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As a note I listened to the audiobook, I do not own the text. I also saw the movie, subless, several months prior.
Basic plot: A man in a clown mask takes a small hospital hostage. He says he wants money, but something else seems to be going on.
I'm inclined to think this is a bit lower than the 34 it landed at (as of 2022-7-26). I suspect this is because I rated it harder than another book with easier grammar but a wider (although exclusively one subject) vocabulary. The grammar in this book is standard for a novel, nothing too difficult.
Vocab wise it stretches a bit, primarily towards medical words, but it doesn't go too deep there. You will need to know basic hospital words, some anatomy, and so on.
I enjoyed the audiobook immensely and listened to it in a very short time frame. Despite knowing the ending (the movie only deviates a bit) I still got sucked into the tension of the story.