Ureteroscopy (URS) is the first line treatment for the majority of symptomatic renal and ureteral stones. This review summarizes the current literature on the costs associated with URS. A high initial investment is required for scope acquisition. Once purchased, maintenance and repair costs continue to accrue. Durability of the scopes is an important consideration as more durable scopes will remain functional for longer and thus have lower overall repair costs. Currently available, newer generation scopes appear highly durable compared to their predecessors. Ancillary equipment, mostly disposable items represent the highest per procedure cost of URS. Despite these costs, URS remains highly profitable. However, it is also efficacious demonstrating superior cost-effectiveness with higher stone free rates at a lower cost relative to shock wave lithotripsy.