In my humble opinion to get through life in the most happy, satisfied, successful way one might want to give priority to what you feel (in other words what makes you happy...place, people, style of teaching, subject matter, family or combo of these things, with perhaps many more factors included).
If you are happy etc. then the next step is to shine in whatever you do. No, I do not mean that you have to be the only shining beacon.
No. What I mean is that be the best you can be. One way is to compete against yourself viz. keep making your goals or standards higher and higher.
So, if I were you i would choose where my special combo thrives (whether ivy or state..it doesn't matter to my special combo), and then give my best to ace and learn (grades). But I am not you. Each person will decide differently their combo of factors.
Now a pinch of salt: Sometimes one has to forget their combo and sacrifice it for something special, here too, only you can choose to sacrifice or retain your special combo of factors.
Your other question...starting 2003, a 45 on the MCAT is possible, and if the person is well rounded in education, extracurriculars, etc. a 30 or above is considered average and worthy of acceptance for some interviews or even a seat, but in my opinion these numbers and qualities on paper become redundant if not followed through to ingrain in your real self.
all the best
Zingy