| Section | B | Imaging |
| Body System | U | Female Reproductive System |
| Type | 0 | Plain Radiography: Planar display of an image developed from the capture of external ionizing radiation on photographic or photoconductive plate |
| Body Part 0 Fallopian Tube, Right 1 Fallopian Tube, Left 2 Fallopian Tubes, Bilateral 6 Uterus 8 Uterus and Fallopian Tubes 9 Vagina |
Contrast 0 High Osmolar 1 Low Osmolar Y Other Contrast |
Qualifier Z None |
Qualifier Z None |