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Related Party Transactions (Tables)
12 Months Ended
Dec. 31, 2013
Related Party Transactions  
Schedule of Related Party Payments
 2013 2012 2011
         
Operating leases $ 29,240 $ 29,079 $ 29,137
Salaries and benefits   72,892   65,908   64,830
Billing fees   11,591   11,126   11,240
Medical advisory services   2,993   2,671   2,575