Full opinion text
MEMORANDUM OPINION AND ORDER MARTHA VAZQUEZ, District Judge. THIS MATTER comes before the Court on the Motion of Defendants Presbyterian Healthcare Services and Presbyterian Network, Inc. to Dismiss the Second Amended Complaint with Prejudice and Memorandum in Support, filed April 15, 2013 [Doc. 33]. The Court, having considered the motion, briefs, and relevant law, and being otherwise fully informed, finds that the motion is well taken in part and will be granted in part. BACKGROUND Plaintiff New Mexico Oncology and Hematology Consultants, Ltd. (“NMOHC”) is a professional corporation with its principal place of business located in Albuquerque, New Mexico. [Doc. 24 ¶ 23]. NMOHC is an integrated, comprehensive cancer treatment facility that offers patients a full range of medical oncology and hematology, radiation oncology, chemotherapy infusion, and radiology and laboratory services. [Id. ¶¶ 24,. 32, 33, 34]. NMOHC offers patients its services at a free standing cancer center owned and operated by NMOHC. [Id. ¶ 31]. While NMOHC is centered in Albuquerque, it has satellite facilities in underserved areas, including Gallup, Silver City, and Ruidoso. [Id. ¶ 35], Defendant Presbyterian Healthcare Services (“Presbyterian Hospital”) is a not-for-profit corporation, with its principle place of business in Albuquerque, New Mexico. [Id. ¶ 36]. Presbyterian owns, operates, and manages eight acute care hospitals, all of which are located in New Mexico and three of which are located in Albuquerque. [Id. ¶ 37]. Presbyterian Hospital is the largest hospital in both Albuquerque and New Mexico and offers a full range of services, including comprehensive oncology services. [Id. ¶¶ 35, 45, 69, 77, 84]. Presbyterian Hospital owns, operates, and manages Presbyterian Medical Group, which employs approximately 700 physicians, including primary care physicians, medical oncologists, and a wide range of other specialists. [Id. ¶ 45]. Presbyterian Hospital also is the ultimate parent company of co-Defendant Presbyterian Network, Inc. [Id. ¶ 39]. Presbyterian Hospital owns and operates Presbyterian Healthcare Services Affiliates, Presbyterian Healthcare Services Affiliates owns Southwest Health Foundation, Southwest Health Foundation owns Defendant Presbyterian Network Inc., and Presbyterian Network Inc. owns and controls Presbyterian Insurance Company, Inc. and Presbyterian Health Plans Inc. [Id]. The Court collectively refers to Presbyterian Network, Inc. and its subsidiaries as “PHP.” [M]. PHP operates, on a for-profit basis, various health maintenance organizations, preferred provider organizations, and other health insurance products. [Id.]. PHP is the largest health insurer in Albuquerque. [IcL ¶ 42]. Despite the legal separation between Presbyterian Hospital and PHP, Presbyterian Hospital actively controls PHP’s actions. [Id. ¶ 43]. Plaintiff NMOHC filed its Second Amended Complaint (hereinafter “complaint”) [Doc. 24] against Defendants Presbyterian Hospital and PHP, alleging various federal and state antitrust claims, claims under the federal Racketeer Influenced and Corrupt Organizations Act (“RICO”), and state common law claims. These claims arise out of Defendants’ alleged use of their dominance in the markets for private health insurance and hospital inpatient services to increase their power in, and drive Plaintiff out of, the market for comprehensive oncology services. To this end, Plaintiff alleges that Defendants engaged in numerous wrongful acts, including but not limited to lowering their rate of reimbursement to Plaintiff in the most recent healthcare provider contract between Plaintiff and PHP, threatening to terminate this provider contract, entering into an exclusive arrangement with the insurance provider United Healthcare pursuant to which United will not take market actions without PHP’s approval, limiting and obstructing referrals to Plaintiffs physicians, pressuring Plaintiffs patients to switch to Presbyterian Hospital’s physicians, obtaining and selling drugs obtained through the federal 340B program (referred to herein as the “340B drugs” and “340B program”) in an unlawful manner, issuing a mandate requiring Plaintiffs patients to purchase chemotherapy and support drugs from Presbyterian Hospital’s specialty pharmacy instead of from Plaintiff (the “mandate”), and falsely informing one of Plaintiffs patients that Plaintiff is not an approved provider under PHP’s healthcare plan. These wrongful acts form the basis of the claims alleged in the complaint. Plaintiff alleges eight counts in the complaint. Plaintiff asserts monopolization and attempted monopolization antitrust claims under Section 2 of the Sherman Act, 15 U.S.C. § 2, and under the New Mexico Antitrust Act (“NMAA”), N.M. Stat. Ann. § 57-1-2. Plaintiffs monopolization claims (Counts I and III) arise out of Defendants’ alleged willful maintenance of a monopoly and/or monopsony in the market for private health insurance services through the alleged anticompetitive acts of lowering Plaintiffs reimbursement rates, threatening to terminate Plaintiffs provider contract, and entering into an exclusive arrangement with United Healthcare. [Id. ¶¶ 471-76, 483-89]. Plaintiffs attempted monopolization claims (Counts II and IV) arise out of Defendants’ alleged attempt to monopolize the comprehensive oncology services market by engaging in the same acts that maintained their monopoly in the private health insurance market and by committing the additional acts of limiting referrals to Plaintiffs physicians and requiring Plaintiffs patients to purchase chemotherapy drugs from Presbyterian Hospital’s pharmacy. [Id. ¶¶ 477-82, 490-95]. Plaintiff also asserts claims for tortious interference with existing and prospective contractual relationships (Counts V and VIII), which arise out of Defendants’ alleged use of improper means to prevent and prohibit referrals to Plaintiff and out of Defendants’ alleged use of improper means to prevent Plaintiffs patients from purchasing chemotherapy drugs from Plaintiff and using Plaintiffs chemotherapy infusion center. [Id. ¶¶ 496-503, 517-25]. Plaintiff in addition asserts state law claims for injurious falsehood and unfair competition (Count VI). Plaintiffs injurious falsehood claim arises out of Defendants’ alleged misrepresentation of Plaintiffs provider status to patients, and Plaintiffs unfair competition claim arises out of Defendants’ coercion of patients to switch to Presbyterian Hospital’s physicians, their pressure upon their physicians to refer patients in-house instead of to Plaintiff, their interference with the ability of their physicians to make referrals to Plaintiff, and their alleged illegal receipt and sale of 340B drugs purchased at a discount from pharmaceutical manufacturers under the federal 340B program and sold in violation of program guidelines to reap inflated profits. [Id. ¶¶ 8, 12, 505]. Plaintiff lastly asserts a federal RICO claim (Count VII), which arises out of Defendants’ aforementioned alleged illegal receipt and sale of 340B drugs, and Defendants’ issuance of the mandate requiring seniors covered by PHP’s health insurance to purchase their chemotherapy drugs (including 340B drugs) from Presbyterian Hospital’s pharmacy instead of from Plaintiff. [Doc. 24 ¶¶ 8-12], STANDARD Federal Rule of Civil Procedure 12(b)(6) authorizes a court to dismiss a complaint for “failure to state a claim upon which relief can be granted.” Fed.R.Civ.P. 12(b)(6). “The nature of a Rule 12(b)(6) motion tests the sufficiency of the allegations within the four corners of the complaint after taking those allegations as true.” Mobley v. McCormick, 40 F.3d 337, 340 (10th Cir.1994). The sufficiency of a complaint is a question of law, and when considering a rule 12(b)(6) motion, a court must accept as true all well-pleaded factual allegations in the complaint, view those allegations in the light most favorable to the plaintiff, and draw all reasonable inferences in the plaintiffs favor. See Tellabs, Inc. v. Makor Issues & Rights, Ltd., 551 U.S. 308, 322, 127 S.Ct. 2499, 168 L.Ed.2d 179 (2007); Smith v. U.S., 561 F.3d 1090, 1098 (10th Cir.2009) (citation omitted), cert. denied, 558 U.S. 1148, 130 S.Ct. 1142, 175 L.Ed.2d 973 (2010). A complaint need not set forth detailed factual allegations, yet a “pleading that offers labels and conclusions or a formulaic recitation of the elements of a cause of action” is insufficient. Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009) (citing Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007)). “Threadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice.” Id. To survive a motion to dismiss pursuant to Rule 12(b)(6), a plaintiffs complaint must contain sufficient facts that, if assumed to be true, state a claim to relief that is plausible on its face. See Twombly, 550 U.S. at 570, 127 S.Ct. 1955; Mink v. Knox, 613 F.3d 995, 1000 (10th Cir.2010). “A claim has facial plausibility when the pleaded factual content allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Ashcroft, 556 U.S. at 678, 129 S.Ct. 1937 (citing Twombly, 550 U.S. at 556, 127 S.Ct. 1955). “Thus, the mere metaphysical possibility that some plaintiff could prove some set of facts in support of the pleaded claims is insufficient; the complainant must give the court reason to believe that this plaintiff has a reasonable likelihood of mustering factual support for these claims.” Ridge at Red Hawk, LLC v. Schneider, 493 F.3d 1174, 1177 (10th Cir.2007) (emphasis omitted). The Tenth Circuit has explained, “[PJlausibility” in this context must refer to the scope of the allegations in a complaint: if they are so general that they encompass a wide swath of conduct, much of it innocent, then the plaintiffs “have not nudged their claims across the line from conceivable to plausible.” The allegations must be enough that, if assumed to be true, the plaintiff plausibly (not just speculatively) has a claim for relief. Robbins v. Okla., 519 F.3d 1242, 1247 (10th Cir.2008) (quoting Twombly, 550 U.S. at 570, 127 S.Ct. 1955) (internal citations omitted). DISCUSSION Defendants ask the Court to dismiss all of Plaintiffs claims with prejudice pursuant to Federal Rule of Civil Procedure 12(b)(6) for failure to state a claim for relief. First, Defendants maintain that the Court should dismiss Plaintiffs Sherman Act and NMAA monopolization claims, because Plaintiff lacks standing to bring the claims and Plaintiff has failed to allege that Defendants possessed monopoly power or maintained that monopoly power through exclusionary conduct. Second, Defendants argue that the Court should dismiss Plaintiffs federal and state attempted monopolization claims, because Plaintiff has failed to allege that Defendants engaged in anticompetitive conduct or had a dangerous probability of achieving monopoly power. Third, Defendants contend that the Court should dismiss Plaintiffs state claims for tortious interference with contractual relationships, because Plaintiff failed to allege that Defendants’ sole motive was to harm Plaintiff and because Defendants’ actions of refusing to deal with Plaintiff cannot form the basis of a tortious interference claim. Fourth, Defendants ask the Court to dismiss Plaintiffs state claim of injurious falsehood, because Plaintiff failed to plead special damages or to allege that Defendants knew that the alleged injurious statement was false. Fifth, Defendants ask the Court to dismiss Plaintiffs state claim for unfair competition, because the Unfair Practices Act preempts the claim and because the Court should not expand New Mexico law by adopting the Restatement (Third) of Unfair Competition’s broad definition of the claim. Finally, Defendants contend that the Court should dismiss Plaintiffs RICO claims, because Plaintiff does not have standing and Plaintiff failed to allege facts establishing that Defendants engaged in a scheme to defraud. The Court will address the merits of each of these requests for dismissal in turn. I. Monopolization Claims (Counts I and III). Plaintiff alleges that Defendants are monopolizing a private health insurance market. Defendants ask the Court to dismiss Plaintiffs monopolization claims, advancing three arguments in support of this request. First, Defendants maintain that Plaintiff fails to state a monopolization claim under Section 2 of the Sherman Act or the New Mexico Antitrust Act because Plaintiff lacks standing to bring a monopolization claim. Second, Defendants contend that Plaintiff has failed to allege that Defendants possess monopoly power. Third, Defendants, argue that Plaintiff has failed to allege that they maintained their monopoly power through exclusionary or predatory conduct. A. Plaintiff has Standing to Assert a Monopolization (or Monopsonization) Claim. Section 4 of the Clayton Act provides that anyone injured “in his business or property by reason of anything forbidden in the antitrust laws” may bring a claim. Reazin v. Blue Cross & Blue Shield, Inc., 899 F.2d 951, 960 (10th Cir.1990), cert. denied, 497 U.S. 1005, 110 S.Ct. 3241, 111 L.Ed.2d 752 (1990); see also 15 U.S.C. § 15. A private plaintiff seeking damages for a violation of the federal antitrust laws under Section 4 must have both antitrust standing and antitrust injury. See id. at 960 (“[standing and antitrust injury are essential elements in a private antitrust damages action brought under section 4 of the Clayton Act”) (citations omitted). The concepts are related, although they are often treated separately by courts. See id. at 960-61 (citation omitted). As one court explained, “It has been suggested that although standing is closely related to antitrust injury, the two concepts are distinct. Once antitrust injury has been demonstrated by a causal relationship between the harm and the challenged aspect of the alleged violation, standing analysis is employed to search for the most effective plaintiff from among those who have suffered loss.” Alberta Gas Chems., Ltd. v. E.I. Du Pont de Nemours & Co., 826 F.2d 1235, 1240 (3d Cir.1987), cert. denied, 486 U.S. 1059, 108 S.Ct. 2830, 100 L.Ed.2d 930 (1988); accord Reazin, 899 F.2d at 961 (citing Alberta Gas, 826 F.2d at 1240). The Tenth Circuit has held that the following factors [should] be considered in determining antitrust standing: the causal connection between the antitrust violations and plaintiffs injury; the defendant’s intent; the nature of the plaintiffs injury; the directness or indirectness of the connection between the plaintiffs injury and the allegedly unlawful market restraint; the spéculativeness of the plaintiffs damages; and the “risk of duplicative recoveries ... or the danger of complex apportionment of damages.” Reazin, 899 F.2d at 962 n. 15 (quoting Associated Gen. Contractors, Inc. v. Carpenters, 459 U.S. 519, 544, 103 S.Ct. 897, 74 L.Ed.2d 723 (1983)). The “nature of the plaintiffs injury factor is designed to implement the requirement that only antitrust injuries are redressable under section 4. An antitrust injury is an ‘injury of the type the antitrust laws were intended to prevent and that flows from that which makes defendants’ acts unlawful.’ ” Id. (quoting Brunswick Corp. v. Pueblo Bowl-O-Mat Inc., 429 U.S. 477, 489, 97 S.Ct. 690, 50 L.Ed.2d 701 (1977)); see also Abraham v. Intermountain Health Care, Inc., 461 F.3d 1249, 1267 (10th Cir.2006). An injury which is merely causally linked in some way to an alleged antitrust violation is insufficient. See id. (citing Cargill, Inc. v. Monfort, Inc., 479 U.S. 104, 109, 107 S.Ct. 484, 93 L.Ed.2d 427 (1986); Brunswick Corp., 429 U.S. at 489, 97 S.Ct. 690). Defendants argue that “[f]or antitrust standing, a plaintiff must compete in, or purchase services or otherwise participate in, the allegedly restrained market.” [Doc. 45 at 2 (citing Glen Holly Entertainment, Inc. v. Tektronix Inc., 352 F.3d 367, 372 (9th Cir.2003) (plaintiff must “be a participant in the same market as the alleged malefactors”); SAS v. Puerto Rico Tel. Co., 48 F.3d 39, 44-45 (1st Cir.1995) (explaining that the “presumptively proper plaintiff is a customer who obtains services in the threatened market”) (internal quotation marks and citation omitted); Eagle v. Star-Kist Foods, Inc., 812 F.2d 538, 540 (9th Cir.1987) (plaintiff “must be either a consumer of the alleged violator’s goods or services or a competitor of the alleged violator in the restrained market”)) ]. Although Defendants cite authority from courts outside of the Tenth Circuit in support of this proposition, the Tenth Circuit does not read Section 4 of the Clayton Act so narrowly as to grant standing only to consumers or competitors. See Reazin, 899 F.2d at 962. Rather, in Reazin v. Blue Cross & Blue Shield, the Tenth Circuit held that a plaintiff — who was not a direct competitor or consumer in the relevant market — had antitrust standing. See id. The Reazin court explained that the Supreme Court in Blue Shield v. McCready, 457 U.S. 465, 102 S.Ct. 2540, 73 L.Ed.2d 149 (1982), noted that “ ‘[Section 4 of the Clayton Act] does not confine its protection to consumers, or to purchasers, or to competitors ... ’ ” Id. (quoting McCready, 457 U.S. at 482-83, 102 S.Ct. 2540) (internal quotations omitted). Instead, the proper inquiry is whether “the injury alleged is so integral an aspect of the [anticompetitive conduct] alleged, [that] there can be no question but that the loss was precisely ‘the type of loss that the claimed violations ... would be likely to cause.’ ” Id. (quoting McCready, 457 U.S. at 479, 102 S.Ct. 2540). Thus, based upon the Tenth Circuit’s interpretation of Section 4 of the Clayton Act and the Supreme Court’s decision in McCready, the Court rejects Defendants’ argument that Plaintiffs claim is barred solely because Plaintiff is not a customer or consumer in the private health insurance market. The Court instead holds that, even though Plaintiff is not a competitor or consumer in the market for private health insurance, the injury Plaintiff alleges nonetheless satisfies the Tenth Circuit’s standard for antitrust injury. In Reazin, the Tenth Circuit held that a plaintiff-hospital had demonstrated that it had suffered antitrust injury as a result of the defendant-insurer’s decision to terminate the hospital’s contracting provider agreement with the insurer, because the hospital’s loss was so integral an aspect of the anticompetitive conduct alleged that there could be no question that the loss - was precisely the type that the anticompetitive conduct would be likely to cause. See id. at 958, 962. The Tenth Circuit held that, although the hospital was not a direct competitor or consumer in the health care financing market, the hospital was a perceived competitor of the defendant-insurer, because the hospital’s parent company was in the business of providing private health care financing (as well as healthcare and hospital management services), and because the parent owned an HMO, which was a direct competitor of the defendant-insurer in the market of health care financing. See id. at 956-57, 962-63. The Reazin court also noted that the plaintiff-hospital had standing because the hospital was the direct victim of the defendant-insurer and because there was evidence that the insurer specifically intended to harm the hospital. See id. at 963. Here, Plaintiff alleges that Defendants’ actions in the private insurance market had the anticompetitive effect of harming Plaintiff in the comprehensive oncology market and that Defendants undertook these actions to advance their position in the comprehensive oncology market. Specifically, Plaintiff alleges that PHP’s exclusive contract with United Healthcare in the private health insurance market enhances Defendants’ ability to monopolize the market for comprehensive oncology services, [Doc. 24, ¶ 282], that Defendants informed Plaintiff that they do not expect Plaintiff to retain its status as a contracting PHP healthcare provider which has caused Plaintiff harm in the comprehensive oncology market, [id. ¶ 267], that PHP used its power in the private insurance market to lower its reimbursement rates to Plaintiff under Plaintiffs most recent provider contract with PHP without any business justification apd for the purpose of eliminating Plaintiff from the comprehensive oncology market and enabling Defendants to enter that market, [id. ¶ 269], and that Presbyterian Hospital used PHP’s dominant position in the private insurance market to limit Plaintiffs ability to expand services in the comprehensive oncology market and to prevent Plaintiff from facilitating the entry of an outpatient surgery center (by refusing to enter into a provider contract with the surgery center), [id. ¶¶ 271, 274]. Admittedly, the allegations do not demonstrate that Plaintiff was a direct competitor of PHP, because PHP operates in the private insurance market and Plaintiff operates in the comprehensive oncology market. The Court, however, nonetheless concludes that, as in Reaz-in, Plaintiff was a perceived competitor of Defendant PHP, because PHP is affiliated with Defendant Presbyterian Hospital, and Presbyterian Hospital is a direct competitor of Plaintiffs in the market for comprehensive oncology services. Plaintiffs status as a perceived competitor of Defendant PHP’s by virtue of PHP’s affiliation with its parent company Presbyterian Hospital, as in Reazin, is sufficient to confer antitrust standing on Plaintiff. Moreover, the allegations in the complaint indicate that Plaintiff, like the Reazin plaintiff, was the direct victim of Defendant PHP’s actions of decreasing reimbursements to Plaintiff and entering into an exclusive arrangement with United Healthcare. See id. at 963. Thus, Plaintiffs injuries were “inextricably intertwined” with the anticompetitive conduct alleged. In addition, the complaint alleges that Defendants specifically intended to harm Plaintiffs interests in the comprehensive oncology market and anticompeti-tive intent is indicative of the presence of antitrust injury. See id. The Court is not persuaded to hold otherwise by Defendants’ citation to Abraham v. Intermountain Health Care, Inc., 461 F.3d 1249 (10th Cir.2006). To the contrary, the Court concludes that Abraham is distinguishable and that dicta in Abraham supports a finding of antitrust injury here. In Abraham, the plaintiffs, a group of