Full opinion text
ORDER GEORGE ROSS ANDERSON, Jr., District Judge. This matter comes before the Court on defendants’ motion for summary judgment on all Counts. The underlying lawsuit raises antitrust and other challenges to a July 1985 contract between Cherokee Memorial Hospital (“CMH”) and Dr. Mijanovich (the “Mijanovich Contract”) whereby Dr. Mijanovich became the exclusive pathology provider at CMH. The inception of the Mijanovich Contract brought to an end the plaintiffs’ longstanding position as the sole pathology providers at CMH. Plaintiffs contend that in entering into and in implementing the Mijanovich Contract defendants have: engaged in a combination and conspiracy to unreasonably restrain trade, an illegal tying arrangement and an illegal boycott in violation of Section 1 of the Sherman Antitrust Act, 15 U.S.C. § 1, (Counts I, IIA, IIB and III); monopolized and/or attempted to or combined or conspired to monopolize trade in violation of Section 2 of the Sherman Antitrust Act, 15 U.S.C. § 2, (Count IV); unlawfully deprived plaintiffs of their right to practice medicine in violation of 42 U.S.C. § 1983 (Count V); committed tortious interference with contract and tortious interference with prospective economic advantage (Count VI); violated the antitrust laws of the State of South Carolina, S.C.Code Ann. §§ 39-3-10; 39-3-130; 39-3-140, (Count VII); engaged in unfair methods of competition and unfair or deceptive acts or trade practices in violation of S.C.Code Ann. § 39-5-20 and the Federal Trade Commission Act, 15 U.S.C. § 45, (Count VIII); and committed breach of contract (Counts IX and X). Following the close of discovery, and after receiving substantial briefs and hearing oral argument from counsel for both parties, the Court has, for the reasons which follow, decided to grant defendants’ Motion for Summary Judgment. I. FINDINGS OF FACT 1. Plaintiffs, Rudolph R. Steuer, Jr., M.D. (“Dr. Steuer”) and Harry S. Latham, M.D. (“Dr. Latham”), are physicians engaged in the practice of pathology through a professional association called Drs. Steuer and Latham, P.A. (the “PA”) (collectively referred to as “plaintiffs”). Amended Complaint 115. 2. National Medical Enterprises, Inc. (“NME”) is a national health care corporation engaged in the hospital business through its subsidiary, N.M.E. Hospitals, Inc. (“NME Hospitals”) (collectively referred to as “defendants”). 3. CMH is a 162 bed acute care hospital located in Gaffney, South Carolina. Tidikis Dep. Tr. at 47. 4. The Hospital building and grounds are owned by Cherokee County (“County”), a political subdivision of the State of South Carolina. 5. On January 3, 1984 the County and defendants entered into a General Agreement (“General Agreement”), (H-443 thru -459), whereby defendants agreed, inter alia, to construct and operate a new hospital in Gaffney to replace CMH, to lease, manage and operate CMH until such time as the new hospital was constructed, and to purchase the working capital, assets and personal properties used in connection with operating CMH. 6. Paragraph 7 of the General Agreement provided, inter alia, for the establishment of a Local Governing Board to be appointed by defendants, and for defendants to “regularly consult such board for advice with respect to any of the various policy issues and matters which both affect the community, and concern the operation of [CMH] and the new hospital and the services to be rendered by [defendants] thereunder____ However, [defendants] will have final authority and responsibility for all decisions relating to the management and operation of CMH and the new hospital.” 7. After the General Agreement was executed, defendants assumed from the County full operational and managerial responsibility for CMH. Moran Dep. Tr. at 50; Medley Dep. Tr. at 53; D. Queen Dep. Tr. at 27-28. 8. CMH was a declining hospital prior to defendants obtaining control thereof, and defendants took “constructive action” after obtaining control of CMH. Latham Dep. Tr. at 186-187. 9. On February 3,1984, the County and the defendants entered into a Lease Agreement (“Lease Agreement”) (H-460 thru -490) to effectuate the General Agreement. 10. Section 3.1 of the Lease Agreement provides: LESSEE [defendants] acknowledges that, in addition to employees and contract physicians, the Hospital is served by a medical staff. LESSEE agrees to accept, on Commencement Date, all members of the medical staff in good standing on that date with the same privileges at Hospital, and to continue such privileges until their normal expiration date, provided they remain in good professional standing in accordance with medical staff rules, regulations and bylaws. It is the intent of the parties that the Hospital will have an open staff except for those departments traditionally served by contract physicians. 11. Section 8.1 of jche Lease Agreement provides, in pertinent part: LESSEE agrees to offer continued employment, at no reduction in salary or benefits, to all Hospital employees who are and remain in good standing and who desire to continue their employment with LESSEE. 12. Exhibit “B” to the Lease Agreement set out a “Schedule of Material Contracts to which [the County], or Hospital is a party or by which any of them is bound or will be bound as of the Commencement Date [of the Lease Agreement] and which affect or relate to the Leased Properties or the operation of the Hospital to the best of both parties’ knowledge.” Section 7.1 of Lease Agreement. [H-471, H-518 thru -520.] This schedule of Material Contracts lists, inter alia, “A pathology agreement with Harry S. Latham, M.D., dated July 1, 1983, terminating on a month to month basis.” Item No. 15. [H-518 thru -520.] 13. Prior to defendants’ assuming control of CMH, the County viewed plaintiffs as having contracted with the Hospital, not the County. D. Queen Dep. Tr. at 26. 14. Prior to February 1984 CMH had been operated under the auspices of the County. Moran Dep. Tr. at 48; Medley Dep. Tr. at 7-10; Tidikis Dep. Tr. at 15-16. 15. There is no evidence in the record that defendants share with the County any profits or losses from the operation of CMH. 16. In March 1962, CMH entered into a Contract for Pathology Services with Dr. Steuer (the “Steuer Agreement”). [TM-172 thru -173.] The Steuer Agreement provided, inter alia, 1. The pathologist assumes the obligation as the Director of the Department in [CMH]. 3. The pathologist will assume the responsibility for the conduct of the Department of Pathology and will devote such time as is necessary to provide proper and adequate service. 5. The professional income of the pathologist shall be determined by the following arrangement: the rate of compensation shall be 40% of gross billings for out-patients and in-patients of each case, certified charity excluded. Pathological fees will be collected by [CMH] in the name of the hospital. Financial settlement will be made between [CMH] and the pathologist on the calendar month of the first day of the succeeding month____ 6. The pathologist shall have the right to set all laboratory and pathology fees. 8. This agreement shall be for one year and shall be deemed to be automatically renewed unless terminated in writing by either party at least 120 days prior to the annual renewal date.” 17. The Steuer Agreement was, in essence, renewed by the parties through August 1979, when it was amended to reflect the fact that (in 1976) Dr. Latham had joined Dr. Steuer in supplying pathology services at CMH and in managing CMH’s Pathology Department. [TM-104 thru -108.] 