The correspondence cites weaknesses we identified in our discussion. We agree that the value of EBUS to our institution should not be generalized and even suggested that using our dollar amount may translate to financial loss in certain institutions. We offered assessment steps (outlined in Table 3 in the article) and feel that by doing their homework, some institutions will discover they are better off not adopting a new procedure. We also designed the study to be conservative in estimates of downstream revenue by excluding patients already in the system, capturing actual collections, and only including collections related to the reason for EBUS. Furthermore, our collections are likely less in relation to other practices because our payer mix includes a substantial percentage of unfunded or underfunded patients. Our institution is a tertiary care center with pulmonologists trained in EBUS, but our catchment area contains hospitals with mediastinoscopy, endoscopic ultrasound fine needle aspiration, and traditional transbronchial needle aspiration, and EBUS and medical oncologists, thoracic surgeons, and radiation oncologists.