For what it's worth, I have inbound SIP calls working now, but with a new VOIP provider, in this case Babytel.ca Using manual outbound NAT did not work as it broke Squid web access.
For google search purposes, we're using a Talkswitch VOIP enabled PBX behind PFSENSE, and Babytel is configured on the unit to handle long distance calls (auto call routing). Once I made the switch to this provider, everything works. Automatic NAT is enabled, however port forwards for SIP signalling and audio are set up on PFSENSE 2.0.1
Inbound calls (via VOIP), remote extensions etc. all work properly now. Previous provider was iristel.ca , and the switch to babytel.ca, solved the previous issues of SIP invites not being recieved through the router due to NATing I suspect of the packets. For what it's worth, babytel's online account configuration as well as iphone app (softphone) all performed flawlessly in testing. Quite impressed with their feature set/pricing etc.