For Case $6,$ what procedure codes and modifiers are supported for this encounter?

Column$1/$Column $2$ Edits

Column $1$ Column $2*=$ In existence prior to $1996$ Effective Date Deletion Date

$*=$no data Modifier

$0=$not allowed

$1=$allowed

$9=$not applicable

$171111315020121001201312311$

$171111315120121001*1$

$171111315220121001*1$

$171111315320121001*1$

$171111700020070701*1$

$171111700419990101200706301$

$171111711019980401*0$

$171111726219990101*1$

$171111727019990101*1$

a$.$

As reported on the fee ticket

b$.$

$17000-59,17003$ X $17$

c$.$

$17111,17000-59,17003$ x $2$

d$.$

$17111$ x$15,17000,17003$ x $2$