If a medical transcription agency quotes a rate, a potential client may say "Yeah, but I want you throw in the following items....."
If you expect people to treat you as a professional, then you have to treat them as professionals. There aren't too many surgeons around who would acquiesce to a patient's demand that: "As long as you're doing surgery on my wrist for carpal tunnel syndrome, why don't you throw in a nose job for the same price!"
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