; (ii) the level of training, education, and experience of the out-of-network health care provider; (iii) the circumstances and complexity of the particular dispute, including the time and place of the service; and (iv) the payment rate determined for the item or service under the original Medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act. (5) Effect of decision A final decision of an independent dispute resolution entity under paragraph (4)(B)— (A) shall be binding