Request a Deseret Mutual Fee Schedule*

Please provide the following provider information to receive a Deseret Mutual fee schedule...
Provider's Last Name:
(please do not use a Clinic's name)
 
Provider's First Name and Middle Initial:  
Provider Tax ID:  
Contact Name:  
E-mail Address:  
Confirm E-mail Address:  
Provider/Contact Phone Number:
(including area code)
 
Fee Schedule delivery method:

FAX Number: (required for FAX delivery of Fee Schedule)  

*To create a fee schedule table for your reference, we’ll pull codes from claims you’ve submitted in the last 18 months. We may also supplement your fee schedule with up to 200 codes typically billed by other providers in your specialty.