Our middle-of-the-road program used 230 as a cutoff this year. The majority of our candidates interviewed were >245. It's competitive as hell. Can you match with a 220? Sure. You better have something pretty incredible that makes you stand out though -- ie. impressive publications, amazing letters, phone calls from leaders in the field, AOA/great grades, and preferably multiple of the previously mentioned. Even then, it's an uphill battle. Program directors generally don't have time to read through the 250-300 applications for 1-3 spots. They have to start filtering, and usually it's board scores first.