18. The 1979 Amendment stated, in pertinent part that: . 1. The Pathologist shall provide for the proper functioning of all phases of the Pathology Department’s activities. 3. The Pathologist shall operate and conduct the Department of Pathology at Cherokee County Memorial Hospital ... providing fully the professional needs of [CMH] in a manner satisfactory to [CMH]. 19. The 1979 Amendment also stated that the Pathologist “is at all times acting and performing as an independent contractor” (H 6), reduced compensation from 30% to 25% of “gross monthly Clinical and Anatomical Pathology Charges,” (¶ 7) and provided that the contract had a one year term “and shall be automatically renewed” unless written notice of termination shall be delivered within 120 days prior to the expiration of the agreement. 20. After the 1979 Amendment, the Steuer Agreement was further amended in 1981 to add Dr. Latham as a signatory (hereinafter the Steuer Agreement shall be denominated the “Steuer/Latham Agreement”), and to reduce the compensation rate to 19% of adjusted gross monthly Clinical and Anatomical Pathology charges. (TM-109-110) 21. With the Steuer/Latham Agreement set to expire on July 31, 1984, CMH and plaintiffs extended that Agreement “so that said Agreement will expire on sixty (60) days written notice to either party by the other party,” effective August 1, 1984. (TM-100-101.) (The “1984 Addendum”). 22. On May 10, 1985, pursuant to the 1984 Addendum, CMH gave plaintiffs written notice that the Steuer/Latham Agreement would terminate within 60 days of plaintiffs’ receipt of the notice. (TM-75.) 23. The non-renewal of the Steuer/Latham Agreement was communicated to plaintiffs in a manner which did not breach that Agreement. Steuer Dep. Tr. at 159. 24. Defendants had the absolute right not to renew the Steuer/Latham Agreement. Steuer Dep. Tr. at 159. 25. On July 15, 1985, defendants entered into a contract with Dr. Mijanovich, whereby he became the exclusive pathology provider at CMH. (JM-30 thru -43.) 26. The Mijanovich Contract is a one year contract, and is subject to termination by either party without cause upon 90 days written notice, and to termination for cause by CMH upon one day written notice. Paragraph 17 of the Mijanovich Contract provides that Dr. Mijanovich shall be compensated as follows: $113,900 for clinical laboratory and administrative services rendered, and Dr. Mijanovich “shall separately bill and collect for all patients for Anatomical Pathology and Clinical Pathology Services rendered.” Exhibit “B” to Mijanovich Contract, (JM-42). 27. CMH has no economic interest in the professional fees generated by Dr. Mijanovich with respect to surgical/anatomical consults, for which he separately bills. Exhibit “B” to Mijanovich Contract (JM-42). 28. The terms and conditions set forth in the Mijanovich Contract were initially proposed by defendants to plaintiffs in May 1984, (TM-176, TM-178 thru -191), but were rejected by plaintiffs in June 1984 (TM-132 thru -144). Plaintiffs counter-proposed that they receive $201,600 for all clinical laboratory and administrative services rendered. [TM-144.] 29. For the 23 years prior to defendants entering into the Mijanovich Contract, plaintiffs (and their designees) had been the sole pathology providers at CMH. Steuer Dep. tr. at 34-35. 30. In November 1984 the Joint Commission on the Accreditation of Hospitals (“JCAH”) conducted a survey of CMH. The survey report (H-833-851), listed 18 deficiencies in the pathology department. CMH’s receiving a three year accreditation was contingent upon its removing five of these deficiencies. JCAH also directed CMH to give high priority to an additional four of the deficiencies. 31. During the Steuer/Latham Agreement CMH’s pathology department did not function in accordance with high professional standards. Steuer Dep. Tr. at 417. 32. The arrival of Dr. Mijanovich created competition with plaintiffs for the provision of pathology services that did not exist prior to the arrival of Dr. Mijanovich. Steuer Dep. Tr. at 99. 33. Plaintiffs never competed on the basis of price in providing pathology services under the Steuer/Latham Agreement. Steuer Dep. Tr. at 479-480. 34. Defendants’ decision not to renew the Steuer/Latham Agreement was made solely by employees of defendants. Tidikis Dep. Tr. at 66; Moran Dep. Tr. at 56-57. 35. The County was neither consulted about nor did it otherwise influence, or seek to influence, defendants’ decision whether to renew the Steuer/Latham Agreement or defendants’ decision whether to enter into a pathology contract with pathologists other than plaintiffs. Medley Dep. Tr. 37, 53; Moran Dep. Tr. at 56-57. 36. The decision whether to renew the Steuer/Latham Agreement was solely within the purview of defendants. Steuer Dep. Tr. at 159. 37. The responsibility of determining whether, and if so, under what terms, to renew the Steuer/Latham Agreement was not within the purview of the CMH board of directors or medical staff. August 1, 1984 Addendum to Steuer/Latham Agreement [TM-100]; General Agreement § 7 [H-449]; Steuer Dep. Tr. at 668-670, 678. 38. Defendants are not, and have never been, parties to the Bylaws of the Medical Staff of CMH (“Bylaws”). Bylaws [Appendix B(l) to Defendants’ Trial Brief.] 39. Defendants have never agreed to be bound by the Bylaws. Id. 40. The Bylaws deal with granting and revocation of medical staff privileges, not with whether a contract with a physician ought to be entered into or renewed. Id. 41. The Bylaws do not confer upon plaintiffs a right to have access to CMH’s pathology department. Steuer Dep. Tr. at 726. 42. Defendants’ non-renewal decision was based on a variety of business factors, including a determination that it was in the best interests of CMH and its patients that the Steuer/Latham Agreement be replaced with the Mijanovich Contract. Tidikis Dep. Tr. at 56-57; Moran Dep. Tr. at 32. 43. Defendants’ decision not to renew the Steuer/Latham Agreement was not made for the purpose of obtaining a competitive advantage over, or inflicting competitive injury upon, the plaintiffs. Latham Dep. Tr. at 208-213; Steuer Dep. Tr. at 307-323. 44. The substitution of Dr. Mijanovich for plaintiffs as CMH’s exclusive contract pathology provider has not resulted in an increase in price over competitive levels, or a diminution of quality. Steuer Dep. Tr. at 469-71; Barrett Dep. Tr. at 48, 92. 45. Certain members of CMH’s board of directors and medical staff shared defendants’ view that the interests of CMH and its patients would be best served by replacing plaintiffs as the contract pathologists at CMH, and they assisted defendants in their efforts to recruit a new contract pathologist. Moran Dep. Tr. at 56-58; 91-94. Steuer Dep. Tr. at 316-321. 46. None of the members of CMH’s board of directors or its medical staff referenced in the preceding numbered paragraph compete with plaintiffs, and none of their conduct was intended to obtain a competitive advantage over or to inflict competitive injury upon plaintiffs. Steuer Dep. Tr. at 305-324. 47. Members of the Board of directors and medical staff entertained negative views about plaintiffs even before defendants acquired control of CMH. Steuer Dep. Tr. at 312-13. 48. Dr. Mijanovich was completing his residency in Wisconsin at the time he filed an application with defendants’ corporate headquarters in California seeking a contract to furnish pathology services. Mijanovich Dep. Tr. at 33-42. 