Here are a few more reasons:<p>1) High touch sales process, slow sales cycles - ultrasounds take a long time to sell to hospitals&#x2F;clinics so the sales process is very high touch and requires a significant number of demos and in person time. Those sales reps are usually paid on commission. Cheap products don&#x27;t make sense to sell this way.<p>2) Lack of competition and high development cost - Ultrasound machines are a Class II medical device and so are regulated by the FDA. FDA requires compliance with most relevant ISO standards, and there would probably be a dozen relevant standards for an ultrasound machine.<p>3) Liability - complex medical devices that are used for critical diagnoses create big liability problems for the hospitals&#x2F;clinicians. They have no incentive to choose the low-cost model sold by a startup. No one ever got sued for choosing GE&#x2F;Philips&#x2F;etc.<p>4) Lack of price transparency - its often hard to find prices for big ticket medical devices, so the natural pressure to reduce costs through competition isn&#x27;t  as effective, especially with a high touch&#x2F;high cost sales process.