Abstract Safety regulators in the railroad industry need comprehensive injury costs by cause, and cost comparisons to other modes of transport to gain policy insights. This study links case-level data from the Federal Railroad Administration to monetary costs and consequences of specific injuries. Lost quality of life was estimated from physicians' ratings of injury impairment and the value of fatal risk reduction. Railroad injuries and illnesses cause an average of $3 billion in fatality costs and $650 million in nonfatal incident costs annually. Impacts at rail-highway crossings impose three times as much cost as the next highest cause. Commercial air travel is the safest per passenger mile. Trains, second lowest, have injury costs six times higher, but only one-fifth as high as cars. The relative safety of trains and airplanes in transport means highway modes enjoy implicit price subsidies. Better injury cost recovery through taxation or insurance would make the subsidies explicit. More informed modal choices and thus enhanced economic efficiency would result.