Gildea and Nicolacakis review how EBUS has been used, how a procedure code is valued, and the new Current Procedural Terminology codes for EBUS as well as EBUS reimbursement for the practitioner and how that reimbursement is decreasing. It gives one pause when a transformative technology that improves care, yields, safety, time to diagnosis, and treatment is reimbursed less than that which it supplants, beats, or enhances (ie, mediastinosocpy,,) and is valued even lower once it has gained substantial traction. However, the process has its own internal logic and it is simply the reality. Medicare is a zero sum game. There is a finite pool of dollars to pay for it. If new technologies and treatments enter the market, they squeeze in with already-present efforts. If volumes go up for a particular procedure, the pressure is to decrease reimbursement per procedure or for other things, creating a net zero increase. In the current system, a procedure is valued based on the work and risk involved in the procedure itself and not on the value to the patient or system overall.