Background: Several diagnostic aids have been developed to improve diagnosis in suspected acute appendicitis. Modified Alvarado Score includes signs and symptoms associated with ones degree of clinical suspicion. Graded Compression Ultrasonograpy is used in many institutions to aid the diagnosis of acute appendicitis. Aim: The aim of present study is to compare and evaluate diagnostic accuracy of Modified Alvarado Score and Graded Compression Ultrasonography in co-relation to histopathology report for diagnosis of acute appendicitis. Methodology: A cross-sectional study of 75 patients who underwent appendectomy for suspected acute appendicitis have been considered and were evaluated by Modified Alvarado Score and Graded Compression Ultrasonography, which was correlated with histopathological findings. Result: Out of 75 patients, 29 patients (38.66%) had acute appendicitis. In the present study, modified Alvarado Score has sensitivity of 76.86%, specificity 82.61%, positive predictive value 73.33%, negative predictive value 84.44%, diagnostic accuracy 80.0%, false positive error rate 17.39% and false negative error rate 24.11%. Graded Compression Ultrasonography has sensitivity of 82.76%, specificity 89.13%, positive predictive value 82.76%, negative predictive value 89.13%, diagnostic accuracy 86.67%, false positive error rate 10.87% and false negative error rate 17.24%. Conclusion: From the findings, the present study intended to conclude that it is highly clinically suggestive that the Modified Alvarado Score should be combined with Graded Compression Ultrasonography for better diagnosis of acute appendicitis.