While press releases are not the only service PR companies offer they are a good part of it. Many PR companies offer additional services such as website review (functionality & design), copy editing for your website, media training, and help with your overall marketing efforts.
As I said before costs can range from a few hundred to several thousand, but most PR companies will want you to engage them with a monthly retainer. The retainers for reputable firms can run from $10-20K a month.
For startups I would highly recommend against engaging a PR company. Everything you will need as a startup you can do yourself or by hiring a college student to handle for you. Your main concerns in a startup environment typically will be to make sure your website makes sense and is clear, building connections with bloggers who have an interest in your space, and utilizing those connections to get the word out. The wire services are a waste of time really. Your story is not going to make it in the NY Times are Washington Post by releasing a press release on the wires.
Pricing varies and sometimes they charge retainers and other times they charge hourly fees. It can be a big expenditure for a startup, but PR companies often have relationships with reporters that can help get your name out there.
With this kind of service, the agency will define your target media and create a media list, create messaging and operational strategy, call reporters and pitch stories about you, and report to you on the stories that are placed about you.
You might also get services like media training for interviews, ghost-writing of articles to place in magazines, research on competitors media placements, and maybe even something like a PR emergency plan if you are a large business or in a business with high media risk.