49. At the time he submitted the above-referenced application to defendants, Dr. Mijanovich was pursuing potential employment opportunities throughout the United States. Mijanovich Dep. Tr. at 33-42. 50. At the time defendants were considering Dr. Mijanovich’s application, they were considering entering into a contract with a pathologist from Florida to furnish pathology services at CMH. Latham Dep. Tr. at 205. 51. Hospitals recruit pathologists in a nationwide market. Steuer Dep. Tr. at 465-468. 52. The “exclusivity” provision in the Mijanovich Contract was inserted by defendants, and was not requested by Dr. Mijanovich. Mijanovich Dep. Tr. at 72-73. 53. Dr. Mijanovich did not exert any pressure on defendants to enter into a contract with him. Mijanovich Dep. Tr. at 37-43. 54. For 21 years, plaintiffs operated a pathology laboratory in an office housed in a building owned by Dr. Steuer located adjacent to CMH. Plaintiffs continue to operate this laboratory. Steuer Dep. Tr. at 13. 55. Plaintiffs have continued up to the present time to perform pathology work in their private, non-hospital-based laboratory adjacent to CMH even after the Steuer/Latham Agreement was not renewed. Steuer Dep. Tr. at 131. 56. Prior to Dr. Mijanovich’s arrival at CMH, almost all of the physicians in Gaffney sent their office-generated clinical and surgical pathology work to pathology reference laboratories located outside of South Carolina. Very few of these physicians used the pathology facilities of CMH or plaintiffs’ private laboratory for their office-generated specimens. Steuer Dep. Tr. at 62-63; Mijanovich Dep. Tr. at 98-102. 57. After the arrival of Dr. Mijanovich, most of the physicians in Gaffney stopped using pathology reference laboratories located outside of South Carolina, and began using CMH’s pathology facilities for their office-generated specimens. Mijanovich Dep. Tr. at 99-102. 58. In 1984, 38.8% of the residents of Cherokee County who were hospitalized were hospitalized in a hospital other than CMH; see Harris Affidavit at ¶ 24; in 1985, 40.4% of the residents of Cherokee County who were hospitalized were hospitalized in a hospital other than CMH. Id. 59. Twelve of CMH’s staff physicians, who account for 42.1% of CMH’s total admissions in Fiscal Year 1987, have staff privileges at hospitals other than CMH. Harris Affidavit at ¶ 38. 60. CMH perceives itself to be in competition with hospitals outside of Cherokee County, including hospitals in Spartanburg, Union, and Shelby. Watson Dep. Tr. at 8-9, 22; Barrett Dep. Tr. at 112. 61. CMH is perceived by consumers, and its staff physicians to be in competition with the hospitals referenced in the preceding paragraph. Hammett Dep. Tr. at 55-56. Johnson Dep. Tr. at 20; Gutta Dep. Tr. at 22-24; Watson' Dep. Tr. at 8-9, 22; Steuer Dep. Tr. at 66-71. 62. In Fiscal Year (“FY”) 1985 CMH’s occupancy rate was 42.6%. Harris Affidavit at ¶ 37. In FY 1986 CMH’s occupancy rate was 39.5%: Id. In FY 1987 CMH’s occupancy rate was 32.1%. Id. 63. Consumers of hospital services in Cherokee County view hospitals located outside Cherokee County as good substitutes for the services offered by CMH. Johnson Dep. Tr. at 20; Watson Dep. Tr. at 8-9, 22. 64. Hospitals always arrange for the provision of pathology services to their patients. Steuer Dep. Tr. at 438-440. 65. A physician’s decision whether to seek privileges at a particular hospital is not influenced by the identity of the pathologist at that hospital. Latham Dep. Tr. at 220. 66. Pathology services at CMH have always been furnished pursuant to a request by, or instruction from, the attending physician, not the patient. Steuer Dep. Tr. at 440. 67. Pathology services rendered to patients at CMH are always rendered in connection with the provision of hospital services. Steuer Dep. Tr. at 504-507. 68. Pathologists at CMH have only occasional face-to-face contact with patients receiving pathology services. Steuer Dep. Tr. at 464-465. 69. During the long life of the Steuer/Latham Agreement, a physician or patient rarely, if ever, requested the services of a specific pathologist, i.e., Dr. Steuer or Dr. Latham. Steuer Dep. Tr. at 440-468; Latham Dep. Tr. at 219-220. 70. During their many years of service at CMH under the Steuer/Latham Agreement, plaintiffs spent most of their time at CMH in the pathology laboratories. Steuer Dep. Tr. at 440-468, 513. 71. Prior to and at the time of the non-renewal of the Steuer/Latham Agreement plaintiffs had medical staff privileges at CMH. Steuer Dep. Tr. at 215. 72. Even after the Steuer/Latham Agreement was not renewed, plaintiffs’ medical staff privileges at CMH remained intact. Steuer Dep. Tr. at 215. 73. Plaintiffs’ medical staff privileges at CMH have remained intact up through the present time. Steuer Dep. Tr. at 215; Amended Complaint at ¶ 5. 74. After the arrival of Dr. Mijanovich, certain staff physicians at CMH requested that plaintiffs perform primary pathological consults. Moran Dep. Tr. at 165; Mijanovich Dep. Tr. at 27-29. 75. These requests were not made pursuant to any preexisting agreements, binding or otherwise, between said physicians and plaintiffs. Steuer Dep. Tr. at 715-724. 76. The staff physicians making these requests were not obligated to do so; these requests were strictly voluntary on the part of each said staff physician. Steuer Dep. Tr. at 715-724. 77. Plaintiffs were not obligated to accept these requests. Steuer Dep. Tr. at 716-724. 78. No physician on the medical staff at CMH ever promised plaintiffs that he (or she) would request that plaintiffs perform primary pathological consults. Steuer Dep. Tr. at 716-724. 79. No physician on the medical staff at CMH ever promised plaintiffs that he (or she) would request that plaintiffs perform primary pathology consults in the event that the Steuer/Latham Agreement was not renewed. Steuer Dep. Tr. at 716-724. 80. Plaintiffs never promised any physicians on the medical staff of CMH that they would perform primary pathology consults in the event the Steuer/Latham Agreement was not renewed. Steuer Dep. Tr. at 716-724. 81. After Dr. Mijanovich arrived at CMH, plaintiffs were, pursuant to the Mijanovich Contract, prohibited from using CMH’s pathology laboratories and from performing primary pathology consults on specimens generated at CMH. Steuer Dep. Tr. at 683-684; Moran Dep. Tr. at 163-169; Tidikis Dep. Tr. at 102-106. 82. In order to offer pathology services at any hospital, it is necessary for the pathologist to have staff privileges as well as a contract with that hospital to provide pathology services. Steuer Dep. Tr. at 679, 681. 83. As a general rule, pathology services are not offered at a hospital by pathologists who are in competition with each other. Steuer Dep. Tr. at 251, 255-257. 84. As a general rule, it is more efficient for pathologists to furnish pathology services at a hospital in coordination, rather than in competition with each other. Latham Dep. Tr. at 36-37; Steuer Dep. Tr. at 252, 255-259. 85. As a general rule, it is more efficient for the pathology department of a hospital to be under the control of a single person. Steuer Dep. Tr. at 387. 86. The non-renewal of the Steuer/Latham Agreement did not affect the ability of plaintiffs to offer pathology services to any hospital other than CMH. Steuer Dep. Tr. at 469-471; 617; 619-621. 