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Use of Estimates (Details) (USD $)	3 Months Ended
Use of Estimates (Details) (USD $)	Mar. 31, 2012	Mar. 31, 2011	Dec. 31, 2011
Use Of Estimates [Abstract]
Allowances for contractual adjustments	$ 218,884,000		$ 136,265,000
Allowances for accounts receivable	22,753,000		18,844,000
Bad debt expense included in other operating expenses	$ 5,247,000	$ 4,050,000

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).

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