optometrists, claimed that the defendant, a vertically-integrated company providing hospital, managed health care insurance, and physician services, see id. at 1253-54, attempted to monopolize the market for surgical facilities, see id. at 1266-67. The plaintiff-optometrists, however, were not competitors or customers in the surgical facilities market and were only licensed to provide non-surgical eye care services. See id. at 1253. The defendant argued that the plaintiffs lacked standing to assert their attempted monopolization claim because there was no connection between the defendant’s dominance in the surgical facilities market and the plaintiffs’ alleged injury in the non-surgical eye care market. See id. at 1267. The plaintiff-optometrists, however, alleged (1) that the defendant leveraged its greater power in the managed care market to increase its power in the surgical facilities market, (2) that because health care providers, including ophthalmologists (who did compete against plaintiffs in the market for nonsurgical eye care), wanted to be included on the defendant’s provider panels, those providers were willing to agree to send as many patients as possible to the defendant’s surgical facilities in exchange for provider paneling, and (3) that this, in turn, had the effect of increasing the defendant’s presence in the surgical facilities market. See id. The Tenth Circuit held that the plaintiff-optometrists lacked standing because they made “no attempt to delineate any injury they ha[d] suffered or w[ould] suffer that [wa]s associated with [the defendant’s] dominance in the surgical facilities market, let alone explain how that injury is ‘of the type the antitrust laws were designed to prevent and that flows from that which makes defendants’ acts unlawful.’ ” Id. (quoting Associated Gen. Contractors, Inc. v. Carpenters, 459 U.S. 519, 535 n. 31, 103 S.Ct. 897, 74 L.Ed.2d 723 (1983)). The Tenth Circuit emphasized that “the Plaintiffs completely fail[ed] to discuss how [the defendant’s] purported plan to monopolize the surgical facilities market b[ore] any relation to the practice of optometry or any other interest the Plaintiffs could possibly allege was invaded as a result of that plan. Rather, the Plaintiffs’ argument on this point simply assume[d] the existence of standing, [which wa]s insufficient to meet the Plaintiffs’ burden.” Id. at 1267-68. Defendants contend that Abraham compels a finding here that Plaintiffs do not have standing to maintain their Section 2 claims. Abraham, however, is distinguishable, because in Abraham the plaintiffs did not provide any connection between the defendant’s dominance in the surgical facilities market and the plaintiffs’ injury in the non-surgical eye care market. Plaintiff here has alleged facts sufficient to establish such a connection. See supra at 1202-03. Thus, the Court rejects Defendants’ argument that Abraham supports their claim that Plaintiff lacks standing to maintain its monopolization claim. Instead, the Court concludes that Abraham supports — and does not negate — the Court’s conclusion that Plaintiff has standing to assert a Section 2 monopolization claim. In Abraham, Tenth Circuit noted that “[s]ignificantly, the Plaintiffs do not allege that part of the monopolization attempt involved the quid pro quo discussed in [relation to the Plaintiffs’ Sherman Act Section 1 claim].” Abraham, 461 F.3d at 1267 n. 12 (first emphasis added). It is this dicta which suggests that had the plaintiffs in Abraham alleged a quid pro quo agreement between the defendant and the ophthalmologists (pursuant to which the defendant used its dominance in the surgical facilities market to conspire with ophthalmologists to harm the plaintiffs in a separate market for non-surgical eye care) the plaintiffs would have had standing and which supports the Court’s finding of antitrust injury here. In support of their Section 1 claim, the Abraham “plaintiffs alleged that [the defendant] at the behest of several of its panel ophthalmologists ... unlawfully excluded optometrists from its provider panels” in exchange for the ophthalmologists agreeing to refer patients to the defendant’s hospital and surgical facilities, “and that this exclusion injured both competition, generally, and the Plaintiffs, specifically.” Id. at 1256. The plaintiffs maintained that “both [the defendant] and the panel ophthalmologists would benefit [from this agreement]: [the defendant] would profit by increasing the utilization of (and, accordingly, payment for) its [hospital and surgical] facilities, and the ophthalmologists would profit by preventing lower-cost optometrists from competing with them for [non-surgical eye care].” Id. at 1260. The Abraham court held that the plaintiffs presented insufficient evidence of an agreement between the defendant and the ophthalmologists and that they therefore could not survive summary judgment. See id. at 1259. The court explained: At first blush, it might appear as though [the defendant] and its panel ophthalmologists acted in concert to exclude optometrists from [the defendant’s] provider panels — thereby establishing that element of a § 1 claim. Indeed, it is clear that [the defendant] excluded optometrists because of the actions of its panel ophthalmologists. But simply because [the defendant] acted in response to ophthalmologists’ complaints is not enough to establish the concerted action requirement. To the contrary, it is well-established in antitrust cases that a manufacturer’s exclusion of a buyer-distributor in response to another buyer-distributor’s complaints is insufficient as a matter of law to establish conspiracy, see Monsanto [Co. v. Spray-Rite Serv. Corp.], 465 U.S. [752] at 763, 104 S.Ct. 1464 [79 L.Ed.2d 775 (1984) ]; accordingly, that [the defendant] chose not to panel optometrists because its ophthalmologists lobbied [the defendant] for that decision does not indicate that [the defendant] and the ophthalmologists acted in concert within the meaning of § 1. Id. The Tenth Circuit explained that the plaintiffs were required to “present evidence that tends to exclude the possibility that [the defendant] was acting independently and not pursuant to an agreement with the ophthalmologists” and held that the plaintiffs had failed to satisfy this summary judgment burden. Id. The Tenth Circuit’s acknowledgement that it was “[s]ignificant[ ]” that the plaintiffs did “not allege that part of the monopolization attempt involved the quid pro quo discussed in [relation to the Plaintiffs’ Sherman Act Section 1 claim],” id. at 1267 n. 12, suggests that an allegation that the plaintiffs sustained their injuries in the non-surgical eye care market as a result of the quid pro quo conspiracy between the defendant and the ophthalmologists would have been sufficient to confer antitrust standing upon the plaintiffs. This is because a quid pro quo agreement would have provided the missing connection between the plaintiffs’ injuries in the nonsurgical eye care market and the defendant’s dominance in the surgical facilities market. The Court construes the Tenth Circuit’s dicta in Abraham as providing a basis for a plaintiff who is not a competitor or customer in the market dominated by the defendant to sustain a Section 2 claim against a defendant for injuries sustained in the plaintiffs market. Defendants here are, like the defendant in Abraham, a vertically integrated company. Likewise, Plaintiff here has