During a scrum, Jacob got tangled up awkwardly, fell, and then felt excruciating pain in his rib cage. Rushed to the nearest hospital by his teammates, Jacob had to undergo emergency surgery to reset the bones and ensure neither of his lungs got punctured. Luckily, Jacob had health insurance. Jacob's health insurance plan had a $166 monthly premium, a $520 deductible, and a $2,485 out-of-pocket maximum. Jacob's copay for emergency room visits was $255 and his coinsurance rate was 80/20, so he paid 20% of the bills after his deductible and copays had been paid. If Jacob's total bill came to $17,735, detail his portion of payments necessary to settle his hospital bill.

Hospital bill subject to insurance benefit		$.
Jacob's share of co-insurance		$
Jacob's total responsibility for the hospital bill		$