The injury death rate in Alaska for American Indians and Alaska Natives is more than triple the injury death rate for the United States. We examined the direct medical expenditures for injury-related hospitalizations to one Alaska Native health care system, the Tanana Chiefs Conference in Interior Alaska, to identify priorities for injury prevention and to promote efforts at prevention. The total expenditure for the 511 injuries resulting in hospitalizations from 1994-1998 was $4,145,440. Suicide attempts, falls, and acts of violence were the most frequent causes of injury hospitalization. Injuries caused by acts of violence, suicide attempts, and falls had the highest overall expenditures. On a per-victim basis, unintentional injuries involving the use of firearms and snowmobile/all-terrain vehicle injuries were the most expensive. We hope this report will raise the visibility of injuries as a prevention priority for Alaska Native communities, Native health systems, and community action programs.