sustained injuries, like the plaintiffs in Abraham, in a market different from the market dominated by Defendants. Plaintiff here, however, unlike the plaintiffs in Abraham, has alleged facts sufficient to provide a connection between Defendants’ dominance in the private health insurance market and Plaintiffs injury in the market for comprehensive oncology services. See supra at 1202-03. The Court therefore concludes that Plaintiff has alleged facts that are sufficient to state a Section 2 claim for injuries in a market different from the distorted market and that Plaintiff has standing to maintain this claim even though it is not a competitor or á customer in the private health insurance market. The Court also concludes that the complaint contains allegations — which if construed in Plaintiffs favor — are sufficient to confer antitrust standing on a different ground — namely, by virtue of Plaintiffs status as a seller of services to Defendant PHP. The complaint contends that Defendant PHP lowered reimbursement rates to Plaintiff. Defendants properly characterize this as a monopsony claim. [Doc. 33 at 11 (explaining that “monopsonization ... is the relevant term here because [PHP] is purchasing services from, and not selling services to, [Plaintiff]”) ]. Allegations that PHP used its market power in the private health insurance market to lower the price it was willing to pay to buy services from Plaintiff is sufficient to confer antitrust injury. Just as consumers can be injured by a monopolist-seller’s practices, so too can a seller suffer antitrust injury by a monop-sonist-buyer’s power in a particular market. See Telecor Comm., Inc. v. S.W. Bell Tel. Co., 305 F.3d 1124, 1134 (10th Cir.2002) (acknowledging that antitrust injury-in a monopsony claim can be based upon injury to a seller), cert. denied, 538 U.S. 1031, 123 S.Ct. 2073, 155 L.Ed.2d 1060 (2003); Dyer v. Conoco, Inc., No. 93-2801, 1995 WL 103233 (5th Cir. Feb. 21, 1995) (explaining that Fifth Circuit “cases have recognized that sellers to a monopsony or oligopsony can establish antitrust injury” because “ ‘the seller faces a Hobson’s choice: he can sell into the rigged market and take the depressed price, or he can refuse to sell at all’ ”) (citing and quoting In re Beef Indus. Antitrust Litig., 600 F.2d 1148 (5th Cir.1979)); Phillip E. Areeda & Herbert Hovenkamp, et. ah, Antitrust Law ¶ 350b (2007) (“Notwithstanding numerous statements to the effect that the primary or even exclusive concern of antitrust is ‘consumer’ welfare, upstream, or monopsony, injury to suppliers is treated in largely the same way as injury to consumers.”). B. Plaintiff has Stated a Claim for Monopolization (or Monopsonization) (Counts I and III). Plaintiff alleges that Defendants have willfully maintained a monopoly and/or monopsony in the market for private health insurance services in violation of Section 2 of the Sherman Act and the New Mexico Antitrust Act. [Doc. 24, ¶¶ 471-76]. To bring a monopolization or monopsonization claim, Plaintiff must allege both (1) the possession of monopoly or monopsony power and (2) the maintenance of that power through exclusionary conduct. See Eastman Kodak Co. v. Image Tech. Servs., Inc., 504 U.S. 451, 481, 112 S.Ct. 2072, 119 L.Ed.2d 265 (1992); U.S. v. Grinnell Corp., 384 U.S. 563, 570-71, 86 S.Ct. 1698, 16 L.Ed.2d 778 (1966); SolidFX, LLC v. Jeppesen Sanderson, Inc., 935 F.Supp.2d 1069 (D.Colo.2013). Defendants ask the Court to dismiss Plaintiffs monopolization claims on the ground that Plaintiff has not stated a plausible federal or state law monopoly claim with respect to either of these elements. 1. Plaintiff has Alleged Facts that Establish Possession of Monopoly Power. Defendants argue that Plaintiff has failed to allege facts indicating that Defendant PHP has monopoly power in the private health insurance market, because Plaintiff alleges that PHP has a 46% share of the market and anything less than “ ‘[f]ifty percent is below any accepted benchmark for inferring monopoly power from market share.’ ” [Doc. 33 at 10 (citations omitted)]. Defendants also reject Plaintiffs argument that Defendants have leveraged their alleged monopoly power in the hospital inpatient services market to monopolize the private health insurance market, because Defendants contend that Plaintiff has alleged only that Presbyterian Hospital has a market share of “42% of the total staffed] hospital beds in Albuquerque,” [Doc. 24, ¶ 57], and that this market share precludes a claim of monopoly power, [Doc. 45 at 3-4]. In support of these contentions, Defendants cite the Tenth Circuit case Colorado Interstate Gas Co. v. Natural Gas Pipeline Co. of America, 885 F.2d 683 (10th Cir.1989), cert. denied, 498 U.S. 972, 111 S.Ct. 441, 112 L.Ed.2d 424 (1990), in which the Tenth Circuit stated that “courts generally require a minimum share of between 70% and 80%” to plead a claim of monopoly power. Id. at 694 n. 18, cited in Doc. 45 at 4. Defendants further reject Plaintiffs attempt to “cobble together a market share [in the private health insurance market] ...- in excess of 50% by adding the market shares of two unrelated entities” — namely, Cigna and United Healthcare insurance companies — to PHP’s share. [Doc. 33 at 10-11 (citing City of Moundridge v. Exxon Mobil Corp., 471 F.Supp.2d 20, 42 (D.D.C.2007) (affirming dismissal of monopolization claim and noting that “to sustain a charge of monopolization ... a plaintiff must allege the necessary market domination of a particular defendant”)) ]. Similarly, Defendants contend that Plaintiff cannot raise Presbyterian Hospital’s alleged 42% market share in the hospital inpatient services market by alleging “on information and belief’ that Presbyterian Hospital was responsible for or controlled “approximately 50%” of patients with private health insurance and something “more than 50%” of patients with Medicare. [Doc. 24 ¶ 59]. Even if Plaintiff could raise the market shares in these alleged markets to 50%, however, Defendants cite case law from the Eleventh Circuit explaining that the court “h[as] discovered no cases in which a court found the existence of actual monopoly established by a bare majority share of the market.” U.S. Anchor Mfg., Inc. v. Rule Indus., Inc., 7 F.3d 986, 1000 (11th Cir.1993), cert. denied, 512 U.S. 1221, 114 S.Ct. 2710, 129 L.Ed.2d 837 (1994), cited in Doc. 45 at 4; see also Nobody in Particular Presents, Inc. v. Clear Channel Communications, Inc., 311 F.Supp.2d 1048, 1098 (D.Colo.2004) (rejecting monopolization claim where defendant was alleged to have a 50.48% share of the relevant market), cited in Doc. 33 at 10. Plaintiff rejects Defendants’ arguments and instead contends that a firm’s market share is only one factor relevant to determining whether a firm has monopoly power, [Doc. 40 at 19 (citing Reazin v. Blue Cross & Blue Shield, Inc., 899 F.2d 951, 963 (10th Cir.1990) (additional citations omitted)) ], and that a moderate market share does not preclude the presence of monopoly power, [id. at 20 (citing Cost Mgmt. Servs., Inc. v. Washington Natural Gas Co., 99 F.3d 937, 951 (9th Cir.1996)) ]. The Court agrees. The Tenth Circuit specifically addressed the question of the relevance of market share to determining monopoly power in Reazin v. Blue Cross & Blue Shield, Inc., 899 F.2d at 963. In Reazin, the jury found that the defendant insurance company possessed both market power and monopoly power in the relevant market, and