary!A24","v":0},{"$f":"IF(ISBLANK(Summary!C24), \"\", Summary!C24)","v":""}]
[{"$f":"Summary!A25","v":0},{"$f":"IF(ISBLANK(Summary!C25), \"\", Summary!C25)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[{"$f":"Summary!A26","v":"Sponsored Projects"},"Sponsored Projects",null,null,null,null,null,2,null,2,16,2,null,null,null,null,null,null,null,null,1.0576923076923078E-2]
["Total Number of Staff Hours:  ",null,null,null,null,{"$f":"SUM(F54:F61)","v":6},{"$f":"SUM(G54:G61)","v":0},2,0,2,16,2,0,0,0,0,0,0,0,0]
[]
[]
[]
[]
[]
["Position","Name"]
[null,null,null,null,null,"Protocol Review","Feasibility Assessment","Internal logistics /operational preparation","Complete Regulatory Documents","Coverage Analysis","Budget Negotiations","Coordination of SPA Contract review and financial account set up","Submission of paperwork to IRB (Includes ICF preparation)","Protocol specific training and Protocol  in-service with study team and collaborators if applicable","CRF system training","Investigator meeting","Site Initiation Visit (include Site Feasibility Visit if applicable)","CRU coordination and Communication","MHH Protocol Submission  (Submission, submission follow up communications )","Study drug Coordination (Coordination and communication with MHH IDS  or communication and coordination for departmental storage.)","TOTALS"]
[{"$f":"Summary!A18","v":"PI"},{"$f":"B54","v":""},null,null,null,{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*F54","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*G54","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*H54","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*I54","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*J54","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*K54","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*L54","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*M54","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*N54","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*O54","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*P54","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*Q54","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*R54","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*S54","v":0},{"$f":"((Summary!$E$18+ (Summary!$E$18*Summary!$J$18))/2080)*T54","v":0}]
[{"$f":"Summary!A20","v":"Coordinator"},{"$f":"B55","v":0},null,null,null,{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*F55","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*G55","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*H55","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*I55","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*J55","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*K55","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*L55","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*M55","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*N55","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*O55","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*P55","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*Q55","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*R55","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*S55","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*T55","v":0}]
[{"$f":"Summary!A21","v":"Coordinator Admin "},{"$f":"B56","v":0},null,null,null,{"$f":"((Summary!$E$21+ (Summary!$E$21*Summary!$J$21))/2080)*F56","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*G56","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*H56","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*I56","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*J56","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*K56","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*L56","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*M56","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*N56","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*O56","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*P56","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*Q56","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*R56","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*S56","v":0},{"$f":"((Summary!$E$20+ (Summary!$E$20*Summary!$J$20))/2080)*T56","v":0}]
