Purpose To evaluate costs associated with hospitalization due to Firearm-Related Violence and Injuries (FREVI) in the United States over the last decade, 2001-2009. We explored the following research questions: 1. Is there an increase in the prevalence of firearm injuries over the last decade (2001-2009)? 2. What are the demographic patterns that characterize FREVIs in the U.S (i.e., age, sex, racial and ethnic variations, urban/rural locations)? 3. What are the costs associated with firearm-related hospitalizations in the US? Methods This is a descriptive cross-sectional study. A stratified sample of 54,875 hospital discharges were extracted from the National Inpatient Sample Database (NIS-HCUP) using E-Codes (ICD-9) for FREVI. We performed trend analyses to determine the cost and prevalence of the firearm related injuries. Results An estimated 268,639 firearm-related hospital discharges were observed from 2001-2009. Homicidal intent was the leading cause of FREVI, followed by accidents. Hispanic and blacks were more likely to become injured by firearms as compared to whites. Young adults aged 18-34 were more prone to firearm injuries than children and the elderly. Male sex, urban residence and being black or Hispanic were the main risk factors for firearm-related hospitalizations. The average cost of firearm-related hospitalization to the United States is $60,000 every hour, $17,700 per firearm injury related admission, and total of $5.28 billion for the last decade. The prevalence of FREVI and cost trends remained constant over the last decade. Conclusion Firearm Related Violence and Injuries (FREVI), and associated costs remain a major source of hospital-related expenditures in the United States. The constant trend in number of firearm injuries per year over the last decade suggests the absence of effective policy measures to curtail firearm injuries