High-Intensity Focused Ultrasound (HIFU) therapy provides a non-invasive technique with which to destroy cancerous tissue without using ionizing radiation. To drive large singleelement HIFU transducers, ultrasound transmitters capable of delivering high powers at relevant frequencies are required. The acoustic power delivered to a transducers focal region will determine the treated area, and due to safety concerns and intervening layers of attenuation, control of this output power is critical.A typical setup involves large inefficient linear power amplifiers to drive the transducer. Switched mode transmitters allow for a more compact drive system with higher efficiencies, with multi-level transmitters allowing control over the output power. Real-time monitoring of power delivered can avoid damage to the transducer and injury to patients due to over treatment, and allow for precise control over the output power.This study demonstrates a transformer-less, high power, switched mode transmit transmitter based on Gallium-Nitride (GaN) transistors that is capable of delivering peak powers up to 1.8 kW at up to 600 Vpp, while operating at frequencies from DC to 5 MHz. The design includes a 12 bit 16 MHz floating Current/Voltage (I-V) measurement circuit to allow real-time high-side monitoring of the power delivered to the transducer allowing use with multi-element transducers.