[{"$f":"Summary!A22","v":"Finanical Management"},{"$f":"B57","v":""},null,null,null,{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*F57","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*G57","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*H57","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*I57","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*J57","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*K57","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*L57","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*M57","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*N57","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*O57","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*P57","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*Q57","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*R57","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*S57","v":0},{"$f":"((Summary!$E$22+ (Summary!$E$22*Summary!$J$22))/2080)*T57","v":0}]
[{"$f":"Summary!A23","v":0},{"$f":"B58","v":""},null,null,null,{"$f":"((Summary!$E$23+ (Summary!$E$23*Summary!$J$23))/2080)*F58","v":0},{"$f":"((Summary!$E$23+ (Summary!$E$23*Summary!$J$23))/2080)*G58","v":0},{"$f":"((Summary!$E$23+ (Summary!$E$23*Summary!$J$23))/2080)*H58","v":0},{"$f":"((Summary!$E$23+ (Summary!$E$23*Summary!$J$23))/2080)*I58","v":0},{"$f":"((Summary!$E$23+ (Summary!$E$23*Summary!$J$23))/2080)*J58","v":0},{"$f":"((Summary!$E$23+ (Summary!$E$23*Summary!$J$23))/2080)*K58","v":0},{"$f":"((Summary!$E$23+ (Summary!$E$23*Summary!$J$23))/2080)*L58","v":0},{"$f":"((Summary!$E$23+ (Summary!$E$23*Summary!$J$23))/2080)*M58","v":0},{"$f":"((Summary!$E$23+ (Summary!$E$23*Summary!$J$23))/2080)*N58","v":0},{"$f":"((Summary!$E$23+ (Summary!$E$23*Summary!$J$23))/2080)*O58","v":0},{"$f":"((Summary!$E$23+ (Summary!$E$23*Summary!$J$23))/2080)*P58","v":0},{"$f":"((Summary!$E$23+ (Summary!$E$23*Summary!$J$23))/2080)*Q58","v":0},{"$f":"((Summary!$E$23+ (Summary!$E$23*Summary!$J$23))/2080)*R58","v":0},{"$f":"((Summary!$E$23+ (Summary!$E$23*Summary!$J$23))/2080)*S58","v":0},{"$f":"((Summary!$E$23+ (Summary!$E$23*Summary!$J$23))/2080)*T58","v":0}]
[{"$f":"Summary!A24","v":0},{"$f":"B60","v":""},null,null,null,{"$f":"((Summary!$E$24+ (Summary!$E$24*Summary!$J$24))/2080)*F60","v":0},{"$f":"((Summary!$E$24+ (Summary!$E$24*Summary!$J$24))/2080)*G60","v":0},{"$f":"((Summary!$E$24+ (Summary!$E$24*Summary!$J$24))/2080)*H60","v":0},{"$f":"((Summary!$E$24+ (Summary!$E$24*Summary!$J$24))/2080)*I60","v":0},{"$f":"((Summary!$E$24+ (Summary!$E$24*Summary!$J$24))/2080)*J60","v":0},{"$f":"((Summary!$E$24+ (Summary!$E$24*Summary!$J$24))/2080)*K60","v":0},{"$f":"((Summary!$E$24+ (Summary!$E$24*Summary!$J$24))/2080)*L60","v":0},{"$f":"((Summary!$E$24+ (Summary!$E$24*Summary!$J$24))/2080)*M60","v":0},{"$f":"((Summary!$E$24+ (Summary!$E$24*Summary!$J$24))/2080)*N60","v":0},{"$f":"((Summary!$E$24+ (Summary!$E$24*Summary!$J$24))/2080)*O60","v":0},{"$f":"((Summary!$E$24+ (Summary!$E$24*Summary!$J$24))/2080)*P60","v":0},{"$f":"((Summary!$E$24+ (Summary!$E$24*Summary!$J$24))/2080)*Q60","v":0},{"$f":"((Summary!$E$24+ (Summary!$E$24*Summary!$J$24))/2080)*R60","v":0},{"$f":"((Summary!$E$24+ (Summary!$E$24*Summary!$J$24))/2080)*S60","v":0},{"$f":"((Summary!$E$24+ (Summary!$E$24*Summary!$J$24))/2080)*T60","v":0}]
[{"$f":"Summary!A26","v":"Sponsored Projects"},"Sponsored Projects",null,null,null,{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*F61","v":0},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*G61","v":0},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*H61","v":87.5},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*I61","v":0},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*J61","v":87.5},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*K61","v":700},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*L61","v":87.5},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*M61","v":0},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*N61","v":0},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*O61","v":0},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*P61","v":0},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*Q61","v":0},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*R61","v":0},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*S61","v":0},{"$f":"((Summary!$E$26+ (Summary!$E$26*Summary!$J$26))/2080)*T61","v":0}]
