Billing is abysmal and has literally cost people their jobs. Typical Natera philosophy, where they brag about "building the plane while flying it", launched Empower before having billing/reimbursement sorted out. That, along with ELT who did not understand their client base, led to the demise of the division (and 120+ jobs). And billing for panorama and horizon continues to be downright predatory, just search Natera on reddit and you'll see what I mean.