87. It is practical for plaintiffs to offer pathology services at hospitals other than CMH without changing their present residences. Steuer Dep. Tr. 707-08. 88. From 1966 up to the present, plaintiffs have had the sole contract to provide pathology services at Wallace Thompson Hospital in Union, South Carolina. Steuer Dep. Tr. at 34-35; 89-90. 89. Plaintiffs have continued to furnish pathology services at Wallace Thompson Hospital even after the Steuer/Latham Agreement was not renewed. Steuer Dep. Tr. at 132-33. 90. Plaintiffs have never competed with each other in providing pathology services at CMH or Wallace Thompson Hospital. Latham Dep. Tr. at 183. 91. Apart from their disinclination to compete with each other, nothing has prevented plaintiffs from competing with each other in furnishing pathology services at CMH or Wallace Thompson Hospital. Latham Dep. Tr. at 179. 92. The identity of a hospital’s pathologist does not affect the hospital’s ability to attract patients. Steuer Dep. Tr. at 502-03. 93. To the knowledge of all parties, with the possible exception of a single hospital in Arkansas, all hospitals in the United States require that pathology services be furnished in accordance with a contract between the pathologist and the hospital. Steuer Dep. Tr. at 696; Latham Dep. Tr. at 229-30. 94. To the knowledge of all parties, with the possible exception of a single hospital in Arkansas, no hospital in the United States has a contract with more than one pathologist or one group of pathologists to offer pathology services at that hospital. Steuer Dep. Tr. at 249-51; Latham Dep. Tr. at 229-30. 95. To the knowledge of all parties, with the possible exception of a single hospital in Arkansas, no hospital in the United States permits pathologists to furnish pathology services at a hospital in competition with each other. Steuer Dep. Tr. at 249-51; Latham Dep. Tr. at 229-30. 96. To the knowledge of all parties, with the possible exception of a single hospital in Arkansas, the relief requested here by plaintiffs is unique insofar as it would permit a pathologist or a group of pathologists to offer primary pathology services at a hospital despite the fact that said group does not have a pathology contract with that hospital. Steuer Dep. Tr. at 507-514, 696; Latham Dep. Tr. at 229-30. 97. Exclusive contracts with pathologists accrue significant advantages to hospitals generally; in particular, they promote “order” in the provision of pathology services. Steuer Dep. Tr. 580-591; 606-610. II. FINDINGS OF LAW A. Federal Antitrust Claims At its core, plaintiffs’ case amounts to a challenge to a unilateral decision by the administration of CMH to substitute Dr. Mijanovich — the hospital’s current pathologist — for the plaintiffs, who together had been the long-standing sole providers of pathology services at the hospital prior to Dr. Mijanovich. For defendants’ conduct to give rise to antitrust liability, plaintiffs must demonstrate that the hospital’s decision to contract exclusively with Dr. Mijanovich resulted from an unlawful agreement, or that the hospital or Dr. Mijanovich has market power in a properly defined antitrust market. As a matter of law, neither such showing can be made in this case. Plaintiffs do not challenge the legality of defendants’ contract with Dr. Mijanovich. Instead, they argue only that the defendants’ decision to require that all primary pathology services at the hospital be performed by Dr. Mijanovich is illegal because it unreasonably restrains competition in the rendering of primary pathology consults at the hospital. As will be shown below, plaintiffs’ antitrust arguments have been rejected recently by numerous courts, including the Supreme Court. 1. Standard for Summary Judgment To prevail on a motion for summary judgment, the moving party must show that there are no genuine issues of material fact and that it is, therefore, entitled to summary judgment as a matter of law. Fed.R.Civ.P. 56(c). Thereafter, the non-moving party “may not rest upon the mere allegations or denials of his pleading, but his response ... must set forth specific facts showing that there is a genuine issue for trial.” Fed.R.Civ.P. 56(e). The Supreme Court has recently described the non-moving party’s burden in the context of alleged antitrust conspiracies as follows: To survive [defendants'] motion for summary judgment, [plaintiffs] must establish that there is a genuine issue of material fact as to whether [defendants] entered into an illegal conspiracy that caused [plaintiffs] to suffer a cognizable injury. This showing has two components. First, [plaintiffs] must show more than a conspiracy in violation of the antitrust laws; they must show an injury to them resulting from the illegal conduct____ Second, the issue of fact must be ‘genuine.’ When the moving party has carried its burden under Rule 56(c), its opponent must do more than simply show that there is some metaphysical doubt as to the material facts____ Where the record taken as a whole could not lead a rational trier of fact to find for the non-moving party, there is no ‘genuine issue for trial.’ Matsushita Electric Industrial Co. v. Zenith Radio Corp., 475 U.S. 574, 106 S.Ct. 1348, 1355-56, 89 L.Ed.2d 538 (1986) (citations and footnotes omitted). The Court went on to observe that “if the factual context renders [plaintiff’s] claim implausible — if the claim is one that simply makes no economic sense — [plaintiffs] must come forward with more persuasive evidence to support [their] claim than would otherwise be necessary.” Id. at 1356. Matsushita and other recent Supreme Court cases. Although this Court will, of course, adhere to the standards set forth in Matsushita, the Court wishes to emphasize that a different result would not obtain here even if the Court applied the more exacting preMatsushita, standard. 2. Antitrust Injury A threshold question in analyzing the antitrust implications of a business practice is whether it will lessen competition, not whether it harms a competitor. Brunswick Corp. v. Pueblo Bowl-O-Mat, Inc., 429 U.S. 477, 488, 97 S.Ct. 690, 697, 50 L.Ed.2d 701 (1977); Brown Shoe Co. v. United States, 370 U.S. 294, 320, 82 S.Ct. 1502, 1521, 8 L.Ed.2d 510 (1962) (The antitrust laws ... were enacted “for the protection of competition, not competitors.”) Accordingly, for plaintiffs to prevail in an antitrust case, they must show more than the mere fact that they have suffered economic injury. Rather, they must establish that they have suffered antitrust injury, i.e., injury of the type the “antitrust statute was intended to forestall,” as a consequence of the complained of acts. Associated General Contractors, Inc. v. California State Council of Carpenters, 459 U.S. 519, 540, 103 S.Ct. 897, 909, 74 L.Ed.2d 723 (1983); Military Services Realty, Inc. v. Realty Consultants of Virginia, Ltd., 823 F.2d 829 (4th Cir.1987). The Supreme Court has described antitrust injury as [Ijnjury of the type the antitrust laws were intended to prevent and that flows from that which makes defendants' acts unlawful. The injury should reflect the anticompetitive effect either of the violation or of anti-competitive acts made possible by the violation. It should, in short, be ‘the type of loss that the claimed violations ... would be likely to cause.’ Brunswick Corp. v. Pueblo Bowl-O-Mat, Inc., 429 U.S. 477, 489, 97 S.Ct. 690, 697, 50 L.Ed.2d 701 (1977) (quoting Zenith Radio Corp. v. Hazeltine Research, Inc., 395 U.S. 100, 125, 89 S.Ct. 1562, 1577, 23 L.Ed.2d 129 (1969). See also Blue Shield of Virginia v. McCready, 457 U.S. 465, 102 S.Ct. 2540, 73 L.Ed.2d 149 (1982); Associated General Contractors, Inc. v. California State Council of Carpenters, 459 U.S. 519, 103 S.Ct. 897, 74 L.Ed.2d 723 (1983). The plaintiffs have failed to demonstrate any such injury in this case. At the core of plaintiffs’ complaint are allegations that the defendants have acted to restrain competition in the furnishing of medical/surgical hospital services and professional pathology services in Cherokee County. Amended Complaint at 1ÍH 32, 51. Since CMH is the only hospital in Cherokee County, plaintiffs are, in effect, alleging that CMH is the relevant market for this case. As discussed below, the provision of such services at CMH does not constitute a relevant market for antitrust purposes. Even if plaintiffs had established the existence of such a market, however, they nonetheless failed to demonstrate either the presence of competition within that “market” prior to the termination of their contract with CMH, or any lessening of such competition after that termination. Plaintiffs’ services to CMH were at all times provided pursuant to a contract with the hospital. At no time during the period that plaintiffs were the contract pathologists at CMH did the hospital contract with any other pathologists, nor do plaintiffs contend that they engaged in competition with any other pathologists at CMH at any time prior to the termination of their contract. Since that time, of course, Dr. Mijanovich has been the sole contract pathologist at the hospital. Thus, reduced to its essentials, plaintiffs’ Amended Complaint rests not on any showing of lessened competition, but merely on the fact that they are disappointed competitors who must now provide their services elsewhere. In Jefferson Parish Hospital District No. 2 v. Hyde, 466 U.S. 2, 104 S.Ct. 1551, 80 L.Ed.2d 2 (1984), the Supreme Court confirmed that the mere fact that a disappointed competitor must practice elsewhere does not constitute “antitrust injury.” In rejecting an antitrust challenge to a hospital’s exclusive contract with a single group of anesthesiologists, the Supreme Court observed that It may well be true that the [exclusive] contract made it necessary for [plaintiff] and others to practice elsewhere____ But there has been no showing that the market as a whole has been affected at all by the contract____ There is simply no showing here of the kind of restraint on competition that is prohibited by the Sherman Act. Id. 31-32, 104 S.Ct. at 1568. For 23 years, plaintiffs had what amounted to an exclusive contract to provide pathology services at CMH. In 1985, the hospital decided to contract instead with Dr. Mijanovich. Merely changing exclusive contractors, however, cannot constitute a violation of the antitrust laws. Great Escape, Inc. v. Union City Body Co., 791 F.2d 532, 539-40 (7th Cir.1986); Car Carriers, Inc. v. Ford Motor Co., 745 F.2d 1101 (7th Cir.1984), cert. denied, 470 U.S. 1054, 105 S.Ct. 1758, 84 L.Ed.2d 821 (1985); Trepel v. Pontiac Osteopathic Hospital, 599 F.Supp. 1484, 1492 (E.D.Mich.1984) aff'd mem, 780 F.2d 1023 (6th Cir.1985) ; Ace Beer Distributors, Inc. v. Kohn, Inc., 318 F.2d 283, 287 (6th Cir.1963), cert. denied, 375 U.S. 922, 84 S.Ct. 267, 11 L.Ed.2d 166 (1963). This is true despite the fact that substituting one exclusive contractor for another may have the consequence of “boycotting or shutting out” the displaced contractor. In Barry v. Blue Cross of California, 805 F.2d 866 (9th Cir.1986), plaintiffs argued that a Blue Cross plan had the consequence of boycotting or shutting out non-participating physicians by interfering with their access to patients insured by the plan. The Ninth Circuit stated: We agree. However, every contract between a buyer and seller has precisely the effect of which the [plaintiffs] complain. When a buyer contracts with one seller, a second seller no longer has access to the buyer’s business to the extent it is covered by the existing contract. This consequence, however, is not unlawful. The [plaintiffs] have confused an agreement to boycott with an agreement to buy and sell services. Id. at 871. In opposing defendants’ Motion for Summary Judgment, the only injury to competition alleged by plaintiffs relates to a claim that prices for pathology services are higher than those charged by plaintiffs when they were the contract pathologists at CMH. Even assuming that this assertion were true, it would not establish injury to competition because the relevant inquiry is not whether prices have increased, but whether they have increased over the competitive level. Plaintiffs, however, failed to offer any evidence regarding competitive pricing levels. The only evidence in the record regarding price changes establishes that the pathology charges of defendants and Dr. Mijanovich were based on prices charged by their competitors. Barrett Dep. Tr. at 102-111, 172; Mijanovich Dep. Tr. at 171, 235, 252-260, 288. Moreover, doctors who formerly sent their office-generated specimens to out-of-state reference laboratories have switched to CMH since the arrival of Dr. Mijanovich. The fact that consumers of pathology services have switched to, rather than away from, Dr. Mijanovich and CMH provides very compelling evidence that the prices charged since Dr. Mijanovich replaced the plaintiffs have not exceeded competitive levels. 3. Applicability of the Rule of Reason Plaintiffs characterize defendants’ exclusive contract with Dr. Mijanovich as a per se unlawful tying arrangement and a per se unlawful group boycott in violation of Section 1 of the Sherman Act. Amended Complaint at UU 40, 47, 49. As shown below, however, there is no basis for applying the per se rule to these facts, which means that the competitive effects of the actions of the defendants must be assessed in properly defined antitrust markets. When that is done, the conclusion that the defendants have not violated the antitrust laws is inescapable. In determining whether an agreement unreasonably restrains trade, courts have employed two methods of analysis: In the first category are agreements whose nature and necessary effect are so plainly anticompetitive that no elaborate study of the industry is needed to establish their illegality — they are illegal per se. In the second category are agreements whose competitive effect can only be evaluated by analyzing the facts peculiar to the business, the history of the restraint, and the reasons why it was imposed. National Society of Professional Engineers v. United States, 435 U.S. 679, 692, 98 S.Ct. 1355, 1365, 55 L.Ed.2d 637 (1978). The per se rule is reserved for activities that “always or almost always tend to restrict competition and decrease output.” Broadcast Music, Inc. v. CBS, 441 U.S. 1, 19-20, 99 S.Ct. 1551, 1562, 60 L.Ed.2d 1 (1979). Although the Supreme Court has in the past stated that group boycotts are unlawful per se, see United States v. General Motors Corp., 384 U.S. 127, 86 S.Ct. 1321, 16 L.Ed.2d 415 (1966); Klor’s Inc. v. Broadway Hale-Stores, Inc., 359 U.S. 207, 79 S.Ct. 705, 3 L.Ed.2d 741 (1959), in two more recent cases the Court has declined to apply the per se rule to horizontal boycotts. FTC v. Indiana Federation of Dentists, 476 U.S. 447, 106 S.Ct. 2009, 2017-18, 90 L.Ed.2d 445 (1986); Northwest Wholesale Stationers, Inc. v. Pacific Stationery & Printing Co., 472 U.S. 284, 105 S.Ct. 2613, 86 L.Ed.2d 