the district court refused to disturb those findings because it concluded that the plaintiffs had presented sufficient evidence that the insurance company had both power over competition and power over price, the two factors relevant to determining monopoly or market power. See id. at 968. The evidence before the jury indicated that the estimates of the insurance company’s market share varied, that one internal memorandum prepared by an insurance company employee estimated that “ ’60% of all medically insured Kansans are insured with [the defendant insurer],’ ” id. at 969 (citing memorandum), that one of the plaintiffs’ experts testified that, based on his own' calculations, the insurance company’s percentage of all medically insured Kansans, including self-insureds, was, “ ‘conservatively],’ forty-seven percent,” id. (citing record), and that another of plaintiffs’ experts testified that the insurance company received sixty-two percent of the insurance premiums in its service area compared to less than five percent for its next largest rival, id. On appeal, the insurance company argued, among other things, that this market share was insufficient as a matter of law to permit the inference of market power. See id. The Tenth Circuit rejected the insurance company’s argument that a market share of 45 or 47 percent “prohibits, as a matter of law, a conclusion of market or monopoly power.” Id. at 970. The Tenth Circuit held that, while relevant, “ ‘market share alone is insufficient to establish market power.’ ” Id. at 967 (quoting Bright v. Moss Ambulance Serv., Inc., 824 F.2d 819, 824 (10th Cir.1987) (citing Colo. Interstate Gas Co. v. Natural Gas Pipeline Co., 885 F.2d 683, 695 (10th Cir.1989); Shoppin’ Bag of Pueblo, Inc. v. Dillon Cos., 783 F.2d 159, 162 (10th Cir.1986)) (additional citation omitted)). The Tenth Circuit noted that market share “may or may not reflect actual power to control price or exclude competition,” id. (citing Ball Mem. Hosp., Inc. v. Mutual Hosp. Ins., Inc., 784 F.2d 1325, 1335 (7th Cir.1986)), and explained that “[c]ourts have not completely agreed on whether a particular market share should be given conclusive or merely presumptive effect in determining market or monopoly power, or whether market share is only a starting point in the inquiry into market or monopoly power,” id. The Tenth Circuit then acknowledged that it opined in “dicta” in Colorado Interstate Gas Co. v. Natural Gas Pipeline of America, 885 F.2d at 694 n. 18 — a case Defendants cite in support of their contention that a minimum market share of between 70 to 80 percent is required to establish monopoly power — that “[w]hile the Supreme Court has refused to specify a minimum market share necessary to indicate a defendant has monopoly power, lower courts generally require a minimum market share of between 70% and 80%.” Id. (quoting Colo. Interstate Gas Co., 885 F.2d at 694 n. 18). The Tenth Circuit in Reazin ultimately held, however, that “[the Circuit does] not view Colorado Interstate Gas as establishing a firm market share percentage required before a finding of monopoly power can ever be sustained” and that “[it] prefer[s] the view that market share percentages may give rise to presumptions, but will rarely conclusively establish or eliminate market or monopoly power.” Id. at 967-68. The Tenth Circuit therefore held that “[the insurance company’s] market share [was] such that there could be at most a presumption of a lack of monopoly or market power.” Id. at 969-70. In so holding, the Tenth Circuit reasoned that, regardless of whether the defendant’s market share was 62 percent or 47 percent, the insurance company was “by far the largest private source of health care financing in its service area.” Id. at 969. The Tenth Circuit explained, “By virtue of its size, [the insurance company] has economic leverage over hospitals. As [the insurance company’s] president ... conceded, [the company’s] membership base gives [it] ‘clout’ over hospitals.” Id. biting record). Thus, the Tenth Circuit concluded that even if the insurance company had only a market share of 46 percent, this lower percentage alone would not alter the insurance company’s relative dominance in the market. See id. at 949 & n. 27. Having rejected the insurance company’s contention that a market share of 45 or 47 percent precluded a finding of monopoly power as a matter of law, the Tenth Circuit in Reazin next turned to other characteristics of the private health care financing market at issue and to more specific evidence of the insurance company’s power over price and competition to determine whether sufficient evidence supported the jury’s finding of monopoly and market power. See id. at 968. The Reaz-in court held that other factors relevant to this inquiry “include the number and strength of the defendant’s competitors, the difficulty or ease of entry into the market by new competitors, consumer sensitivity to change in prices, innovations or developments in the market, whether the defendant is a multimarket firm, as well as other evidence presented ... that [a court] may deem persuasive regarding [a] defendant’s market strength.” Id. The Tenth Circuit’s holding in Reazin is directly applicable here. Although Defendants urge the Court to dismiss Pláintiff s monopolization claim solely on the ground that Plaintiffs allegations of market share are insufficient to state a claim, the Reazin court specifically rejected the application of a minimum threshold market share to sustain a Section 2 claim and instead held that market share percentages may give rise to presumptions, but that they will rarely conclusively establish or eliminate market or monopoly power. See id. at 967-68. Thus, the Court declines to dismiss Plaintiffs monopolization claims solely on the ground that Plaintiff has alleged an insufficient market share. At best, allegations of a 42 percent, 46 percent, or in excess of 50 percent market share, [Doc. 33 at 10; Doc 24, ¶ 57; Doc. 45 at 10-11; Doc. 24 ¶ 59], give rise to a presumption that Defendants lack monopoly power. Cf. Reazin, 899 F.2d at 967-68. Consistent with the Tenth Circuit’s analysis in Reazin, the Court next must determine whether other characteristics of the private health insurance market are sufficient to state a plausible claim that Defendants had monopoly power. See id. at 968. With respect to the first factor identified by the Reazin court, the number and strength of competitors, Plaintiff has alleged that the private insurance market is concentrated and includes only PHP, Lovelace, Blue Cross, United Healthcare, and Cigna. Plaintiff further has alleged that PHP has a 46 percent market share, that Lovelace- — PHP’s most significant competitor — has a 27 percent market share, and that United Healthcare and Cigna each have less than a ten percent market share. Plaintiff also has alleged that Defendants have tied up additional health* insurers — ie., United Healthcare and Cigna — with exclusive dealing arrangements in order to prevent their working with rivals and potential entrants, thus causing further concentration of the private health insurance market. [Doc. 40 at 21]. In addition, Plaintiff has alleged that Blue Cross is planning to exit the market for private health insurance. These allegations demonstrate that Defendant PHP effectively has only one competitor, Lovelace, whose market share is, construing the allegations in the complaint in Plaintiffs