I'm looking to spend about $150 on a mid range video card, up to $200 if there's a significant performance gain, but prefer 150 or less. The most graphically intense game I intend to play is probably Diablo III. Since I'm posting on here, I'm obviously looking for something quiet. I have looked at the current crop of passive coolers and I don't think they will cut it for gaming. Are there any mid range cards that you guys would recommend with an active fan that are quiet? I would prefer something straight out of the box but I will go aftermarket cooler if the price justification is there. I will be running this on a 520watt psu so nothing too power draining.

Some candidates I was looking at based on Newegg reviews at different price ranges. Sometimes hard to tell because people have different ideas of what they consider quiet.
PowerColor AX6790 1GBD5-DH Radeon HD 6790 1GB 256-bit GDDR5 PCI Express 2.1 x16
http://www.newegg.com/Product/Product.a ... 6814131397

SAPPHIRE 100315L Radeon HD 6850 1GB 256-bit GDDR5 PCI Express 2.1 x16
http://www.newegg.com/Product/Product.a ... 6814102908

SAPPHIRE 100314-3L Radeon HD 6870 1GB 256-bit GDDR5 PCI Express 2.1 x16
http://www.newegg.com/Product/Product.a ... 6814102948

Any 6770 recommendations?

Before I throw a gpu suggestion out there, what's your monitor resolution? Do you want to play at the super - high quality levels or at moderate levels? This can make the difference between needing a $50 card and a $250 one.

You can find a passively cooled Radeon 6770.

http://www.techpowerup.com/149920/ASUS- ... -Card.html

MSI R6870 TwinFrozr II: you can't get anything quieter with stock heatsinks, IMO.

I second the above proposal (MSI 6870 for 200$), if you are not very picky about noise.
But if you want silence heaven, even at load, I suggest the Powercolor 6850 SCS3 with a 800 rpm Slipstream fan zip-tied.
Link to product at Newegg: http://www.newegg.com/Product/Product.a ... cs3%206850
I have this setup in a Solo case, and with the fan set to ~600 rpm, maximum GPU temperatures I get in games is about 66C.
When running Furmark however, I have to turn up the fan to full 800 rpm, to keep it reasonably cool.
600 rpm is almost silent, 800 rpm is still quiet. You should be warned that this combination takes a lot of space.
When asking for recommendations on quiet hardware, it would be helpful to specify your definition of quiet, by comparison.

If I could make a suggestion at your given budget, the XFX hd 6790 1gb is good deal.

http://www.vuugo.com/en/Brand/XFX/XFX-AMD-Radeon-HD-6790-1GB-GDDR5-PCIE-21-Ready-CrossFireX-Support-Video-Card.aspx

Let me reiterate this comment. I think that the passive 6850 from PowerColor is a nice option, but as Tzupy said, it's large. Width alone is over 2.5 inches, which would be problematic depending on your setup. Toss a Slip Stream on top and you've added another inch.

That said, it's pretty much the top dog for passive cards at the moment. The passive offerings for the Radeon 6770 and 6750 cards are much smaller, and can do general gaming (though the 6850 definitely has better performance), but are significantly smaller in the case. IIRC, the 6750s I installed (http://www.newegg.com/Product/Product.a ... 6814131449) are 40% smaller (by height). That can make a huge difference in your case.

Just remember those items when you're looking at the card. It caused me to take a step back and re-evaluate what was really needed for the box I was using.