["Total Effort Study Start up",null,null,null,null,{"$f":"SUM(F70:F76)","v":0},{"$f":"SUM(G70:G76)","v":0},{"$f":"SUM(H70:H76)","v":87.5},{"$f":"SUM(I70:I76)","v":0},{"$f":"SUM(J70:J76)","v":87.5},{"$f":"SUM(K70:K76)","v":700},{"$f":"SUM(L70:L76)","v":87.5},{"$f":"SUM(M70:M76)","v":0},{"$f":"SUM(N70:N76)","v":0},{"$f":"SUM(O70:O76)","v":0},{"$f":"SUM(P70:P76)","v":0},{"$f":"SUM(Q70:Q76)","v":0},{"$f":"SUM(R70:R76)","v":0},{"$f":"SUM(S70:S76)","v":0},{"$f":"SUM(T70:T76)","v":0},{"$f":"SUM(F77:T77)","v":962.5},"Total"]
["Total Effort Cost Study Start up plus IDC ",null,null,null,null,{"$f":"F77*(1+Summary!I14)","v":0},{"$f":"G77*(1+Summary!I14)","v":0},{"$f":"H77*(1+Summary!I14)","v":113.75},{"$f":"I77*(1+Summary!I14)","v":0},{"$f":"J77*(1+Summary!I14)","v":113.75},{"$f":"K77*(1+Summary!I14)","v":910},{"$f":"L77*(1+Summary!I14)","v":113.75},{"$f":"M77*(1+Summary!I14)","v":0},{"$f":"N77*(1+Summary!I14)","v":0},{"$f":"O77*(1+Summary!I14)","v":0},{"$f":"P77*(1+Summary!I14)","v":0},{"$f":"Q77*(1+Summary!I14)","v":0},{"$f":"R77*(1+Summary!I14)","v":0},{"$f":"S77*(1+Summary!I14)","v":0},{"$f":"T77*(1+Summary!I14)","v":0},{"$f":"SUM(F78:T78)","v":1251.25},"Total with IDC"]

{"sheet":"QQBR","index":8,"n_rows":45,"n_cols":14,"rows_kept":45,"cut":false,"hidden":false,"merged":[[14,13,20,19],[6,0,6,2],[6,3,6,5],[45,0,50,9],[34,0,34,9],[35,0,35,9],[36,0,36,9],[37,0,37,9],[38,0,38,9],[39,0,39,9],[40,0,40,9],[41,0,41,9],[44,0,44,9],[29,0,29,9],[30,0,30,9],[31,0,31,9],[32,0,32,9],[33,0,33,9],[24,0,24,11],[26,0,26,9],[27,0,27,9],[28,0,28,9],[1,1,1,11],[4,2,4,5],[5,0,5,2],[5,3,5,5],[5,6,5,7],[5,8,5,11],[21,0,21,6],[21,7,21,11],[22,0,22,6],[22,7,22,11],[23,0,23,6],[23,7,23,11],[18,0,18,11],[20,0,20,6],[20,7,20,11],[17,0,17,6],[17,7,17,11],[19,0,19,11],[13,0,13,6],[13,7,13,11],[15,0,15,11],[14,0,14,6],[14,7,14,11],[11,7,11,11],[12,0,12,6],[12,7,12,11],[9,0,10,6],[9,7,9,11],[16,0,16,11],[10,7,10,11],[7,0,7,11],[8,0,8,11],[2,8,2,11],[3,2,3,5],[3,6,3,7],[3,8,3,11],[4,6,4,7],[4,8,4,11],[3,0,3,1],[4,0,4,1],[2,0,2,1],[2,2,2,5],[2,6,2,7],[11,0,11,6]]}
[]
["Project Title:",{"$f":"Summary!B9","v":0}]
["Principal Investigator:",null,{"$f":"Summary!C10","v":0},null,null,null,"Department:",null,{"$f":"Summary!I10","v":0}]
["Sponsor/CRO:",null,{"$f":"Summary!C11","v":0},null,null,null,"Project Period:",null,{"$f":"Summary!I11","v":0}]
["CPHS Study Number:",null,{"$f":"Summary!C12","v":0},null,null,null,"Coordinator:",null,{"$f":"Summary!I12","v":0}]
["ClinicalTrials.gov # / NCT #:",null,null,{"$f":"Summary!D13","v":0},null,null,"IDE #:",null,{"$f":"Summary!I13","v":0}]
["Coverage Analysis Version Date:",null,null,{"$f":"'Coverage Analysis'!N6","v":{"$error":"#NAME?"}}]
[]
["Device Studies"]
["What type of device is being studied?"]
[]
["Is the investigational product provided for free by sponsor?"]
["If IDE, has the device “packet” been sent to CMS for approval?"]
["Has it been approved by CMS for billing?"]
["Has the MHH device checklist been completed?",null,null,null,null,null,null,null,null,null,null,null,null,"A DEEMED study is one that meets one of the following criteria:\n\n1. Trials funded by NIH, CDC, AHRQ, CMS, DOD or VA.\n2. Trials supported by centers or cooperative groups that are funded by the NIH, CDC, AHRQ, CMS, DOD or VA.\n3. Trials conducted under an investigational new drug application (IND) reviewed by the FDA.\n4. Drug trials that  are exempt from having an IND under 21 CFR 312.2(b)(1)."]
[]
["Drug/Biologic/Behavioral Studies"]
["Is the investigational product provided for free by sponsor?"]
[]
["Conditions for Qualifying Clinical Trial"]
["The subject or purpose of the trial is the evaluation of an item or service that falls within a Medicare benefit category (e.g., physicians' service, durable medical equipment, or diagnostic test) and is not statutorily excluded from coverage (e.g., cosmetic surgery, hearing aids)."]
["The trial has therapeutic intent (i.e., the trial is not designed exclusively to test toxicity or disease path physiology)."]
["For a trial of a therapeutic intervention, the trial must enroll patients with diagnosed disease rather than healthy volunteers."]
["The trial is considered to be a DEEMED study."]
["Please submit the completed form along with the completed Coverage Analysis to crf@uth.edu.   "]
[]
["Federal Requirements (As Applicable to Medicare and Other Third Party Payers):"]
["1) The billing provider must include in the beneficiary's medical record the following information: trial name, sponsor, and sponsor-assigned protocol number. This information does not need to be submitted with the claim but must be provided if requested for medical review."]
