Don't know Maryland much, but U Rochester, Pittsburgh, U.Chicago and Northwestern are more 'first tier' programs. Of course this all depends on where your first tier ends, but they are very strong, solid places. In similar locales, some 'second tier' programs might be: SUNY Upstate, Mercy Hosp. in Pittsburgh, Illinois-Masonic, Loyola, UIC.
The only way to tell if you're competitive at competitive places is to apply though. If you want, say Chicago, apply to all of the programs and see where you get interviews at. If U-Chicago and Northwestern don't offer, then take UIC and Loyola. Both great places, but without the national reputation. Don't forget Rush either, probably above Loyola in terms of competitiveness.