Indeed, I offer consultancy for both cloud-based clients and ones using managed hosting like Hetzner, and colo'ed own servers, and the clients who host in the cloud routinely need more of my time on a per-server/instance basis.
Most of the time when people bring up these costs they have no experience with modern server hardware, and hosting. You can have the server shipped directly to a colo, you can file tickets with the provider to have it plugged into your power bar and your network, and you can connect with your IPMI client and set it to boot from your PXE/bootp/tftp server to get an install image.
With a well-configured setup, you have a one-off cost to set up your firewalls, wire-up the switches and power bars, and set up a server for the rest to network boot off, and the rest of bringing up your servers is near automatic and most management can be done remotely via IPMI or similar.
It's not the 90's any more.