202 (1985). Similarly, with respect to the tying, a plaintiff must establish that the defendant “has sufficient economic power with respect to the tying product to appreciably restrain free competition in the market for the tied product and [that] a not insubstantial amount of interstate commerce is affected.” Northern Pacific Railway Co. v. United States, 356 U.S. 1, 5-6, 78 S.Ct. 514, 518, 2 L.Ed.2d 545 (1958). As discussed above, in Jefferson Parish v. Hyde, the Supreme Court more recently explained that “the essential characteristic of an invalid tying arrangement lies in the seller’s exploitation of its control over the tying product to force the buyer into the purchase of a tied product that the buyer either did not want at all, or might have preferred to purchase elsewhere on different terms.” Hyde, supra, 466 U.S. at 12, 104 S.Ct. at 1558; Rockingham, supra. Assessments of “sufficient economic power” or “control” with respect to the tying product are simply another way of saying that a showing of market power is necessary before liability may be found. Thus, absent a threshold showing of market power on the part of the defendants, the per se rule may not be invoked. Under the rule of reason, the plaintiff bears the burden of proving that the practice in question is unreasonable. E.g., United States v. Arnold, Schwinn & Co., 388 U.S. 365, 374 n. 5, 87 S.Ct. 1856, 1863 n. 5, 18 L.Ed.2d 1249 (1967). The function of the court is to determine whether the alleged restraint “is one that promotes competition or one that suppresses competition.” National Society of Professional Engineers v. United States, 435 U.S. 679, 691, 98 S.Ct. 1355, 1365, 55 L.Ed.2d 637 (1978). That inquiry is limited to determining the “market impact” of the alleged restraint, id. at 691 n. 17, 98 S.Ct. at 1365 n. 17, which, in turn, requires that the impact of the practice in question be assessed in a properly defined relevant market. See, e.g., Schwinn, supra at 381-82, 87 S.Ct. at 1866-67; Stearns v. Genrad, Inc., 564 F.Supp. 1309 (M.D.N.C.1983), aff'd 752 F.2d 942 (4th Cir.1984) (Rule of reason analysis requires examination of restraint on overall competition in the relevant market. The court is to focus on the preservation of competition and not on an individual competitor (citing Brown Shoe Co. v. U.S., 370 U.S. 294, 330, 82 S.Ct. 1502, 1526, 8 L.Ed.2d 510 (1962)). Even if a plaintiff succeeds in proving a restraint on competition in a relevant market, the restraint must also be shown to be “substantially adverse.” Schwinn, supra at 375, 87 S.Ct. at 1863. Practices that produce only an “insignificant,” “de minim-is,” “trivial,” or “insubstantial” restriction of competition are not unlawful. See United States v. Topco Associates, Inc., 405 U.S. 596, 606, 92 S.Ct. 1126, 1133, 31 L.Ed. 2d 515 (1972). See also Harron v. United Hospital Center, Inc., 522 F.2d 1133 (4th Cir.1975), cert. denied, 424 U.S. 916, 96 S.Ct. 1116, 47 L.Ed.2d 321 (1976). In Harron, the plaintiff had been the exclusive radiologist at one of two Clarksburg, West Virginia hospitals. After a merger of the two hospitals, the board of directors entered into an exclusive contract with a competing radiologist to provide all initial radiology interpretations for the surviving hospital. The Fourth Circuit stated unequivocally: “it is frivolous to urge that the employment of a single doctor to operate the radiology department of a hospital invokes the Sherman Act and the civil rights statute pleaded.” Harron, supra, 522 F.2d at 1134. Plaintiffs’ claims that the defendants have run afoul of the rule of reason can be disposed of by virtue of plaintiffs’ failure to establish that the defendants have market power in a properly defined market. Liability in antitrust law almost always requires proof of market power. This is because market power is an essential ingredient of injury to consumers. Market power means the ability to injure consumers by curtailing output and raising price; no possible injury, no market power; no market power, no violation; injury to consumers is therefore an essential ingredient of liability. Fishman v. Estate of Wirtz, 807 F.2d 520, 568 (7th Cir.1986) (Easterbrook, J. dissenting in part). As demonstrated below, there is no basis in the record for any finding of market power because there is insufficient evidence to support plaintiffs’ purported market definitions. Moreover, plaintiffs have offered no evidence to refute defendants’ contention — amply supported by Collins v. Associated Pathologists, Ltd., 1987-1 Trade Cas. (CCH) ¶ 67,603 (C.D.Ill.1987) [Available on WESTLAW, 1987 WL 16947] —that proper market definition in this case must include examination of both the alternatives available to consumers of hospital services in Cherokee County and the alternatives available to pathologists seeking job opportunities at CMH. Plaintiffs have advanced numerous antitrust arguments seeking to challenge defendants’ exclusive contract with Dr. Mijanovich (the “Mijanovich contract”). Plaintiffs’ principal argument is that the Mijanovich Contract violates Section One of the Sherman Act, 15 U.S.C. § 1, which renders unlawful any contract, combination or conspiracy in restraint of trade or commerce. Plaintiffs claim that the Mijanovich contract is a combination and conspiracy in restraint of, trade (Count I), an illegal tying arrangement (Counts IIA and IIB) and an unlawful boycott (Count III). Although plaintiffs have not explicitly abandoned any of their claims under Section One, in their Memorandum opposing summary judgment and at oral argument plaintiffs emphasized almost exclusively their concern that the Mijanovich contract constituted an illegal tying arrangement. Accordingly, this Court will deal first with that argument. 4. Tying Arrangement In order to establish that an arrangement constitutes an illegal tying arrangement plaintiffs must demonstrate that the defendants have attempted to sell one product (the tying product) on the condition that the buyer also purchase a second product (the tied product), and that the defendants have “ ‘sufficient economic power with respect to the tying product to appreciably restrain free competition in the market for the tied product____Rockingham, supra, 820 F.2d at 103 (4th Cir.1987), quoting Northern Pacific Railway, Co. v. United, States, 356 U.S. 1, 5-6, 78 S.Ct. 514, 518, 2 L.Ed.2d 545 (1958). (i) Product Market Plaintiffs claim that the Mijanovich Contract constitutes an illegal tying arrangement in two respects: first, that CMH patients undergoing “surgical-type procedures in which tissue is removed from the body” must also “purchase a primary anatomical pathology consultation on that tissue from Dr. Mijanovich.” Count IIA; and second, that CMH patients undergoing “medical/surgical procedures requiring clinical pathology consultations must “purchase a primary clinical consultation from Dr. Mijanovich.” Count IIB. Plaintiffs claim that defendants have “sufficient economic power” in the “relevant market” for each of the tying products “to appreciably restrain free competition in the market” for each of the tied products.” Count IIA and IIB. Plaintiffs further claim that defendants “participate in the revenues derived from [each of] the tied productfs].” Id. Finally, plaintiffs allege that the Mijanovich Contract constitutes a “per se unlawful tying arrangement.” Id. The Supreme Court has recently made clear that alleged tying arrangements should be adjudged under