["2) The billing provider must report a National Clinical Trial (NCT) number on claims for items and services provided in clinical trials that are qualified for coverage. Services that are dictated in the clinical trial protocol, including routine care for the condition in the clinical trial, must be submitted with an NCT identifier number on a Medicare claim related to the clinical trial. Only items dictated in the research protocol are required to have the NCT identifier."]
["3) The clinical trial number is assigned by the National Library of Medicine website (http://clincialtrials.gov) when a new study is registered in the NLM Clinical Trials Database."]
["4) Claims also should include the following identifiers when being submitted to Medicare: a) Condition Code 30 (qualified clinical trial) b) ICD-10 code z00.6 (clinical research participant) as a secondary diagnosis c) Modifier Q0 (investigational item) or Q1 (routine services)"]
[]
["UTHealth Clinical Research Billing Policy"]
["1)  It is the responsibility of the PI to ensure that the clinical research billing of his or her studies is in compliance with all laws and regulations and adhere to university policy. The PI, his or her research staff, department administrators, and the CRF Team must work together to ensure the components of accurate billing are in place. Please refer to the Coverage Analysis Procedure and the Clinical Research Billing Procedure."]
["2)  The PI and study staff must prepare and submit a coverage analysis"]
["3)  The coverage analysis should be consistent with the study protocol and informed consent and should accurately and appropriately allocate the costs associated with the performance of the clinical study to the responsible payer. "]
["4)  The study budget should reflect all charges listed in the coverage analysis as sponsored paid research. "]
["5)  The PI and study staff must ensure that there is an outlined plan to identify research patients prior to providing services. "]
["6)  The PI and study staff must ensure that the services for study subjects enrolled in the clinical research project are billed in accordance with the coverage analysis and that the bills are based on actual services rendered and consistent with the informed consent. "]
["7)  After services are provided, study staff must coordinate with the appropriate personnel to ensure that proper billing information is provided. "]
["8)  Each department and clinic must follow clinical research billing procedures specific to its unit or practice in order to ensure that clinical research billing is conducted appropriately and accurately. "]
["9)  Study staff must conduct periodic reconciliation of clinical research billing charges."]
[]
["CERTIFICATION: "]
["I certify that I have read and understand the UTHealth Clinical Research Billing Policy and will comply with all applicable laws and UTHealth rules and policies governing clinical research billing.  I certify to the best of my ability that the coverage analysis dated above is correct."]

{"sheet":"Budget","index":9,"n_rows":95,"n_cols":16,"rows_kept":95,"cut":false,"hidden":true,"merged":[[65,0,65,2],[66,0,66,2],[67,0,67,2],[68,0,68,2],[94,0,94,2],[60,0,60,2],[61,0,61,2],[62,0,62,2],[63,0,63,2],[64,0,64,2],[55,0,55,2],[56,0,56,2],[57,0,57,2],[58,0,58,2],[59,0,59,2],[2,1,2,3],[3,1,3,3],[6,1,6,3],[5,1,5,3],[4,1,4,3]]}
["Summary info:",null,null,null,null,null,null,null,null,null,"Summary Information ",null,"Total Direct","Total W/IDC","Grand Total"]
["Project info:",null,null,null,null,null,null,null,null,null,null,"Start up ",{"$f":"Summary!L30","v":6007.8846153846152},{"$f":"M2*Summary!I14","v":1802.3653846153845},{"$f":"M2+N2","v":7810.25}]
["Project Title:",{"$f":"Summary!B9","v":0},null,null,"Department",{"$f":"Summary!I10","v":0},null,null,null,null,null,"Invoiceable",{"$f":"Summary!G31","v":1000},{"$f":"M3*Summary!I14","v":300},{"$f":"M3+N3","v":1300}]
["PI ",{"$f":"Summary!C10","v":0},null,null,"Project Period",{"$f":"Summary!I11","v":0},null,null,null,null,null,"Patient care ",{"$f":"Summary!J33*Summary!D14","v":0},{"$f":"M4*Summary!I14","v":0},{"$f":"M4+N4","v":0}]
["Spnosr",{"$f":"Summary!C11","v":0},null,null,"Coordinator",{"$f":"Summary!I12","v":0},null,null,null,null,null,"Effort",{"$f":"Summary!L27","v":0},{"$f":"M5*Summary!I14","v":0},{"$f":"M5+N5","v":0}]
["CPHS Study Number ",{"$f":"Summary!C12","v":0},null,null,"IDE#",{"$f":"Summary!I13","v":0},null,null,null,null,null,"Grand total",{"$f":"SUM(M2:M5)-M3","v":6007.8846153846152},{"$f":"M6*Summary!I14","v":1802.3653846153845},{"$f":"M6+N6","v":7810.25},"Does not include invoiceable costs "]
