I think it depends on the design. BMW and other German cars like to use an oil-damped/filled assembly. The seal breaks, the oil leaks out and mount performance degrades. See also - Lower Control Arm bushings that often do the same thing.
The joys of German over-engineering...
As far as the accuracy of the flat-rate, it really depends. When dealing with AWD vehicles, some of the mounts can be really buried and a PITA to get to. After watching this video - definitely a PITA to get to:
It should also be noted that figuring out work-arounds like the guy above used is how most techs make money. They bill whatever the flat-rate is and if they can do it faster then that's $$$ in their pocket. Keeping in mind the opposite also applies - if something goes sideways and it takes them longer than the flat rate, they don't get to charge for those additional hours. Especially here in the rustbelt where one broken bolt can turn a 5 min task into a 3-hour ordeal.
It also helps when you have all of the tools and a lift like in the video above.