| Agency | Health Cost | Rank |
| Water Replenishment District of Southern California | $32,289 | 1 |
| Central Contra Costa Sanitary District (Contra Costa) | $29,923 | 2 |
| Truckee-Donner Public Utility District | $28,219 | 3 |
| Stockton-East Water District | $26,203 | 4 |
| Sweetwater Authority | $25,946 | 5 |
| Humboldt Bay Municipal Water District | $25,694 | 6 |
| Lassen Municipal Utility District | $25,569 | 7 |
| Western Municipal Water District | $24,948 | 8 |
| Florin Resource Conservation District | $24,689 | 9 |
| El Dorado Hills County Water District | $24,646 | 10 |
| South Feather Water and Power Agency | $24,177 | 11 |
| Wheeler Ridge-Maricopa Water Storage District | $24,156 | 12 |
| Monterey One Water | $24,107 | 13 |
| South Tahoe Public Utility District | $23,746 | 14 |
| Montecito Fire Protection District | $23,578 | 15 |
| Modesto Irrigation District | $23,563 | 16 |
| North Tahoe Fire Protection District | $22,988 | 17 |
| Santa Clara Valley Open Space Authority | $22,889 | 18 |
| Mission Springs Water District | $22,870 | 19 |
| Stanislaus Consolidated Fire Protection District | $22,646 | 20 |
| Woodside Fire Protection District | $22,631 | 21 |
| Vista Irrigation District | $22,388 | 22 |
| Yuba County Water Agency | $22,374 | 23 |
| Northern Inyo Healthcare District | $22,279 | 24 |
| Valley Center Municipal Water District | $22,233 | 25 |
| Delta Diablo Sanitation District (Contra Costa) | $22,086 | 26 |
| West Basin Municipal Water District | $22,005 | 27 |
| Central Fire Protection District (Santa Cruz) | $21,980 | 28 |
| Glenn-Colusa Irrigation District | $21,977 | 29 |
| Oro Loma Sanitary District (Alameda) | $21,964 | 30 |
| San Ramon Valley Fire Protection | $21,932 | 31 |
| Monterey County Regional Fire Protection District | $21,928 | 32 |
| San Luis and Delta-Mendota Water Authority | $21,919 | 33 |
| Mammoth County Water District | $21,795 | 34 |
| Menlo Park Fire Protection District | $21,760 | 35 |
| Los Angeles County Metropolitan Transportation Authority | $21,757 | 36 |
| San Juan Water District | $21,688 | 37 |
| Alameda County Waste Management Authority and Source Reduction Recycling Board | $21,608 | 38 |
| Olivenhain Municipal Water District | $21,395 | 39 |
| Tulelake Irrigation District | $21,370 | 40 |
| Salinas Valley Memorial Healthcare District | $21,336 | 41 |
| Truckee Fire Protection District | $21,232 | 42 |
| San Lorenzo Valley Water District | $21,022 | 43 |
| Orange County Fire Authority | $20,962 | 44 |
| Santa Cruz Metropolitan Transit District | $20,829 | 45 |
| Amador Water Agency | $20,823 | 46 |
| Indian Wells Valley Water District | $20,733 | 47 |
| Kern County Water Agency | $20,664 | 48 |
| Central County Fire Department | $20,653 | 49 |
| Helix Water District | $20,646 | 50 |
| Aptos-La Selva Fire Protection Services | $20,614 | 51 |
| Stockton Port District | $20,544 | 52 |
| Ross Valley Fire Department | $20,487 | 53 |
| Tahoe-Truckee Sanitation Agency | $20,462 | 54 |
| Fairfield-Suisun Sewer District | $20,427 | 55 |
| San Benito Health Care District | $20,427 | 56 |
| Union Sanitary District (Alameda) | $20,328 | 57 |
| Salinas Valley Solid Waste Authority | $20,323 | 58 |
| Alameda County Water District | $20,300 | 59 |
| Northstar Community Services District | $20,236 | 60 |
