LifeSave KuPono, an air ambulance company in Hawaii, is now shuttered after its parent company decided to close several bases nationwide, leaving the isles with only one other major provider for the service.

Air Methods, which is headquartered in Colorado, confirmed it closed LifeSave KuPono on Wednesday, among other locations, citing inflation and the “significant under-reimbursement from Medicare,” which it said the government has not updated in nearly 20 years.

The company also cited the tremendous pressure from the new No Surprises Act, which requires that upfront costs be provided to consumers prior to service, as a factor in the closures.

“The decision to close a base is never taken lightly as we understand this further impacts access to critical healthcare services in communities that greatly depend on them,” said the company in a statement. “Therefore, Air Methods conducted extensive financial analysis and explored every option at our disposal for nearly a year but ultimately, determined that keeping these bases open is simply unsustainable. We are, however, always open to collaborating with hospitals or local agencies to find viable ways to keep bases open as our ultimate goal is to provide life-saving efforts to those who need us the most.”

LifeSave KuPono was a division of Air Methods’ Lifesave Transport, which offers air and ground transport for critically ill or injured patients, with coverage in multiple states, including Kansas, Nebraska, Oklahoma, Missouri, and Hawaii.

Air Methods continues to operate more than 300 bases serving 49 states.

LifeSave KuPono operated fixed-wing aircraft from three bases, including Honolulu, Kahului, and Hilo, and flew patients from neighbor isles to major hospitals such as The Queen’s Medical Center and Kapiolani Medical Center for Women & Children.