favor, significantly less than PHP’s (or PHP/United’s) market share. This factor, therefore, weighs in favor of finding possession of monopoly power. With respect to the second factor, the difficulty or ease of entry into the market by new competitors, the Tenth Circuit has explained that “[e]ntry barriers are particular characteristics of a market which impede entry by new firms into that market. Entry barriers may include high capital costs or regulatory or legal requirements such as patents or licenses.” Reazin, 899 F.2d at 968 (citations omitted). Also relevant could be entrenched buyers’ preferences. See Areeda & Turner, Antitrust Law, ¶ 409 (1978), cited in Reazin, 899 F.2d at 968. “Substantial market power can persist only if there are significant and continuing barriers to entry.” Id., ¶ 505, cited in Reazin, 899 F.2d at 968; accord Cargill, Inc. v. Monfort, Inc., 479 U.S. 104, 119-20 n. 15, 107 S.Ct. 484, 93 L.Ed.2d 427 (1986). Plaintiff has alleged that significant barriers to entry exist in the private health 'insurance market and that entering this market even under normal conditions requires significant capital, expertise, and time. [Doc. 24, ¶ 473]. Plaintiff also has alleged that Blue Cross does not have enough enrollees to independently facilitate entry, that firms that currently exist have not been able to challenge Defendants’ market position for many years (particularly given Defendants’ alleged monopoly power of hospital inpatient services), that no meaningful entry has occurred in decades, [id. ¶¶ 128, 131,137-43], that entry by new firms has failed because Defendants have closed significant market segments to these entrants, [id. ¶¶ 131-36], and that Defendants have maintained their dominant position over many years and have expanded their market position with the acquisition of hundreds of physician practices, [id. ¶¶ 193-206]. Because Plaintiff has alleged that significant barriers to entry exist, this factor weighs in favor of a finding of monopoly power. With respect to the fourth factor, whether the defendant is a multimarket firm, the complaint alleges that Defendants are part of a multimarket enterprise that competes in, at a minimum, the hospital inpatient services market, the private health insurance market, and the comprehensive oncology market. Moreover, Plaintiff has alleged that because Defendants are part of a multimarket firm, they can use their power in one market to impede entry in another market. Plaintiff alleges, for example, that Blue Cross cannot act as a substitute for, or challenge the market position of, Defendant PHP because Blue Cross enrollees cannot receive covered treatment at Presbyterian Hospital and because Presbyterian’s monopoly power over hospital inpatient services ensures that patients seeking treatment at Presbyterian will not purchase Blue Cross’s products. Because Defendants are part of a multimarket firm and Plaintiff has alleged that they have used their dominance in one market to impede entry in another, this factor weighs in favor of a finding of monopoly power. Plaintiff has alleged facts from which the Court has concluded that three of the four factors identified in Reazin weigh in favor of a finding that Defendants possessed monopoly power over the market for private health insurance. From these allegations, as well as Plaintiffs allegations that Defendant possessed a market share of up to in excess of 50 percent, the Court concludes that Plaintiff has satisfied its burden of alleging facts that, if true, could establish the possession of monopoly power. The Court therefore denies the Motion to Dismiss to the extent Defendants seek dismissal on the ground that Plaintiff has failed to allege facts sufficient to establish that Defendants possessed monopoly power in the relevant market. 2. Plaintiff has Alleged Facts that Establish Maintenance of Monopoly Power. Defendants also argue that Plaintiff has failed to allege that Defendants engaged in the illegal maintenance of PHP’s claimed monopoly power in the private health insurance market. The second element of the offense of monopolization is the “willful acquisition or maintenance of [monopoly] power as distinguished from growth or development as a consequence of a superior product, business acumen, or historic accident.” U.S. v. Grinnell Corp., 384 U.S. 563, 570-71, 86 S.Ct. 1698, 16 L.Ed.2d 778 (1966). Stated differently, it “is the use of monopoly power ‘to foreclose competition, to gain a competitive advantage, or to destroy a competitor.’ ” Eastman Kodak, 504 U.S. at 482-83, 112 S.Ct. 2072; accord SolidFX, LLC v. Jeppesen Sanderson, Inc., 935 F.Supp.2d 1069 (D.Colo.2013). This is generally referred to as anti-competitive or predatory behavior. “ ‘Anticompetitive conduct’ can come in too many different forms, and is too dependent upon context, for any court or commentator ever to have enumerated all the varieties.” Id. (citing Caribbean Broad. Sys., Ltd. v. Cable & Wireless PLC, 148 F.3d 1080, 1087 (D.C.Cir.1998)). Monopolistic acts include exclusionary practices like refusals to deal and predatory pricing. See Flying J Inc. v. TA Operat ing Corp., No. 1:06-CV-30-TC, 2008 WL 4923041, at *9 (D.Utah Nov. 14, 2008). Plaintiff does not identify any specific allegations of conduct that Defendants engaged in to maintain a monopoly in the private health insurance market. Rather, Plaintiff generally argues that the anti-competitive actions Plaintiff alleges that Presbyterian Hospital committed are attributable to PHP because Presbyterian Hospital is the ultimate parent of PHP. [Doc. 40 at 21-22 (citing Copperweld Corp. v. Independence Tube Corp., 467 U.S. 752, 104 S.Ct. 2731, 81 L.Ed.2d 628 (1984) (a parent and subsidiary are treated as a single entity under the antitrust laws)) ]. Because Plaintiff does not specifically identify Defendants’ alleged anticompeti-tive conduct, it has left to Defendants— and the Court — the task of discerning the alleged anticompetitive conduct that forms the basis of Plaintiffs federal and state monopoly claims. On a motion to dismiss, a court must accept as true all well-pleaded factual allegations in the complaint, view those allegations in the light most favorable to the plaintiff, and draw all reasonable inferences in the plaintiffs favor. See Tellabs, Inc. v. Makor Issues & Rights, Ltd., 551 U.S. 308, 322, 127 S.Ct. 2499, 168 L.Ed.2d 179 (2007); Smith v. U.S., 561 F.3d 1090, 1098 (10th Cir.2009) (citation omitted). The 86-page complaint contains 525 numbered paragraphs setting forth the basis of Plaintiffs claims and does not specifically identify which factual allegations constitute predatory conduct to maintain a monopoly in the private health insurance market. While the Court is obligated to construe the allegations in the complaint and draw all reasonable inferences from those allegations in the light most favorable to Plaintiff, Plaintiff also is required to support its legal positions with authority. See D.N.M.LR-Civ. 7.3(a). This duty requires Plaintiff to identify its opposing arguments with sufficient specificity to determine the applicable supporting authority. Plaintiff has not fulfilled this duty. Defendants construe the complaint as alleging only one act of anticompetitive conduct in the private health insurance market: that Defendants lowered reimbursement rates in the most recent provider contract. [Doc. 33 at 11], The Court, however, consistent with its obligation to construe