| Lathrop-Manteca Fire Protection District | $20,182 | 61 |
| Goleta Sanitary District (Santa Barbara) | $20,135 | 62 |
| East Bay Municipal Utility District | $20,086 | 63 |
| Truckee Sanitary District (Nevada) | $20,080 | 64 |
| Merced County Association of Governments | $19,932 | 65 |
| Antelope Valley-East Kern Water Agency | $19,829 | 66 |
| Central Marin Police Authority | $19,819 | 67 |
| Vallejo Sanitation and Flood Control District | $19,815 | 68 |
| Sanitary District No. 1 (Marin) | $19,672 | 69 |
| West County Wastewater District (Contra Costa) | $19,658 | 70 |
| Washington Township Health Care District | $19,584 | 71 |
| Otay Water District | $19,546 | 72 |
| Association of California Water Agencies Joint Powers Insurance Authority | $19,525 | 73 |
| San Francisco Bay Area Rapid Transit District | $19,449 | 74 |
| Casitas Municipal Water | $19,414 | 75 |
| Central Marin Sanitation Agency | $19,342 | 76 |
| Vallecitos Water District | $19,295 | 77 |
| Tuolumne Utilities District | $19,288 | 78 |
| Sacramento Metropolitan Fire District | $19,218 | 79 |
| Laguna Beach County Water District | $19,201 | 80 |
| Rancho California Water District | $19,193 | 81 |
| Cucamonga Valley Water District | $19,171 | 82 |
| Turlock Irrigation District | $19,041 | 83 |
| Calaveras County Water District | $19,030 | 84 |
| South Placer Municipal Utility District | $18,982 | 85 |
| East Bay Regional Park District | $18,975 | 86 |
| Calleguas Municipal Water District | $18,971 | 87 |
| Nevada Irrigation District | $18,955 | 88 |
| Marina Coast Water District | $18,916 | 89 |
| West Valley Water District | $18,858 | 90 |
| Tahoe City Public Utility District | $18,853 | 91 |
| Water Employee Services Authority | $18,761 | 92 |
| North County Fire Protection District (San Diego) | $18,705 | 93 |
| South Bay Regional Public Safety Training Consortium | $18,669 | 94 |
| Sacramento Municipal Utility District | $18,654 | 95 |
| El Dorado County Transit Authority | $18,634 | 96 |
| Monterey Regional Waste Management District | $18,524 | 97 |
| Metropolitan Water District of Southern California | $18,506 | 98 |
| Marin/Sonoma Mosquito and Vector Control District | $18,484 | 99 |
| Sonoma-Marin Area Rail Transit District | $18,396 | 100 |
| Silicon Valley Clean Water | $18,273 | 101 |
| Rainbow Municipal Water District | $18,261 | 102 |
| Alameda Health System | $18,205 | 103 |
| San Mateo County Transit District | $18,204 | 104 |
| Coachella Valley Mosquito and Vector Control District | $18,200 | 105 |
| Desert Water Agency | $18,180 | 106 |
| Valley of the Moon Fire Protection District | $18,076 | 107 |
| Alameda County Transportation Commission | $18,065 | 108 |
| Ramona Municipal Water District | $18,058 | 109 |
| San Francisco County Transportation Authority | $18,032 | 110 |
| Big Bear City Community Services District | $18,020 | 111 |
| West Kern Water District | $17,943 | 112 |
| Walnut Valley Water District | $17,934 | 113 |
| South Coast Water District | $17,906 | 114 |
| Placer County Water Agency | $17,871 | 115 |
| El Toro Water District | $17,806 | 116 |
| Northern California Power Agency | $17,796 | 117 |
| Central Coast Water Authority | $17,776 | 118 |
| Las Virgenes Municipal Water District | $17,722 | 119 |
| El Dorado Irrigation District | $17,706 | 120 |
| North Kern Water Storage District | $17,689 | 121 |
