To address both issues:
1. The match is set up so that you should try for the brass ring, so to speak. ALWAYS put the place you'd like to be most as your #1, regardless of whether or not you think you have a realistic chance. Not doing so cheats you out of the best chance of getting it.
2. Definitely transmit your Step 2 score. As a PD, it shows a nice degree of consistency to see both scores, especially when they are as good as yours. I agree with previous posters that scores above 240 are not the mean [particularly in IM] - outside of Dermatology, they're not the mean for any field. We MUCH prefer to see a solid Step 2 score if we have to pick. [obviously solid on both is better]
I wish you all the best!