Sponsors and sites often disagree about budgets because they are looking at different cost structures. This session breaks down what it actually costs a site to conduct a study: coordinator and investigator effort, pharmacy and laboratory support, regulatory and administrative work, equipment, storage, overhead, and the many activities that never appear on a per-visit grid. We will examine how protocol complexity, visit density, and monitoring demands drive effort, and how to quantify costs that are easy to overlook. The session gives sites language for justifying their numbers and gives sponsors insight into what they are buying. Attendees will leave with a clearer framework for cost justification.