Will this bolt straight into my truck without modifications?

Yes. This radiator mounts at factory points and connects to existing coolant and transmission lines. No drilling or fabrication needed—drop-in replacement.

What's the difference between this and a standalone radiator plus cooler setup?

This is one integrated unit with both engine coolant and transmission oil circuits built in. You get a cleaner engine bay and simpler plumbing versus running separate components.

Do I need to flush my cooling system before installing this?

Yes. Drain the old coolant completely and flush the system with distilled water before installing. Clean system prevents sediment from clogging the new radiator core.