the complaint in the light most favorable to Plaintiff, reads the complaint as alleging a second set of acts of anticompetitive conduct: that Defendant PHP entered into an exclusive arrangement with United Healthcare, that United will not take market actions without PHP’s approval, and that this arrangement has caused significant concentration of the market for private health insurance. [Doc. 24 ¶¶ 276, 277]. Because Plaintiff presents no argument or cites no authority in support of any other specific alleged action constituting anticompetitive conduct in the private health insurance market, see D.N.M.LR-Civ. 7.3(a) & 7.1(b), the Court considers whether only the aforementioned sets of acts constitute predatory conduct sufficient to withstand the Motion to Dismiss Plaintiffs monopoly claims. a. Lower Reimbursement Rates. Defendants . contend that PHP’s offer to pay less for services is not an act of monopolization, or, more accurately, its inverse, monopsonization (because PHP is purchasing services from, and not selling services to, Plaintiff). [Doc. 33 at 11]. “Monopsony, also known as a buyer’s monopoly, is a form of monopoly power in which the monopolist is a buyer who controls the price, volume, and/or can make other anticompetitive demands on a seller.” White Mule Co. v. ATC Leasing Co., 540 F.Supp.2d 869 (N.D.Ohio 2008). “Monopsony power involves the ability of buyers to lower input prices below competitive levels, which requires the ability to restrict the quantity demanded of the input.” Roger D. Blair & Jeffrey L. Harrison, Antitrust Policy & Monopsony, 76 Cornell L.Rev. 297 (1991). With either a monopolist or monopsonist, “the quantity that would be exchanged is less than the quantity exchanged under competitive conditions, and the result is allocatively inefficient.” Id. “Ironically, the reduced input prices the monopsonist enjoys do not lead to reduced output prices. In fact, when the monopsonist [in the input market] also has market power in its output market, the reduced input prices cause higher output prices.” Id.; see also Telecor Communications, Inc. v. S.W. Bell Tel. Co., 305 F.3d 1124, 1136 (10th Cir.2002) (explaining that monopsony still affects consumers because “there is a dead-weight loss associated with imposition of monopsony pricing restraints,” and “[s]ome producers will either produce less or cease production altogether, resulting in less-than-optimal output of the product or service, and over the long run higher consumer prices, reduced product quality, or substitution of less efficient alternative products”), cert. denied, 538 U.S. 1031, 123 S.Ct. 2073, 155 L.Ed.2d 1060 (2003); accord White Mule Co., 540 F.Supp.2d at 888 n. 11. “Monopsony power [therefore] leads a profit-maximizing firm to restrict the quantity employed of an input, thereby reducing social welfare.” Id. at 306-07. Defendants argue that “ ‘[a] firm that has substantial power on the buy side of the market ... is generally free to bargain aggressively when negotiating the prices it will pay for goods and services.’ ” [Doc. 33 at 11 (citing W. Penn Allegheny Health Sys.) Inc. v. UPMC, 627 F.3d 85, 103 (3d Cir.2010) (noting plaintiff “would have little basis for challenging the reimbursement rates” of defendant private insurer) (additional citations omitted)) ]. Courts are in agreement that simply possessing monopoly or monopsony power and charging or bidding at monopoly or monopsony prices does not violate Section 2 of the Sherman Act. See Pac. Bell Tel. Co. v. Linkline Communications, Inc., 555 U.S. 438, 447-48, 129 S.Ct. 1109, 172 L.Ed.2d 836 (2009); see Verizon Communications, Inc. v. Law Offices of Curtis V. Trinko, LLP, 540 U.S. 398, 407, 124 S.Ct. 872, 157 L.Ed.2d 823 (2004); White Mule Co., 540 F.Supp.2d at 888. “As a general rule, businesses are free to choose the parties with whom they will deal, as well as the prices, terms, and conditions of that dealing.” U.S. v. Colgate & Co., 250 U.S. 300, 307, 39 S.Ct. 465, 63 L.Ed. 992 (1919); accord Linkline Communications, 555 U.S. at 448, 129 S.Ct. 1109 (citing Colgate & Co., 250 U.S. at 307, 39 S.Ct. 465). Likewise, in general, a purchaser or seller may unilaterally refuse to deal with another. See Susan Foster, Monopsony and Backward Integration: Section 2 Violations in the Buyer’s Market, 11 U. Puget Sound L.Rev. 687, 715 (1988) (hereinafter “Foster”). Thus, based upon this principle, “courts will not interfere with a buyer’s price decisions absent anticompetitive conduct even if the monopsonist in the input market (the buy side of the market) has monopoly power in the output market (the sell side of the market). See Kartell v. Blue Shield, Inc., 749 F.2d 922, 929 (1st Cir.1984) (explaining that “even if the buyer has monopoly power, an antitrust court (which might, in appropriate circumstances, restructure the market) will not interfere with a buyer’s (nonpredatory) determination of price”) (emphasis added), cert. denied, 471 U.S. 1029, 105 S.Ct. 2040, 85 L.Ed.2d 322 (1985). Indeed, “A legitimate buyer is entitled to use its market power to keep prices down.” Id.; see Royal Drug Co., Inc. v. Group Life & Health Ins. Co., 737 F.2d 1433, 1438 (5th Cir.1984) (explaining that where an insurer and a pharmacy provider “sit on opposite sides of the bargaining table,” “[a]bsent any evidence of the presence and abuse of monopoly power, [the insurer] has the clear right to bargain for the lowest price and best deal for itself and its customers/insureds.”), cert. denied, 469 U.S. 1160, 105 S.Ct. 912, 83 L.Ed.2d 925 (1985). In the event, however, that the monposonist maintains its market power on the buy side of the market through anticompetitive or predatory conduct, the monopsonist is equally as culpable as the monopolist in violating Section 2. See Campfield v. State Farm, Mut. Auto. Ins. Co., 532 F.3d 1111, 1118 (10th Cir.2008) (“Monopsonistic practices by buyers are included within the practices prohibited by the Sherman Act.”) (citing Telecor Communications, Inc., 305 F.3d at 1134). “The ultimate question in such a claim is whether the monopolist’s (or monopsonist’s) activity has an anticompetitive effect. Claims involving abuse of existing monop-sony power may be based on a variety of activities including price fixing, refusals to deal[] and vertical integration.” Foster, supra, at 700. Plaintiff has alleged that Defendants have a monopoly in the private health insurance market and that they have vertically integrated backwards into the comprehensive oncology services market, which is the market in which Plaintiff sells its services and in which Defendant Presbyterian Hospital is Plaintiffs competitor. The complaint, construed in the light most favorable to Plaintiff, also alleges that Defendants have set a predatory price, that Defendants explicitly and implicitly refused to deal with Plaintiff, that Defendants engaged in these acts for the anti-competitive purpose of harming Plaintiff and advancing themselves in the secondary comprehensive oncology market, and that the Defendants’ conduct has anticompeti-tive effects. The Court considers whether these allegations are sufficient to satisfy the second element of a monopolization claim. i. Refusal to Deal. “[I]f a monopsonist or a monopolist acts with the purpose of excluding competitors,” its express or implied “refusal to deal may result in a violation of Section 2.” Foster, supra at 716; see also Aspen Skiing Co. v. Aspen Highlands Skiing Cor