| El Dorado County Fire Protection District | $17,682 | 122 |
| Moulton-Niguel Water District | $17,620 | 123 |
| Bay Area Air Quality Management District | $17,583 | 124 |
| Nevada County Consolidated Fire District | $17,506 | 125 |
| Orange County Water District | $17,473 | 126 |
| Napa Sanitation District | $17,373 | 127 |
| Marin Municipal Water District | $17,253 | 128 |
| Beaumont-Cherry Valley Water District | $17,172 | 129 |
| Eastern Contra Costa County Transit Authority | $17,158 | 130 |
| Eastern Municipal Water District | $17,155 | 131 |
| Contra Costa Water District | $17,056 | 132 |
| Santa Clara Valley Water District | $16,913 | 133 |
| CSAC Excess Insurance Authority | $16,841 | 134 |
| Humboldt Transit Authority | $16,804 | 135 |
| Santa Fe Irrigation District | $16,754 | 136 |
| Lake Arrowhead Community Services District | $16,667 | 137 |
| Monterey-Salinas Transit | $16,661 | 138 |
| Municipal Water District of Orange County | $16,588 | 139 |
| Dublin San Ramon Services District | $16,586 | 140 |
| Moraga/Orinda Fire Protection District | $16,580 | 141 |
| Greater Los Angeles County Vector Control District | $16,540 | 142 |
| Palo Verde Irrigation District | $16,539 | 143 |
| Midpeninsula Regional Open Space District | $16,412 | 144 |
| Arvin-Edison Water Storage District | $16,374 | 145 |
| San Diego County Water Authority | $16,374 | 146 |
| County Sanitation District No. 2 (Los Angeles) | $16,362 | 147 |
| Mojave Desert Air Quality Management District | $16,230 | 148 |
| Central Sierra Child Support Agency | $16,149 | 149 |
| Hayward Area Recreation and Park District | $16,089 | 150 |
| Fresno Metropolitan Flood Control District | $16,067 | 151 |
| City and County of San Francisco Redevelopment Financing Authority | $16,020 | 152 |
| Santa Clara Community Health Authority | $16,012 | 153 |
| North Marin Water District | $15,973 | 154 |
| Soquel Creek Water District | $15,913 | 155 |
| South Orange County Wastewater Authority | $15,895 | 156 |
| East Valley Water District | $15,645 | 157 |
| Irvine Ranch Water District | $15,634 | 158 |
| Sacramento Suburban Water District | $15,572 | 159 |
| Citrus Heights Water District | $15,453 | 160 |
| Kern County Hospital Authority | $15,379 | 161 |
| Oak Valley Hospital District | $15,316 | 162 |
| Orange County Transportation Authority | $15,313 | 163 |
| Merced Irrigation District | $15,303 | 164 |
| San Diego Association of Governments | $15,227 | 165 |
| Novato Fire Protection District | $15,117 | 166 |
| Orange County Sanitation District | $15,089 | 167 |
| North Sonoma County Healthcare District | $15,088 | 168 |
| Sacramento Regional Transit System | $15,035 | 169 |
| Palmdale Water District | $15,003 | 170 |
| Imperial Irrigation District | $14,895 | 171 |
| Central Contra Costa Transit Authority | $14,846 | 172 |
| Hi-Desert Water District | $14,835 | 173 |
| Foothill/Eastern Transportation Corridor Agency | $14,777 | 174 |
| San Joaquin Regional Transit District | $14,757 | 175 |
| Crescenta Valley County Water District | $14,750 | 176 |
| Encina Wastewater Authority | $14,723 | 177 |
| Friant Water Authority | $14,615 | 178 |
| Sacramento Metropolitan Air Quality Management District | $14,611 | 179 |
| Yorba Linda Water District | $14,493 | 180 |
| Los Angeles County West Vector Control District | $14,436 | 181 |
