I followed the procedure from this Netgate documentation below

https://docs.netgate.com/pfsense/en/latest/recipes/nat-voip-pbx.html

Our environment is trying to configure our Grandstream PBX to talk to Twilio.
Twilio's support confirmed that all is good on their end.

Packet Capture
Shows incoming to port 5060, but not forwarding to the PBX.

Port Forward Configuration
Firewall rules required from Twilio's documenation.

NAT Outbound Rules

WAN Firewall Rules
While the documentation didn't mention to do to this, I created this after seeing that the packet captures were not forwarding to the PBX.

Also wanted to add that in the packet capture, when I enter the host IP as being the PBX, the packet capture comes back blank, which I think is expected if no traffic is being forwarded to the PBX.

Any help is greatly appreciated.

Thank you very much,
Sonny