I'm not sure what an open box means, but it seems to me that the card should be ok, the price difference seems to be becouse of( probably) lack of the cables that are usually in the box. If the images are correct they sell the sapphire without the usual bundle.
As far as I know the X1950 Pro does not out perform the X1900XTX, however, as I recall, it does out perform the X1900GT
EDIT: to answer the question
I would go with the Open Box one... all it simply means is the packaging was opened... perhaps someone didn't like the idea that it took up two slots, or someone didn't realize it was PCI-E *shrugs*.
I've ordered open box things from newegg and I wasn't disappointed. 219 is an awesome deal for a 1900XTX. I was able to get a 1900XTX built by ATI for 239 (and that was from a deal for the company I work for) and that was a hell of deal... honestly, if I had seen that deal when I was ordering my card I would have been all over it.
Open box from newegg could mean a plethora of things. They are customer returns and they restock them as long as they are in aesthetically pleasing condition. It may or may not work, you'll find out if you order it. The x1950 pro is going to be your better choice in this situation, you'll save money and get a good card. Then when directx 10 comes out you wont be bummed because you dropped a lot of cash on a GPU.
I ordered "open box" headphones and the ear muff was not on at all, this would not be aesthetically pleasing...
Yes it can mean a plethora of things... honestly I would have hopped at the chance because 20 bucks more on a better performing card is something I would look forward to.
EDIT: my headphones worked just fine, I just had to reattach the ear muff to the head set (took 20 minutes) and then I had a 100 dollar pair of headphones (5.1 surround sound, USB interface + built in mic) for 60 bucks.
I suppose it's up to the OP, my personal experience of "opened box" items has been awesome... but I've heard horror stories... If you're willing to take the risk I would say the sweet spot is the open box for 219, if you don't want to risk it I would say X1950 Pro for cheaper but still a good deal as it's quite a bit less than the Asus card, but still a good competitor.
Mind the difference between X1950Pro CROSSFIRE, vs the single card, as you will see the single card is not quite as good as a performer, run the bad boys in crossfire (which is being redone) and then you will looking at awesome performance for a cheaper price.
EDIT: All this talking about this video card and I forgot to point out... the X1950Pro is to compete with the 7900GS in single card performance...