| Inland Empire Utilities Agency | $14,299 | 182 |
| Eastern Plumas Health Care District | $14,289 | 183 |
| Goleta Water District | $14,244 | 184 |
| Oxnard Harbor District | $14,232 | 185 |
| Padre Dam Municipal Water District | $14,225 | 186 |
| Cordova Recreation and Park District | $14,196 | 187 |
| Contra Costa Mosquito Abatement District | $14,184 | 188 |
| Southern California Coastal Water Research Project Authority | $14,116 | 189 |
| Lakeside Fire Protection District | $14,055 | 190 |
| Kings River Conservation District | $14,048 | 191 |
| Sacramento Regional Public Safety Communications Center | $14,035 | 192 |
| San Miguel Consolidated Fire Protection District | $14,017 | 193 |
| Southern California Regional Rail Authority | $13,941 | 194 |
| Fallbrook Public Utility District | $13,929 | 195 |
| Santa Barbara Metropolitan Transit District | $13,912 | 196 |
| Cooperative Personnel Services | $13,834 | 197 |
| Beta Healthcare Group Risk Management Authority | $13,816 | 198 |
| Mt. San Jacinto Winter Park Authority | $13,770 | 199 |
| Santa Margarita Water District | $13,546 | 200 |
| Inland Empire Health Plan | $13,507 | 201 |
| Southern Mono Health Care District | $13,457 | 202 |
| Madera Irrigation District | $13,438 | 203 |
| Foothill Transit | $13,424 | 204 |
| Mendocino Transit Authority | $13,423 | 205 |
| Kaweah Delta Health Care District | $13,387 | 206 |
| Mojave Water Agency | $13,380 | 207 |
| North Bay Schools Insurance Authority | $13,290 | 208 |
| Fresno Regional Workforce Investment Board | $13,249 | 209 |
| Lake Hemet Municipal Water District | $13,240 | 210 |
| Selma – Kingsburg – Fowler County Sanitation District (Fresno) | $13,164 | 211 |
| Pleasant Hill Recreation and Park District | $13,148 | 212 |
| Plumas Hospital District | $13,106 | 213 |
| Solano Irrigation District | $13,104 | 214 |
| Santa Cruz Port District | $13,097 | 215 |
| Oakdale Irrigation District | $13,065 | 216 |
| Semitropic Water Storage District | $13,060 | 217 |
| Antelope Valley Healthcare District | $12,904 | 218 |
| Mountains Recreation and Conservation Authority | $12,865 | 219 |
| Chino Valley Independent Fire District | $12,853 | 220 |
| Orange County Mosquito and Vector Control District | $12,811 | 221 |
| Sonoma County Library | $12,790 | 222 |
| Humboldt Waste Management Authority | $12,783 | 223 |
| Amador-Tuolumne Community Action Agency | $12,778 | 224 |
| Shasta Area Safety Communications Agency | $12,660 | 225 |
| Southgate Recreation and Park District | $12,637 | 226 |
| United Water Conservation District | $12,616 | 227 |
| Henry Miller Reclamation District No. 2131 | $12,509 | 228 |
| Desert Recreation District | $12,453 | 229 |
| Rancho Santa Fe Fire Protection District | $12,452 | 230 |
| Jurupa Community Services District | $12,417 | 231 |
| Monterey Bay Unified Air Pollution Control District | $12,237 | 232 |
| Humboldt Bay Fire | $12,235 | 233 |
| Coachella Valley Water District | $12,085 | 234 |
| Mayers Memorial Hospital District | $11,966 | 235 |
| Golden Empire Transit District | $11,947 | 236 |
| Community Human Services Project | $11,911 | 237 |
| Mesa Water District (Orange) | $11,904 | 238 |
| Yolo County Communications Emergency Services Agency | $11,872 | 239 |
| San Diego Transit Corporation | $11,824 | 240 |