the per se, rather than the rule of reason, only when it is “probable” that defendants have “market power” in the market for the tying product. Jefferson Parish Hospital District No. 2 v. Hyde, 466 U.S. 2, 104 S.Ct. 1551, 80 L.Ed.2d 2 (1984). The Hyde Court found that when the seller does not have either the degree or the kind of market power that enables him to force customers to purchase a second, unwanted product in order to obtain the tying product, an antitrust violation can be established only by evidence of an unreasonable restraint on competition in the relevant market. Id. at 18, 104 S.Ct. at 1561. For the reasons outlined below, this Court finds that it would be inappropriate to invoke the per se test here because plaintiffs’ allegations regarding market power and antitrust injury are “implausible.” Matsushita, supra, 106 S.Ct. at 1356. In assessing plaintiffs’ tying arguments under the rule of reason, the plaintiffs must first demonstrate the existence of two separate products. In Hyde the Supreme Court set forth the analytical framework for determining whether one or two products are involved in an alleged tying arrangement. This “turns not on the functional relation between them, but rather on the character of the demand for the two items.” Hyde, supra, 466 U.S. at 19, 104 S.Ct. at 1562 (footnote omitted). The Hyde Court went on to emphasize that the critical issue was whether the products were “distinguishable in the eyes of buyers”, and that the product markets must be analyzed “from the buyers perspective____” Id. Applying these guidelines to the instant case, it is clear that separate product markets, as alleged by plaintiffs do not, in fact, exist. The Court notes at the outset that plaintiffs have offered no evidence to support their contention that separate product markets exist here. Likewise, plaintiffs have made virtually no effort to apply the Hyde formulation to demonstrate why the evidence in the record reveals the existence of separate product markets. Indeed, plaintiffs have failed to adduce evidence to enable a fact-finder to determine that each of the alleged tying products is, in fact, a product. First, plaintiffs have failed to identify the surgical-type procedures involving removal of tissue; nor does it appear from the record that surgical-type procedures involving removal of tissue are different in function or demand from any other surgical procedures offered at CMH. Second, plaintiffs have failed to offer evidence to enable a fact-finder to discern the existence of “a specific class of hospital medical/surgical procedures” requiring the utilization of clinical pathology consultations; the record does not indicate any reasoned basis for distinguishing between or among any of the numerous medical/surgical procedures which are performed at CMH or other hospitals. Finally, although there is a recognized difference between anatomical and clinical pathology, there is no evidence in the record which would support distinguishing between those two branches of pathology for purposes of this case. Accordingly, the Court treats the two tying claims as a single tying claim and construes the alleged tying product to be inpatient hospital services, and the alleged tied product to be professional anatomical and clinical pathology. There is, however, no evidence in the record which would warrant a finding that these alleged products constitute separate markets for purposes of this case. To the contrary, the uncontradicted evidence in the record establishes that professional pathology services are offered to hospital inpatients only in conjunction with the provision of inpatient hospital services, and that hospital patients consume professional pathology services only in conjunction with the consumption of hospital inpatient services. In short, the only record evidence regarding consumption of pathology services by hospital inpatients unequivocally demonstrates that there is no separate demand for professional pathology services by hospital inpatients. The Court’s conclusion that professional pathology services do not constitute a separate product from inpatient hospital services is reinforced by Collins v. Associated Pathologists, Ltd., 1987-1 Trade Cas. (CCH) ¶ 67,603 at 60,609 (C.D.Ill. Feb. 11, 1987) [Available on WESTLAW, DCT database], which is virtually on all fours with the instant case. In Collins, the plaintiff, a pathologist, claimed that he was illegally prevented from practicing pathology at the defendant hospital (St. John’s Hospital) where he had worked for eight years because his membership in the group, Associated Pathologists, Ltd. (“APL”), providing pathology services to the hospital had been terminated. APL’s relationship with St. John’s had been governed by successive contracts, each of which contains a provision allowing termination at any time upon 90 days notice. Plaintiff joined APL in 1974. The employment contracts between the individual pathologists and APL were of one year duration subject to annual renewal. The directors of APL asked for and received plaintiff’s resignation from the group, effective January 31, 1982. After leaving APL, plaintiff requested that St. John’s hire him as a pathologist on an individual basis, but St. John’s refused to do so. Plaintiff maintained staff privileges at St. John’s on a leave of absence basis and was employed as a pathologist at a hospital in California. Subsequently, plaintiff filed a lawsuit alleging that the contract between APL and St. John’s was a combination in restraint of trade, an unlawful boycott and an unlawful tying agreement in violation of Section 1 of the Sherman Act, and monopolization, attempted monopolization and conspiracy to monopolize in violation of Section 2 of the Sherman Act. Plaintiff also advanced several state antitrust and common law claims, including wrongful removal or reduction of staff privileges and tortious interference with staff privileges. In a thorough and well-reasoned opinion, the Court granted summary judgment for the defendants on all counts. The plaintiff in Collins argued that the hospital had illegally tied hospital services and pathology services. In rejecting plaintiff’s tying arguments the Collins Court focused on the statement in Hyde that “analysis of whether one or two products are involved in an alleged tying scheme ‘turns not on the functional relation between them, but rather on the character of the demand for the two items.’ ” Hyde, supra, 466 U.S. at 19, 104 S.Ct. at 1562, (emphasis added). Collins, supra at 60,-618. Based on its review of the record, a record which is strikingly similar to the record here, the court “conclude[d] as a matter of law that the provision of pathological services is not a separate product from the other services routinely offered by a hospital.” Id. at 60,619. [T]he vast majority of work performed by pathologists involve laboratory tests and analyses that require the pathologist to rely a great deal upon the hospital’s physical facilities and equipment. Thus, it is easy to see the pathologist as similar to an employee of the hospital rather than an independent contractor hired by the hospital for each specific task he must perform. The evidence shows that there is some demand for pathological services on an outpatient basis, not in connection with the provision of other hospital services, but the number of such requests are insubstantial when compared to the amount of pathological work done for hospital-based patients. In addition, the work of a pathologist is laboratory based, so there is not the close, face-to-face contact between the physician and the patient as there is in the practice of anesthesiology. Finally, the evidence is overwhelming that patients never request specific pathologists, and it is only on rare occasions that physicians themselves request the services of a specific pathologist____ Because pathologists are recognized as having a hospital-based practice rather than a practice oriented toward obtaining individual patients, the Court finds that pathological services are just one of the many services provided by a hospital for the care of its patients. The Plaintiff’s claim of an unlawful tying arrangement between the Defendant Hospital and APL must fail on these Motions for Summary Judgment, because there are not separate and distinct products involved. Collins, supra, at 60,619. The record here contains uncontroverted evidence consistent with and supportive of the reasoning of the Collins Court. Accordingly, the Court finds that professional pathology services are not a product separate from hospital services. Even assuming that professional pathology services constituted a separate product, an illegal tying arrangement would not exist unless plaintiffs could prove that defendants had an economic interest in the tied product. The Court finds that although defendants do derive revenue from the sale of pathology services, it is undisputed that defendants do not share in the pathology fees earned by Dr. Mijanovich. In this respect the instant case is no different from Rockingham where a neurologist challenged a decision by a hospital to designate a certain group of radiologists as the official interpreters of all CT scans performed for patients of the hospital. In rejecting the allegation of that hospital CT scans had been illegally tied to professional CT scanning services, the Court found that [t]he hospital is not a competitor in the market for the tied product. It receives no part of the fee for interpreting the scans. In this respect the case differs from Jefferson Parish where the hospital and the anesthesiologists shared the fees for anesthesiological services____ The lack of the hospital’s economic interest in the tied product is sufficient to defeat [the] tying claim under either theory that he presses. Rockingham, supra, 820 F.2d at 104 (citing Carl Sandburg Village Condominium Association No. 1 v. First Condominium Development Co., 758 F.2d 203, 207-08 (7th Cir.1985); Miller Motors, Inc. v. Ford Motor Co., 252 F.2d 441, 446-47 (4th Cir.1958); ABA Antitrust Section, Antitrust Law Developments (Second) 75 (2d ed. 1984)). Plaintiffs seek to distinguish Rocking-ham on two grounds: first, whereas in Rockingham “the defendants were not requiring the purchasers of medical/surgical hospital services to also purchase a CT scan”, in the instant case “[w]ith certain limited exceptions, each patient who purchases a hospital surgical-type procedure in which tissue is removed from the body is required by hospital policy to also purchase an anatomical consultation performed by Dr. Mijanovich.” Plaintiffs’ Memorandum in Opposition to Summary Judgment (“Plaintiffs’ Mem.”) at 41. Plaintiffs have mischaracterized both the holding in Rockingham and the facts disclosed by uncontroverted evidence in the record here. The Rockingham court rejected the argument that the hospital had exploited its alleged control over medical/surgical services because “[t]he hospital does not require each of its patients to undergo a [CT] scan. The patient’s physician determines whether a scan is needed.” Rockingham, supra, 820 F.2d at 104. Likewise, plaintiffs here concede that CMH “does not require each of its patients to purchase an anatomical consultation [whether or not performed by Dr. Mijanovich]. The patient’s physician determines whether [an anatomical consultation] is needed.” Plaintiffs next seek to distinguish Rockingham on the ground that “the plaintiff in Rockingham failed to establish ... that the hospital had an economic interest in the provision of CT scans____ [Whereas,] Cherokee Memorial Hospital has a direct unequivocal economic interest in anatomical consultations performed by Dr. Mijanovich. For in-patient procedures, the bill is split. The hospital and Dr. Mijanovich both directly bill the patient for their respective portion.” Plaintiffs’ Mem. at 42. Plaintiffs’ factual claims miss the point of the holding in Rockingham. The finding in Rockingham that the hospital had no “economic interest in the interpretation of CT scans”, 820 F.2d at 104, hinged on the fact that the hospital “receives no part of the fee for interpreting the scans”, id. and on the fact that the “hospital receives no part of the radiologists fees.” Id. at 100. As in Rockingham, CMH “receives no part of [Dr. Mijanovich’s] fees.” Mijanovich Dep. Tr. at 117-120. Likewise, CMH has no input or control over the professional fees set by Dr. Mijanovich for performing primary anatomical consults. These fees are set solely by Dr. Mijanovich and billed directly by him to in-patients (or their payors) as a “professional component.” Mijanovich Dep. Tr. at 117-120; Barrett Dep. Tr. at 20-24, 35-41. The only revenues derived by CMH from primary anatomical consults relate to the “technical component” which CMH bills directly to its patients (or their payors). The “technical component” relates to the use of the materials and equipment in CMH’s pathology department, and has no relationship whatsoever to Dr. Mijanovich’s professional fee. Thus, contrary to plaintiffs’ assertions, CMH has no economic interest in the tied product, i.e., the professional fees of Dr. Mijanovich. Plaintiffs’ also argue that “the defendants in this case do sell the technical component of anatomical surgical consults and in that sense share profits with Dr. Mijanovich in the sale of those services.” Plaintiffs’ Supp. Mem. at 52. Plaintiffs’ argument reflects a basic misunderstanding of their antitrust theory of this case. Plaintiffs’ principal antitrust contention is that CMH is an ‘essential facility’ for the practice of pathology in Cherokee County, South Carolina. That is, a physician who specializes in pathology must have access to the equipment owned and/or controlled by the hospital in order to practice his profession. If Cherokee Memorial Hospital is allowed to retain an exclusive contract pathologist and deny access to its pathology equipment for other qualified physicians, including the Plaintiffs, the result will be a restraint on free trade in the market for the provision of hospital services and professional pathology services in the relevant geographic market. Amended Complaint at If 30. Thus, plaintiffs are not complaining about the fact that CMH’s equipment is used to furnish pathology services; instead, plaintiffs complain about their being denied access to that equipment because denial of access deprives them of the ability to earn professional fees. Thus, the tied product is the professional fees earned by the contract pathologist, not the technical fees earned by the hospital. Moreover, there is no evidence in the record that furnishes CMH or Dr. Mijanovich with power to raise prices above competitive levels. See discussion, infra, re: injury to competition. (ii) Geographic Market Even assuming that there is a separate tied product, and that defendants have an economic interest in that produ