This is a study of the historical, archaeological, and anatomical/pathological evidence for human sacrifice at the Peruvian coastal site of Pachacamac during the Late Intermediate and Late Horizon Periods (A.D. 1000-1475 and 1475-1533). It highlights the problems associated with the identification of archaeological sacrifice, then goes on to summarize the pathological and cultural evidence from the site. The significance of this evidence is evaluated using not only traditional paradigms but also the notion of “deviant” burial; this is proposed as a formalized means of identifying archaeological sacrifice in collaboration with—and in the absence of—other indicators. Comparisons are carried out with selected sites and periods, and in both coastal and inland regions. Supplementary evidence from international contexts is also considered. The anatomical and contextual findings from Pachacamac reflect a shift from the somewhat sanguineous cultures such as the Nasca and the Moche, to the perfection-obsessed sacrificial modality of the Incas. The former seems to be concerned primarily with retainer burials and the punishment of enemies or opponents, which were offered to an uncertain eternity as a gesture to some higher power. The iconographic, archaeological, and anatomical evidence for sacrifice in these groups is commensurately dramatic. In the case of the Incas, the sacrifices were intended to bless objects or missions, give thanks, or to appeal for supernatural favors or assistance. We go on to propose—for the first time in Latin America—a theoretical framework for identifying and interpreting “deviant” burials in the Andean archaeological record.