You should also remember that the system has to be supported from a software and hardware perspective. This is typically done by vendor staff, which need to be paid, as well. There are always bugs and other support issues that add to the cost of supporting the system, which, in a hospital environment, usually requires 24x7 support access. Most BB systems also need to be interfaced to the HIS or LIS in use, even if from the same provider. HL7 interfaces, while relatively standard, still add a layer of complexity, which again, adds to the cost of the system (HL7 interfaces are big business because they are ingrained in every system in some way) Finally, in the US, you need to stay compliant with the FDA (510k), which is expensive. All these things considered, if the systems are too "cheap", the vendors lose money on them. That's why there are so few HIS vendors offering BB systems, and even fewer companies focused on just the BB component. I will close by saying that if you can get any BB system for less that $50K, you're doing pretty good.