; or (bb) in the case neither such charge or such rate is determined by the entity to be reasonable, the final offer submitted under subclause (II) that is determined more reasonable in accordance with such subclause. (II) Final offers For purposes of subclause (I)(bb), the health plan and the nonparticipating provider party to the independent dispute resolution under this paragraph shall each submit to the IDR entity their final offer for an amount for the payment that is subject to the dispute not later than 30 days after the IDR entity determines under such subclause that neither the charge or rate described in subclause (I)(aa) were reasonable. Not later than 60 days after such date of such determination, such entity shall determine which of the 2 final offers is more reasonable based on the factors described in subclause (III). (III) Factors For purposes of subclauses (I) and (II), the factors described in this subclause include, as relevant— (aa) commercially reasonable rates for comparable services or items in the same geographic area (which shall take into consideration in-network rates for that geographic area and not charges); (bb) the usual and customary cost of the item or service involved, determined as the 80th percentile of charges for comparable items and services for the specialty involved in the geographical area in which the item or service was furnished, as determined through reference to a medical claims database; (cc) other factors that may be submitted at the discretion of either party, which may include— (dd) the level of training, education, experience, and quality and outcomes measurements of the nonparticipating provider; (ee) the circumstances and complexity of the particular dispute, including the time and place of the service; (ff) the provider’s quality and outcome metrics; (gg) the provider’s usual charge for comparable services with regard to patients in health care plans in which the provider is not participating; (hh) the individual patient characteristics