Satellite pediatric emergency departments (PEDs) have emerged as a strategy to increase patient capacity. We sought to determine the impact on patient visits, physician fee collections, and value of emergency department (ED) time at the primary PED after opening a nearby satellite PED. We also illustrate the spatial distribution of patient demographics and overlapping catchment areas for the primary and satellite PEDs using geographical information system. A structured, financial retrospective review was conducted. Aggregate patient demographic data and billing data were collected regarding physician fee charges, collections, and patient visits for both PEDs. All ED visits from January XNUMX to December XNUMX were analyzed. Geographical information system mapping using ArcGIS mapped ED patient visits. Patient visits at the primary PED were XNUMX in XNUMX before the satellite PED opened. The primary PED visits increased after opening the satellite PED to XNUMX in XNUMX. The satellite PED visits increased to XNUMX in XNUMX. Collections per visit at the primary PED decreased from $XNUMX per visit in XNUMX to $XNUMX per visit in XNUMX. Total collections at the satellite PED decreased per visit from $XNUMX per visit in XNUMX to $XNUMX per visit in XNUMX. After opening a nearby satellite PED, patient visits at the primary PED did not substantially decrease, suggesting that there was a previously unrecognized demand for PED services. The collections per ED visit were greater at the satellite ED, likely due to a higher collection rate.