Where in the Midwest? Near a big city? I'd agree with your assessment (no crazy high prices). But if you live in a smaller city (like I do, not Midwest but Southeast), you may also have a disproportionately unhealthy population compared to the national average, along with being disproportionately poor. This means that our regional medical costs are higher both by need (unhealthy population needs more than average care) and scarcity of resources (difficulty in persuading doctors to come here).