There are cheap, generic scopes (Sprague-Rappaport types) that are very sensitive but the double tube also causes a lot of noise. There are knock-offs of the Littmann scopes in the market. Then there are the scopes doctors usually buy, which are Littmann, Harvey (made by Welch-Allyn) and Heine, and a few smaller makers. No marketer of a high-quality scope wants to sell it at a $30 or less price point, and if you're going to go higher, might as well place it in the same market as the Littmann ($115+). I'll be honest, for emergency medicine use, the Littmann lightweight scope is good enough and cost about $45 when I bought it. But if I actually want to hear the subtleties in a chest, I'll use my personal scope (a Littmann Cardiology IV). Why choose this one? I already know it and they are very consistent. It doesn't feel cold to the patient and it has the right level of sensitivity without much noise. It is a little heavy. If a dog is bucking around, it can go flying and hurt if it hits someone.