Large agencies price an office, a sales team and an account manager into every invoice. We carry none of that, and the difference is the whole reason the price is lower. The tasks are the same ones any competent agency does: crawl the site, fix what is broken, write pages for the searches that matter, keep the Google Business Profile active, earn links from real sites and report on it.
What you do not get is a sales team, a downtown office or an account manager who relays your questions to someone else. You talk to the people doing the work. For a clinic or a trade business with a modest monthly budget, that trade is usually the right one.
We keep two things out of the package on purpose. We do not buy links from networks, because Google has penalized sites for that since 2012 and the sites we inherit from other agencies still carry the damage. We do not publish machine-written articles unedited, because they do not rank for long and they make a business look careless.