Lori Mill is challenging a $418 fee included in the bill for "miscellaneous hospital charges" because she had her toenail clipped to check for fungus at Virginia Mason Medical Center's downtown complex rather than at one of its other clinics.

Mill's lawyer said the hospital has not yet provided how many patients were assessed such a fee.

Virginia Mason Medical Center says its downtown complex is authorized by Medicare to charge higher fees because it is licensed as a hospital. It maintains that such charges are standard practice elsewhere.

Judge Gregory Canova said the main question is whether those charges were properly disclosed, or were unfair or deceptive.

If Virginia Mason loses, the state Consumer Protection Act allows triple damages of up to $10,000 per patient who provides documentation of such a billing.

Mill's attorney has obtained internal emails showing Virginia Mason doctors and staff have complained about the charges, court filings show.

One unidentified doctor who had a procedure on his own toe at the downtown complex emailed Virginia Mason chief executive last year after being billed $1,200, including a facilities charge of $1,138.

"I call it obscene," the doctor fumed. "There has to be some sense of appropriateness or fairness or reasonableness to our charges."