["Expected # of Patients",{"$f":"Summary!D14","v":0},null,null,"ICD RATE:",{"$f":"Summary!I14","v":0.3},null,null,null,null,null,{"$f":"Summary!A41","v":"Total Anticipated Revenue"},null,null,{"$f":"Summary!G41","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,"Study Revenue or Deficit",null,null,{"$f":"Summary!G42","v":-7810.25}]
[null,null,null,null,null,null,null,null,null,null,null,"Total Cost to UTH per 1 Patient excluding start up costs",null,null,{"$f":"(O5+O4)/Summary!D14","v":{"$error":"#DIV/0!"}},"Expense cost + effort +plus IDC  "]
[]
["Clinical Cost"]
["Procedures/Activities",{"$f":"'Coverage Analysis'!F8","v":0},{"$f":"'Coverage Analysis'!G8","v":0},{"$f":"'Coverage Analysis'!H8","v":0},{"$f":"'Coverage Analysis'!I8","v":0},{"$f":"'Coverage Analysis'!J8","v":0},{"$f":"'Coverage Analysis'!K8","v":0},{"$f":"'Coverage Analysis'!L8","v":0},{"$f":"'Coverage Analysis'!M8","v":0}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B13),,'Cost-Expenses'!B13)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B14),,'Cost-Expenses'!B14)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B15),,'Cost-Expenses'!B15)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B16),,'Cost-Expenses'!B16)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B17),,'Cost-Expenses'!B17)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B18),,'Cost-Expenses'!B18)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B19),,'Cost-Expenses'!B19)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B20),,'Cost-Expenses'!B20)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B21),,'Cost-Expenses'!B21)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B22),,'Cost-Expenses'!B22)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B23),,'Cost-Expenses'!B23)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B24),,'Cost-Expenses'!B24)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B25),,'Cost-Expenses'!B25)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B26),,'Cost-Expenses'!B26)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B27),,'Cost-Expenses'!B27)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B28),,'Cost-Expenses'!B28)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B29),,'Cost-Expenses'!B29)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B30),,'Cost-Expenses'!B30)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B31),,'Cost-Expenses'!B31)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B32),,'Cost-Expenses'!B32)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B33),,'Cost-Expenses'!B33)","v":""}]
["NOT LISTED IN PROTOCOL SCHEDULE "]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B35),\"\",'Cost-Expenses'!B35)","v":""}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B36),\"\",'Cost-Expenses'!B36)","v":"CRF Data Entry"}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B37),\"\",'Cost-Expenses'!B37)","v":"Chart set up"}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B38),\"\",'Cost-Expenses'!B38)","v":"Schedule next visit"}]
[{"$f":"IF(ISBLANK('Cost-Expenses'!B39),\"\",'Cost-Expenses'!B39)","v":"Describe Study drug"}]
["Subtotal",{"$f":"SUBTOTAL(9,B13:B39)","v":0},0,0,0,0,0,0,0]
[]
[{"$f":"Effort!A18","v":"Position "},{"$f":"'Coverage Analysis'!F8","v":0},{"$f":"'Coverage Analysis'!G8","v":0},{"$f":"'Coverage Analysis'!H8","v":0},{"$f":"'Coverage Analysis'!I8","v":0},{"$f":"'Coverage Analysis'!J8","v":0},{"$f":"'Coverage Analysis'!K8","v":0},{"$f":"'Coverage Analysis'!L8","v":0},{"$f":"'Coverage Analysis'!M8","v":0}]
[{"$f":"Effort!A20","v":"PI"},{"$f":"Effort!E36","v":0},{"$f":"Effort!F36","v":0},{"$f":"Effort!G36","v":0},{"$f":"Effort!H36","v":0},{"$f":"Effort!I36","v":0},{"$f":"Effort!J36","v":0},{"$f":"Effort!K36","v":0},{"$f":"Effort!L36","v":0}]
[{"$f":"Effort!A21","v":"Coordinator"},{"$f":"Effort!E37","v":0},{"$f":"Effort!F37","v":0},{"$f":"Effort!G37","v":0},{"$f":"Effort!H37","v":0},{"$f":"Effort!I37","v":0},{"$f":"Effort!J37","v":0},{"$f":"Effort!K37","v":0},{"$f":"Effort!L37","v":0}]
[{"$f":"Effort!A22","v":"Coordinator Admin "},{"$f":"Effort!E38","v":0},{"$f":"Effort!F38","v":0},{"$f":"Effort!G38","v":0},{"$f":"Effort!H38","v":0},{"$f":"Effort!I38","v":0},{"$f":"Effort!J38","v":0},{"$f":"Effort!K38","v":0},{"$f":"Effort!L38","v":0}]
[{"$f":"Effort!A23","v":"Finanical Management"},{"$f":"Effort!E39","v":0},{"$f":"Effort!F39","v":0},{"$f":"Effort!G39","v":0},{"$f":"Effort!H39","v":0},{"$f":"Effort!I39","v":0},{"$f":"Effort!J39","v":0},{"$f":"Effort!K39","v":0},{"$f":"Effort!L39","v":0}]
