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One thing is with all of the data that is now available for research, what we are seeing is and what is being seen by insurers, in fact that higher prices for the services does not indicate better outcomes. They are rebuilding or fixing knees and the more they do it, the more familiar with the better the out come and because they do of them. And often the price of that particular procedure is lower than it is for the guy who does one a week. If they do or two or three a day versus one a month, what we are seeing in terms of the outcomes is that often times the lower cost procedure is really producing better outcomes. The place for the network and cheaper. I think we also know that we have seen a lot of networks in the networks and the pricings are the lower in general and they expect my view that we dont know how to measure quality. A few things we do know and what i like to point out is who scores well on the care and fivestar system that is one of the systems that is leading the way

United statesDistrict of columbiaAt ta mimCapitol hillSaudi arabiaChuck hagelJames foleyJoyce friedmanAnna eshooMartin dempseyJoe bidenDavid jonesWoodrow wilsonData availablePrices servicesTimes lower