Objective: The paper analyzes the implementation characteristics, price levels, and adjustments of the Guidelines for Establishing Pricing Items for Nursing Medical Services (Trial) across provincial-level regions in China, to provide empirical evidence for nursing pricing reform. Methods: Policy documents on nursing medical service pricing were collected from 31 provincial-level regions. Descriptive statistics and price change analysis were used to evaluate item setting, price distribution, and price changes of typical nursing items. Results: All provincial-level regions have completed the alignment and implementation of the Guidelines, with highly consistent item setting. Only Shanghai City and Zhejiang Province lacked a few items. Accompaniment-free care services underwent localized adaptations such as “one-on-one” “one-to-many” in 13 provincial-level regions. Price distribution showed that special care for children had the highest average price (196.3 yuan/day), while basic nursing items (e.g., oral care) averaged about 10 yuan per session. The coefficient of variation for most items ranged between 20% and 45%. Regarding price adjustments for typical items, Grade I nursing exhibited the highest average increase (71.3%), followed by special care (37.8%) and neonatal care (48.1%), with significant inter-provincial variation in adjustment magnitude. Conclusion: The integration logic of the Guidelines is reasonable, and provincial implementation is generally standardized, yet regional price differences exist. It is recommended to strengthen uniformity in provincial execution, improve price monitoring mechanisms, enhance publicity and training, and coordinate supporting reforms such as compensation systems.