[{"$f":"Effort!A25","v":0},{"$f":"Effort!E41","v":0},{"$f":"Effort!F41","v":0},{"$f":"Effort!G41","v":0},{"$f":"Effort!H41","v":0},{"$f":"Effort!I41","v":0},{"$f":"Effort!J41","v":0},{"$f":"Effort!K41","v":0},{"$f":"Effort!L41","v":0}]
[{"$f":"Effort!A26","v":0},{"$f":"Effort!E42","v":0},{"$f":"Effort!F42","v":0},{"$f":"Effort!G42","v":0},{"$f":"Effort!H42","v":0},{"$f":"Effort!I42","v":0},{"$f":"Effort!J42","v":0},{"$f":"Effort!K42","v":0},{"$f":"Effort!L42","v":0}]
[{"$f":"Effort!A27","v":"Sponsored Projects"},{"$f":"Effort!E43","v":0},{"$f":"Effort!F43","v":0},{"$f":"Effort!G43","v":0},{"$f":"Effort!H43","v":0},{"$f":"Effort!I43","v":0},{"$f":"Effort!J43","v":0},{"$f":"Effort!K43","v":0},{"$f":"Effort!L43","v":0}]
["Total Effort Cost per Visit",{"$f":"SUM(B43:B49)","v":0},0,0,0,0,{"$f":"SUM(G43:G49)","v":0},0,{"$f":"SUM(I43:I49)","v":0}]
[]
["Total Direct Effort and Expense Cost per Visit ",{"$f":"B50+B40","v":0},{"$f":"C50+C40","v":0},{"$f":"D50+D40","v":0},{"$f":"E50+E40","v":0},0,{"$f":"G50+G40","v":0},0,{"$f":"I50+I40","v":0}]
["IDC per Visit",{"$f":"B52*0.3","v":0},0,0,0,0,0,{"$f":"H52*0.3","v":0},0]
["Total Cost per Visit with IDC ",{"$f":"SUM(B52:B53)","v":0},{"$f":"SUM(C52:C53)","v":0},0,0,0,{"$f":"SUM(G52:G53)","v":0},0,{"$f":"SUM(I52:I53)","v":0}]
[]
["Start cost",null,null,"Total ","Total W IDC"]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A6),\"\",'Start up and Invoiceables'!A6)","v":"Start Up Effort"},null,null,{"$f":"IF(ISBLANK('Start up and Invoiceables'!D6),\"\",'Start up and Invoiceables'!D6)","v":962.5},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D6),\"\",'Start up and Invoiceables'!D6*1.3)","v":1251.25}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A7),\"\",'Start up and Invoiceables'!A7)","v":"IRB Review Fee - Local or Permission to Rely"},null,null,{"$f":"IF(ISBLANK('Start up and Invoiceables'!D7),\"\",'Start up and Invoiceables'!D7)","v":2000},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D7),\"\",'Start up and Invoiceables'!D7*1.3)","v":2600}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A8),\"\",'Start up and Invoiceables'!A8)","v":"Coverage Analysis Fee"},null,null,{"$f":"IF(ISBLANK('Start up and Invoiceables'!D8),\"\",'Start up and Invoiceables'!D8)","v":1545.3846153846152},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D8),\"\",'Start up and Invoiceables'!D8*1.3)","v":2009}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A9),\"\",'Start up and Invoiceables'!A9)","v":"Investigational Pharmacy Setup Fee (Delete if N/A)"},null,null,{"$f":"IF(ISBLANK('Start up and Invoiceables'!D9),\"\",'Start up and Invoiceables'!D9)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D9),\"\",'Start up and Invoiceables'!D9*1.3)","v":""}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A10),\"\",'Start up and Invoiceables'!A10)","v":"MHH Adminsitrative Start up Fee (Delete if N/A)"},null,null,{"$f":"IF(ISBLANK('Start up and Invoiceables'!D10),\"\",'Start up and Invoiceables'!D10)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D10),\"\",'Start up and Invoiceables'!D10*1.3)","v":""}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A11),\"\",'Start up and Invoiceables'!A11)","v":"Radiology Dept Setup Fee (Delete if N/A)"},null,null,{"$f":"IF(ISBLANK('Start up and Invoiceables'!D11),\"\",'Start up and Invoiceables'!D11)","v":750},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D11),\"\",'Start up and Invoiceables'!D11*1.3)","v":975}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A12),\"\",'Start up and Invoiceables'!A12)","v":"CRU Start up Fee (Delete if N/A)"},null,null,{"$f":"IF(ISBLANK('Start up and Invoiceables'!D12),\"\",'Start up and Invoiceables'!D12)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D12),\"\",'Start up and Invoiceables'!D12*1.3)","v":""}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A13),\"\",'Start up and Invoiceables'!A13)","v":"Lab set up Fee (Delete if N/A)"},null,null,{"$f":"IF(ISBLANK('Start up and Invoiceables'!D13),\"\",'Start up and Invoiceables'!D13)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D13),\"\",'Start up and Invoiceables'!D13*1.3)","v":""}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A14),\"\",'Start up and Invoiceables'!A14)","v":"Patient Population Assessment Fee"},null,null,{"$f":"IF(ISBLANK('Start up and Invoiceables'!D14),\"\",'Start up and Invoiceables'!D14)","v":750},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D14),\"\",'Start up and Invoiceables'!D14*1.3)","v":975}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A15),\"\",'Start