<p>This study aimed to evaluate patients’ preferences for different bone graft materials and assess the influence of treatment cost on these preferences in the Pakistani population. A cross-sectional survey was conducted among adult patients across three tertiary-care hospitals in Karachi. A validated bilingual questionnaire assessed demographic characteristics, initial graft preferences, reasons for refusal, and changes in preference after introducing treatment cost. Descriptive statistics were reported and data were analyzed using chi-square test, and Bowker’s test of symmetry. A total of 101 participants were included. Autologous grafts, particularly those derived from intraoral sites, were the most preferred type, while xenografts showed the highest refusal rates. Pain and discomfort were the primary concerns associated with autologous grafts, fear of disease transmission influenced allograft refusal, and religious considerations were the dominant factor for xenograft rejection. No statistically significant association was found between demographic variables and graft preference (<i>p</i> value &gt; 0.05). Furthermore, introduction of treatment cost did not result in a significant preference shift (<i>p</i> value = 0.42). Cultural and safety-related perceptions significantly influenced decision-making. Although cost was acknowledged as an important factor, it did not significantly affect preferences, highlighting the need for culturally sensitive and patient-centered counseling.</p>