Background: Biliary tract disorders represent a significant clinical challenge requiring accurate diagnostic imaging for optimal patient management. Ultrasonography (USG) and Magnetic Resonance Cholangiopancreatography (MRCP) have emerged as cornerstone imaging modalities in the evaluation of biliary pathologies. Objective: To evaluate the diagnostic accuracy, clinical utility, and comparative effectiveness of USG and MRCP in detecting and characterizing various biliary pathologies including cholelithiasis, choledocholithiasis, biliary strictures, and malignant obstructions. Methods: A retrospective analysis was conducted on 485 patients presenting with suspected biliary pathologies between January 2020 and December 2023. All patients underwent initial USG examination followed by MRCP. Diagnostic accuracy was assessed using surgical findings and endoscopic retrograde cholangiopancreatography (ERCP) as reference standards. Results: USG demonstrated excellent sensitivity (96.2%) for gallbladder pathologies but lower sensitivity (78.4%) for common bile duct stones. MRCP showed superior performance in detecting choledocholithiasis (sensitivity 94.7%, specificity 97.1%) and characterizing biliary strictures. Combined USG and MRCP approach achieved diagnostic accuracy of 98.3% for biliary pathologies. Cost-effectiveness analysis favored initial USG screening followed by selective MRCP. Conclusion: USG remains the first-line imaging modality for biliary evaluation, while MRCP provides superior detailed anatomical assessment and should be utilized for complex cases, preoperative planning, and when USG findings are inconclusive.