up and Invoiceables'!A15)","v":""},null,null,{"$f":"IF(ISBLANK('Start up and Invoiceables'!D15),\"\",'Start up and Invoiceables'!D15)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D15),\"\",'Start up and Invoiceables'!D15*1.3)","v":""}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A16),\"\",'Start up and Invoiceables'!A16)","v":""},null,null,{"$f":"IF(ISBLANK('Start up and Invoiceables'!D16),\"\",'Start up and Invoiceables'!D16)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D16),\"\",'Start up and Invoiceables'!D16*1.3)","v":""}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A17),\"\",'Start up and Invoiceables'!A17)","v":""},null,null,{"$f":"IF(ISBLANK('Start up and Invoiceables'!D17),\"\",'Start up and Invoiceables'!D17)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D17),\"\",'Start up and Invoiceables'!D17*1.3)","v":""}]
["Total Start up Cost ",null,null,{"$f":"SUM(D57:D68)","v":6007.8846153846152},{"$f":"SUM(E57:E68)","v":7810.25}]
[]
["Invoiceable Procedures","Unit cost ","Quantity","Total ","Total W IDC"]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A21),\"\",'Start up and Invoiceables'!A21)","v":"IRB annual Review"},{"$f":"IF(ISBLANK('Start up and Invoiceables'!B21),\"\",'Start up and Invoiceables'!B21)","v":1000},{"$f":"IF(ISBLANK('Start up and Invoiceables'!C21),\"\",'Start up and Invoiceables'!C21)","v":1},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D21),\"\",'Start up and Invoiceables'!D21)","v":1000},{"$f":"IF(ISBLANK('Start up and Invoiceables'!E21),\"\",'Start up and Invoiceables'!E21)","v":1300}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A22),\"\",'Start up and Invoiceables'!A22)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!B22),\"\",'Start up and Invoiceables'!B22)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!C22),\"\",'Start up and Invoiceables'!C22)","v":1},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D22),\"\",'Start up and Invoiceables'!D22)","v":0},{"$f":"IF(ISBLANK('Start up and Invoiceables'!E22),\"\",'Start up and Invoiceables'!E22)","v":0}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A23),\"\",'Start up and Invoiceables'!A23)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!B23),\"\",'Start up and Invoiceables'!B23)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!C23),\"\",'Start up and Invoiceables'!C23)","v":1},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D23),\"\",'Start up and Invoiceables'!D23)","v":0},{"$f":"IF(ISBLANK('Start up and Invoiceables'!E23),\"\",'Start up and Invoiceables'!E23)","v":0}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A24),\"\",'Start up and Invoiceables'!A24)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!B24),\"\",'Start up and Invoiceables'!B24)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!C24),\"\",'Start up and Invoiceables'!C24)","v":1},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D24),\"\",'Start up and Invoiceables'!D24)","v":0},{"$f":"IF(ISBLANK('Start up and Invoiceables'!E24),\"\",'Start up and Invoiceables'!E24)","v":0}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A25),\"\",'Start up and Invoiceables'!A25)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!B25),\"\",'Start up and Invoiceables'!B25)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!C25),\"\",'Start up and Invoiceables'!C25)","v":1},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D25),\"\",'Start up and Invoiceables'!D25)","v":0},{"$f":"IF(ISBLANK('Start up and Invoiceables'!E25),\"\",'Start up and Invoiceables'!E25)","v":0}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A26),\"\",'Start up and Invoiceables'!A26)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!B26),\"\",'Start up and Invoiceables'!B26)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!C26),\"\",'Start up and Invoiceables'!C26)","v":1},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D26),\"\",'Start up and Invoiceables'!D26)","v":0},{"$f":"IF(ISBLANK('Start up and Invoiceables'!E26),\"\",'Start up and Invoiceables'!E26)","v":0}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A27),\"\",'Start up and Invoiceables'!A27)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!B27),\"\",'Start up and Invoiceables'!B27)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!C27),\"\",'Start up and Invoiceables'!C27)","v":1},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D27),\"\",'Start up and Invoiceables'!D27)","v":0},{"$f":"IF(ISBLANK('Start up and Invoiceables'!E27),\"\",'Start up and Invoiceables'!E27)","v":0}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A28),\"\",'Start