On the surface, a capital investment of $90,000 to $130,000 plus ongoing maintenance costs of as much as $100 per procedure16 seem particularly high, especially if the calculation is made using only the reimbursement for that procedure when making decisions about capital investment. By calculating downstream revenue to a health-care system, we were able to demonstrate that for a capital investment of approximately $100,000, the health-care system could generate $2.4 million in collections after 13 months of having an EBUS-TBNA service (based on revenue generated from all 97 NPs, each followed for 7 months). This calculation was based on the purchase of only 1 EBUS bronchoscope and allowed for periods when the bronchoscope was damaged and procedures had to be postponed (typically < 1 week turnaround for repairs). A different way to calculate this would be based on collections per patient ($2.4 million per 97 patients). Both are conservative estimates but further validate the point that investing in this technology was worth the cost. These calculations are based on the payer mix from a state-supported academic medical center that likely has a lower percentage of private insurance coverage compared with private health-care institutions. In an employment arrangement like this one, where physicians are fully employed by a hospital system, there is more likely to be a collaborative atmosphere among employed physicians and the hospital financial department. In a private hospital system, where physician employment is separate from the hospital system, there may be more barriers to obtaining financial information to make estimates of profit from a new procedure. Relatively speaking, the financial benefit to pulmonologists is modest. The technical fee is the same as that for a traditional blind TBNA, and the professional fee is only slightly more. These reimbursement rates are low relative to the procedural time, especially for complete mediastinal staging procedures. This represents time away from potentially higher paying endeavors by the pulmonologist, such as critical care time, outpatient collections, or polysomnography interpretation. In striking comparison, the financial gain to other services such as medical oncology, radiology, and radiation oncology from an EBUS-TBNA program is large. To reimburse physicians performing EBUS-TBNA in a more equitable way, a future direction may entail revenue sharing, where physicians receive compensation in whole or in part based on the economic benefit of their services (eg, cancer care) to the hospital. Alternatively, local centers of excellence in EBUS-TBNA may develop that maintain the necessary procedural volume to justify purchase of the necessary equipment and avoid duplication of expenses by smaller hospitals.