No difference between rendering settings - Med, high or Ultra - wtf??

Hey community,

I have an image I need to render for a client delivery by tomorrow.  I rendered the first one mistakenly at the medium quality setting.  It rendered fast, but the quality was poor.  I re-rendered at high, which took much longer, but the quality was the same!  I went for broke and rendered at "ultra", and yet again, the image was the same size and dpi.  They're all the same!  What's up with this??  Worst of all, I have to pay $49 a month for this?!  I starting to give up on Adobe.  This is simply poor software.  Seriously poor.

The "Ultra" version has small (yet noticeable) specks in the image.  I can't show this to a client, it's unusable.  

Is there a way to up the resolution besides using the drop down settings?  Dimensions offered that, at least...I've included images.

If anyone knows how to improve the imagery, I would appreciate any tips.