up and Invoiceables'!A28)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!B28),\"\",'Start up and Invoiceables'!B28)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!C28),\"\",'Start up and Invoiceables'!C28)","v":1},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D28),\"\",'Start up and Invoiceables'!D28)","v":0},{"$f":"IF(ISBLANK('Start up and Invoiceables'!E28),\"\",'Start up and Invoiceables'!E28)","v":0}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A29),\"\",'Start up and Invoiceables'!A29)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!B29),\"\",'Start up and Invoiceables'!B29)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!C29),\"\",'Start up and Invoiceables'!C29)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D29),\"\",'Start up and Invoiceables'!D29)","v":0},{"$f":"IF(ISBLANK('Start up and Invoiceables'!E29),\"\",'Start up and Invoiceables'!E29)","v":0}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A30),\"\",'Start up and Invoiceables'!A30)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!B30),\"\",'Start up and Invoiceables'!B30)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!C30),\"\",'Start up and Invoiceables'!C30)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D30),\"\",'Start up and Invoiceables'!D30)","v":0},{"$f":"IF(ISBLANK('Start up and Invoiceables'!E30),\"\",'Start up and Invoiceables'!E30)","v":0}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A31),\"\",'Start up and Invoiceables'!A31)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!B31),\"\",'Start up and Invoiceables'!B31)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!C31),\"\",'Start up and Invoiceables'!C31)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D31),\"\",'Start up and Invoiceables'!D31)","v":0},{"$f":"IF(ISBLANK('Start up and Invoiceables'!E31),\"\",'Start up and Invoiceables'!E31)","v":0}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A32),\"\",'Start up and Invoiceables'!A32)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!B32),\"\",'Start up and Invoiceables'!B32)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!C32),\"\",'Start up and Invoiceables'!C32)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D32),\"\",'Start up and Invoiceables'!D32)","v":0},{"$f":"IF(ISBLANK('Start up and Invoiceables'!E32),\"\",'Start up and Invoiceables'!E32)","v":0}]
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[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A37),\"\",'Start up and Invoiceables'!A37)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!B37),\"\",'Start up and Invoiceables'!B37)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!C37),\"\",'Start up and Invoiceables'!C37)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D37),\"\",'Start up and Invoiceables'!D37)","v":0},{"$f":"IF(ISBLANK('Start up and Invoiceables'!E37),\"\",'Start up and Invoiceables'!E37)","v":0}]
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[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A41),\"\",'Start up and Invoiceables'!A41)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!B41),\"\",'Start up and Invoiceables'!B41)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!C41),\"\",'Start up and Invoiceables'!C41)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D41),\"\",'Start up and Invoiceables'!D41)","v":0},{"$f":"IF(ISBLANK('Start up and Invoiceables'!E41),\"\",'Start up and Invoiceables'!E41)","v":0}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A42),\"\",'Start up and Invoiceables'!A42)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!B42),\"\",'Start up and Invoiceables'!B42)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!C42),\"\",'Start up and Invoiceables'!C42)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D42),\"\",'Start up and Invoiceables'!D42)","v":0},{"$f":"IF(ISBLANK('Start up and Invoiceables'!E42),\"\",'Start up and Invoiceables'!E42)","v":0}]
[{"$f":"IF(ISBLANK('Start up and Invoiceables'!A43),\"\",'Start up and Invoiceables'!A43)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!B43),\"\",'Start up and Invoiceables'!B43)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!C43),\"\",'Start up and Invoiceables'!C43)","v":""},{"$f":"IF(ISBLANK('Start up and Invoiceables'!D43),\"\",'Start up and Invoiceables'!D43)","v":0},{"$f":"IF(ISBLANK('Start up and Invoiceables'!E43),\"\",'Start up and Invoiceables'!E43)","v":0}]
["Total Invoicable Costs ",null,null,{"$f":"SUM(D72:D94)","v":1000},{"$f":"SUM(E72:E94)","v":1300}]