Issue with formula giving inconsistent answers

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I am trying to identify FAILS and PASSES the question "Within how many days is your earliest routine appt" (dropdown with selection of days to chose from). Many of the states have different requirements to determine pass and fail. Therefore, the formula is somewhat complex depending on state and the requirement.

Above is my formula. The answer under column [Within how many days is your earliest routine appt] shows 5 days. The formula states "If contract state is Utah, and is <=21, then Pass", but you can see that it is showing FAIL under the [Routine] column. What is weird is that many of the other answers under 21 state Pass. Below are all of the Passes, and Fails for Routine (all for Utah). There seems to be no rhyme or reason....and I am experiencing this for other states too. Any ideas as to why this might be happening?

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