Usually the difference is in landing minimums or circling vs. straight in, depending on the course. In other cases you might have a certain minimum climb gradient on the missed approach.
Look at some of these Montana airports, for instance. Some approaches require 5 miles, unless, of course, your airline convinces the FAA that they can "get back out of there" on the missed approach, and can come up with their own approach with lower mins.
If I were to guess, I'd say that the addition of the CECTA fix allows for lower minima, but that eliminates VNAV operations for some reason (probably approach angle...3.09 degrees vs 3.0), so they have the other approach for folks who like VNAV approaches.
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