Consider you are doing distinct on you output so by themselves

AccountNumber,

originalBilledAmount,

tbl_PerformedProcedure.PatientPrimaryKey

You get 3252 but when you add in

PhysicianID,

cptcode

You will of course have more potentials for differences should accoutn for that.

If you remove distinct they should be the same either way.

If there is a reason for distinct please explain what you are wanting.