OBJECTIVES Acute coronary syndromes (ACS) are life-threatening disorders requiring intensive medical management or invasive cardiovascular procedures. CABG is an important therapeutic procedure among these patients. In Brazil almost 21,000 CABG are performed in public hospitals costing the government R$ 7379.49 each in average. The aim of this study is to determine the direct medical costs of CABG among different Brazilian regions in the private setting. METHODS Retrospective single-cohort study analyzed administrative claims data for patients with ACS submitted to CABG in 2007-2008. From a nationwide database with 1,801,344 people all the patients with ACS submitted to CABG were selected. The patients were split according to the Brazilian geographical region where the procedure was performed. Student T test was used to compare the costs among three different regions. RESULTS We identified 263 patients with ACS submitted to CABG. 67% of the procedures were performed in Southeast (SE) region, 25% in Middle West (MW) and 8% in the south region. The average± SD, quartile 25%, median and 75% of the CABG cost of whole sample were R$15,849.72±R$ 7,355.69, R$12,153.84, R$ 14,605.45 and R$18,735.46, respectively. The same parameters for the SE, MW and S regions were, respectively R$15,721.25±R$8,309.74, R$11,545.23, R$14,398.47 and R$18,657.87; R$16,744.15±R$ 4,212.57, R$13,340.56, R$ 15,688.26 and R$19,325.96 and R$14,035.03±R$ 6,272.96, R$ 9,145.53, R$14,163.88 and R$17,103.31. There was no statistical difference among the different regions of Brazil of total CABG cost. There was no statistical difference among the different regions and the total sample average. CONCLUSIONS The CABG average cost we found represent the average Brazilian private setting health cost independent of the region studied. The average total CABG cost in the private setting is at least the double in relation to the average total CABG cost in the public setting.