I've no good experience with an outsourced service monitor, but I heartily second the recommendation of Nagios. I use it to monitor servers both here in the office and at remote locations, and after much configuration and some customization I've got a system that I cannot imagine being without. The only additional cost of adding more machines is that of my time to add it, usually by copying an existing configuration and editing it just a bit. No monthly bump, no repeated conversations trying to get proof that the voice on the other end of the phone is connected to a brain, no waiting for simple changes such as adding another recipient to the notification list.