| South Placer Fire Protection District | $11,742 | 241 |
| San Diego Unified Port District | $11,691 | 242 |
| Southeast Area Animal Control Authority | $11,678 | 243 |
| Alliance of Schools For Cooperative Insurance Programs | $11,638 | 244 |
| Sonoma Valley Healthcare District | $11,567 | 245 |
| Riverside Transit Agency | $11,415 | 246 |
| Chico Area Recreation and Park District | $11,334 | 247 |
| Capitol Area Development Authority | $11,320 | 248 |
| North County Transit District | $11,239 | 249 |
| Central California Irrigation District | $11,227 | 250 |
| Conejo Recreation and Park District | $11,057 | 251 |
| San Diego County Regional Airport Authority | $11,050 | 252 |
| Ventura Port District | $11,000 | 253 |
| Rancho Simi Recreation and Park District | $10,911 | 254 |
| Sunline Transit Agency | $10,850 | 255 |
| John C. Fremont Healthcare District | $10,728 | 256 |
| Tri-City Hospital District | $10,668 | 257 |
| San Diego Metropolitan Transit System | $10,659 | 258 |
| Lower Tule River Irrigation District | $10,435 | 259 |
| Gold Coast Transit District | $10,426 | 260 |
| San Bernardino Mountains Community Hospital District | $10,315 | 261 |
| Sacramento Public Library Authority | $10,253 | 262 |
| Ventura County Air Pollution Control | $10,200 | 263 |
| South Bay Regional Public Communications Authority | $9,936 | 264 |
| Long Beach Public Transportation Company | $9,924 | 265 |
| Greater Vallejo Recreation District | $9,871 | 266 |
| Antelope Valley Transit Authority | $9,791 | 267 |
| Fresno Irrigation District | $9,741 | 268 |
| Altamont Corridor Express – ACE | $9,700 | 269 |
| South Coast Air Quality Management District | $9,679 | 270 |
| Tahoe Regional Planning Agency | $9,634 | 271 |
| Omnitrans | $9,489 | 272 |
| Palos Verdes Library District | $9,441 | 273 |
| Tri-City Mental Health Center | $9,393 | 274 |
| Seneca Hospital District | $9,366 | 275 |
| Schools Insurance Authority | $9,308 | 276 |
| San Joaquin Valley Unified Air Pollution Control District | $9,284 | 277 |
| Beach Cities Health District | $9,277 | 278 |
| San Diego Convention Center Corporation Inc. | $9,222 | 279 |
| Sierra View Local Health Care District | $9,159 | 280 |
| Sacramento Area Council of Governments | $9,097 | 281 |
| Westlands Water District | $9,044 | 282 |
| Riverside County Transportation Commission | $8,995 | 283 |
| Marin Clean Energy | $8,987 | 284 |
| North of the River Recreation and Park District | $8,630 | 285 |
| Consolidated Fire Agencies | $8,423 | 286 |
| San Luis Obispo Regional Transit Authority (RTA) | $8,278 | 287 |
| Ventura Region Sanitation District | $8,011 | 288 |
| San Diego Trolley Inc. | $7,969 | 289 |
| Southern California Association of Governments | $7,793 | 290 |
| Los Angeles Homeless Services Authority | $7,752 | 291 |
| Kern Valley Hospital District | $7,668 | 292 |
| Bear Valley Community Healthcare District | $7,460 | 293 |
| Sacramento-Yolo Mosquito and Vector Control District | $7,455 | 294 |
| Mountain Community Medical Services District dba Trinity Hospital | $6,682 | 295 |
| Last Frontier Health District | $6,263 | 296 |
| San Bernardino County Transportation Authority | $3,607 | 297 |
| South San Joaquin Irrigation District | $2,447 | 298 |
| North Tahoe Public Utility District | $2,091 | 299 |
| Metropolitan Transportation Commission | $1,420 | 300 |
