I have one of these (got one of the refurb for $210 and then exchanged it with leadtek for a new one). It is the quietest graphics card I have ever owned, but that being said, it is the loudest fan in my computer. However, I have a silience freak, so my case fans are 12cm running at 5 volts, so they are very quiet. I don't think I'll have to do anything to the Leadtek though, as it is quiet enough.
Edit: Oops, I have the AGP version, but I assume the fan is the same...