Use Of Estimates (Details) (USD $)	3 Months Ended	9 Months Ended
Sep. 30, 2011	Sep. 30, 2010	Sep. 30, 2011	Sep. 30, 2010	Dec. 31, 2010
Use Of Estimates [Abstract]
Allowances for contractual adjustments	$ 129,154,000		$ 129,154,000		$ 118,503,000
Allowances for accounts receivable	14,161,000		14,161,000		13,070,000
Bad debt expense included in other operating expenses	$ 5,100,000	$ 4,240,000	$ 13,034,000	$ 13,385,000

Amount of the current period expense charged against operations, the offset which is generally to the allowance for doubtful accounts for the purpose of reducing receivables, including notes receivable, to an amount that approximates their net realizable value (the amount expected to be collected).

Reference 1: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Accounting Standards Codification

-Topic 225

-SubTopic 10

-Section S99

-Paragraph 2

-Subparagraph (SX 210.5-03.5)

-URI http://asc.fasb.org/extlink&oid=6880815&loc=d3e20235-122688

Reference 2: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Statement of Financial Accounting Standard (FAS)

-Number 95

-Paragraph 28

-LegacyDoc This reference is SUPERSEDED by the Accounting Standards Codification effective for interim and annual periods ending after September 15, 2009. This reference is included to help users transition from the previous accounting hierarchy and will be removed from future versions of this taxonomy.

Reference 3: http://www.xbrl.org/2003/role/presentationRef

-Publisher SEC

-Name Regulation S-X (SX)

-Number 210

-Article 5

-Section 03

-Paragraph 5

Reference 4: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Accounting Standards Codification

-Topic 230

-SubTopic 10

-Section 45

-Paragraph 28

-Subparagraph (a)

-URI http://asc.fasb.org/extlink&oid=6943989&loc=d3e3602-108585

Name:	us-gaap_ProvisionForDoubtfulAccounts
Namespace Prefix:	us-gaap
Data Type:	xbrli:monetaryItemType
Balance Type:	debit
Period Type:	duration