Price Estimate Request Form

Before you come to Holy Cross Hospital or Holy Cross Germantown  Hospital, you can know the estimate of your out-of-pocket costs for a medical service or procedure. Out-of-pocket costs represent the portion of the price for medical services and treatment for which the patient is responsible. This includes copayments, coinsurance, and deductibles. 

Complete the following form to obtain an estimate of charges and out of pocket expenses. What you’ll need:

  • your insurance card
  • physician information
  • description of service or procedure you are considering
  • the Holy Cross Health hospital where the procedure will be performed


To speak with our Financial Counselors, call  301-754-7195 for Holy Cross Hospital or 301-557-6195 for Holy Cross Germantown Hospital.

The information that you will be provided is the best estimate based on the information we currently have and is not a guarantee of what our charge or your assigned liability will be. Holy Cross Health does not employ the physicians and other professional providers who practice at the hospital, and each physician group that provides service to you will charge you separately for their services. 

Please understand that in many cases it is impossible to predict the final charges that will result, as there are variables involved in your actual services such as the length of time spent in surgery or recovery, the number of days spent in the hospital, specific equipment, supplies and medications required, additional tests required by your physician and/or any unusual special care or unexpected conditions or complications.