The differences are many and counterfeits are dangerous.
Almost all of those products you are seeing on the internet are not FDA compliant, are not using medical-grade plastics, and those companies have no real humans working there. None of them have been tested in clinical trials. We have had users that have purchased these products call and complained of a burning sensation on their lips and pieces of plastic flying into their mouth/airway.
That's why we are aiming to take them off Amazon and other platforms. Amazon even filed a lawsuit with us as a joint plaintiff so we can protect our customers.
You may also note that they sell them at half price. They can afford that because they are companies based out of China, with no clinical staff or even presence in the USA, who knock off successful products in the medical industry and profit from all our research and hard work. Here is the link we created to help our customers. Piper and other known bad actors are listed on this page - https://www.pnmedical.com/counterfeit/.